BILL REQ. #:  H-3392.2 

Read first time 01/22/14.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to developing and authorizing the federal basic health program; adding a new section to chapter 70.47 RCW; and creating a new section.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   (1) The federal patient protection and affordable care act, section 1331 of P.L. 111-148 of 2010, provides states the option to establish a federal basic health program for individuals with incomes up to two hundred percent of the federal poverty level who are not eligible for coverage under medicaid. States electing to operate a basic health program may receive federal funding equal to ninety-five percent of the amount of the premium tax credits and cost-sharing reductions that would have been available had the eligible individual obtained coverage through the exchange.
     (2) The United States department of health and human services has proposed regulations for the development of the basic health program, including the development of a basic health blueprint for certification by the centers for medicare and medicaid services that will grant states operational authority for the program.

NEW SECTION.  Sec. 2   A new section is added to chapter 70.47 RCW to read as follows:
     (1) The health care authority must develop a blueprint for the establishment of a federal basic health program, consistent with requirements established in 42 C.F.R. Part 144. In preparation for the blueprint, the authority must begin the necessary econometric modeling to analyze the program enrollment, and the costs and impacts to the state, the enrollees, and the insurance marketplace. The blueprint must be submitted to the governor for signature and submission to the centers for medicare and medicaid services for review and certification. The blueprint must be submitted by a date that allows for enrollment in the program to begin on October 1, 2015, and coverage to begin on January 1, 2016.
     (2) The blueprint is the policy framework for the program and must identify the standards and requirements in 42 C.F.R. Part 144. At a minimum, the blueprint must address the following:
     (a) The program eligibility as established in federal law;
     (b) The essential health benefits under the federal basic health plan;
     (c) Assurance that enrollee premiums and cost sharing will not exceed the amounts basic health plan enrollees would have paid in the exchange;
     (d) Core administrative procedures such as eligibility determinations using the single streamlined applications, enrollment, disenrollment and nonpayment of premiums, eligibility appeals, consumer assistance, data collection and reporting, and extending essential protections to American Indians and Alaska Natives;
     (e) Fiscal policies and accountability procedures;
     (f) A competitive process to contract with standard health plans;
     (g) Basic health plan trust fund trustees;
     (h) The operational agency responsible for program administration, operations, and financial oversight;
     (i) A funding plan that identifies the funding sources, if any beyond the basic health plan trust fund, and that identifies the enrollment and cost projections for the first twelve months of operation and the funding sources; and
     (j) Other requirements articulated in a final regulation.
     (3) The blueprint must be developed with stakeholder engagement, including tribal consultation and public comment.
     (4) In tandem with the program design, the authority, in consultation with the health benefit exchange and other impacted programs, must identify the system design requirements to implement and operate a federal basic health program, and develop an initial system project timeline and funding estimate. The initial timeline and funding estimate must be shared with the fiscal committees of the legislature. Subject to appropriation, the system design work may begin with preliminary certification from the centers for medicare and medicaid services.
     (5) Upon certification by the federal centers for medicare and medicaid services, the blueprint for the federal basic health program is the operational authority for the program, documenting all program requirements and obligations. The authority is authorized to operate the program in accordance with the federal law and regulations captured in 42 C.F.R. Part 144.