H-2569.2

HOUSE BILL 2351

ByRepresentatives Riccelli, Chapman, Bateman, Tharinger, Macri, Ryu, Gregerson, Simmons, Leavitt, Davis, Doglio, Nance, Low, Pollet, Reed, Ramel, and Ormsby

AN ACT Relating to establishing the essential worker health care program; amending RCW 48.125.030; adding a new section to chapter 43.20A RCW; adding new sections to chapter 48.02 RCW; and creating new sections.

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

(2) Therefore, the legislature intends to address this crisis by:

(a) Offering increased funding to nursing home operators who commit to offering high quality and affordable health care to their employees;

(b) Encouraging nursing home operators to offer health care in the most cost-effective way possible, through large-scale, multiemployer, self-funded plans; and

(c) Requiring that funds appropriated for this purpose are spent as intended and that these funds supplement rather than supplant existing health care funding for employee health care coverage.

NEW SECTION.  Sec. 2. A new section is added to chapter 43.20A RCW to read as follows:

(1) The essential worker health care program is established within the department to help provide nursing home and assisted living workers with high quality, affordable health coverage through participating nursing home employers. The department shall distribute funding through a supplemental payment to participating employers and seek any necessary approvals from the centers for medicare and medicaid services to provide this supplemental payment. The supplemental payment must be distributed annually in proportion to their medicaid bed days in the previous calendar year.

(2) To participate in the essential worker health care program, employers must operate at least one nursing home licensed under chapter 18.51 RCW in Washington that participates in medicaid and enter into a memorandum of understanding with the department committing to:

(a) Participate in a multiemployer health fund certified as a qualified health fund by the office of the insurance commissioner;

(b) Allocate substantially all of the funds distributed through this program to the qualified health fund;

(c) Provide documentation to the department of its spending on employee health benefits in Washington in the two years prior to its entry into the program;

(d) Maintain spending on health care benefits in the first year of its participation in the program at least equal to the average of its spending in the two years prior to its entry into the program and maintain spending in subsequent years at least equal to this level plus the consumer price index medical inflation rate maintained by the United States bureau of labor statistics. Spending to meet this requirement must flow through the certified qualified health fund. For qualified health plans offered through a Taft-Hartley fund in which union representatives occupy at least 50 percent of board seats, a certification from each participating union is sufficient to comply with this requirement;

(e) Provide the department with information concerning its health plan benefits, covered employee uptake, cost to the employer and covered employees, and employee retention in the two years prior to its entry into the program, and provide updated information at the end of each year of participation in the program;

(f) Demonstrate at least annually or more frequently at the request of the department that it has used all of the supplemental payments received through the program to significantly improve the quality of health care offered to covered employees;

(g) Demonstrate to the department at least annually or more frequently at the request of the department that it has processes in place to offer covered employees significant input into health benefit design and delivery; and

(h) Meet any other conditions or requirements specified by the department in rule to achieve the goals of this program.

(3) Only covered employees may participate in the program. A "covered employee" is any permanent employee of a company that operates a participating facility who works primarily in the state of Washington including, but not limited to, employees providing direct care to nursing home or assisted living facility residents, employees indirectly involved in resident care, employees providing dietary, housekeeping, laundry, or environmental services on location, administrative employees and management, and corporate office employees, or any subcontractor of such a company who works on a full-time, permanent basis in a nursing home or assisted living facility.

NEW SECTION.  Sec. 3. A new section is added to chapter 48.02 RCW to read as follows:

The office of the insurance commissioner shall certify that a proposed health care benefit arrangement is a qualified health fund that meets the requirements of this section. Supplemental payments to participating employers may be disbursed only to employers that offer employee health benefits solely through a qualified health fund that meets the following requirements:

(1) Includes at least two distinct and unrelated employers in each year of the program;

(2) Operates as either a self-insured multiemployer welfare arrangement or a self-insured Taft-Hartley fund with equal union and employer participation;

(3) Offers benefits to at least 5,000 employees in the long-term care industry in Washington state in each year of the program;

(4) Offers a benefit package that is either equivalent to an affordable care act platinum plan in covered benefits and cost sharing, or, if the plan is offered by a Taft-Hartley trust, a plan approved by the board of the trust;

(5) Certifies each year that participating employers are complying with the terms of the program, including the maintenance of spending requirement provided in section 2(2)(d) of this act;

(6) Except for Taft-Hartley plans, demonstrates on entry to the program and annually that it has provided the opportunity for substantive input on the plan from substantially all covered employees;

(7) Except for Taft-Hartley plans, demonstrates on entry to the program and annually that it has a robust enrollment process in place to ensure that covered employees fully understand their benefits; and

(8) Complies with any other requirements determined by the office of the insurance commissioner in rule to further the goals of the program.

NEW SECTION.  Sec. 4. A new section is added to chapter 48.02 RCW to read as follows:

(1) The office of the insurance commissioner may revoke certification for a qualified health fund that fails to meet the requirements of sections 2 and 3 of this act and any rules adopted by the office of the insurance commissioner. Employers participating in a health plan that loses certified qualified health plan status for noncompliance shall return any supplemental payments received under this program during the period in which the qualified health fund was out of compliance with the requirements established in sections 2 and 3 of this act and in rule from the program.

(2) The office of the insurance commissioner may terminate any participating employer that fails to comply with the requirements established in the memorandum of understanding, sections 2 and 3 of this act, and in rule from the program. The office of the insurance commissioner shall recoup any supplemental payments from any participating employer who fails to comply with the program requirements for the fiscal years in which the operator was out of compliance.

Sec. 5. RCW 48.125.030 and 2008 c 217 s 96 are each amended to read as follows:

((The))(1) Except as provided in subsection (2) of this section, the commissioner may not issue a certificate of authority to a self-funded multiple employer welfare arrangement unless the arrangement establishes to the satisfaction of the commissioner that the following requirements have been satisfied by the arrangement:

(((1)))(a) The employers participating in the arrangement are members of a bona fide association;

(((2)))(b) The employers participating in the arrangement exercise control over the arrangement, as follows:

(((a)))(i) Subject to (b)(ii) of this subsection, control exists if the board of directors of the bona fide association or the employers participating in the arrangement have the right to elect at least ((seventy-five))75 percent of the individuals designated in the arrangement's organizational documents as having control over the operations of the arrangement and the individuals designated in the arrangement's organizational documents in fact exercise control over the operation of the arrangement; and

(((b)))(ii) The use of a third-party administrator to process claims and to assist in the administration of the arrangement is not evidence of the lack of exercise of control over the operation of the arrangement;

(((3)))(c) In this state, the arrangement provides only health care services;

(((4)))(d) In this state, the arrangement provides or arranges benefits for health care services in compliance with those provisions of this title that mandate particular benefits or offerings and with provisions that require access to particular types or categories of health care providers and facilities;

(((5)))(e) In this state, the arrangement provides or arranges benefits for health care services in compliance with RCW 48.43.500 through 48.43.535, 48.43.545, and 48.43.550;

(((6)))(f) The arrangement provides health care services to not less than ((twenty))20 employers and not less than ((seventy-five))75 employees;

(((7)))(g) The arrangement may not solicit participation in the arrangement from the general public. However, the arrangement may employ licensed insurance producers who receive a commission, unlicensed individuals who do not receive a commission, and may contract with a licensed insurance producer who may be paid a commission or other remuneration, for the purpose of enrolling and renewing the enrollments of employers in the arrangement;

(((8)))(h) The arrangement has been in existence and operated actively for a continuous period of not less than ((ten))10 years as of December 31, 2003, except for an arrangement that has been in existence and operated actively since December 31, 2000, and is sponsored by an association that has been in existence more than ((twenty-five))25 years; and

(((9)))(i) The arrangement is not organized or maintained solely as a conduit for the collection of premiums and the forwarding of premiums to an insurance company.

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