S-3912 _______________________________________________
SENATE BILL NO. 6229
_______________________________________________
State of Washington 51st Legislature 1990 Regular Session
By Senators Talmadge and Kreidler
Read first time 1/9/90 and referred to Committee on Health & Long Term Care.
AN ACT Relating to comprehensive health care coverage; amending RCW 74.09.700, 48.41.020, 48.41.060, 48.41.030, 70.47.010, 70.47.020, 70.47.030, 70.47.060, 70.47.080, 43.131.355, and 43.131.356; adding new sections to chapter 48.41 RCW; adding a new section to chapter 74.09 RCW; adding new sections to chapter 50.24 RCW; creating a new section; and prescribing penalties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1. Section 22, chapter 6, Laws of 1981 1st ex. sess. as last amended by section 3, chapter 87, Laws of 1989 and RCW 74.09.700 are each amended to read as follows:
(1) To the
extent of available funds, medical care may be provided under the limited
casualty program to persons not otherwise eligible for medical assistance or
medical care services who are medically needy as defined in the social security
Title XIX state plan ((and)), whose income does not exceed one
hundred thirty-three percent of the aid to families with dependent children
payment standard, and who are medical indigents in accordance with medical
eligibility requirements established by the department. This includes
residents of skilled nursing homes, intermediate care facilities, and intermediate
care facilities for the mentally retarded who are aged, blind, or disabled as
defined in Title XVI of the federal social security act and whose income
exceeds three hundred percent of the federal supplement security income benefit
level.
(2) ((Determination
of)) The amount, scope, and duration of medical coverage under the
limited casualty program shall be the ((responsibility of the department,
subject to the following:
(a) Only
inpatient hospital services; outpatient hospital and rural health clinic
services; physicians' and clinic services; prescribed drugs, dentures,
prosthetic devices, and eyeglasses; skilled nursing home services, intermediate
care facility services, and intermediate care facility services for the
mentally retarded; home health services; other laboratory and x-ray services;
rehabilitative services; medically necessary transportation; and other services
for which funds are specifically provided in the omnibus appropriations act
shall be covered;
(b) Persons
who are medically indigent and are not eligible for a federal aid program shall
satisfy a deductible of not less than one hundred dollars nor more than five
hundred dollars in any twelve-month period;
(c))) same as the medical assistance provided under RCW
74.09.520. Medical care services provided to the medically indigent and
received no more than seven days prior to the date of application shall be
retroactively certified and approved for payment on behalf of a person who was
otherwise eligible at the time the medical services were furnished: PROVIDED,
That eligible persons who fail to apply within the seven-day time period for
medical reasons or other good cause may be retroactively certified and approved
for payment.
(3) The department shall establish standards of assistance and resource and income exemptions. All nonexempt income and resources of limited casualty program recipients shall be applied against the cost of their medical care services.
Sec. 2. Section 2, chapter 431, Laws of 1987 and RCW 48.41.020 are each amended to read as follows:
It is the
purpose and intent of the legislature to provide access to health insurance
coverage to all residents of Washington who are denied adequate health
insurance for any reason. It is the intent of the legislature that adequate
levels of health insurance coverage be made available to residents of
Washington who are otherwise considered uninsurable ((or)), who
are underinsured, or who are not insured by virtue of their inability to pay
for health insurance. It is the intent of the Washington state health
insurance coverage access act to provide a mechanism to insure the availability
of comprehensive health insurance to persons unable to obtain such insurance
coverage on either an individual or group basis directly under any health plan.
Sec. 3. Section 6, chapter 431, Laws of 1987 as amended by section 3, chapter 121, Laws of 1989 and RCW 48.41.060 are each amended to read as follows:
The board shall have the general powers and authority granted under the laws of this state to insurance companies licensed to transact the kinds of insurance defined under this title. In addition thereto, the board may:
(1) Enter into contracts as are necessary or proper to carry out the provisions and purposes of this chapter including the authority, with the approval of the commissioner, to enter into contracts with similar pools of other states for the joint performance of common administrative functions, or with persons or other organizations for the performance of administrative functions;
(2) Sue or be sued, including taking any legal action as necessary to avoid the payment of improper claims against the pool or the coverage provided by or through the pool;
(3) Establish appropriate rates, rate schedules, rate adjustments, expense allowances, agent referral fees, claim reserve formulas and any other actuarial functions appropriate to the operation of the pool. Rates shall not be unreasonable in relation to the coverage provided, the risk experience, and expenses of providing the coverage. Rates and rate schedules may be adjusted for appropriate risk factors such as age and area variation in claim costs and shall take into consideration appropriate risk factors in accordance with established actuarial underwriting practices;
(4) Assess members of the pool in accordance with the provisions of this chapter, and make advance interim assessments as may be reasonable and necessary for the organizational or interim operating expenses. Any interim assessments will be credited as offsets against any regular assessments due following the close of the year;
(5) Indemnify health care providers up to the limits prescribed in section 14 of this 1990 act;
(6) Issue policies of insurance, including medical professional liability insurance policies to qualified health care providers, in accordance with the requirements of this chapter;
(((6)))
(7) Appoint appropriate legal, actuarial and other committees as
necessary to provide technical assistance in the operation of the pool, policy,
and other contract design, and any other function within the authority of the
pool; and
(((7)))
(8) Conduct periodic audits to assure the general accuracy of the
financial data submitted to the pool, and the board shall cause the pool to
have an annual audit of its operations by an independent certified public
accountant.
Sec. 4. Section 3, chapter 431, Laws of 1987 as amended by section 1, chapter 121, Laws of 1989 and RCW 48.41.030 are each amended to read as follows:
As used in this chapter, the following terms have the meaning indicated, unless the context requires otherwise:
(1) "Accounting year" means a twelve-month period determined by the board for purposes of record-keeping and accounting. The first accounting year may be more or less than twelve months and, from time to time in subsequent years, the board may order an accounting year of other than twelve months as may be required for orderly management and accounting of the pool.
(2) "Administrator" means the entity chosen by the board to administer the pool under RCW 48.41.080.
(3) "Board" means the board of directors of the pool.
(4) "Charity care or services" means care or services provided by a health care provider to indigent persons who are unable to pay for the care or services, or to pay deductibles or coinsurance amounts required by a third-party payor or who are participants in:
(a) The medical assistance program, Title XIX of the social security act (42 U.S.C. Sec. 1396 et seq.);
(b) The maternity care and access program, RCW 74.09.760 through 74.09.820;
(c) The Washington state basic health plan, chapter 70.47 RCW; or
(d) Any other publicly funded health care program for which eligibility is based on income up to a maximum of two hundred percent of the federal poverty level.
(5) "Commissioner" means the insurance commissioner.
(((5)))
(6) "Eligible medical malpractice claim" means a medical claim
filed pursuant to chapter 7.70 RCW against a health care provider who renders
charity care in at least ten percent of the patient encounters engaged in by
that health care provider during the policy year in which the claim was made.
(7) "Health care facility" has the same meaning as in RCW 70.38.025.
(((6)))
(8) "Health care provider" means any physician, facility, or
health care professional, who is licensed in Washington state and entitled to
reimbursement for health care services.
(((7)))
(9) "Health care services" means services for the purpose of
preventing, alleviating, curing, or healing human illness or injury.
(((8)))
(10) "Health insurance" means any group or individual
disability insurance policy, health care service contract, and health
maintenance agreement, except those contracts entered into for the provision of
health care services pursuant to Title XVIII of the social security
act, 42 U.S.C. Sec. 1395 et seq. The term does not include short-term
care, long-term care, dental, vision, accident, fixed indemnity, disability
income contracts, civilian health and medical program for the uniform services
(CHAMPUS), 10 U.S.C. 55, limited benefit or credit insurance, coverage issued
as a supplement to liability insurance, insurance arising out of the worker's
compensation or similar law, automobile medical payment insurance, or insurance
under which benefits are payable with or without regard to fault and which is
statutorily required to be contained in any liability insurance policy or
equivalent self-insurance.
(((9)))
(11) "Health plan" means any arrangement by which persons,
including dependents or spouses, covered or making application to be covered
under this pool, have access to hospital and medical benefits or reimbursement
including any group or individual disability insurance policy; health care
service contract; health maintenance agreement; uninsured arrangements of group
or group-type contracts including employer self-insured, cost-plus, or other
benefit methodologies not involving insurance or not governed by Title 48 RCW;
coverage under group-type contracts which are not available to the general
public and can be obtained only because of connection with a particular
organization or group; and coverage by medicare or other governmental
benefits. This term includes coverage through "health insurance" as
defined under this section, and specifically excludes those types of programs
excluded under the definition of "health insurance" in subsection (((8)))
(10) of this section.
(((10)))
(12) "Insured" means any individual resident of this state who
is eligible to receive benefits from any member, or other health plan.
(((11)))
(13) "Medical assistance" means coverage under Title XIX of
the federal social security act (42 U.S.C., Sec. 1396 et
seq.) and chapter 74.09 RCW.
(((12)))
(14) "Medicare" means coverage under Title XVIII of the social
security act, (42 U.S.C. Sec. 1395 et seq., as amended).
(((13)))
(15) "Member" means any commercial insurer which provides
disability insurance, any health care service contractor, and any health
maintenance organization licensed under Title 48 RCW. "Member" shall
also mean, as soon as authorized by federal law, employers and other entities,
including a self-funding entity and employee welfare benefit plans that provide
health plan benefits in this state on or after May 18, 1987.
"Member" does not include any insurer, health care service
contractor, or health maintenance organization whose products are exclusively
dental products or those products excluded from the definition of "health
insurance" set forth in subsection (((8))) (10) of this
section.
(((14)))
(16) "Patient encounter" means an occasion on which a health care
provider renders professional health care services to a patient.
(17) "Plan of operation" means the pool, including articles, by-laws, and operating rules, adopted by the board pursuant to RCW 48.41.050.
(((15)))
(18) "Pool" means the Washington state health insurance pool
as created in RCW 48.41.040.
(((16)))
(19) "Substantially equivalent health plan" means a
"health plan" as defined in subsection (((9))) (11) of
this section which, in the judgment of the board or the administrator, offers
persons including dependents or spouses covered or making application to be
covered by this pool an overall level of benefits deemed approximately
equivalent to the minimum benefits available under this pool.
Sec. 5. Section 3, chapter 5, Laws of 1987 1st ex. sess. and RCW 70.47.010 are each amended to read as follows:
(1) The legislature finds that:
(a) A significant percentage of the population of this state does not have reasonably available insurance or other coverage of the costs of necessary basic health care services;
(b) This lack of basic health care coverage is detrimental to the health of the individuals lacking coverage and to the public welfare, and results in substantial expenditures for emergency and remedial health care, often at the expense of health care providers, health care facilities, and all purchasers of health care, including the state; and
(c) The use
of managed health care systems has significant potential to reduce the growth
of health care costs incurred by the people of this state generally, and by medical
assistance recipients and low-income pregnant women who are an especially
vulnerable population, along with their children, ((and)) who need
greater access to managed health care.
(2) The
purpose of this chapter is to provide necessary basic health care services in
an appropriate setting to working persons and others who lack coverage, at a
cost to these persons that does not create barriers to the utilization of
necessary health care services. To that end, this chapter establishes a
program to be made available to those residents under sixty-five years of age
not otherwise eligible for medicare ((with gross family income at or below
two hundred percent of the federal poverty guidelines)) who share in the
cost of receiving basic health care services from a managed health care system.
(3) It is
((not)) the intent of this chapter to provide health care services for
those persons who are presently covered through private employer-based health
plans((, nor to replace employer-based health plans)) or, in the
absence of such coverage, to provide an alternative. Further, it is the
intent of the legislature to expand, wherever possible, the availability of
private health care coverage and to discourage the decline of employer-based
coverage.
(4) ((The
program authorized under this chapter is strictly limited in respect to the
total number of individuals who may be allowed to participate and the specific
areas within the state where it may be established. All such restrictions or
limitations shall remain in full force and effect until quantifiable evidence
based upon the actual operation of the program, including detailed cost benefit
analysis, has been presented to the legislature and the legislature, by
specific act at that time, may then modify such limitations.)) By
enrolling medical assistance recipients within managed health care systems, the
state goal is to ensure that medical assistance recipients receive at least the
same quality of care as they currently receive. In order to implement this
subsection, the department shall obtain the necessary waiver from the federal
government as required in Title XIX of the social security act (42 U.S.C. Sec.
1396 et seq.).
Sec. 6. Section 4, chapter 5, Laws of 1987 1st ex. sess. and RCW 70.47.020 are each amended to read as follows:
As used in this chapter:
(1) "Washington basic health plan" or "plan" means the system of enrollment and payment on a prepaid capitated basis for basic health care services, administered by the plan administrator through participating managed health care systems, created by this chapter.
(2) "Administrator" means the Washington basic health plan administrator.
(3) "Managed health care system" means any health care organization, including health care providers, insurers, health care service contractors, health maintenance organizations, or any combination thereof, that provides directly or by contract basic health care services, as defined by the administrator and rendered by duly licensed providers, on a prepaid capitated basis to a defined patient population enrolled in the plan and in the managed health care system.
(4)
"Enrollee" means an individual, or an individual plus the
individual's spouse and/or dependent children, all under the age of sixty-five
and not otherwise eligible for medicare, who resides in ((an area of))
the state ((served by a managed health care system participating in the plan)),
whose gross family income at the time of enrollment does not exceed ((twice))
four times the federal poverty level as adjusted for family size and
determined annually by the federal department of health and human services, or,
if employed, whose employer does not provide health care benefits as defined in
section 11 of this 1990 act, who chooses to obtain basic health care
coverage from a particular managed health care system in return for periodic
payments to the plan.
(5) "Subsidy" means the difference between the amount of periodic payment the administrator makes, from funds appropriated from the basic health plan trust account, to a managed health care system on behalf of an enrollee and the amount determined to be the enrollee's responsibility under RCW 70.47.060(2).
(6) "Premium" means a periodic payment, based upon gross family income and determined under RCW 70.47.060(2), which an enrollee makes to the plan as consideration for enrollment in the plan.
(7) "Rate" means the per capita amount, negotiated by the administrator with and paid to a participating managed health care system, that is based upon the enrollment of enrollees in the plan and in that system.
Sec. 7. Section 5, chapter 5, Laws of 1987 1st ex. sess. and RCW 70.47.030 are each amended to read as follows:
The basic health plan trust account is hereby established in the state treasury. All funds appropriated for this chapter, including moneys received from the tax levied in section 8 of this 1990 act which may be used for the purpose of indemnifying health care providers under chapter 48.41 RCW, shall be deposited in the basic health plan trust account and may be expended without further appropriation. Disbursements from other moneys in the account shall be made pursuant to appropriation and upon warrants drawn by the Washington basic health plan administrator. Moneys in the account shall be used exclusively for the purposes of this chapter, including payments to participating managed health care systems on behalf of enrollees in the plan and payment of costs of administering the plan. The earnings on any surplus balances in the basic health plan trust account shall be credited to the account, notwithstanding RCW 43.84.090. After January 1, 1988, the administrator shall not expend or encumber for an ensuing fiscal period amounts exceeding ninety percent of the amounts anticipated to accrue in the account during the fiscal period.
Sec. 8. Section 8, chapter 5, Laws of 1987 1st ex. sess. and RCW 70.47.060 are each amended to read as follows:
The administrator has the following powers and duties:
(1) To design and from time to time revise a schedule of covered basic health care services, including physician services, inpatient and outpatient hospital services, and other services that may be necessary for basic health care, which enrollees in any participating managed health care system under the Washington basic health plan shall be entitled to receive in return for premium payments to the plan. The schedule of services shall emphasize proven preventive and primary health care, shall include all services necessary for prenatal, postnatal, and well-child care, and shall include a separate schedule of basic health care services for children, eighteen years of age and younger, for those enrollees who choose to secure basic coverage through the plan only for their dependent children. In designing and revising the schedule of services, the administrator shall consider the guidelines for assessing health services under the mandated benefits act of 1984, RCW 48.42.080, and such other factors as the administrator deems appropriate.
(2) To design and implement a structure of periodic premiums due the administrator from enrollees that is based upon gross family income, giving appropriate consideration to family size as well as the ages of all family members. The enrollment of children shall not require the enrollment of their parent or parents who are eligible for the plan.
(3) To design and implement a structure of nominal copayments due a managed health care system from enrollees. The structure shall discourage inappropriate enrollee utilization of health care services, but shall not be so costly to enrollees as to constitute a barrier to appropriate utilization of necessary health care services.
(4) To design and implement, in concert with a sufficient number of potential providers in a discrete area, an enrollee financial participation structure, separate from that otherwise established under this chapter, that has the following characteristics:
(a) Nominal premiums that are based upon ability to pay, but not set at a level that would discourage enrollment;
(b) A modified fee-for-services payment schedule for providers;
(c) Coinsurance rates that are established based on specific service and procedure costs and the enrollee's ability to pay for the care. However, coinsurance rates for families with incomes below one hundred twenty percent of the federal poverty level shall be nominal. No coinsurance shall be required for specific proven prevention programs, such as prenatal care. The coinsurance rate levels shall not have a measurable negative effect upon the enrollee's health status; and
(d) A case management system that fosters a provider-enrollee relationship whereby, in an effort to control cost, maintain or improve the health status of the enrollee, and maximize patient involvement in her or his health care decision-making process, every effort is made by the provider to inform the enrollee of the cost of the specific services and procedures and related health benefits.
The potential financial liability of the plan to any such providers shall not exceed in the aggregate an amount greater than that which might otherwise have been incurred by the plan on the basis of the number of enrollees multiplied by the average of the prepaid capitated rates negotiated with participating managed health care systems under RCW 70.47.100 and reduced by any sums charged enrollees on the basis of the coinsurance rates that are established under this subsection.
(5) To limit enrollment of persons who qualify for subsidies so as to prevent an overexpenditure of appropriations for such purposes. Whenever the administrator finds that there is danger of such an overexpenditure, the administrator shall close enrollment until the administrator finds the danger no longer exists except that enrollees eligible because their employer contributes the tax in section 11 of this 1990 act shall be enrolled without limitation.
(6) To adopt a schedule for the orderly development of the delivery of services and availability of the plan to residents of the state, subject to the limitations contained in RCW 70.47.080.
((In the
selection of any area of the state for the initial operation of the plan, the
administrator shall take into account the levels and rates of unemployment in
different areas of the state, the need to provide basic health care coverage to
a population reasonably representative of the portion of the state's population
that lacks such coverage, and the need for geographic, demographic, and
economic diversity.
Before July
1, 1988, the administrator shall endeavor to secure participation contracts
with managed health care systems in discrete geographic areas within at least
five congressional districts.))
(7) To solicit and accept applications from managed health care systems, as defined in this chapter, for inclusion as eligible basic health care providers under the plan. The administrator shall endeavor to assure that covered basic health care services are available to any enrollee of the plan from among a selection of two or more participating managed health care systems. In adopting any rules or procedures applicable to managed health care systems and in its dealings with such systems, the administrator shall consider and make suitable allowance for the need for health care services and the differences in local availability of health care resources, along with other resources, within and among the several areas of the state.
(8) To receive periodic premiums from enrollees, deposit them in the basic health plan operating account, keep records of enrollee status, and authorize periodic payments to managed health care systems on the basis of the number of enrollees participating in the respective managed health care systems.
(9) To
accept applications from individuals residing in areas served by the plan, on
behalf of themselves and their spouses and dependent children, for enrollment
in the Washington basic health plan, to establish appropriate
minimum-enrollment periods for enrollees as may be necessary, and to determine,
upon application and at least annually thereafter, or at the request of any
enrollee, eligibility due to current gross family income for sliding scale
premiums. An enrollee who remains current in payment of the sliding-scale
premium, as determined under subsection (2) of this section, and whose gross
family income has risen above ((twice)) four times the federal
poverty level, may continue enrollment unless and until the enrollee's gross
family income has remained above ((twice)) four times the poverty
level for six consecutive months, by making payment at the unsubsidized rate
required for the managed health care system in which he or she may be
enrolled. No enrollee, however, whose eligibility is based on his or her
employer's contribution of the tax in section 11 of this 1990 act, shall be
subject to disenrollment. An employee of an employer who ceases paying the tax
applied to the basic health plan trust account and commences providing private
health care benefits to employees as provided in section 11 of this 1990 act,
shall ensure enrollees can participate in the private benefit plan without
restriction. No subsidy may be paid with respect to any enrollee whose
current gross family income exceeds twice the federal poverty level or, subject
to RCW 70.47.110, who is a recipient of medical assistance or medical care
services under chapter 74.09 RCW. If a number of enrollees drop their
enrollment for no apparent good cause, the administrator may establish
appropriate rules or requirements that are applicable to such individuals
before they will be allowed to re-enroll in the plan.
(10) To require that prospective enrollees who may be eligible for categorically needy medical coverage under RCW 74.09.510 or whose income does not exceed the medically needy income level under RCW 74.09.700 apply for such coverage, but the administrator shall enroll the individuals in the plan pending the determination of eligibility under chapter 74.09 RCW.
(11) To determine the rate to be paid to each participating managed health care system in return for the provision of covered basic health care services to enrollees in the system. Although the schedule of covered basic health care services will be the same for similar enrollees, the rates negotiated with participating managed health care systems may vary among the systems. In negotiating rates with participating systems, the administrator shall consider the characteristics of the populations served by the respective systems, economic circumstances of the local area, the need to conserve the resources of the basic health plan trust account, and other factors the administrator finds relevant.
(12) To
monitor the provision of covered services to enrollees by participating managed
health care systems in order to assure enrollee access to good quality basic
health care, to require periodic data reports concerning the utilization of
health care services rendered to enrollees in order to provide adequate information
for evaluation, and to inspect the books and records of participating managed
health care systems to assure compliance with the purposes of this chapter. In
requiring reports from participating managed health care systems, including
data on services rendered enrollees, the administrator shall endeavor to
minimize costs, both to the managed health care systems and to the
administrator. The administrator shall coordinate any such reporting
requirements with other state agencies, such as the insurance commissioner and
the ((hospital commission)) department of health, to minimize
duplication of effort.
(13) To monitor the access that state residents have to adequate and necessary health care services, determine the extent of any unmet needs for such services or lack of access that may exist from time to time, and make such reports and recommendations to the legislature as the administrator deems appropriate.
(14) To evaluate the effects this chapter has on private employer-based health care coverage and to take appropriate measures consistent with state and federal statutes that will discourage the reduction of such coverage in the state.
(15) To develop a program of proven preventive health measures and to integrate it into the plan wherever possible and consistent with this chapter.
(16) To provide, consistent with available resources, technical assistance for rural health activities that endeavor to develop needed health care services in rural parts of the state.
Sec. 9. Section 10, chapter 5, Laws of 1987 1st ex. sess. and RCW 70.47.080 are each amended to read as follows:
On and
after July 1, 1988, the administrator shall accept for enrollment applicants
eligible to receive covered basic health care services from the respective
managed health care systems which are then participating in the plan. ((The
administrator shall not allow the total enrollment of those eligible for
subsidies to exceed thirty thousand.
Thereafter,)) Total enrollment shall not exceed the number established
by the legislature in any act appropriating funds to the plan.
((Before
July 1, 1988, the administrator shall endeavor to secure participation
contracts from managed health care systems in discrete geographic areas within
at least five congressional districts of the state and in such manner as to
allow residents of both urban and rural areas access to enrollment in the
plan. The administrator shall make a special effort to secure agreements with
health care providers in one such area that meets the requirements set forth in
RCW 70.47.060(4).))
The administrator shall at all times closely monitor growth patterns of enrollment so as not to exceed that consistent with the orderly development of the plan as a whole, in any area of the state or in any participating managed health care system.
NEW SECTION. Sec. 10. A new section is added to chapter 74.09 RCW to read as follows:
A physician who agrees to provide charity care as defined in RCW 48.41.030 for patients in need of emergency obstetrical care shall not be subject to civil liability for treatment of emergency medicaid patients so long as the physician acts in good faith without gross negligence.
NEW SECTION. Sec. 11. A new section is added to chapter 50.24 RCW to read as follows:
(1) Additional contributions for the basic health plan trust account shall accrue and become payable by each employer as defined in RCW 50.04.080 for each calendar year in which the employer is subject to this chapter at a rate of eight percent of the wages paid to employees as provided in RCW 50.04.355.
(2) The amount of wages subject to this tax for each individual shall be one hundred fifteen percent of the amount of wages subject to tax in the previous year rounded to the next lower one hundred dollars: PROVIDED, That the amount of wages subject to tax in any rate year shall not exceed eighty percent of the average annual wage for contributions purposes.
(3) Contributions shall become due and be paid by each employer under rules as the commissioner may prescribe, and shall not be deducted, in whole or in part, from the remuneration of individuals in the employ of the employer. Any deduction in violation of this section is unlawful, and is subject to collections as provided in this chapter.
(4) In the payment of any contributions, a fractional part of a cent shall be disregarded unless it amounts to one-half cent or more, in which case it shall be increased to one cent.
(5) It is the intent of the legislature that the application and collection of the tax imposed by this section shall be identical, insofar as possible, to employer contributions under the unemployment compensation laws of the state, Title 50 RCW, except that, for rate year 1991, the tax shall not apply to employers of fewer than twenty-five employees; for rate year 1992, the tax shall not apply to employers of fewer than twenty employees; for rate year 1993, the tax shall not apply to employers of fewer than fifteen employees; and for rate year 1994 and thereafter, the tax shall not apply to employers of fewer than ten employees.
(6) An employer may deduct from the tax owing under this section any amounts expended by the employer for health care for employees and their dependents, including amounts expended for:
(a) Health care insurance premiums or similar fees; and
(b) Direct health care services provided by the employer.
(7) An employer may apply deductions from one tax year to the next tax year, but shall not apply those same deductions to any subsequent tax year.
NEW SECTION. Sec. 12. A new section is added to chapter 50.24 RCW to read as follows:
(1) The commissioner shall provide a receipt for contributions required in section 11 of this act and deposit the contributions into the basic health plan trust account in accordance with such rules as the commissioner may prescribe.
(2) One-half percent of the tax contributed as provided in section 11 of this act shall be expended solely for the purposes of implementing sections 13 through 15 of this act.
NEW SECTION. Sec. 13. PERSONS INDEMNIFIED. In a cause of action against a health care provider based on conduct described in section 14 of this act, the board shall indemnify a health care provider for actual damages adjudged against the health care provider or which the health care provider becomes obligated to pay pursuant to a settlement reached in accordance with sections 14 through 16 of this act.
NEW SECTION. Sec. 14. SCOPE OF INDEMNIFICATION. (1) The pool is liable for indemnification under sections 13 through 16 of this act only if the damages are based on an eligible medical malpractice claim against a health care provider in the course and scope of the person's professional health care activities.
(2) The state is not liable for indemnification for an intentional act or an act of gross negligence.
NEW SECTION. Sec. 15. LIMITS ON RECOVERABLE DAMAGES. (1) State liability for indemnification under sections 13 through 16 of this act may not exceed:
(a) Fifty thousand dollars for a single occurrence in the case of an eligible medical malpractice claim arising as a result of prenatal care, care during labor and delivery, and care given to a mother or as a result of emergency care; or
(b) Ten thousand dollars for a single occurrence in the case of any other eligible medical malpractice claim.
(2) The state shall be payor of first resort for an eligible medical malpractice claim for amounts falling within the limits set forth in subsection (1) of this section.
NEW SECTION. Sec. 16. PREREQUISITES TO INDEMNIFICATION‑-NOTICE TO ATTORNEY GENERAL. The state is not liable for indemnification for damages under sections 13 through 16 of this act unless the health care provider against whom the cause of action is asserted:
(1) Is covered under a valid professional liability insurance policy that is issued by an insurer and that provides coverage for the medical malpractice claim that is the subject of the claim or action with a policy limit of not less than fifty thousand dollars per occurrence and two hundred fifty thousand dollars aggregate for the policy period; and
(2) Delivers or causes to be delivered to the risk manager a true copy of any written notice of the medical malpractice claim and any summons or citation served on the health care provider, which written notice, summons, or citation shall be delivered to the risk manager not later than the forty-fifth day after the receipt thereof by the health care provider.
NEW SECTION. Sec. 17. CAPTIONS NOT LAW. Section headings as used in sections 13 through 17 of this act do not constitute any part of the law.
Sec. 18. Section 24, chapter 5, Laws of 1987 1st ex. sess. and RCW 43.131.355 are each amended to read as follows:
The
Washington basic health plan administrator and its powers and duties shall be
terminated on June 30, ((1992)) 1996, as provided in RCW 43.131.356.
Sec. 19. Section 25, chapter 5, Laws of 1987 1st ex. sess. and RCW 43.131.356 are each amended to read as follows:
The
following acts or parts of acts, as now existing or hereafter amended, are each
repealed, effective June 30, ((1993)) 1997:
(1) Section 1, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.900;
(2) Section 2, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.140;
(3) Section 3, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.010;
(4) Section 4, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.020;
(5) Section 5, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.030;
(6) Section 6, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.040;
(7) Section 7, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.050;
(8) Section 8, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.060;
(9) Section 9, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.070;
(10) Section 10, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.080;
(11) Section 11, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.090;
(12) Section 12, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.100;
(13) Section 13, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.110;
(14) Section 14, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.120;
(15) Section 15, chapter 5, Laws of 1987 1st ex.s. and RCW 70.47.130;
(16) Section 16, chapter 5, Laws of 1987 1st ex.s. and RCW 50.20.210;
(17) Section 17, chapter 5, Laws of 1987 1st ex.s. and RCW 51.28.090; and
(18) Section 18, chapter 5, Laws of 1987 1st ex.s. and RCW 74.04.033.
NEW SECTION. Sec. 20. The insurance commissioner shall recommend by January 1, 1991, a reasonable plan for the establishment of a nonprofit, joint underwriting authority for long-term care insurance.
NEW SECTION. Sec. 21. Sections 13 through 17 of this act are each added to chapter 48.41 RCW.