BILL REQ. #: H-0043.2
State of Washington | 58th Legislature | 2003 Regular Session |
Read first time 01/20/2003. Referred to Committee on Appropriations.
AN ACT Relating to offering health care benefit plans to school district employees; amending RCW 41.05.065; and reenacting and amending RCW 41.05.050.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 41.05.050 and 2002 c 319 s 4 and 2002 c 142 s 2 are
each reenacted and amended to read as follows:
(1) Every department, division, or separate agency of state
government, and such county, municipal, school district, educational
service district, or other political subdivisions as are covered by
this chapter, shall provide contributions to insurance and health care
plans for its employees and their dependents, the content of such plans
to be determined by the authority. Contributions, paid by the county,
the municipality, or other political subdivision for their employees,
shall include an amount determined by the authority to pay such
administrative expenses of the authority as are necessary to administer
the plans for employees of those groups, except as provided in
subsection (4) of this section.
(2) If the authority at any time determines that the participation
of a county, municipal, or other political subdivision covered under
this chapter adversely impacts insurance rates for state employees, the
authority shall implement limitations on the participation of
additional county, municipal, or other political subdivisions.
(3) The contributions of any department, division, or separate
agency of the state government, and such county, municipal, or other
political subdivisions as are covered by this chapter, shall be set by
the authority, subject to the approval of the governor for availability
of funds as specifically appropriated by the legislature for that
purpose. Insurance and health care contributions for ferry employees
shall be governed by RCW 47.64.270.
(4)(a) Beginning September 1, ((2002)) 2003, the authority shall
collect from each participating school district((s)) and educational
service district((s shall be charged the same)) an amount equal to the
composite rate ((as)) charged to state agencies, plus ((the same
amounts for)) an amount equal to the employee premiums by plan and
family size as ((are)) would be charged to state employees, for groups
of district employees enrolled in authority plans as of January 1,
((2002)) 2003.
(b) For all groups of district employees enrolling in authority
plans for the first time after September 1, 2002, the authority shall
((charge)) collect from districts the same composite rate charged to
state agencies, plus the same amounts for employee premiums by plan and
by family size as are charged to state employees, only if the authority
determines that this method of billing the districts will not result in
a material difference between revenues from districts and expenditures
made by the authority on behalf of districts and their employees.
(c) If the authority determines at any time that the conditions in
(b) of this subsection cannot be met, the authority shall offer
enrollment to additional groups of district employees on a tiered rate
structure until such time as the authority determines there would be no
material difference between revenues and expenditures under a composite
rate structure for all district employees enrolled in authority plans.
(d) The authority may charge districts a one-time set-up fee for
employee groups enrolling in authority plans for the first time.
(e) For the purposes of this subsection:
(i) "District" means school district and educational service
district; and
(ii) "Tiered rates" means the amounts the authority must pay to
insuring entities by plan and by family size.
(f) Notwithstanding this subsection and RCW 41.05.065(3), the
authority may allow districts enrolled on a tiered rate structure prior
to September 1, 2002, to continue participation based on the same rate
structure and under the same conditions and eligibility criteria.
(5) The authority shall transmit a recommendation for the amount of
the employer contribution to the governor and the director of financial
management for inclusion in the proposed budgets submitted to the
legislature.
Sec. 2 RCW 41.05.065 and 2002 c 142 s 3 are each amended to read
as follows:
(1) The board shall study all matters connected with the provision
of health care coverage, life insurance, liability insurance,
accidental death and dismemberment insurance, and disability income
insurance or any of, or a combination of, the enumerated types of
insurance for employees and their dependents on the best basis possible
with relation both to the welfare of the employees and to the state.
However, liability insurance shall not be made available to dependents.
(2) The board shall develop employee benefit plans that include
comprehensive health care benefits for all employees. In developing
these plans, the board shall consider the following elements:
(a) Methods of maximizing cost containment while ensuring access to
quality health care;
(b) Development of provider arrangements that encourage cost
containment and ensure access to quality care, including but not
limited to prepaid delivery systems and prospective payment methods;
(c) Wellness incentives that focus on proven strategies, such as
smoking cessation, injury and accident prevention, reduction of alcohol
misuse, appropriate weight reduction, exercise, automobile and
motorcycle safety, blood cholesterol reduction, and nutrition
education;
(d) Utilization review procedures including, but not limited to a
cost-efficient method for prior authorization of services, hospital
inpatient length of stay review, requirements for use of outpatient
surgeries and second opinions for surgeries, review of invoices or
claims submitted by service providers, and performance audit of
providers;
(e) Effective coordination of benefits;
(f) Minimum standards for insuring entities; and
(g) Minimum scope and content of public employee benefit plans to
be offered to enrollees participating in the employee health benefit
plans. To maintain the comprehensive nature of employee health care
benefits, employee eligibility criteria related to the number of hours
worked and the benefits provided to employees shall be substantially
equivalent to the state employees' health benefits plan and eligibility
criteria in effect on January 1, 1993. Nothing in this subsection
(2)(g) shall prohibit changes or increases in employee point-of-service
payments or employee premium payments for benefits.
(3) The board shall design benefits and determine the terms and
conditions of employee participation and coverage, including
establishment of eligibility criteria. The same terms and conditions
of participation and coverage, including eligibility criteria, shall
apply to state employees and to school district employees and
educational service district employees.
(4) The board may authorize premium contributions for an employee
and the employee's dependents in a manner that encourages the use of
cost-efficient managed health care systems. The board shall require
participating school district and educational service district
employees to pay at least the same employee premiums by plan and family
size as state employees pay.
(5) Employees shall choose participation in one of the health care
benefit plans developed by the board and may be permitted to waive
coverage under terms and conditions established by the board.
(6) The board shall review plans proposed by insuring entities that
desire to offer property insurance and/or accident and casualty
insurance to state employees through payroll deduction. The board may
approve any such plan for payroll deduction by insuring entities
holding a valid certificate of authority in the state of Washington and
which the board determines to be in the best interests of employees and
the state. The board shall promulgate rules setting forth criteria by
which it shall evaluate the plans.
(7) Before January 1, 1998, the public employees' benefits board
shall make available one or more fully insured long-term care insurance
plans that comply with the requirements of chapter 48.84 RCW. Such
programs shall be made available to eligible employees, retired
employees, and retired school employees as well as eligible dependents
which, for the purpose of this section, includes the parents of the
employee or retiree and the parents of the spouse of the employee or
retiree. Employees of local governments and employees of political
subdivisions not otherwise enrolled in the public employees' benefits
board sponsored medical programs may enroll under terms and conditions
established by the administrator, if it does not jeopardize the
financial viability of the public employees' benefits board's long-term
care offering.
(a) Participation of eligible employees or retired employees and
retired school employees in any long-term care insurance plan made
available by the public employees' benefits board is voluntary and
shall not be subject to binding arbitration under chapter 41.56 RCW.
Participation is subject to reasonable underwriting guidelines and
eligibility rules established by the public employees' benefits board
and the health care authority.
(b) The employee, retired employee, and retired school employee are
solely responsible for the payment of the premium rates developed by
the health care authority. The health care authority is authorized to
charge a reasonable administrative fee in addition to the premium
charged by the long-term care insurer, which shall include the health
care authority's cost of administration, marketing, and consumer
education materials prepared by the health care authority and the
office of the insurance commissioner.
(c) To the extent administratively possible, the state shall
establish an automatic payroll or pension deduction system for the
payment of the long-term care insurance premiums.
(d) The public employees' benefits board and the health care
authority shall establish a technical advisory committee to provide
advice in the development of the benefit design and establishment of
underwriting guidelines and eligibility rules. The committee shall
also advise the board and authority on effective and cost-effective
ways to market and distribute the long-term care product. The
technical advisory committee shall be comprised, at a minimum, of
representatives of the office of the insurance commissioner, providers
of long-term care services, licensed insurance agents with expertise in
long-term care insurance, employees, retired employees, retired school
employees, and other interested parties determined to be appropriate by
the board.
(e) The health care authority shall offer employees, retired
employees, and retired school employees the option of purchasing long-term care insurance through licensed agents or brokers appointed by the
long-term care insurer. The authority, in consultation with the public
employees' benefits board, shall establish marketing procedures and may
consider all premium components as a part of the contract negotiations
with the long-term care insurer.
(f) In developing the long-term care insurance benefit designs, the
public employees' benefits board shall include an alternative plan of
care benefit, including adult day services, as approved by the office
of the insurance commissioner.
(g) The health care authority, with the cooperation of the office
of the insurance commissioner, shall develop a consumer education
program for the eligible employees, retired employees, and retired
school employees designed to provide education on the potential need
for long-term care, methods of financing long-term care, and the
availability of long-term care insurance products including the
products offered by the board.
(h) By December 1998, the health care authority, in consultation
with the public employees' benefits board, shall submit a report to the
appropriate committees of the legislature, including an analysis of the
marketing and distribution of the long-term care insurance provided
under this section.