BILL REQ. #:  H-0637.1 

Read first time 02/06/13.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to state implementation of the federal patient protection and affordable care act; amending RCW 43.71.010, 43.71.030, 43.71.075, 43.71.065, and 48.43.715; and repealing RCW 48.43.700, 48.43.705, and 70.47.250.

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

Sec. 1   RCW 43.71.010 and 2012 c 87 s 2 are each amended to read as follows:
     The definitions in this section apply throughout this chapter unless the context clearly requires otherwise. Terms and phrases used in this chapter that are not defined in this section must be defined as consistent with implementation of a state health benefit exchange pursuant to the affordable care act.
     (1) "Affordable care act" means the federal patient protection and affordable care act, P.L. 111-148, as amended by the federal health care and education reconciliation act of 2010, P.L. 111-152, or federal regulations or guidance issued under the affordable care act.
     (2) "Authority" means the Washington state health care authority, established under chapter 41.05 RCW.
     (3) "Board" means the governing board established in RCW 43.71.020.
     (4) "Commissioner" means the insurance commissioner, established in Title 48 RCW.
     (5) "Exchange" means the Washington health benefit exchange established in RCW 43.71.020.
     (6) "Self-sustaining" means capable of operating without direct state tax subsidy. Self-sustaining sources include, but are not limited to, federal grants, federal premium tax subsidies and credits, charges to health carriers, and premiums or user fees paid by enrollees.

Sec. 2   RCW 43.71.030 and 2012 c 87 s 4 are each amended to read as follows:
     (1)(a) The exchange may, consistent with the purposes of this chapter: (((a))) (i) Sue and be sued in its own name; (((b))) (ii) make and execute agreements, contracts, and other instruments, with any public or private person or entity; (((c))) (iii) employ, contract with, or engage personnel; (((d))) (iv) pay administrative costs; (((e))) (v) accept grants, donations, loans of funds, and contributions in money, services, materials or otherwise, from the United States or any of its agencies, from the state of Washington and its agencies or from any other source, and use or expend those moneys, services, materials, or other contributions; (((f))) (vi) aggregate or delegate the aggregation of funds that comprise the premium for a health plan; and (((g))) (vii) complete other duties necessary to begin open enrollment in qualified health plans through the exchange beginning October 1, 2013.
     (b) The exchange may not provide information about, or enroll individuals in, any programs other than public and private health coverage as required by the affordable care act.
     (2) The board shall develop a methodology to ensure the exchange is self-sustaining after December 31, 2014. The board shall seek input from health carriers to develop funding mechanisms that fairly and equitably apportion among carriers the reasonable administrative costs and expenses incurred to implement the provisions of this chapter. The board shall submit its recommendations to the legislature by December 1, 2012. If the legislature does not enact legislation during the 2013 regular session to modify or reject the board's recommendations, the board may proceed with implementation of the recommendations.
     (3) The board shall establish policies that permit city and county governments, Indian tribes, tribal organizations, urban Indian organizations, private foundations, and other entities to pay premiums on behalf of qualified individuals.
     (4) The employees of the exchange may participate in the public employees' retirement system under chapter 41.40 RCW and the public employees' benefits board under chapter 41.05 RCW.
     (5) Qualified employers may access coverage for their employees through the exchange for small groups under section 1311 of P.L. 111-148 of 2010, as amended. The exchange shall enable any qualified employer to specify a level of coverage so that any of its employees may enroll in any qualified health plan offered through the small group exchange at the specified level of coverage.
     (6) The exchange shall report its activities and status to the governor and the legislature as requested, and no less often than annually.

Sec. 3   RCW 43.71.075 and 2012 c 87 s 25 are each amended to read as follows:
     (1) A person or entity functioning as a navigator consistent with the requirements of section 1311(i) of P.L. 111-148 of 2010, as amended, shall not be considered soliciting or negotiating insurance as stated under chapter 48.17 RCW.
     (2) A person or entity functioning as a navigator shall utilize grant funding from the exchange only for purposes of providing information about, or enrolling individuals in, qualified health plans.

Sec. 4   RCW 43.71.065 and 2012 c 87 s 8 are each amended to read as follows:
     (1) The board shall certify a plan as a qualified health plan to be offered through the exchange if the plan is determined by the:
     (a) Insurance commissioner to meet the requirements of Title 48 RCW and rules adopted by the commissioner pursuant to chapter 34.05 RCW to implement the requirements of Title 48 RCW; and
     (b) Board to meet the requirements of the affordable care act for certification as a qualified health plan((; and
     (c) Board to include tribal clinics and urban Indian clinics as essential community providers in the plan's provider network consistent with federal law. If consistent with federal law, integrated delivery systems shall be exempt from the requirement to include essential community providers in the provider network)).
     (2) Consistent with section 1311 of P.L. 111-148 of 2010, as amended, the board shall allow stand-alone dental plans to offer coverage in the exchange beginning January 1, 2014. Dental benefits offered in the exchange must be offered and priced separately to assure transparency for consumers.
     (3) The board may permit direct primary care medical home plans, consistent with section 1301 of P.L. 111-148 of 2010, as amended, to be offered in the exchange beginning January 1, 2014.
     (4) Upon request by the board, a state agency shall provide information to the board for its use in determining if the requirements under subsection (1)(b) ((or (c))) of this section have been met. Unless the agency and the board agree to a later date, the agency shall provide the information within sixty days of the request. The exchange shall reimburse the agency for the cost of compiling and providing the requested information within one hundred eighty days of its receipt.
     (5) A decision by the board denying a request to certify or recertify a plan as a qualified health plan may be appealed according to procedures adopted by the board.

Sec. 5   RCW 48.43.715 and 2012 c 87 s 13 are each amended to read as follows:
     (1) Consistent with federal law, the commissioner, in consultation with the board and the health care authority, shall, by rule, select the largest small group plan in the state by enrollment as the benchmark plan for the individual and small group market for purposes of establishing the essential health benefits in Washington state under P.L. 111-148 of 2010, as amended.
     (2) If the essential health benefits benchmark plan for the individual and small group market does not include all of the ten benefit categories specified by section 1302 of P.L. 111-148, as amended, the commissioner, in consultation with the board and the health care authority, shall, by rule, supplement the benchmark plan benefits as needed, but no more than the extent necessary to meet the minimum requirements of section 1302.
     (3) A health plan required to offer the essential health benefits, other than a health plan offered through ((the federal basic health program or)) medicaid, under P.L. 111-148 of 2010, as amended, may ((not)) be offered in the state unless the commissioner finds that it is not substantially equal to the benchmark plan. ((When making this determination, the commissioner must:
     (a) Ensure that the plan covers the ten essential health benefits categories specified in section 1302 of P.L. 111-148 of 2010, as amended; and
     (b) May consider whether the health plan has a benefit design that would create a risk of biased selection based on health status and whether the health plan contains meaningful scope and level of benefits in each of the ten essential health benefit categories specified by section 1302 of P.L. 111-148 of 2010, as amended.))
     (4) Beginning December 15, 2012, and every year thereafter, the commissioner shall submit to the legislature a list of state-mandated health benefits, the enforcement of which will result in federally imposed costs to the state related to the plans sold through the exchange because the benefits are not included in the essential health benefits designated under federal law. The list must include the anticipated costs to the state of each state-mandated health benefit on the list and any statutory changes needed if funds are not appropriated to defray the state costs for the listed mandate. The commissioner may enforce a mandate on the list for the entire market only if funds are appropriated in an omnibus appropriations act specifically to pay the state portion of the identified costs.

NEW SECTION.  Sec. 6   The following acts or parts of acts are each repealed:
     (1) RCW 48.43.700 (Exchange -- Plans that a carrier must offer--Review -- Rules) and 2012 c 87 s 6;
     (2) RCW 48.43.705 (Plans offered outside of exchange) and 2012 c 87 s 7; and
     (3) RCW 70.47.250 (Federal basic health option -- Report to legislature -- Certification -- Director's findings -- Program's guiding principles) and 2012 c 87 s 15.