BILL REQ. #: H-0637.1
State of Washington | 63rd Legislature | 2013 Regular Session |
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.