State of Washington | 63rd Legislature | 2013 Regular Session |
READ FIRST TIME 03/01/13.
AN ACT Relating to ensuring the ongoing sustainability and vitality of the Washington health benefit exchange by providing a financing mechanism sufficient to defray the exchange's operating expenses; amending RCW 43.71.010, 43.71.060, and 48.14.0201; adding a new section to chapter 43.71 RCW; adding a new section to chapter 43.135 RCW; adding a new section to chapter 82.04 RCW; creating a new section; and providing an expiration date.
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)) with revenue attributable to the operations of the
exchange. Self-sustaining sources include, but are not limited to,
federal grants, federal premium tax subsidies and credits, charges to
health carriers, ((and)) premiums paid by enrollees, and premium taxes
under RCW 48.14.0201(5)(b).
Sec. 2 RCW 43.71.060 and 2012 c 87 s 5 are each amended to read
as follows:
(((1))) The health benefit exchange account is created in the
((custody of the state treasurer)) state treasury. Moneys in the
account may be spent only after appropriation. Expenditures from the
account may only be used to fund the operation of the exchange and
identification, collection, and distribution of premium taxes collected
under RCW 48.14.0201(5)(b). The following funds must be deposited in
the account:
(1) All receipts from federal grants received under the affordable
care act may be deposited into the account. Expenditures from the
account may be used only for purposes consistent with the grants((.
Until March 15, 2012, only the administrator of the health care
authority, or his or her designee, may authorize expenditures from the
account. Beginning March 15, 2012, only the board of the Washington
health benefit exchange or designee may authorize expenditures from the
account. The account is subject to allotment procedures under chapter
43.88 RCW, but an appropriation is not required for expenditures.));
(2) This section expires January 1, 2014
(2) Premium taxes collected under RCW 48.14.0201(5)(b); and
(3) Assessments authorized under section 3 of this act.
NEW SECTION. Sec. 3 A new section is added to chapter 43.71 RCW
to read as follows:
(1) Beginning January 1, 2014, the exchange may require each
carrier writing premiums for qualified health benefits plans or dental
plans through the exchange to pay an assessment in an amount necessary
to fund the operations of the exchange. Assessments of carriers may be
made only if the amount of expected premium taxes, as provided under
RCW 48.14.0201(5)(b), and other funds deposited in the health benefit
exchange account in the current calendar year are insufficient to fund
exchange operations in the following calendar year at the level
appropriated by the legislature for that purpose in the omnibus
appropriations act. If the exchange is charging an assessment, the
exchange shall set forth the amount of the assessment per member per
month on monthly billing statements.
(2) The board shall determine the amount of the assessment by
multiplying, by a fraction, for each carrier offering health or dental
coverage in the exchange, the number of its covered lives in qualified
health plans and dental plans in the exchange. The numerator of the
fraction is an estimate of the shortfall in revenues in the health
benefit exchange account necessary to operate the exchange at the level
appropriated for that purpose by the legislature in the omnibus
appropriations act for the following calendar year. The denominator of
the fraction equals the total number of expected covered lives in the
exchange for the calendar year that the assessment will be collected
in.
(3) The exchange shall collect the assessments required under this
section from carriers in quarterly installments. Upon determination of
the amount of the assessment, the exchange shall notify carriers of the
due dates of the quarterly installments. The exchange shall deposit
proceeds from the assessments in the health benefit exchange account
under RCW 43.71.060.
(4) The exchange shall reconcile assessment payments based on
actual covered lives at the end of the calendar year of the assessment.
At the end of the calendar year, the exchange shall compare the amount
of the assessment for each carrier calculated in subsection (2) of this
section to the amount of the assessment that would have been collected
from each carrier based on each carrier's actual covered lives in
qualified health plans and dental plans in the exchange during that
calendar year. If a carrier's share of the assessment would have been
smaller if it were based on actual covered lives, the exchange shall
refund the carrier for the difference between the collected amount of
the assessment and the amount of the assessment that would have been
collected based on the carrier's actual covered lives. If the
carrier's share of the assessment would have been larger if it were
based on actual covered lives, the exchange shall collect from the
carrier the difference between the collected amount of the assessment
and the amount of the assessment that would have been collected based
on the carrier's actual covered lives.
(5) The assessment described in this section shall be considered a
special purpose obligation or assessment in connection with coverage
described in this section for the purpose of funding the operations of
the exchange.
(6) The board shall establish procedures allowing carriers subject
to assessments under this section to have grievances reviewed by an
impartial body and reported to the board.
(7) By July 1, 2016, the state auditor shall conduct a performance
review of the cost of exchange operations and shall make
recommendations to the board and the health care committees of the
legislature addressing improvements in cost performance and adoption of
best practices. The auditor shall further evaluate the potential cost
and customer service benefits through regionalization with other states
of some exchange operation functions or through a partnership with the
federal government. The cost of the state auditor review must be borne
by the exchange.
NEW SECTION. Sec. 4 A new section is added to chapter 43.135 RCW
to read as follows:
RCW 43.135.034(4) does not apply to the dedication of premium taxes
established under RCW 48.14.0201(5)(b).
Sec. 5 RCW 48.14.0201 and 2011 c 47 s 8 are each amended to read
as follows:
(1) As used in this section, "taxpayer" means a health maintenance
organization as defined in RCW 48.46.020, a health care service
contractor as defined in RCW 48.44.010, or a self-funded multiple
employer welfare arrangement as defined in RCW 48.125.010.
(2) Each taxpayer must pay a tax on or before the first day of
March of each year to the state treasurer through the insurance
commissioner's office. The tax must be equal to the total amount of
all premiums and prepayments for health care services collected or
received by the taxpayer under RCW 48.14.090 during the preceding
calendar year multiplied by the rate of two percent. For tax purposes,
the reporting of premiums and prepayments must be on a written basis or
on a paid-for basis consistent with the basis required by the annual
statement.
(3) Taxpayers must prepay their tax obligations under this section.
The minimum amount of the prepayments is the percentages of the
taxpayer's tax obligation for the preceding calendar year recomputed
using the rate in effect for the current year. For the prepayment of
taxes due during the first calendar year, the minimum amount of the
prepayments is the percentages of the taxpayer's tax obligation that
would have been due had the tax been in effect during the previous
calendar year. The tax prepayments must be paid to the state treasurer
through the commissioner's office by the due dates and in the following
amounts:
(a) On or before June 15, forty-five percent;
(b) On or before September 15, twenty-five percent;
(c) On or before December 15, twenty-five percent.
(4) For good cause demonstrated in writing, the commissioner may
approve an amount smaller than the preceding calendar year's tax
obligation as recomputed for calculating the health maintenance
organization's, health care service contractor's, self-funded multiple
employer welfare arrangement's, or certified health plan's prepayment
obligations for the current tax year.
(5)(a) Except as provided in (b) of this subsection, moneys
collected under this section are deposited in the general fund.
(b) Beginning January 1, 2014, moneys collected from taxpayers for
premiums written on qualified health benefit plans and dental plans
offered through the health benefit exchange under chapter 43.71 RCW and
on premiums written on medicaid plans provided to newly eligible
clients enrolling in the medicaid expansion under the federal patient
protection and affordable care act of 2010 (42 U.S.C.
1396a(a)(10)(A)(i)(VIII)) must be deposited in the health benefit
exchange account under RCW 43.71.060.
(6) The taxes imposed in this section do not apply to:
(a) Amounts received by any taxpayer from the United States or any
instrumentality thereof as prepayments for health care services
provided under Title XVIII (medicare) of the federal social security
act.
(b) Amounts received by any taxpayer from the state of Washington
as prepayments for health care services provided under:
(i) The medical care services program as provided in RCW 74.09.035;
or
(ii) The Washington basic health plan on behalf of subsidized
enrollees as provided in chapter 70.47 RCW.
(c) Amounts received from business conducted outside of the health
benefit exchange under chapter 43.71 RCW by any health care service
contractor, as defined in RCW 48.44.010, as prepayments for health care
services included within the definition of practice of dentistry under
RCW 18.32.020.
(d) Participant contributions to self-funded multiple employer
welfare arrangements that are not taxable in this state.
(7) Beginning January 1, 2000, the state preempts the field of
imposing excise or privilege taxes upon taxpayers and no county, city,
town, or other municipal subdivision has the right to impose any such
taxes upon such taxpayers. This subsection is limited to premiums and
payments for health benefit plans offered by health care service
contractors under chapter 48.44 RCW, health maintenance organizations
under chapter 48.46 RCW, and self-funded multiple employer welfare
arrangements as defined in RCW 48.125.010. The preemption authorized
by this subsection must not impair the ability of a county, city, town,
or other municipal subdivision to impose excise or privilege taxes upon
the health care services directly delivered by the employees of a
health maintenance organization under chapter 48.46 RCW.
(8)(a) The taxes imposed by this section apply to a self-funded
multiple employer welfare arrangement only in the event that they are
not preempted by the employee retirement income security act of 1974,
as amended, 29 U.S.C. Sec. 1001 et seq. The arrangements and the
commissioner must initially request an advisory opinion from the United
States department of labor or obtain a declaratory ruling from a
federal court on the legality of imposing state premium taxes on these
arrangements. Once the legality of the taxes has been determined, the
multiple employer welfare arrangement certified by the insurance
commissioner must begin payment of these taxes.
(b) If there has not been a final determination of the legality of
these taxes, then beginning on the earlier of (i) the date the fourth
multiple employer welfare arrangement has been certified by the
insurance commissioner, or (ii) April 1, 2006, the arrangement must
deposit the taxes imposed by this section into an interest bearing
escrow account maintained by the arrangement. Upon a final
determination that the taxes are not preempted by the employee
retirement income security act of 1974, as amended, 29 U.S.C. Sec. 1001
et seq., all funds in the interest bearing escrow account must be
transferred to the state treasurer.
(9) The effect of transferring contracts for health care services
from one taxpayer to another taxpayer is to transfer the tax prepayment
obligation with respect to the contracts.
(10) On or before June 1st of each year, the commissioner must
notify each taxpayer required to make prepayments in that year of the
amount of each prepayment and must provide remittance forms to be used
by the taxpayer. However, a taxpayer's responsibility to make
prepayments is not affected by failure of the commissioner to send, or
the taxpayer to receive, the notice or forms.
NEW SECTION. Sec. 6 A new section is added to chapter 82.04 RCW
to read as follows:
(1) The taxes imposed by this chapter do not apply to amounts
received by the Washington health benefit exchange established under
chapter 43.71 RCW.
(2) This section expires on July 1, 2023.
NEW SECTION. Sec. 7 If any provision of this act or its
application to any person or circumstance is held invalid, the
remainder of the act or the application of the provision to other
persons or circumstances is not affected.
NEW SECTION. Sec. 8 Section 6 of this act applies both
prospectively and retroactively.