Washington State
House of Representatives
Office of Program Research
BILL
ANALYSIS
Health Care & Wellness Committee
SB 5084
Brief Description: Concerning health carrier reporting.
Sponsors: Senators Robinson, Muzzall, Dhingra, Hasegawa, Krishnadasan, Nobles and Salomon.
Brief Summary of Bill
  • Authorizes the Office of the Insurance Commissioner (Commissioner) to require health carriers to annually report primary care expenditures.
  • Requires the Commissioner to consider a specific definition of primary care and data reporting requirements developed by the Health Care Authority when determining the form and content of health carrier primary care reporting requirements.
Hearing Date: 3/14/25
Staff: Emily Poole (786-7106).
Background:

The Health Care Authority and the Health Care Cost Transparency Board. 

The Health Care Cost Transparency Board (Board), a board within the Health Care Authority (HCA), is responsible for the analysis of total health care expenditures in Washington, identifying trends in health care cost growth, and establishing a health care cost growth benchmark.  As part of its work, the Board is tasked with developing a definition of primary care for purposes of calculating primary care expenditures as a proportion of total health care expenditures, as well as measuring and reporting on primary care expenditures in Washington and the progress towards increasing it to 12 percent of total health care expenditures.

 

The HCA uses a single definition of primary care in its contracts with managed care organizations and health carriers for Medicaid and employee benefits coverage, and as part of those contracts, collects a standard set of primary care data. 

 

Office of the Insurance Commissioner. 

The Office of the Insurance Commissioner (Commissioner) regulates commercial health insurance carriers and requires them to submit details about their plans and rates for the Commissioner to review. 

 

The Commissioner is authorized to assess carriers' primary care expenditures when it reviews carriers' health plan forms or rate filings.  When conducting the review, the Commissioner must consider any definition of primary care expenditures and any primary care expenditure targets established by the Board.  The Commissioner may determine the form and content of carrier primary care expenditure reporting.
Summary of Bill:

The Commissioner may require health carriers to annually report primary care expenditures in previous calendar years, or anticipated expenditures for the upcoming calendar years. 

 

In developing the form and content for reporting, the Commissioner is required to consider the definition of primary care expenditures and any primary care expenditure targets established by the Board.  Additionally, the Commissioner is required to consider primary care expenditure reporting systems implemented by the HCA for medical assistance and employee benefits coverage programs. 

 

Primary care expenditure reports submitted by carriers are public information.
Appropriation: None.
Fiscal Note: Available.
Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.