EMERGENCY RULES
INSURANCE COMMISSIONER
Date of Adoption: November 30, 2000.
Purpose: Clarify the ambiguity created by E2SSB 6067 and HB 3154 regarding enrollment in the Washington state health insurance pool (WSHIP) by certain categories of Medicare beneficiaries.
Statutory Authority for Adoption: RCW 48.02.060, 48.30.010, 48.41.170.
Other Authority: RCW 48.41.100.
Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest; and that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.
Reasons for this Finding: Since the creations of the Washington state health insurance pool (WSHIP) in 1987, it has permitted certain categories of Medicare beneficiaries to enroll in pool coverage without the requirement of rejection by a health carrier. The legislative history of chapter 79, Laws of 2000 (E2SSB 6067) and chapter 80, Laws of 2000 (HB 3154) indicates no intent to change this situation.
However, chapter 79, Laws of 2000 (E2SSB 6067) and chapter 80, Laws of 2000 (HB 3154) made several modifications to WSHIP provisions requiring the use of a questionnaire to determine rejection from private coverage and WSHIP eligibility that could be read to create ambiguity regarding WSHIP-Medicare enrollment. It was clearly not legislative intent of modify the WSHIP law as it applies to Medicare beneficiaries.
An emergency presently exists because over 32,000 Medicare beneficiaries have been notified that they are being terminated from Medicare managed care programs (Medicare HMOs) effective January 1, 2001, and need to secure replacement medical coverage, including WSHIP coverage, no later than that termination date. This vulnerable population must secure new medical coverage, including WSHIP pool coverage, effective on the termination of their existing Medicare HMO coverage, or they may be left without access to health care needed to preserve their health or even their lives. This is particularly troublesome for those Medicare beneficiaries who lack necessary prescription coverage from some other source. The requirement of a questionnaire and/or carrier rejection would not only be unnecessarily burdensome to this already fragile and sometimes confused group of people but also would prevent many of those seeking coverage from WSHIP from enrolling in WSHIP and securing needed medical coverage, at all, immediately upon termination of their existing Medicare HMO coverage. The need of these elderly residents for access to WSHIP pool coverage, and the health and medical services such coverage would provide, immediately upon termination of their Medicare HMO coverage on January 1, 2001, creates an emergency situation requiring the issuance of rules effective immediately to protect the health and welfare of this vulnerable population. The termination of these elderly citizens from Medicare HMO coverage, and the effective date of such termination, results from and is controlled by federal rather than Washington law, and cannot be delayed or postponed by action of the insurance commissioner.
It is necessary to dispense with normal requirements of notice and opportunity to comment if rules are to be issued and effective in time for those affected to be eligible for WSHIP pool coverage on January 1, 2001, when their existing Medicare HMO coverage terminates. Observing the normal time provisions for notice and comment in rule making would prevent any rule from being issued until after those affected were terminated by their existing Medicare HMO, and any such rules would therefor largely be futile. It is contrary to the public interest to deny affected elderly residents losing Medicare HMO coverage immediate access to WSHIP pool coverage, and the health and medical care services such coverage provides, upon termination of their Medicare HMO coverage.
Based on the above, the commissioner finds that immediate adoption of this rule is necessary for the preservation of the public health, safety and welfare and that observing the time requirements of notice and comment upon adoption of a permanent rule would be contrary to the public interest. The commissioner also finds that an emergency rule is necessary because of federal law or a federal rule.
This rule will expire one hundred twenty days after adoption.
Number of Sections Adopted in Order to Comply with Federal Statute: New 1, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0. Effective Date of Rule: Immediately.
November 30, 2000
Robert Harkins
Chief Deputy Commissioner
OTS-4458.2
NEW SECTION
WAC 284-91-070
Clarification of pool coverage eligibility
for certain Medicare beneficiaries.
(1) It is the intent of this
rule to clarify that chapter 79, Laws of 2000 (E2SSB 6067) and
chapter 80, Laws of 2000 (HB 3154), commonly known, in
combination, as the "Health Insurance Reform Act of 2000," did
not modify pool coverage eligibility requirements for the
categories of Medicare beneficiaries listed in subsection (2) of
this section.
(2) A Medicare beneficiary is eligible for pool coverage and exempt from the requirements set forth in RCW 48.41.060(1) and 48.41.100(1) if:
(a) Involuntarily terminated from coverage;
(b) Disabled or has end stage renal disease and has no other coverage;
(c) Disabled or has end stage renal disease and coverage has been terminated because of benefit maximums; or
(d) Enrolled in Medicare, parts A and B, but not enrolled in Medicare supplemental insurance, as defined in chapter 48.66 RCW.
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