Bill Summary – FastDemocracy

S-0571.1
                                 SENATE BILL 5335
     State of Washington         68th Legislature     2023 Regular Session
     By Senators Hasegawa, Hunt, Liias, Nguyen, and Stanford
     Read first time 01/12/23.     Referred to Committee on Health & Long
     Term Care.
     AN ACT Relating to health care financing and development of the
 Washington health trust to ensure that all Washington residents can
 enroll in nonprofit health insurance coverage providing an essential
 set of health benefits, including medical, dental, vision, and
 prescription drug benefits; adding a new section to chapter 82.32
 RCW; adding a new section to chapter 82.04 RCW; adding a new chapter
 to Title 43 RCW; adding a new chapter to Title 82 RCW; adding a new
 title to the Revised Code of Washington to be codified as Title 50C
 RCW; prescribing penalties; providing effective dates; providing a
 contingent effective date; and providing contingent expiration dates.
 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
                                Part I
              Universal Health Care for Washington State
     NEW SECTION.   Sec. 101.    WASHINGTON HEALTH TRUST PROTECTIONS.
 During this time of deep racial and socioeconomic inequity,
 Washingtonians have watched as loved ones and neighbors slipped
 through the widening gaps in our health care system. According to the
 Washington state department of health, the COVID-19 pandemic has
 worsened these structural disparities, showing in their recent
 COVID-19 morbidity report that the death and burden of this pandemic
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 has disproportionately affected those already marginalized and
 underserved communities. With the intent to start healing the wounds
 of generations of inequality and to ensure a future where health care
 is recognized as a basic right afforded to each resident, the people
 of the state of Washington declare their intention to create a
 single, primary nonprofit health financing entity called the
 Washington health trust. The trust will simplify health care
 financing, eliminate administrative waste, respond to the health
 needs of each regional health district, and guarantee all residents
 coverage of a comprehensive set of essential health benefits without
 the burden of premiums, deductibles, copayments, or medical bills.
     (1) All residents of the state of Washington are eligible for
 coverage through this chapter.
     (2) Individuals enrolled for essential health benefits under this
 chapter   may   obtain   health  services   from   any   participating
 institution, agency, or individual qualified to provide the service
 including participating providers outside the state.
     (3) Residents may obtain coverage for health care benefits in
 excess of those available under the trust, including additional
 benefits that an employer may provide to employees and their
 dependents and spouses or to former employees and their dependents
 and spouses.
     (4) No person shall, on the basis of race, color, national
 origin, age, disability, immigration status, or sex, including sex
 stereotyping, gender identity, sexual orientation, and pregnancy and
 related medical conditions, be excluded from participation in, be
 denied the benefits of, or be subjected to discrimination by any
 participating provider or any entity conducting, administering, or
 funding a health program or activity, including contracts of
 insurance, under this chapter.
     (5) Participating providers may not be denied reimbursement by
 the Washington health trust for any essential health benefit that is
 within the scope of their practice, consistent with the accepted
 standard of care as described in RCW 7.70.040.
     (6) A participating health care provider is not required to
 furnish any health care service that is outside the scope of their
 practice or, in the health care provider's reasonable clinical
 judgment, not consistent with the accepted standard of care as
 described in RCW 7.70.040.
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     (7) Participating providers may receive payments from sources
 other than the trust. However, any provider who does accept payment
 from the trust for a service must accept that payment, along with
 applicable copayments, as payment in full.
     (8) Any provider, institution, agency, or individual that is
 qualified to provide a health care service covered under this
 chapter, is entitled to participate and receive reimbursement as
 described in section 109 of this act.
     (9) Nothing in this chapter is intended to interfere with tribal
 sovereignty over any federal or state funding set aside for tribal
 health or Indian health services, including those provided by chapter
 43.71B RCW.
     NEW SECTION.  Sec. 102.  DEFINITIONS. The definitions in this
 section apply throughout this chapter unless the context clearly
 requires otherwise.
      (1) "Board" means the Washington health trust board of trustees
 created in section 104 of this act.
     (2) "Chair" means the presiding officer of the board.
     (3) "Community health access" means a reimbursement system
 managed by the health care authority for eligible residents to
 receive essential health services free to the individual at the point
 of service through community health providers.
     (4) "Community health provider" means a qualified provider
 electing participation in the trust as a coordinating nonprofit
 health care provider to negotiate reimbursements based on quality and
 availability of services for residents in each regional health
 district as described in section 109 of this act.
     (5) "Department" means the Washington state department of health.
     (6) "Eligible nonresident" shall be defined by the board of
 trustees created in section 104 of this act, and includes nonresident
 students attending college within the state, nonresidents employed
 within the state, and the spouses or domestic partners and dependents
 of eligible nonresidents.
     (7)(a) "Employee" means an individual who is in the employment of
 an employer.
      (b) "Employee" does not include employees of the federal
 government.
      (8) "Employer" has the meaning provided in section 201 of this
 act.
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     (9) "Employment investment" means a cost paid by or on behalf of
 employed individuals for enrollment in the Washington health trust.
     (10) "Essential benefits package" means a single comprehensive
 health insurance that covers essential health benefits.
     (11) "Essential health benefits" means any of the following items
 and services provided on an inpatient or outpatient basis when
 medically necessary or appropriate for the maintenance of health or
 for the diagnosis, treatment, or rehabilitation of a health
 condition:
     (a) Hospital services, including inpatient and hospital-based
 outpatient care and 24-hour emergency services;
     (b)   Ambulatory  primary   and   specialty   services,  including
 preventative care and chronic disease management;
     (c) Prescription drugs, medical devices, and biological products;
     (d) Mental health and substance use disorder treatment services;
     (e)   Laboratory   and   other  diagnostic   services,   including
 diagnostic imaging services;
     (f) Reproductive, maternity, and newborn care;
     (g) Pediatric primary and specialty care;
     (h) Palliative care and end-of-life care services;
     (i) Oral health, audiology, and vision services;
     (j) Short-term rehabilitative and habilitative services and
 devices; and
     (k) Licensed naturopathic, acupuncture, and massage therapies.
     (12) "Essential health benefits-benchmark plan" means the set of
 benefits that an issuer must include in nongrandfathered plans
 offered in the individual or small group market in Washington state,
 as defined in section 1302 of the affordable care act, 124 Stat. 119,
 P.L. 111–148 (2010), and 45 C.F.R. 156.100.
     (13) "Federal poverty level" means the federal poverty guidelines
 determined annually by the United States department of health and
 human services or its successor agency.
     (14) "Global annual budget" means the specific amount of money
 required for health care facilities participating for reimbursement
 as a community health provider to operate as negotiated by the board.
     (15) "Health care facility" or "facility" includes any of the
 following appropriately accredited entities: Hospices and home health
 agencies licensed pursuant to chapter 70.127 RCW; hospitals licensed
 pursuant to chapter 70.41 RCW; rural health care facilities as
 defined in RCW 70.175.020; psychiatric hospitals licensed pursuant to
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 chapter 71.12 RCW; nursing homes licensed pursuant to chapter 18.51
 RCW; community mental health centers licensed pursuant to chapter
 71.05 or 71.24 RCW; kidney disease treatment centers; ambulatory
 surgical facilities licensed under chapter 70.230 RCW; approved drug
 and alcohol treatment facilities certified by the department of
 social and health services; such other facilities owned and operated
 by a political subdivision or instrumentality of the state; a
 tribally operated facility as defined in RCW 43.71B.010; and such
 other facilities as required by federal law and implementing
 regulations.
     (16) "Income" means the adjusted gross household income for
 federal income tax purposes.
     (17)   "Long-term    care"   means   institutional,    residential,
 outpatient, or community-based services that meet the individual
 needs of persons of all ages who are limited in their functional
 capacities   or  have   disabilities   and  require   assistance   with
 performing two or more activities of daily living for an extended or
 indefinite period of time. These services include case management,
 protective supervision, in-home care, nursing services, convalescent,
 custodial, chronic, and terminally ill care.
     (18) "Native American" means an American Indian or Alaska Native
 as defined under 25 U.S.C. Sec. 1603.
     (19) "Participating provider" means a person, health care
 provider, practitioner, health care facility, or entity acting within
 their scope of practice that has negotiated a written contract to
 participate and receive reimbursement as described in section 109 of
 this act.
     (20) "Qualified provider" means a person, health care provider,
 practitioner, health care facility, or entity acting within their
 scope of practice who is licensed or certified and meets: (a) All the
 requirements of state law to provide such services in the state where
 the services are provided; and (b) applicable requirements of federal
 law to provide such services. "Qualified provider" includes a
 licensed   or   certified   hospital,   clinic,   health   maintenance
 organization, or nursing home or an officer, director, employee, or
 agent thereof acting in the course and scope of their employment.
     (21) "Reimbursement accounts" means health care accounts with
 funds that can be used for essential health benefits incurred by
 residents and eligible nonresidents with health insurance coverage
 other than the trust for copayments and out-of-pocket costs.
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     (22) "Resident" means an individual who presents evidence of
 established permanent residency in the state of Washington and meets
 residency requirements consistent with RCW 46.16A.140. "Resident"
 also includes people and their accompanying family members who are
 residing in the state for the purpose of engaging in employment for
 at least one month. The confinement of a person in a nursing home,
 hospital, or other medical institution in the state may not by itself
 be sufficient to qualify such person as a resident.
     (23) "Revocable expenditure" means a health care expenditure that
 an employer allocated for use by a covered employee but not actually
 paid to the employee, or any amount actually paid to a third-party
 administrator that could revert to the employer at any point. Funds
 do not have to revert to the employer for the health care expenditure
 to be revocable. Rather, the entire expenditure is considered
 revocable if there is the possibility that any or all of it could be
 returned to the employer, such as flexible spending accounts.
     (24) "Trust" means the Washington health trust created in section
 103 of this act.
     NEW SECTION. Sec. 103. WASHINGTON HEALTH TRUST. The Washington
 health trust is created within the department. The purpose of the
 trust is to provide coverage for a set of essential health benefits
 to all Washington residents.
     NEW SECTION.   Sec. 104.   THE BOARD OF TRUSTEES. (1) The trust
 must be governed by a board of trustees consisting of 15 members with
 expertise in health care financing and delivery and representing
 Washington citizens, business, labor, and health professions.
 Trustees must include individuals with knowledge of the health care
 needs of diverse populations, including low-income, Native American,
 undocumented, non-English speaking, disabled, rural, incarcerated,
 and other minority populations. Members of the board must have no
 pecuniary interest in any business subject to regulation by the
 board.
     (2) The universal health care commission established under RCW
 41.05.840 shall assume the responsibility of the board.
     (3) If the universal health care commission is disbanded or
 unable to assume the responsibilities of the board, the board shall
 be formed using the same process defined in RCW 41.05.840 for full
 formation no later than May 15, 2024.
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     (4) A trustee whose term has expired or who otherwise leaves the
 board must be replaced by gubernatorial appointment. When the person
 leaving was nominated by one of the caucuses of the house of
 representatives or the senate, their replacement must be appointed
 from a list of five nominees submitted by that caucus within 30 days
 after the vacancy occurs. If the caucus or the insurance commissioner
 fails to submit the list of nominees or if the nominees do not meet
 the qualifications specified in subsection (1) of this section, the
 governor shall appoint a trustee meeting the qualifications specified
 in subsection (1) of this section at the governor's discretion. A
 person appointed to replace a trustee who leaves the board before the
 expiration of their term shall serve only the duration of the
 unexpired term.
     (5) If convinced by a preponderance of the evidence in a due
 process hearing that a trustee has failed to perform required duties
 or has a conflict with the public interest, the governor may remove
 that trustee and appoint another to serve the unexpired term.
     (6) Members of the board are subject to chapter 42.52 RCW.
     (7) The trustees occupy their positions according to the bylaws,
 rules, and relevant governing documents of the board and are exempt
 from chapter 41.06 RCW. The board and its professional staff are
 subject to the public disclosure provisions of chapter 42.17A RCW.
 Trustees shall be paid a salary to be fixed by the governor in
 accordance with RCW 43.03.040. A majority of the board constitutes a
 quorum for the conduct of business.
     NEW SECTION. Sec. 105. ADVISORY COMMITTEES. (1) Subject to the
 approval of the board, the chair shall appoint three standing
 advisory committees:
     (a) A finance committee consisting of financial experts from the
 office of financial management, the office of the state treasurer,
 the employment security department, and the office of the insurance
 commissioner. The finance committee shall recommend specific details
 for major budget decisions and for appropriations, taxes, and other
 funding legislation necessary to conduct the operations of the trust;
     (b) A citizen committee consisting of balanced representation
 from health experts, business, labor, and consumers, specifically
 including   representation   from  populations   where   health   care
 disparities are known to exist as described in section 107 of this
 act. The citizen committee shall hold public hearings on priorities
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 for inclusion in the set of health services to be offered through the
 trust, survey public satisfaction, investigate complaints, and
 identify and report on health care access and other priority issues
 for residents; and
     (c) A provider committee consisting of members with broad
 experience in and knowledge of health care delivery, research, and
 policy, as well as public and private funding of health care
 services. The provider committee shall make recommendations to the
 board on issues related to scope of covered benefits, quality
 improvement, continuity of care, resource utilization, and other
 issues as requested by the board.
     (2) The