After three special sessions, the Washington State Legislature has concluded its work. Below you will find a table of bills (literally and figuratively) adopted by the Legislature with a focus on legislation affecting health plans and health carriers. Enjoy contemplating the new policies and standards because you won’t have long to savor them before implementing rules appear.
2015 Washington State Final Legislative Report for Health Plans (07/13/2015)
| Bill # | Summary | Law | Links |
| SHB 1002 | Dental coverage expansion and regulatory reporting. Prohibits a health carrier that offers a dental only plan from denying coverage for treatment of emergency dental conditions, that would otherwise be considered a covered service of an existing benefit contract, on the basis that the services were provided on the same day the covered person was examined and diagnosed for the emergency dental condition. Requires dental plan reports on experience and loss ratios. | Chapter 009 Laws of 2015 (C009 L15) | Law: Session Laws/House/1002-S.SL.pdf Bill Report: Bill Reports/House/1002-S HBR FBR 15.pdf |
| ESHB 1471 | Prior authorization and provider discounts for non-covered services. A health carrier may not require prior authorization for an evaluation and management visit or an initial treatment visit with a contracting provider in a new episode of chiropractic, physical therapy, occupational therapy, East Asian medicine, massage therapy, or speech and hearing therapies. A health carrier may not require a provider to provide a discount from his or her usual and customary rates for non-covered services. | C 251 L 15Effective 1/1/2017 | Law: Session Laws/House/1471-S2.SL.pdf Bill Report: Bill Reports/House/1471-S2.E HBR FBR 15.pdf |
| HB 1652 | Medicaid Non-‐participating providers. Current law permits the payment of a Medicaid nonparticipating provider no more than the lowest amount paid for that service for participating providers. The 2016 expiration of this provision is extended to 2021. | C 256 L 15 | Law: Session Laws/House/1652.SL.pdf Bill Report: Bill Reports/House/1652 HBR FBR 15.pdf |
| SHB 1721 | Ambulance transport to non-hospital facilities. The Health Care Authority must develop a reimbursement methodology for ambulance services in cases when they transport Medicaid clients to a mental health facility or chemical dependency treatment program in accordance with regional alternative facility procedures. | C 157 L 15 | Law: Session Laws/House/1721-S.SL.pdf Bill Report: Bill Reports/House/1721-S HBR FBR 15.pdf |
| EHB 1890 | Third party payments for health insurance. Health carriers are not required to accept third party payments for premiums; but must accept payment from “second-parties” such as banks issuing payment from an enrollee account. This is intended to prevent hospitals from paying premiums so the hospital can get paid. | C 284 L 15 | Law: Session Laws/House/1890.SL.pdf Bill Report: Bill Reports/House/1890.E HBR FBR 15.pdf |
| HB 2007 | Medicaid coverage of public emergency transportation. The Health Care Authority (HCA) must provide supplemental payments for publicly provided Medicaid ground emergency medical transportation (GEMT) services to the extent allowed by law. The supplemental payments, combined with other sources of reimbursement from the HCA, may not exceed the actual costs of providing the services. | C 147 L 15 | Law: Session Laws/House/2007.SL.pdf Bill Report: Bill Reports/House/2007 HBR FBR 15.pdf |
| SB 5011 | Correcting the Washington Uniform Health Care Information Act. The Act is corrected to allow third-party payors to release health care information only to the extent health care providers are authorized to do so or as permitted under the All Payer Claims Database | C 289 L 15 | Law: Session Laws/Senate/5011.SL.pdf Bill Report: Bill Reports/Senate/5011 SBR FBR 15.pdf |
| SB 5023 | Health Plan Rate and form filing. Creates regulatory uniformity in the filing requirements for group health benefit plans other than small group plans, as well as stand-‐alone dental plan and stand-‐alone vision plan rates and forms. | C 19 L 15 | Law: Session Laws/Senate/5023-S.SL.pdf Bill Report: Bill Reports/Senate/5023-S SBR FBR 15.pdf |
| ESSB 5084 | All Payer Claims Database amendments. Extensive stakeholder discussions were held over the 2014 interim to identify modifications for submission of claims data, protection of proprietary financial data, and additional parameters for the release of data and reports. | C 246 L 15 | Law: Session Laws/Senate/5084-S.SL.pdf Bill Report: Bill Reports/Senate/5084-S.E SBR FBR 15.pdf |
| SSB 5147 | Medicaid Enrollee Baseline Health Assessment. Managed care contracts must require an initial health screen be conducted for new enrollees, consistent with the terms and conditions of the contract to implement the health screen required by the 2013-15 legislative budget. | C 209 L 15 | Law: Session Laws/Senate/5147-S.SL.pdf Bill Report: Bill Reports/Senate/5147-S SBR FBR 15.pdf |
| SSB 5165 | Palliative care mandate expansion. A person who is not homebound is eligible for optional home health care and hospice coverage if he or she is seeking the services in conjunction with treatment or management of serious or life-threatening illness. | C 22 L 15 | Law: Session Laws/Senate/5165-S.SL.pdf Bill Report: Bill Reports/Senate/5165-S SBR FBR 15.pdf |
| SSB 5175 | Telemedicine insurance coverage. Health insurance carriers, including health plans offered to state employees and Medicaid managed care plan enrollees, must reimburse a provider for a health care service delivered through telemedicine or store and forward technology if the plan provides coverage of the health care service when provided in person; the health care service is medically necessary; and the health care service is a service recognized as an essential health benefit under the ACA. | C 23 L 15 | Law: Session Laws/Senate/5175-S.SL.pdf Bill Report: Bill Reports/Senate/5175-S SBR FBR 15.pdf |
| SSB 5317 | Medicaid coverage for autism and developmental delays. The Health Care Authority must require universal screening and provider payment for autism and developmental delays as recommended by the Bright Futures guidelines of the American Academy of Pediatrics subject to the availability of funds. | C 8 L 15Effective: 01/01/2016 | Law: Session Laws/Senate/5317-S.SL.pdf Bill Report: Bill Reports/Senate/5317-S SBR FBR 15 E2.pdf |
| ESSB 5441 | Health plan enrollee medication coordination. Health insurance plans, including the self-insured Uniform Medical Plan, that provide coverage for prescription drugs must implement a medication synchronization policy for the dispensing of prescription drugs for the 2016 plan year. | C 213 L 15 | Law: Session Laws/Senate/5441-S.SL.pdf Bill Report: Bill Reports/Senate/5441-S.E SBR FBR 15.pdf |
| ESB 5471 | Clarifying insurer electronic notice and communication. Authorizes a notice or other document in an insurance transaction or evidence of insurance coverage to be delivered, stored, and presented electronically meeting requirements of the state electronic authentication act. | C 263 L 15 | Law: Session Laws/Senate/5471.SL.pdf Bill Report: Bill Reports/Senate/5471.E SBR FBR 15.pdf |
| ESSB 5557 | “Every Category of Provider” statute amended to include explicitly pharmacist services. Health plans issued or renewed on or after January 1, 2016, may not deny benefits for health care services provided by licensed pharmacists. The health plan must include an adequate number of pharmacists in its network of participating medical providers. Health carriers are required to reimburse every category of provider for services or care included in the essential health benefits benchmark plan. The Insurance Commissioner must designate a “lead organization” (private sector organization) to create an advisory committee to report on implementation of pharmacist coverage no later than December 1, 2015. | C 237 L 15 | Law: Session Laws/Senate/5557-S.SL.pdf Bill Report: Bill Reports/Senate/5557-S.E SBR FBR 15.pdf |
| SB 5717 | Adoption of the NAIC Model Holding Company Act. The model act: (1) allows new disclosure regarding enterprise risk and supervisory colleges; (2) updates the provisions for acquisitions, divestitures, and examinations; (3) updates intercompany agreement requirements between insurers and their affiliates; and (4) updates confidentiality provisions of holding company filings and information. | C 122 L 15 Effective – 01/01/2016Section 14 (confidentiality provisions) Effective – 07/01/2017 | Law: Session Laws/Senate/5717.SL.pdfBill Report: Senate/5717 SBR FBR 15.pdf |
| SB 5743 | Insurance Producers limits on illegal inducements. Gift cards and gift certificates are added to the items that may be given to insureds or prospective insureds under limited circumstances. The limit on the value of the prizes, goods, wares, gift cards, gift certificates, or merchandise is increased to $100. The provision allowing these items up to $100 in value as insurance rebates and inducements is not applicable to title insurers or title agents. | C 272 L 15 | Law: Session Laws/Senate/5743-S.SL.pdf Bill Report: Senate/5743-S.E SBR FBR 15.pdf |
| ESB 5935 | Biological Products. Until August 1, 2020, the pharmacist must notify the prescriber if an interchangeable biological product is being substituted for the drug prescribed. | C 242 L 15 | Law: Session Laws/Senate/5935.SL.pdf Bill Report: Bill Reports/Senate/5935.E SBR FBR 15.pdf |
| SB 5974 | Insurance Commissioner Study of Supplemental Insurance Products. The Office of the Insurance Commissioner must review current barriers to attracting supplemental plans into the state and report on steps the state and the Department of Veterans Affairs can take to promote access to the supplemental policies. The review of the barriers and recommendations must be submitted to the appropriate committees of the Legislature, the Governor, and the Department of Veterans Affairs by November 11, 2015. | C 127 L 15 | Law: Session Laws/Senate/5974.SL.pdf Bill Report: Bill Reports/Senate/5974 SBR FBR 15.pdf |
| ESB 6089 | Washington Health Benefit Exchange Amendments. New reporting requirements are imposed on the Exchange including a five-year spending plan due January 1, 2016. A strategic plan must be submitted by September 30, 2015. The Exchange must verify qualifying documentation for enrollees seeking special enrollment due to a qualifying event as established by the Insurance Commissioner. The Exchange must terminate “premium aggregation” functionality and implement required policies concerning premium payments. | C 33 L 15 E 3 | Law: Senate Passed Legislature/6089.PL.pdf Bill Report: Bill Reports/Senate/6089.E2 SBR FBR 15 E3.pdf |
