HB 1045 — Creating the evergreen basic income pilot program.

(9) The department shall provide funding to tribal entities and community-based organizations that serve and are substantially governed by marginalized populations to pay the costs associated with program outreach, assistance completing applications, and related activitiesp. that directly support the goal of encouraging application and participation by people of color.

(10)4 TheHB department1045 shallactivities contractthat withdirectly asupport third-partythe vendorgoal toof processencouraging andapplication approve applications and provideparticipation allby aspectspeople of operations,color. including:

EligibilityThe determination,department enrollment,shall cashcontract dispersion,with administrationa ofthird-party controlvendor groupto participantprocess compensation, and reimbursementapprove ofapplications. public benefits lost due to participation in the pilot program.

(10) The third-partypilot vendorprogram shall shareoffer administrativeparticipants dataongoing onbenefit pilotcounseling programthat operationsincludes withan theanalysis contractedof evaluatorwhether entityand orhow entitiesany toother supportpublic thebenefits programmay evaluation.be impacted and ensures informed consent.

(11) The pilot program shall offerreimburse participantsany ongoingpilot benefitparticipant counselingfor thatthe includesloss an analysis of whether and how any other public benefits maydue beto impactedparticipation andin ensuresthe informedpilot. consent.

(12) The pilot program shall reimbursedevelop anyeasy, pilotefficient, participantand clearly communicated reenrollment plans for theparticipants lossto ofimmediately otherreenroll publicin any benefits lost due to participation in the pilot.evergreen basic income pilot program.

(13) The pilot program shall develop easy, efficient, and clearly communicated reenrollment plans for participants to immediately reenroll in any benefits lost due to participation in the evergreen basic income pilot program.

(1) A board of directors is established as a collaboration of the state, tribal nations, and community partners p.to administer the evergreen basic income pilot program.

5 SHB 1045 to administer the evergreen basic income pilot program.

(2) The board of directors must consist of at least 1817 members appointed by the secretary of the department of social and health services as follows:

(b)p. At least one representative of a federally recognized tribe from each of the four regions established by the department's office of Indian policy;

5 HB 1045 (b) At least one representative of a federally recognized tribe from each of the four regions established by the department's office of Indian policy;

and (d) OneTen representatives from community-based organizations, with at least one representative from each of athe federallypriority recognizedpopulations tribeidentified whosein reservationsection is3 largely(2)(d) rural;of this act.

and (e) Ten representatives from community-based organizations, with at least one representative from each of the priority populations identified in section 3(2)(d) of this act.

p.NEW SECTION.

6 SHB 1045 NEW SECTION.

(1) To ensure statewide distribution of participants in the pilot program, each of the following regions mustwill be allotted a maximum number of eligible participants:

(f)p. The King and Pierce region comprised of King and Pierce counties and the reservations of the Muckleshoot, Puyallup, and Snoqualmie tribes;

6 HB 1045 (f) The King and Pierce region comprised of King and Pierce counties and the reservations of the Muckleshoot, Puyallup, and Snoqualmie tribes;

and p.(i) The Spokane region comprised of Adams, Ferry, Lincoln, Pend Oreille, Stevens, and Spokane counties, the reservations of the Kalispel and Spokane tribes, and the portion of the Confederated Tribes of the Colville Reservation located within the boundaries of Ferry county.

7 SHB 1045 (i) The Spokane region comprised of Adams, Ferry, Lincoln, Pend Oreille, Stevens, and Spokane counties, the reservations of the Kalispel and Spokane tribes, and the portion of the Confederated Tribes of the Colville Reservation located within the boundaries of Ferry county.

(1) The department mustmay collect data directlyon a voluntary basis from participants in the pilot program and control group.

Data collected may include suchage, topicsrace, as:ethnicity, geographic location, and the life transition or condition the participant is experiencing.

Age, gender, race, ethnicity, geographic location, life transitions or conditions the participant is experiencing, household composition, health, education, caregiving, work participation, income, assets, household spending, power and autonomy, belonging, mobility, and economic success.

ParticipantsThe anddepartment controlmay groupoffer membersincentives mustto haveparticipants accessthat toencourage anycompletion of theirany individualsurveys dataor collected.evaluations.

DirectlyParticipants collectedmust have access to any of their individual data collected, and the entity collecting the data shall beanonymize usedthe fordata programbefore monitoringsharing andit evaluationwith purposesa bythird party unless the departmentparticipant andconsents contractedto evaluatortheir entities.identity being shared.

Directly collected data must be anonymized before sharing with any additional noncontracted entities unless the participant consents to their identity being shared.

(a)p. Include a cost-benefit analysis;

7 HB 1045 (a) Include a cost-benefit analysis;

p.

8 SHB 1045 (3) The department shall contract with a third-party organization to design and implement the program evaluation, with consultation from the department, including the research and data analysis division, and the board of directors established in section 4 of this act.

This contracted evaluator shall be responsible for:

Evaluation design;

directly collecting data from participants and control group members as described in subsection (1) of this section;

analyzing administrative and supplemental data;

performing cost-benefit analyses;

soliciting and incorporating input from community partners;

and preparing the report as described in subsection (2) of this section.

The department shall also subcontract with the department's research and evaluation division for consultation on data and evaluation.

Areas of consultation may include:

Data quality monitoring;

identifying prioritized populations as identified in section 3(2)(d) of this act;

evaluation design;

and use of administrative data for program evaluation.

Both the third-party evaluator and the department's research and data analysis division are considered contracted evaluator entities as referenced in this chapter.

(1) As allowable by federal and state law, state agencies shallwill minimize, to the greatest extent possible, the impact of cash assistance provided under the pilot program on public assistance eligibility and benefit amounts including, but not limited to:

p.(e) Disability benefits, including the aged, blind, or disabled assistance program as provided for in RCW 74.62.030;

9(f) SHBMedical 1045assistance (e)programs, Disability benefits, including themedicaid; aged, blind, or disabled assistance program as provided for in RCW 74.62.030;

(f) Medical assistance programs, including medicaid and eligibility for hospital charity care;

(2) By December 1, 2023,2024, state agencies shall complete any actions required to comply with this section, which may include rule making, coordinating with federal regulatory agencies, and proposing changes to existing state law, and provide a summary of their analysis and actions to the department.

Sec.p.

8 HB 1045 Sec.

(a) All appreciable gains in real or personal property (cash or kind) or other assets, which are received by or become available for use and enjoyment by an applicant or recipient during the month of p.application or after applying for or receiving public assistance.

10 SHB 1045 application or after applying for or receiving public assistance.

Furthermore, any cash assistance a person receives from the evergreen basic income pilot program as provided for in section 3 of this act or any guaranteed basic income program operated by a governmentp. or private entity may not be considered in determining a person's initial or ongoing eligibility for public assistance.

9 HB 1045 government or private entity may not be considered in determining a person's initial or ongoing eligibility for public assistance.

p.(a) A home that an applicant, recipient, or their dependents is living in, including the surrounding property;

11 SHB 1045 (a) A home that an applicant, recipient, or their dependents is living in, including the surrounding property;

(f)p. Applicants for or recipients of benefits under RCW 74.62.030 and 43.185C.220 shall have their eligibility based on resource limitations consistent with the temporary assistance for needy families program rules adopted by the department;

10 HB 1045 (f) Applicants for or recipients of benefits under RCW 74.62.030 and 43.185C.220 shall have their eligibility based on resource limitations consistent with the temporary assistance for needy families program rules adopted by the department;

and p.(D) At the time assistance is authorized, the department files a lien without a sum certain on the specific property.

12 SHB 1045 (D) At the time assistance is authorized, the department files a lien without a sum certain on the specific property.

(ii)p. Filed or are preparing to file an application with the appropriate federal agency for status pursuant to 8 U.S.C.

11 HB 1045 (ii) Filed or are preparing to file an application with the appropriate federal agency for status pursuant to 8 U.S.C.

11011101(a)(15)(T) (a)(15)(T) or (U) as either existed on January 1, 2020, when the crime is against a spouse who is a victim of human trafficking or against the child of a victim of human trafficking.

(17) For purposes of determining eligibility for public assistance and participation levels in the cost of medical care, the department shall exempt restitution payments made to people of Japanese and Aleut ancestry pursuant to the Civil Liberties Act of 1988 and the Aleutian and Pribilof Island Restitution Act passed by p.congress, P.L.

13 SHB 1045 congress, P.L.

For the early childhood education and assistance program, the department may not consider any cash assistance a person receives from the evergreen basic income pilot program as provided for in sectionp. 3 of this act or any guaranteed basic income program operated by a government or private entity in determining family income or a child's eligibility.

12 HB 1045 section 3 of this act or any guaranteed basic income program operated by a government or private entity in determining family income or a child's eligibility.

and p.(b) The household meets all other program eligibility requirements.

14 SHB 1045 (b) The household meets all other program eligibility requirements.

(5)(a)p. Beginning October 1, 2021, through June 30, 2023, the department must calculate a monthly copayment according to the following schedule:

13 HB 1045 (5)(a) Beginning October 1, 2021, through June 30, 2023, the department must calculate a monthly copayment according to the following schedule:

otherwise, a maximum of $15 Above 20 percent and at or below 36 $65cent of the state median income Above 36 percent and at or below 50 $90cent of the state median income Above 50 percent and at or below 60 $165ent of the state median income p.(c) Beginning July 1, 2025, the department must calculate a maximum monthly copayment of $215 for households with incomes above 60 percent and at or below 75 percent of the state median income.

15 SHB 1045 (c) Beginning July 1, 2025, the department must calculate a maximum monthly copayment of $215 for households with incomes above 60 percent and at or below 75 percent of the state median income.

(6)p. The department must adopt rules to implement this section, including an income phase-out eligibility period.

14 HB 1045 (6) The department must adopt rules to implement this section, including an income phase-out eligibility period.

For the sole purpose of meeting the initial distribution of funds date, the department may distribute partial funds upon the department's approval of a preliminary p.expenditure plan.

16 SHB 1045 expenditure plan.

For purposes of this chapter, "substantial risk" means the client has provided documentation that he or she will lose his or her housing withinp. the next thirty days or that the services will be discontinued within the next thirty days.

15 HB 1045 within the next thirty days or that the services will be discontinued within the next thirty days.

p.(5)(a) Essential needs and housing support entities must use funds distributed under this section as flexibly as is practicable to provide essential needs items and housing support to recipients of the essential needs and housing support program, subject to the requirements of this section.

17 SHB 1045 (5)(a) Essential needs and housing support entities must use funds distributed under this section as flexibly as is practicable to provide essential needs items and housing support to recipients of the essential needs and housing support program, subject to the requirements of this section.

(i) Develop a process for reviewing the caseload of designated essential needs and housing support entities, and for redistributingp. grant funds from those entities experiencing reduced actual caseloads to those with increased actual caseloads;

16 HB 1045 redistributing grant funds from those entities experiencing reduced actual caseloads to those with increased actual caseloads;

Savings resulting from program caseload attrition from the essential needs and housing support program shall not result in increased perper-client -client expenditures.

A preliminary report shall be submitted by December 31, 2011, and must include (c)(i), (iii), and p.(v) of this subsection.

18 SHB 1045 (v) of this subsection.

and (v)p. Efforts made to partner with other entities and leverage sources or public and private funds;

17 HB 1045 (v) Efforts made to partner with other entities and leverage sources or public and private funds;

(a) Any cash assistance a person receives from the evergreen basic income pilot program under section 3 of this act or any guaranteed basic income program operated by a government or private entity may not be considered in determining a person's initial or p.ongoing eligibility for the essential needs and housing support program.

19 SHB 1045 ongoing eligibility for the essential needs and housing support program.

RCW 74.04.805 and 2022 c 208 s 1 are each amended to read as follows:

(1) The department is responsible for determining eligibility for referral for essential needs and housing support under RCW 43.185C.220.

Persons eligible are persons who:

(a) Have been determined to be eligible for the pregnant women assistance program under RCW 74.62.030 or are incapacitated from gainful employment by reason of bodily or mental infirmity that will likely continue for a minimum of ninety days.

The standard for incapacity in this subsection, as evidenced by the ninety-day duration standard, is not intended to be as stringent as federal supplemental security income disability standards;

(b) Are citizens or aliens lawfully admitted for permanent residence or otherwise residing in the United States under color of law, or are victims of human trafficking as defined in RCW 74.04.005;

(c)(i) Have furnished the department with their social security number.

If the social security number cannot be furnished because it has not been issued or is not known, an application for a number must be made prior to authorization of benefits, and the social security number must be provided to the department upon receipt;

(ii) This requirement does not apply to victims of human trafficking as defined in RCW 74.04.005 if they have not been issued a social security number;

(d)(i) Have countable income as described in RCW 74.04.005 at or below four hundred twenty-eight dollars for a married couple or at or below three hundred thirty-nine dollars for a single individual;

or (ii) Have income that meets the standard established by the department, who are eligible for the pregnant women assistance program;

(e) Do not have countable resources in excess of those described in RCW 74.04.005;

and (f) Are not eligible for federal aid assistance, other than basic food benefits transferred electronically and medical assistance.

p.

20 SHB 1045 (2) Recipients of aged, blind, or disabled assistance program benefits who meet other eligibility requirements in this section are eligible for a referral for essential needs and housing support services within funds appropriated for the department of commerce.

(3) Recipients of pregnant women assistance program benefits who meet other eligibility requirements in this section are eligible for referral for essential needs and housing support services, within funds appropriated for the department of commerce, for twenty-four consecutive months from the date the department determines pregnant women assistance program eligibility.

(4) Participants in the evergreen basic income pilot program as provided for in section 3 of this act are eligible for a referral for essential needs and housing support regardless of whether or not they meet other eligibility requirements in this section.

The department shall coordinate with the department of commerce to ensure that participants in the evergreen basic income pilot program have access to benefits through the essential needs and housing support program.

(5) The following persons are not eligible for a referral for essential needs and housing support:

(a) Persons who refuse or fail to cooperate in obtaining federal aid assistance, without good cause;

(b) Persons who refuse or fail without good cause to participate in substance use treatment if an assessment by a certified substance use disorder professional indicates a need for such treatment.

Good cause must be found to exist when a person's physical or mental condition, as determined by the department, prevents the person from participating in substance use treatment, when needed outpatient treatment is not available to the person in the county of their residence or when needed inpatient treatment is not available in a location that is reasonably accessible for the person;

and (c) Persons who are fleeing to avoid prosecution of, or to avoid custody or confinement for conviction of, a felony, or an attempt to commit a felony, under the laws of the state of Washington or the place from which the person flees;

or who are violating a condition of probation, community supervision, or parole imposed under federal or state law for a felony or gross misdemeanor conviction.

(((5))) (6) For purposes of determining whether a person is incapacitated from gainful employment under subsection (1) of this section:

p.

21 SHB 1045 (a) The department shall adopt by rule medical criteria for incapacity determinations to ensure that eligibility decisions are consistent with statutory requirements and are based on clear, objective medical information;

and (b) The process implementing the medical criteria must involve consideration of opinions of the treating or consulting physicians or health care professionals regarding incapacity, and any eligibility decision which rejects uncontroverted medical opinion must set forth clear and convincing reasons for doing so.

(((6))) (7) For purposes of reviewing a person's continuing eligibility and in order to remain eligible for the program, persons who have been found to have an incapacity from gainful employment must demonstrate that there has been no material improvement in their medical or mental health condition.

The department may discontinue benefits when there was specific error in the prior determination that found the person eligible by reason of incapacitation.

(((7))) (8) The department must review the cases of all persons who have received benefits under the essential needs and housing support program for twelve consecutive months, and at least annually after the first review, to determine whether they are eligible for the aged, blind, or disabled assistance program.

Sec.

13.

(2)p. "Available funds" means liquid assets and disposable net monthly income calculated after provision is made for bail obligations.

18 HB 1045 (2) "Available funds" means liquid assets and disposable net monthly income calculated after provision is made for bail obligations.

(b) "Income" means salary, wages, interest, dividends, and other earnings which are reportable for federal income tax purposes, and cash payments such as reimbursements received from pensions, p.annuities, social security, and public assistance programs.

22 SHB 1045 annuities, social security, and public assistance programs.

It does not include any cash assistance a person receives from the evergreen basic income pilot program under section 3 of this act or any guaranteed basic income program operated by a government or private entity.

or (d)p. Unable to pay the anticipated cost of counsel for the matter before the court because his or her available funds are insufficient to pay any amount for the retention of counsel.

19 HB 1045 (d) Unable to pay the anticipated cost of counsel for the matter before the court because his or her available funds are insufficient to pay any amount for the retention of counsel.

p.Sec.

2313. SHB 1045 Sec.

14.

(n)p. Pension retirement benefits;

20 HB 1045 (n) Pension retirement benefits;

and p.(u) Income from self-employment, rent, royalties, contracts, proprietorship of a business, or joint ownership of a partnership or closely held corporation.

24 SHB 1045 (u) Income from self-employment, rent, royalties, contracts, proprietorship of a business, or joint ownership of a partnership or closely held corporation.

(e)p. State industrial insurance premiums;

21 HB 1045 (e) State industrial insurance premiums;

(g) Up to five thousand dollars per year in voluntary retirement contributions actually made if the contributions show a pattern of contributions during the one-year period preceding the action establishing the child support order unless there is a determination p.that the contributions were made for the purpose of reducing child support;

25 SHB 1045 that the contributions were made for the purpose of reducing child support;

(iv) Earnings of thirty-two hours per week at minimum wage in the jurisdiction where the parent resides if the parent is on or recently coming off temporary assistance for needy families or recently coming off aged, blind, or disabled assistance benefits, pregnant women assistance benefits, essential needs and housing support, supplemental security income, or disability, has recently been p.

2622 SHBHB 1045 (iv) Earnings of thirty-two hours per week at minimum wage in the jurisdiction where the parent resides if the parent is on or recently coming off temporary assistance for needy families or recently coming off aged, blind, or disabled assistance benefits, pregnant women assistance benefits, essential needs and housing support, supplemental security income, or disability, has recently been released from incarceration, or is a recent high school graduate.

Sec.

15.

RCW 70.170.060 and 2022 c 197 s 2 are each amended to read as follows:

(1) No hospital or its medical staff shall adopt or maintain admission practices or policies which result in:

(a) A significant reduction in the proportion of patients who have no third-party coverage and who are unable to pay for hospital services;

(b) A significant reduction in the proportion of individuals admitted for inpatient hospital services for which payment is, or is likely to be, less than the anticipated charges for or costs of such services;

or (c) The refusal to admit patients who would be expected to require unusually costly or prolonged treatment for reasons other than those related to the appropriateness of the care available at the hospital.

(2) No hospital shall adopt or maintain practices or policies which would deny access to emergency care based on ability to pay.

No hospital which maintains an emergency department shall transfer a patient with an emergency medical condition or who is in active labor p.

27 SHB 1045 unless the transfer is performed at the request of the patient or is due to the limited medical resources of the transferring hospital.

Hospitals must follow reasonable procedures in making transfers to other hospitals including confirmation of acceptance of the transfer by the receiving hospital.

(3) The department shall develop definitions by rule, as appropriate, for subsection (1) of this section and, with reference to federal requirements, subsection (2) of this section.

The department shall monitor hospital compliance with subsections (1) and (2) of this section.

The department shall report individual instances of possible noncompliance to the state attorney general or the appropriate federal agency.

(4) The department shall establish and maintain by rule, consistent with the definition of charity care in RCW 70.170.020, the following:

(a) Uniform procedures, data requirements, and criteria for identifying patients receiving charity care;

and (b) A definition of residual bad debt including reasonable and uniform standards for collection procedures to be used in efforts to collect the unpaid portions of hospital charges that are the patient's responsibility.

(5) For the purpose of providing charity care, each hospital shall develop, implement, and maintain a policy which shall enable indigent persons access to charity care.

The policy shall include procedures for identifying patients who may be eligible for health care coverage through medical assistance programs under chapter 74.09 RCW or the Washington health benefit exchange and actively assisting patients to apply for any available coverage.

If a hospital determines that a patient or their guarantor is qualified for retroactive health care coverage through the medical assistance programs under chapter 74.09 RCW, a hospital shall assist the patient or guarantor with applying for such coverage.

If a hospital determines that a patient or their guarantor qualifies for retroactive health care coverage through the medical assistance programs under chapter 74.09 RCW, a hospital is not obligated to provide charity care under this section to any patient or their guarantor if the patient or their guarantor fails to make reasonable efforts to cooperate with the hospital's efforts to assist them in applying for such coverage.

Hospitals may not impose application procedures for charity care or for assistance with retroactive p.

28 SHB 1045 coverage applications which place an unreasonable burden upon the patient or guarantor, taking into account any physical, mental, intellectual, or sensory deficiencies, or language barriers which may hinder the responsible party's capability of complying with application procedures.

It is an unreasonable burden to require a patient to apply for any state or federal program where the patient is obviously or categorically ineligible or has been deemed ineligible in the prior 12 months.

(a) At a minimum, a hospital owned or operated by a health system that owns or operates three or more acute hospitals licensed under chapter 70.41 RCW, an acute care hospital with over 300 licensed beds located in the most populous county in Washington, or an acute care hospital with over 200 licensed beds located in a county with at least 450,000 residents and located on Washington's southern border shall grant charity care per the following guidelines:

(i) All patients and their guarantors whose income is not more than 300 percent of the federal poverty level, adjusted for family size, shall be deemed charity care patients for the full amount of the patient responsibility portion of their hospital charges;

(ii) All patients and their guarantors whose income is between 301 and 350 percent of the federal poverty level, adjusted for family size, shall be entitled to a 75 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection;

(iii) All patients and their guarantors whose income is between 351 and 400 percent of the federal poverty level, adjusted for family size, shall be entitled to a 50 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection.

(b) At a minimum, a hospital not subject to (a) of this subsection shall grant charity care per the following guidelines:

(i) All patients and their guarantors whose income is not more than 200 percent of the federal poverty level, adjusted for family size, shall be deemed charity care patients for the full amount of the patient responsibility portion of their hospital charges;

(ii) All patients and their guarantors whose income is between 201 and 250 percent of the federal poverty level, adjusted for family size, shall be entitled to a 75 percent discount for the full amount p.

29 SHB 1045 of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection;

and (iii) All patients and their guarantors whose income is between 251 and 300 percent of the federal poverty level, adjusted for family size, shall be entitled to a 50 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection.

(c)(i) If a hospital considers the existence, availability, and value of assets in order to reduce the discount extended, it must establish and make publicly available a policy on asset considerations and corresponding discount reductions.

(ii) If a hospital considers assets, the following types of assets shall be excluded from consideration:

(A) The first $5,000 of monetary assets for an individual or $8,000 of monetary assets for a family of two, and $1,500 of monetary assets for each additional family member.

The value of any asset that has a penalty for early withdrawal shall be the value of the asset after the penalty has been paid;

(B) Any equity in a primary residence;

(C) Retirement plans other than 401(k) plans;

(D) One motor vehicle and a second motor vehicle if it is necessary for employment or medical purposes;

(E) Any prepaid burial contract or burial plot;

and (F) Any life insurance policy with a face value of $10,000 or less.

(iii) In considering assets, a hospital may not impose procedures which place an unreasonable burden on the responsible party.

Information requests from the hospital to the responsible party for the verification of assets shall be limited to that which is reasonably necessary and readily available to substantiate the responsible party's qualification for charity sponsorship and may not be used to discourage application for such sponsorship.

Only those facts relevant to eligibility may be verified and duplicate forms of verification may not be demanded.

(A) In considering monetary assets, one current account statement shall be considered sufficient for a hospital to verify a patient's assets.

p.

30 SHB 1045 (B) In the event that no documentation for an asset is available, a hospital shall rely upon a written and signed statement from the responsible party.

(iv) Asset information obtained by the hospital in evaluating a patient for charity care eligibility shall not be used for collection activities.

(v) Nothing in this section prevents a hospital from considering assets as required by the centers for medicare and medicaid services related to medicare cost reporting.

(6) Hospitals may not consider money received under the evergreen basic income pilot program under section 3 of this act as income and may not consider a patient's eligibility to receive money under the evergreen basic income pilot program as an asset when determining a patient's eligibility for charity care.

(7) Each hospital shall post and prominently display notice of charity care availability.

Notice must be posted in all languages spoken by more than ten percent of the population of the hospital service area.

Notice must be displayed in at least the following locations:

(a) Areas where patients are admitted or registered;

(b) Emergency departments, if any;

and (c) Financial service or billing areas where accessible to patients.

(((7))) (8) Current versions of the hospital's charity care policy, a plain language summary of the hospital's charity care policy, and the hospital's charity care application form must be available on the hospital's website.

The summary and application form must be available in all languages spoken by more than ten percent of the population of the hospital service area.

(((8))) (9)(a) All hospital billing statements and other written communications concerning billing or collection of a hospital bill by a hospital must include the following or a substantially similar statement prominently displayed on the first page of the statement in both English and the second most spoken language in the hospital's service area:

You may qualify for free care or a discount on your hospital bill, whether or not you have insurance.

Please contact our financial assistance office at [website] and [phone number].

p.

31 SHB 1045 (b) Nothing in (a) of this subsection requires any hospital to alter any preprinted hospital billing statements existing as of October 1, 2018.

(((9))) (10) Hospital obligations under federal and state laws to provide meaningful access for limited English proficiency and non- English-speaking patients apply to information regarding billing and charity care.

Hospitals shall develop standardized training programs on the hospital's charity care policy and use of interpreter services, and provide regular training for appropriate staff, including the relevant and appropriate staff who perform functions relating to registration, admissions, or billing.

(((10))) (11) Each hospital shall make every reasonable effort to determine:

(a) The existence or nonexistence of private or public sponsorship which might cover in full or part the charges for care rendered by the hospital to a patient;

(b) The annual family income of the patient as classified under federal poverty income guidelines as of the time the health care services were provided, or at the time of application for charity care if the application is made within two years of the time of service, the patient has been making good faith efforts towards payment of health care services rendered, and the patient demonstrates eligibility for charity care;

and (c) The eligibility of the patient for charity care as defined in this chapter and in accordance with hospital policy.

An initial determination of sponsorship status shall precede collection efforts directed at the patient.

(((11))) (12) At the hospital's discretion, a hospital may consider applications for charity care at any time, including any time there is a change in a patient's financial circumstances.

(((12))) (13) The department shall monitor the distribution of charity care among hospitals, with reference to factors such as relative need for charity care in hospital service areas and trends in private and public health coverage.

The department shall prepare reports that identify any problems in distribution which are in contradiction of the intent of this chapter.

The report shall include an assessment of the effects of the provisions of this chapter on access to hospital and health care services, as well as an evaluation of the contribution of all purchasers of care to hospital charity care.

p.

32 SHB 1045 (((13))) (14) The department shall issue a report on the subjects addressed in this section at least annually, with the first report due on July 1, 1990.

16.14.

NEWp. SECTION.

23 HB 1045 NEW SECTION.

17.15.

Sections 2 through 7 and 1614 of this act constitute a new chapter in Title 74 RCW.

3324 SHBHB 1045