SB 5344 — Establishing the essential worker health care program.

S-1362.2S-0563.1 SUBSTITUTE SENATE BILL 5344 State of Washington 69th Legislature 2025 Regular Session By Senate Health & Long-Term Care (originally sponsored by Senators Riccelli, Harris, Lovick, Cleveland, Lovelett, Liias, Saldaña, Frame, Hasegawa, Nobles, Trudeau, Valdez, and C.

Wilson)Wilson READRead FIRSTfirst TIMEtime 02/12/25.01/17/25.

Referred to Committee on Health & Long- Term Care.

1 SSBSB 5344 (d) Access to high quality and affordable health care would help address staff turnover, stabilize the workforce, and improve the quality of nursing home care.

(1) SubjectBy toJuly the1, availability2026, of amounts appropriated for this specific purpose, the essential worker health care program shall be established within the department to help provide nursing home workers with high quality, affordable health coverage through participating nursing home employers.

SubjectThe todepartment theshall availabilitydistribute offunding amountsthrough appropriateda forsupplemental thispayment specificto purpose,participating referencingnursing thishome actemployers byand billseek orany chapternecessary number,approvals infrom the omnibuscenters appropriationsfor act,medicare theand departmentmedicaid shall:services to provide this supplemental payment as provided in section 6 of this act.

(a)The Distributesupplemental fundingpayment throughmust abe supplementaldistributed paymentannually in proportion to each participating nursing home employers;employer's medicaid bed days in the previous calendar year.

(b)(2) DistributeTo participate in the supplementalessential paymentworker annuallyhealth incare proportionprogram, toemployers eachmust participatingoperate at least one nursing home employer'slicensed medicaidunder bedchapter days18.51 RCW in Washington that participates in medicaid and enter into a memorandum of understanding with the previousdepartment calendarcommitting year;to:

and (c) Seek any necessary approvals from the centers for medicare and medicaid services to provide this supplemental payment as provided in section 6 of this act.

(2) To offer employee health care benefits through a qualified health fund in the essential worker health care program, employers must operate at least one nursing home licensed under chapter 18.51 RCW in Washington that participates in medicaid and enter into a memorandum of understanding with the department committing to:

p.(b) Allocate substantially all of the funds distributed through this program to the qualified health fund;

2 SSB 5344 (b) Allocate substantially all of the funds distributed through this program to the qualified health fund;

(d) Maintain spending on employee health care benefits in the first year of its participation in the program at least equal to the averagep. of its spending in the two years prior to its entry into the program and maintain spending in subsequent years at least equal to this level plus the consumer price index for health insurance maintained by the United States bureau of labor statistics.

2 SB 5344 average of its spending in the two years prior to its entry into the program and maintain spending in subsequent years at least equal to this level plus the consumer price index for health insurance maintained by the United States bureau of labor statistics.

(4) The department may take any enforcement action authorized under this chapter or terminate any participating employer that fails to comply with the requirements established in the memorandum of understanding, sections 2 and 3 of this act, and any related rules adopted by the department.

(5) The department may adopt rules to administer and implement this act.

3 SSBSB 5344 (4)NEW TheSECTION. department may take any enforcement action authorized under this chapter or terminate any participating employer that fails to comply with the requirements established in the memorandum of understanding, sections 2 and 3 of this act, and any related rules adopted by the department.

(5) Subject to the availability of amounts appropriated for this specific purpose, the department may adopt rules to administer and implement this act.

NEW SECTION.

(1) SubjectThe to the availability of amounts appropriated for this specific purpose, the office of the insurance commissioner shall annually certify a proposed health care benefit arrangement as a qualified health fund if it meets the requirements of this section.

(b)(i) Operates or provides health coverage through a fully insured multiplemultiemployer employer welfare arrangement,arrangement as described in RCW 48.125.020, or an association health plan;

p.(d) Offers a benefit package that is either equivalent to an affordable care act platinum plan in actuarial value, covered benefits and cost sharing, or, if the plan is offered by a Taft- Hartley trust, a plan approved by the board of the trust;

4 SSB 5344 (d) Offers a benefit package that is either equivalent to an affordable care act platinum plan in actuarial value, covered benefits and cost sharing, or, if the plan is offered by a Taft- Hartley trust, a plan approved by the board of the trust;

(g)p. Except for Taft-Hartley plans, demonstrates for the initial year of operation and annually that it has a robust enrollment process in place to ensure that covered employees fully understand their benefits;

4 SB 5344 (g) Except for Taft-Hartley plans, demonstrates for the initial year of operation and annually that it has a robust enrollment process in place to ensure that covered employees fully understand their benefits;

(2) SubjectThe to the availability of amounts appropriated for this specific purpose, the commissioner may adopt rules to administer and implement this act.

(3) For the purposes of this section, "employees in the long-term care industry" includes but is not limited to any individual that qualifies as a long-term care worker as defined in RCW 74.39A.009 and any individual who is employed by a nursing home as licensed under chapter 18.51 RCW.

(4) For the purposes of this section, "association health plan" means a bona fide group or association of employers to whom a health plan is issued that constitutes an employer under section 3(5) of the employee retirement income security act of 1974, 29 U.S.C.

Sec.

1002(5), and United States department of labor guidance related to association health plans.

(1) The commissioner may take any enforcement action authorized under RCW 48.02.080 or revoke certification for a qualified health fund that fails to meet the requirements of sectionsections 2 and 3 of this act or any related rules adopted by the office of the insurance commissioner.

p.(2) If the office of the insurance commissioner takes any enforcement action, revokes a certification, or terminates or is considering terminating a qualified health fund, the office of the insurance commissioner shall notify the department of social and health services.

5 SSB 5344 (2) If the office of the insurance commissioner takes any enforcement action, revokes a certification, or terminates or is considering terminating a qualified health fund, the office of the insurance commissioner shall notify the department of social and health services.

(4)p. The recoupment process must include:

5 SB 5344 (4) The recoupment process must include:

(1) The implementation of the essential worker health care program established in section 2 of this act is contingent upon the approval of a state plan amendment or waiver by the centers for medicare and medicaid services providing federal financial participation for supplemental payments under this program.

(2) The department shall submit the necessary state plan amendment or waiver application to the centers for medicare and medicaid services by July 1, 2025, and provide a report to the legislature on the status of approval by no later than December 1, 2025.

(3) If the centers for medicare and medicaid services does not provide approval by July 1, 2026, the department and the office of the insurance commissioner shall:

(a) Delay implementation of the program until approval is received;

(b) Provide an updated implementation timeline to the legislature;