HB 2516 — Updating health benefit exchange statutes.

H-4101.1SUBSTITUTEH-3477.2HOUSE HOUSE BILL 2516State of Washington65th Legislature2018 Regular SessionBy House Health Care & Wellness (originally sponsored by Representatives Cody, Harris, Jinkins, Robinson, Tharinger, Caldier, and Macri)READMacriRead FIRSTfirst TIMEtime 02/02/18.AN01/10/18. ACT Relating to modernizing the health benefit exchange statutes by aligning statutes with current practice and making clarifying changes to the health benefit exchange enabling statute;

Referred to Committee on Health Care & Wellness.AN ACT Relating to modernizing the health benefit exchange statutes by aligning statutes with current practice and making clarifying changes to the health benefit exchange enabling statute;

c 33 s 1 are each amended to read as follows:(1) The exchange has the authority to:(a) Provide an application and enrollment portal for individual and small group health and dental insurance and state and federal health care programs;(b) Certify qualified health and dental plans to be offered for enrollment through the exchange;(c) Provide consumer education and assistance regarding cost and coverage of certified plans, plan selection, eligibility for subsidies, and health insurance literacy, which must include, but not be limited to, a web site, toll-free call center, and consumer assistance by navigators and insurance producers;(d) Determine eligibility for premium tax credits, cost-sharing reductions, other available subsidies, and enrollment in state and federal health care programsprograms; consistent with applicable federal law;

and (g) ((complete)) perform other duties necessary ((to begin open)) for enrollment in ((qualified health plans)) health coverage through the exchange ((beginning October 1, 2013)).(((2))) (3) The board shall develop and implement a methodology to ensure the exchange is self-sustaining ((after December 31, 2014)).2014.

((TheThe board shall submit its recommendations to the legislature by December 1, 2012.

If the legislature does not enact legislation during the 2013 regular session to modify or reject the board's recommendations, the board may proceed with implementation of the recommendations.(3)))recommendations.(3))).(4) (4) The board shall establish policies that permit city and county governments, Indian tribes, tribal organizations, urban Indian organizations, private foundations, and other entities to pay premiums and cost sharing on behalf of qualified individuals.(((4))) (5) The employees of the exchange may participate in the public employees' retirement system under chapter 41.40 RCW and the public employees' benefits board under chapter 41.05 RCW.(((5))) (6) Qualified employers may access coverage for their employees through the exchange for small groups under ((section 1311 of P.L.

The exchange shall enable any qualified employer to specify a level of coverage so that any of its employees may enroll in any qualified health plan offered through the small group exchange at the specified level of coverage.coverage.(((6))) (7) The exchange shall report its activities and status to the governor and the legislature as requested, and no less often than annually.(((7))) (8) By January ((1, 2016)) 1st of each year, the exchange must submit to the legislature, the governor's office, and the board ((a five-year spending plan)) an annual financial report that identifies ((potential reductions in exchange per member per month spending below the per member per month levels based on a calculation from the 2015-2017 biennium appropriation)) the annual cost of operating the exchange.

The exchange may offer information to consumers and small businesses about qualified small employer health reimbursement arrangements.(((6))) (7) The exchange shall report its activities and status to the governor and the legislature as requested, and no less often than annually.(((7))) (8) By January ((1, 2016)) 1st of each year, the exchange must submit to the legislature, the governor's office, and the board ((a five-year spending plan)) an annual financial report that identifies ((potential reductions in exchange per member per month spending below the per member per month levels based on a calculation from the 2015-2017 biennium appropriation)) the annual cost of operating the exchange.

((TheThe exchange must provide annual updates on the reduction identified in the spending plan))plan. The report must include:(a) A report of all expenses;(b) Beginning and ending fund balances, by fund source;(c) Any contracts or contract amendments signed by the exchange;(d) An accounting of staff required to operate the exchange broken out by full-time equivalent positions, contracted employees, temporary staff, and any other relevant designation that indicates the staffing level of the exchange;

The report must include:(a) A report of all expenses;(b) Beginning and ending fund balances, by fund source;(c) Any contracts or contract amendments signed by the exchange;(d) An accounting of staff required to operate the exchange broken out by full-time equivalent positions, contracted employees, temporary staff, and any other relevant designation that indicates the staffing level of the exchange;

111-148 (2010), as amended)) applicable federal and state law.(b) "Stand-alone pediatric dental plan" means coverage only for pediatric oral services that qualify as coverage for the minimum essential coverage requirement under ((P.L.P.L.

111-148 (2010), as amended))amended.(5) applicable federal and state law.(5) The exchange shall deposit proceeds from the assessments in the health benefit exchange account under RCW 43.71.060.(6) The assessment described in this section shall be considered a special purpose obligation or assessment in connection with coverage described in this section for the purpose of funding the operations of the exchange, and may not be applied by issuers to vary premium rates at the plan level.(7) This section does not prohibit an enrollee of a qualified health plan in the exchange from purchasing a plan that offers dental benefits outside the exchange.(8) This section does not prohibit an issuer from offering a plan that covers dental benefits that do not meet the requirements of a stand-alone family dental plan outside the exchange.(9) The exchange shall monitor enrollment and provide periodic reports which must be available on its web site.(10) The board shall offer all qualified health plans through the exchange, and the exchange shall not add criteria for certification of qualified health plans beyond those set out in RCW 43.71.065 without specific statutory direction.