SB 6241 — Concerning the January 1, 2020, implementation of the school employees' benefits board program.

S-4651.1SUBSTITUTEZ-0818.1SENATE SENATE BILL 6241State of Washington65th Legislature2018 Regular SessionBy Senate Ways & Means (originally sponsored by Senators Hobbs, Fain, Mullet, and Keiser;

by request of Health Care Authority)READAuthorityRead FIRSTfirst TIMEtime 02/01/18.AN01/10/18. ACT Relating to the January 1, 2020, implementation of the school employees' benefits board program;

amendingReferred RCWto 41.05.740,Committee 41.05.006,on 41.05.009,Ways 41.05.011,& 41.05.021,Means.AN 41.05.022,ACT 41.05.023,Relating 41.05.026,to 41.05.050,the 41.05.055,January 41.05.065,1, 41.05.066,2020, 41.05.075,implementation 41.05.080,of 41.05.085,the 41.05.140,school 41.05.225,employees' 41.05.300,benefits 41.05.320,board 41.04.205,program; 28A.400.350, 41.05.120, 41.05.123, 41.05.143, 43.79A.040, 28A.400.280, and 41.05.700;

reenacting and amending RCW 28A.400.27541.05.740, 41.05.006, 41.05.009, 41.05.011, 41.05.021, 41.05.022, 41.05.023, 41.05.026, 41.05.050, 41.05.055, 41.05.065, 41.05.066, 41.05.075, 41.05.080, 41.05.085, 41.05.140, 41.05.225, 41.05.300, 41.05.320, 41.04.205, 28A.400.350, 41.05.120, 41.05.123, 41.05.143, and 42.56.400;43.79A.040;

addingreenacting newand sectionsamending toRCW chapter28A.400.275; 41.05 RCW;

adding a new section to chapter 41.05 RCW;

and declaring an emergency.BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:Sec. 1.  RCWWASHINGTON:PART ISCHOOL EMPLOYEES' BENEFITS BOARD PROGRAMSec. 1.  RCW 41.05.740 and 2017 3rd sp.s.

sess., including establishment of criteria for employing districts and individual employees;))employees;(f))) Establish termspenalties andto conditionsbe forimposed when ((the employing district)) a school employees' benefits board organization tofails have the ability to locallycomply negotiatewith eligibilityestablished criteriaparticipation forcriteria; a school employee who is anticipated to work less than six hundred thirty hours in a school year.

Aand(((g))) school(f) employees'Participate benefitswith boardthe organizationauthority thatin electsthe topreparation useof aspecifications lowerand thresholdselection of hourscarriers contracted for benefits eligibility must use benefits authorized by the school employees'employee benefitsbenefit boardplan andcoverage shall do so as an enrichment to the state's definition of basiceligible education;(f) Establish penalties to be imposed when ((the employing district)) a school employees'employees benefitsin boardaccordance organizationwith failsthe tocriteria complyset withforth establishedin participationrules. criteria;

and(g) Participate with the authority in the preparation of specifications and selection of carriers contracted for school employee benefit plan coverage of eligible school employees in accordance with the criteria set forth in rules.

Individual school employees eligible for benefits under subsection (6)(d) of this section may be permitted to waive coverage under terms and conditions established by the school employees' benefits board.(8) By November 30, 2021, the authority shall review the benefit plans provided through the school employees' benefits board, complete an analysis of the benefits provided and the administration of the benefits plans, and determine whether provisions in chapter 13, Laws of 2017 3rd sp.

These contributions must be provided to the authority for all eligible school employeesemployees, eligible for benefits under RCW 41.05.740(6)(d), including school employees who have waived their coverage;coverage.(e) For the purposes of this subsection((:(i) "District" means school district and educational service district;

contributions to the authority are not required for individuals eligible for benefits under RCW 41.05.740(6)(e) who waive their coverage.(e) For the purposes of this subsection((:(i) "District" means school district and educational service district;

The term of the contract or agreement may not exceed one year, except that the final contract or agreement entered into for the 2018-19 school year mustmay exceed one year only by the months necessary to ensure employee benefits are maintained through December 31, 2019.(2) ((Through December 31, 2019, school districts and their benefit providers shall annually submit, by a date determined by the office of the insurance commissioner, the following information and data for the prior calendar year to the office of the insurance commissioner:(a) Progress by the district and its benefit providers toward greater affordability for full family coverage, health care cost savings, and significantly reduced administrative costs;(b) Compliance with the requirement to provide a high deductible health plan option with a health savings account;(c) An overall plan summary including the following:(i) The financial plan structure and overall performance of each health plan including:(A) Total premium expenses;(B) Total claims expenses;(C) Claims reserves;

and(b) Report all data relating to employees eligible to participate in benefits or plans administered by the school employees' benefits board and the health care authority in a format designed and communicated by the school employees' benefits board and the health care authority.Sec. 25.  RCWauthority.PART IISCHOOL EMPLOYEES' BENEFITS BOARD FISCAL ACCOUNT CREATIONSSec. 25.  RCW 41.05.120 and 2017 3rd sp.s.

The advanced right-of-way revolving fund, the advanced environmental mitigation revolving account, the federal narcotics asset forfeitures account, the high occupancy vehicle account, the local rail service assistance account, and the miscellaneous transportation programs account.(d) Any state agency that has independent authority over accounts or funds not statutorily required to be held in the custody of the state treasurer that deposits funds into a fund or account in the custody of the state treasurer pursuant to an agreement with the office of the state treasurer shall receive its proportionate share of earnings based upon each account's or fund's average daily balance for the period.(5) In conformance with Article II, section 37 of the state Constitution, no trust accounts or funds shall be allocated earnings without the specific affirmative directive of this section.NEW SECTION.  Sec. 29.  ASECTION.  Sec. 29.  Sections new14, section22, isand added23 toof chapterthis 41.05act RCWare tonecessary readfor asthe follows:(1)immediate Thepreservation monthlyof insurance benefit allocated to school districts in the biennialpublic omnibuspeace, operatinghealth, budgetor mustsafety, beor fundedsupport atof a level no less than the funding provided to state agenciesgovernment forand stateits employeeexisting benefits.(2)public Theinstitutions, stateand fundedtake staffingeffect assumptionsimmediately.--- forEND K-12--- benefit allocations to districts in the biennial omnibus operating budget must be adjusted to ensure that a full monthly benefit is allocated for the proportion of staff, by staffing category, that are anticipated to work six hundred thirty hours or more.Sec. 30.  RCW 28A.400.280 and 2017 3rd sp.s.

c 13 s 815 are each amended to read as follows:(1) Except as provided in subsection (2) of this section, school districts may provide employer fringe benefit contributions after October 1, 1990, only for basic benefits.

However, school districts may continue payments under contracts with employees or benefit providers in effect on April 13, 1990, until the contract expires.(2) School districts may provide employer contributions after October 1, 1990, ((and until December 31, 2019,)) for optional benefit plans, in addition to basic benefits.

School district optional benefits cannot be insurance products that compete with any offerings by the school employees' benefits board.

School district optional benefits must be authorized by the school employees' benefits board and be outside the school employees' benefits board's offering authority in RCW 41.05.740(6).

Optional benefits may include direct agreements as defined in chapter 48.150 RCW, and may include employee beneficiary accounts that can be liquidated by the employee on termination of employment.

Optional benefit plans may be offered only if:(a) Each full-time employee, regardless of the number of dependents receiving basic coverage, receives the same additional employer contribution for other coverage or optional benefits;

and(b) For part-time employees, participation in optional benefit plans shall be governed by the same eligibility criteria and/or proration of employer contributions used for allocations for basic benefits.(3) School districts are not intended to divert state basic benefit allocations for other purposes((, and)).

Beginning January 1, 2020, ((no basic or optional benefits may be provided by employer contributions if they are not provided)) school districts must offer all benefits offered by the school employees' benefits board administered by the health care authority, and consistent with RCW 41.56.500(2).(4) Beginning January 1, 2020, a school employees' benefits board organization may offer additional insurance products to school employees that are authorized by the school employees' benefits board and outside the school employees' benefits board's authority in RCW 41.05.740(6).

Any such benefits offered by a school employees' benefits board organization are considered an enhancement to the state's definition of basic education.Sec. 31.  RCW 41.05.700 and 2017 c 219 s 2 are each amended to read as follows:(1) A health plan offered to employees, school employees, and their covered dependents under this chapter issued or renewed on or after January 1, 2017, shall reimburse a provider for a health care service provided to a covered person through telemedicine or store and forward technology if:(a) The plan provides coverage of the health care service when provided in person by the provider;(b) The health care service is medically necessary;(c) The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act in effect on January 1, 2015;

and(d) The health care service is determined to be safely and effectively provided through telemedicine or store and forward technology according to generally accepted health care practices and standards, and the technology used to provide the health care service meets the standards required by state and federal laws governing the privacy and security of protected health information.(2)(a) If the service is provided through store and forward technology there must be an associated office visit between the covered person and the referring health care provider.

Nothing in this section prohibits the use of telemedicine for the associated office visit.(b) For purposes of this section, reimbursement of store and forward technology is available only for those covered services specified in the negotiated agreement between the health plan and health care provider.(3) An originating site for a telemedicine health care service subject to subsection (1) of this section includes a:(a) Hospital;(b) Rural health clinic;(c) Federally qualified health center;(d) Physician's or other health care provider's office;(e) Community mental health center;(f) Skilled nursing facility;(g) Home or any location determined by the individual receiving the service;

or(h) Renal dialysis center, except an independent renal dialysis center.(4) Except for subsection (3)(g) of this section, any originating site under subsection (3) of this section may charge a facility fee for infrastructure and preparation of the patient.

Reimbursement must be subject to a negotiated agreement between the originating site and the health plan.

A distant site or any other site not identified in subsection (3) of this section may not charge a facility fee.(5) The plan may not distinguish between originating sites that are rural and urban in providing the coverage required in subsection (1) of this section.(6) The plan may subject coverage of a telemedicine or store and forward technology health service under subsection (1) of this section to all terms and conditions of the plan including, but not limited to, utilization review, prior authorization, deductible, copayment, or coinsurance requirements that are applicable to coverage of a comparable health care service provided in person.(7) This section does not require the plan to reimburse:(a) An originating site for professional fees;(b) A provider for a health care service that is not a covered benefit under the plan;

or(c) An originating site or health care provider when the site or provider is not a contracted provider under the plan.(8) For purposes of this section:(a) "Distant site" means the site at which a physician or other licensed provider, delivering a professional service, is physically located at the time the service is provided through telemedicine;(b) "Health care service" has the same meaning as in RCW 48.43.005;(c) "Hospital" means a facility licensed under chapter 70.41, 71.12, or 72.23 RCW;(d) "Originating site" means the physical location of a patient receiving health care services through telemedicine;(e) "Provider" has the same meaning as in RCW 48.43.005;(f) "Store and forward technology" means use of an asynchronous transmission of a covered person's medical information from an originating site to the health care provider at a distant site which results in medical diagnosis and management of the covered person, and does not include the use of audio-only telephone, facsimile, or email;

and(g) "Telemedicine" means the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.

For purposes of this section only, "telemedicine" does not include the use of audio-only telephone, facsimile, or email.NEW SECTION.  Sec. 32.  A new section is added to chapter 41.05 RCW to read as follows:(1) All health care and financial related data as required by section 4, chapter 3, Laws of 2012 2nd sp.

sess.

that was sent by school districts and their benefits providers to the office of the insurance commissioner for plan years ending in 2012 through 2016 for the purposes of studying health benefits provided to school employees must be provided to the authority by March 15, 2018.(2) All claims data, including health care and financial related data received by the authority under subsection (1) of this section, is the property of the state and is exempt from disclosure and not subject to chapter 42.56 RCW.Sec. 33.  RCW 42.56.400 and 2017 3rd sp.s.

c 30 s 2 and 2017 c 193 s 2 are each reenacted and amended to read as follows:The following information relating to insurance and financial institutions is exempt from disclosure under this chapter:(1) Records maintained by the board of industrial insurance appeals that are related to appeals of crime victims' compensation claims filed with the board under RCW 7.68.110;(2) Information obtained and exempted or withheld from public inspection by the health care authority under RCW 41.05.026, whether retained by the authority, transferred to another state purchased health care program by the authority, or transferred by the authority to a technical review committee created to facilitate the development, acquisition, or implementation of state purchased health care under chapter 41.05 RCW;(3) The names and individual identification data of either all owners or all insureds, or both, received by the insurance commissioner under chapter 48.102 RCW;(4) Information provided under RCW 48.30A.045 through 48.30A.060;(5) Information provided under RCW 48.05.510 through 48.05.535, 48.43.200 through 48.43.225, 48.44.530 through 48.44.555, and 48.46.600 through 48.46.625;(6) Examination reports and information obtained by the department of financial institutions from banks under RCW 30A.04.075, from savings banks under RCW 32.04.220, from savings and loan associations under RCW 33.04.110, from credit unions under RCW 31.12.565, from check cashers and sellers under RCW 31.45.030(3), and from securities brokers and investment advisers under RCW 21.20.100, all of which is confidential and privileged information;(7) Information provided to the insurance commissioner under RCW 48.110.040(3);(8) Documents, materials, or information obtained by the insurance commissioner under RCW 48.02.065, all of which are confidential and privileged;(9) Documents, materials, or information obtained by the insurance commissioner under RCW 48.31B.015(2) (l) and (m), 48.31B.025, 48.31B.030, and 48.31B.035, all of which are confidential and privileged;(10) Data filed under RCW 48.140.020, 48.140.030, 48.140.050, and 7.70.140 that, alone or in combination with any other data, may reveal the identity of a claimant, health care provider, health care facility, insuring entity, or self-insurer involved in a particular claim or a collection of claims.

For the purposes of this subsection:(a) "Claimant" has the same meaning as in RCW 48.140.010(2).(b) "Health care facility" has the same meaning as in RCW 48.140.010(6).(c) "Health care provider" has the same meaning as in RCW 48.140.010(7).(d) "Insuring entity" has the same meaning as in RCW 48.140.010(8).(e) "Self-insurer" has the same meaning as in RCW 48.140.010(11);(11) Documents, materials, or information obtained by the insurance commissioner under RCW 48.135.060;(12) Documents, materials, or information obtained by the insurance commissioner under RCW 48.37.060;(13) Confidential and privileged documents obtained or produced by the insurance commissioner and identified in RCW 48.37.080;(14) Documents, materials, or information obtained by the insurance commissioner under RCW 48.37.140;(15) Documents, materials, or information obtained by the insurance commissioner under RCW 48.17.595;(16) Documents, materials, or information obtained by the insurance commissioner under RCW 48.102.051(1) and 48.102.140 (3) and (7)(a)(ii);(17) Documents, materials, or information obtained by the insurance commissioner in the commissioner's capacity as receiver under RCW 48.31.025 and 48.99.017, which are records under the jurisdiction and control of the receivership court.

The commissioner is not required to search for, log, produce, or otherwise comply with the public records act for any records that the commissioner obtains under chapters 48.31 and 48.99 RCW in the commissioner's capacity as a receiver, except as directed by the receivership court;(18) Documents, materials, or information obtained by the insurance commissioner under RCW 48.13.151;(19) Data, information, and documents provided by a carrier pursuant to section 1, chapter 172, Laws of 2010;(20) Information in a filing of usage-based insurance about the usage-based component of the rate pursuant to RCW 48.19.040(5)(b);(21) Data, information, and documents, other than those described in RCW 48.02.210(2), that are submitted to the office of the insurance commissioner by an entity providing health care coverage pursuant to RCW 28A.400.275 and 48.02.210;(22) Data, information, and documents obtained by the insurance commissioner under RCW 48.29.017;(23) Information not subject to public inspection or public disclosure under RCW 48.43.730(5);(24) Documents, materials, or information obtained by the insurance commissioner under chapter 48.05A RCW;(25) Documents, materials, or information obtained by the insurance commissioner under RCW 48.74.025, 48.74.028, 48.74.100(6), 48.74.110(2) (b) and (c), and 48.74.120 to the extent such documents, materials, or information independently qualify for exemption from disclosure as documents, materials, or information in possession of the commissioner pursuant to a financial conduct examination and exempt from disclosure under RCW 48.02.065;

((and))(26) Nonpublic personal health information obtained by, disclosed to, or in the custody of the insurance commissioner, as provided in RCW 48.02.068;

((and))(27) Data, information, and documents obtained by the insurance commissioner under RCW 48.02.230;