ࡱ>  `bjbj I~X5 8!,ML8(;8=8=8=8=8=8=8P:<J=8=84R8 $7 ;8 O02  2d 2:7h808E2l<=<=H22<=2| d=8=8 |8<= :   WASHINGTON ASSOCIATION OF HEALTH UNDERWRITERS LEGISLATIVE UPDATE Final Report May 22, 2009 2009 Legislature AdjournsGovernor Takes Action on Bills Passed The 105-day 2009 regular legislative session adjourned at midnight on Sunday, April 26. Although legislators approved a two-year budget for the coming 2009-2011 biennium, they were unable to finish a handful of priorities before the end of the regular session. In the days immediately following the close of the 2009 session, it appeared that Governor Gregoire intended to convene a special session to complete work on a limited group of issues. Legislative leaders, however, were unable to agree on issues to be considered during a possible special session. As a consequence, Governor Gregoire announced that she would not call a special session. With more than 2500 bills introduced since early January, 582 were approved by the legislature. May 19 was the last day for Governor Gregoire to take action on bills. Unless otherwise specified, measures passed by the Legislature become effective 90 days after the close of the session. Thus, most measures approved during the 2009 legislative session will become effective on July 26, 2009. Key Measures Passed During the 2009 Legislative Session 2SSB 5346Health Care Administrative Simplification -Governor Signed in Full -Effective July 26, 2009 The Insurance Commissioner must designate a lead organization to identify and convene work groups to define key processes, guidelines, and standards by December 31, 2010. The lead organization must develop a uniform electronic process for collecting and transmitting provider data to support credentialing, admitting privileges, and other related processes that will serve as the source of credentialing information. The lead organization must establish a uniform standard companion document and data set for electronic eligibility and coverage verification. The lead organization must develop implementation guidelines for the use of code edits, including use of the National Correct Coding Initiative code edit policy, publication of any variations in codes, and use of the Health Insurance Portability and Accountability Act standard group codes, reason codes, and remark codes. The lead organization must develop guidelines by December 31, 2010, to ensure payors do not automatically deny claims for services when extenuating circumstances interfere with a provider obtaining preauthorization before services are performed, or delayed provider notification to the payor of a patient's admission. The Department of Social and Health Services, the Health Care Authority, and the Department of Labor and Industries, to the extent possible under their laws in Title 51, must adopt the processes and guidelines recommended by the lead organization within funds appropriated for the purpose. 2SSB 5945Health Care Reform Study -Governor Partial Veto -Effective July 26, 2009 DSHS must apply for a federal waiver to expand medical assistance with a single eligibility standard for low-income persons, phased-in with incremental steps for low-income parents and individuals with income up to 200 percent of the federal poverty level. The waiver should explore creative and innovative approaches and program features; the ability to impose enrollment limits or benefit design changes; opportunities to maximize enrollment in employer-sponsored health insurance when it is cost-effective for the state; and opportunities to share savings that might accrue to the federal Medicare program for those individuals that are dually eligible for Medicare and Medicaid. DSHS and HCA must identify statutory changes that may be necessary to ensure successful and timely implementation of the waiver and an Apple Health Program for adults. Governor Gregoire vetoed provisions creating a new advisory group to study health care reform options. ESHB 1401Individual Market Standard Health Questionnaire Not Required for COBRA-Eligible Individuals -Governor Signed in Full -Effective July 26, 2009 Individuals who are eligible to purchase the Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation coverage or who drop COBRA continuation coverage are not required to take the standard health questionnaire when they apply for individual health insurance coverage. Individuals who do not qualify for COBRA coverage because their employer employs fewer than 20 employees do not have to complete the Standard Health Questionnaire if they apply for an individual health care policy within 90 days of a federally defined qualifying event. SHB 1308Organ Transplant Waiting Periods -Governor Signed in Full -Effective July 26, 2009 For any new or renewed health benefit plan, a health carrier must reduce any organ transplant benefit waiting period by the amount of time a covered person had prior creditable coverage. Consequently, if a person has less than a 90-day break in health coverage, the amount of time he or she has spent waiting for a transplant under the former health plan must carry over to the new health plan. This requirement applies to any plan issued or renewed on or after January 1, 2010. SSB 5725Organ Transplant Lifetime Benefits -Governor Signed in Full -Effective July 26, 2009 All health benefit plans issued or renewed on or after January 1, 2010, that provide coverage for organ transplants must not include a separate lifetime limit on transplants that is any less than $350,000. The lifetime limit on transplants applies from one day prior to the date of the transplant or the date of hospital admission through 100 days after the transplant. The major medical lifetime limit applies to health care services provided before and after this time period. Donor-related services may apply to the lifetime limit on transplants any time. It is clarified that organ transplants include tissue transplants. SSB 6019Small Group Plans Authorized to Allow Wellness Discounts -Governor Signed in Full -Effective July 26, 2009 Health insurance carriers may allow a wellness discount of up to 20 percent for small employers that develop and implement a wellness program that directly improves employee wellness. Employers must document program activities and may request a reduction in premiums based on three years of experience. Carriers may review the employer's claim history to determine whether the wellness program has improved employee health, except carriers may not use claims for maternity or prevention services to deny the employer's request. SHB 2160Health Carriers Authorized to Establish Wellness Programs -Governor Signed in Full -Effective July 26, 2009 Notwithstanding a prohibition against offering rebates or inducements to purchase insurance, health carriers are specifically permitted to offer a wellness program that complies with the requirements of the Health Insurance Portability and Accountability Act. SSB 5891Medical Home Pilot Project -Governor Signed in Full -Effective July 26, 2009 Public payors, private health carriers, third party purchasers, and providers are encouraged to collaborate and identify appropriate reimbursement methods to align incentives to support primary care medical homes. The discussions and the determination of reimbursement methods are facilitated by state agencies and as such are exempt from antitrust laws through the state action doctrine. HCA and DSHS must design, oversee implementation, and evaluate one or more primary care medical home reimbursement pilot projects. DSHS and HCA may select an additional pilot site with a direct patient-provider primary care practice and reimburse with a fixed monthly payment per person for preventive care, wellness counseling, primary care, coordination of primary care, and urgent care services. The agencies may determine whether the pilot should include a high deductible health plan or other health benefit plan that wraps around the primary care services. SSB 5480Discount Health Plans Regulated -Governor Signed in Full -Effective July 26, 2009 A new chapter is added to Title 48 RCW requiring discount plans to obtain a license from OIC to do business in Washington. Discount plan means a business arrangement or contract in which a person or organization provides discounts on charges by providers for health care services in exchange for fees or dues. Newly defined discount plans do not include discount plans offered by regulated insurance carriers, a Medicare prescription drug plan, or a patient access program sponsored by a pharmaceutical manufacturer that provides free or discounted products to the low-income or uninsured. OIC may suspend or revoke a license if the organization falls out of compliance, does not have the minimum net worth required, has misrepresented its services or engaged in deceptive, misleading, or unfair advertising, or the continued operation would be hazardous to its members. OIC may conduct investigations to ensure discount organizations are in compliance. The products may not be described as insurance nor use terms commonly associated with insurance, such as "health plan," "coverage," "copay," etc. SSB 5436Retainer Practice Arrangements -Governor Partial Veto -Effective July 26, 2009 Direct practices furnishing primary care are allowed to pay for charges associated with routine lab and imaging services. The restriction that these services be limited to wellness examinations is removed. The restrictions on accepting payments for services from insurers is lifted in part, and direct practices are allowed to accept payments from self-insured plans. A direct practice may accept a direct fee paid by a third-party, including an employer; however, the agreement with the employer must be limited to the timing and method of payment. Governor Gregoire vetoed portions of the bill that would have required retainer practice programs to pay assessments to the Washington State Health Insurance Pool and submit their marketing materials to the OIC for approval. SHB 2052Delaying the Implementation of the Health Insurance Partnership -Governor Signed in Full -Effective July 26, 2009 The operation of the Partnership is delayed from March 1, 2009, to January 1, 2011, unless sufficient state or federal funds are provided to begin operation earlier. EHB 1566Emergency Powers Granted to the OIC -Governor Signed in Full -Effective July 26, 2009 When the Governor proclaims a state of emergency, the Commissioner may issue an order that addresses any or all of the following matters related to insurance policies: reporting requirements for claims; grace periods for payment of insurance premiums and performance of other duties by insureds; temporary postponement of cancellations and renewals; and medical coverage to ensure access to care. An order by the Commissioner is effective for up to 60 days. The Commissioner may extend the order if, in the Commissioner's judgment, the circumstances warrant an extension. An order of the Commissioner is not effective after the related state of emergency is terminated by proclamation of the Governor. SHB 1565Business Continuity Plans Required for Domestic Carriers -Governor Signed in Full -Effective January 1, 2011 The Commissioner is granted the authority to adopt rules regarding business continuity standards after considering relevant standards adopted by the National Association of Insurance Commissioners, other states, and other regulatory authorities that regulate financial institutions. The existing provisions of law that apply to business continuity for a domestic insurer in a national emergency are extended to: local and state emergencies; significant business disruptions; and issuers (a group that encompasses domestic insurers, domestic fraternal benefit societies, domestic certified health plans, domestic health maintenance organizations, and domestic health care service contractors). ESSB 5892Prescription Drug Use in State Health Programs -Governor Signed in Full -Effective Immediately The preferred drug substitution provisions of the evidence-based prescription drug program are amended in order to increase generic utilization, maximize appropriate drug usage, and reduce pharmaceutical expenditures. The state purchasing program may impose limited restrictions on an endorsing practitioners authority to write a prescription dispense as written in cases where there is evidence the prescribers frequency of using dispense as written varies significantly from other prescribers. When a less expensive generic product, in a drug class previously reviewed by the P&T Committee, becomes available, the state program may immediately designate the generic drug as a preferred drug if it is equally effective. Key Measures that Failed to Pass During the 2009 Legislative Session SB 5052Coverage Plans for Young Adults This measure would have allowed insurance carriers to design and offer a separate individual health plan targeted at young adults between the ages of 19 and 34. Carriers would have been provided the opportunity to design a benefit package that could exclude some requirements, including: maternity services, prescription drug benefits with at least a $2,000 benefit, every category of provider, direct access to chiropractic services, prostate cancer screening, colorectal cancer exams, and mental health parity in benefits. The bill was considered at hearing in the Senate Health & Long Term Care Committee, but was not brought to a vote. HB 2121Guaranteed Health Benefit Plan Insurance Commissioner Mike Kreidler requested the introduction of his Guaranteed Health Benefit Plan to provide catastrophic coverage for all health care costs over $10,000 a year and key preventive care for every Washington resident up to the age of 65. Commissioner Kreidler proposed funding the Guaranteed Health Benefit Plan through a shared payroll tax between employers and employees. While he still believes this is the most viable funding mechanism, he has indicated that he remains open to other options. The bill was not considered during the 2009 session. SB 5947Apple Health Reform Proposal Apple Health would have been created as a not-for-profit corporation to facilitate the availability and enrollment in private health insurance plans. All insurance carriers certified by the Office of the Insurance Commissioner (OIC) would have been eligible to participate in Apple Health. All regulated small group and individual insurance products offered as of January 1, 2009, would have been grandfathered in and not subject to additional certification by the OIC. Employer groups would have been allowed to sponsor employee coverage through Apple Health and determine their contribution amounts. Participating employers would have been required to establish a Section 125 account for pretax contributions, and would have been allowed to offer supplemental benefits. All employers and self-employed individuals would have been required to file a statement of coverage form annually with the OIC, indicating the coverage status for each employee and their dependents, with the name of the insurance carrier. Individuals with no coverage would have been required to indicate that they take full responsibility for all health care-related expenses, have forfeited their rights to their employer coverage, and have turned down enrollment in Apple Health or any publicly-sponsored insurance or premium subsidy programs. The bill was considered by the Senate Health & Long Term Care Committee, but did not move forward. HB 1712Association Group Plans For regulatory and rating requirements, this bill would have required association health plans to be considered large group plans in which the entire association or the member governed group constitutes the group. The bill was considered by the House Health Care & Wellness Committee, but was not brought to a vote. SHB 1714Association Group Plans The substitute bill would have directed the Insurance Commissioner to gather information on association health plans from health carriers on an annual basis. The bill was approved by the House Health Care & Wellness Committee, but was not brought to a vote on the House Floor. HB 1905Prescription Drug Any Willing Provider Insurers that contract with pharmacies would have been required to offer arrangements that provide comparable terms and conditions to all pharmacies that are willing to meet those terms and conditions. Insurers would have been prohibited from imposing upon a beneficiary a copay, deductible, coinsurance, or prescription quantity limit that is not imposed upon all beneficiaries in the plan. The bill was not considered at hearing. HB 2117Basic Health Plan Economic Recovery Enrollees A new category of the Basic Health enrollee called an "economic recovery enrollee" would have been established as a nonsubsidized program. To qualify, the enrollee would have been required to become involuntarily unemployed on or after September 1, 2008, and be receiving unemployment compensation benefits. The bill was passed by the House, but failed to be considered in the Senate Ways and Means Committee. SB 5203/HB 1210Mandated Benefits for Autism Insurance carriers and health plans offered through the Public Employees Benefits Board program would have been required to cover the diagnosis and treatment of autism spectrum disorders for individuals less than 21 years of age. Treatment is defined to include any care prescribed, ordered, or provided by a licensed physician or licensed psychologist, including applied behavior analysis and other structured behavior programs, pharmacy care, psychiatric care, psychological care, therapeutic care, and any care determined to be medically necessary in rules developed by DOH. The coverage would have allowed no limits on the number of provider visits, but would have been subject to a maximum of $50,000 per year. The Senate bill was considered at hearing, but not brought to a vote. The House bill was not considered. SHB 1412Mandated Benefits for Neurodevelopmental Therapies The existing neurodevelopmental therapy health insurance mandate that applies to the Public Employees Benefit Board and group health plans would have been expanded to cover children up to age 18. The mandate would have covered ABA treatment and other treatments of developmental disabilities or delays. Carriers would have been authorized to set reasonable medical necessity criteria, apply the same deductibles, coinsurance and copayments that apply to other covered services, and ensure the treatment plan complements other neurodevelopmental services a child receives through publicly funded programs. The bill was approved by the House Health Care & Wellness Committee, but was not brought to a vote in the House Ways and Means Committee. SB 5814Mandated Benefits for Elemental Formulas All insurance policies renewed or issued after December 31, 2009, that provide coverage for hospital or medical expenses would have been required to provide coverage for amino acid-based elemental formulas when such specialized formulas are medically necessary, regardless of the delivery method. All insurance carriers would have been impacted, as well as the Public Employees Benefits Board self-insured plans, self-funded multiple employer welfare arrangements, and the medical assistance program. The bill was considered at hearing, but was not brought to a vote. SB 5140/HB 1519Mandated Benefits for Language Interpreters Beginning January 1, 2011, regulated insurance carriers would have been required to provide interpretation services or reimburse providers for interpretation services offered to enrollees with limited English proficiency. The Basic Health plan would have also been required to provide interpretation services when funding is appropriated for implementation. The interpretation services would have been required to be provided to enrollees with no additional premium charges, copayments, deductible, or other cost sharing. The Senate bill was considered at hearing, but was not brought to a vote. The House bill was not considered. SB 5512Mandated Benefits for Oral Chemotherapy Beginning January 1, 2010, all health plans that include coverage for cancer chemotherapy treatment would have been required to cover orally-administered anticancer medications not less favorably than intravenously-administered or injected cancer medications, including copayments. The requirements would have extended to individual plans, group plans, Basic Health plans, and Public Employees Benefits Board plans. The bill was considered at hearing, but was not brought to a vote. SSB 6052Coverage for Surgical Treatment of Morbid Obesity All health insurance plans issued or renewed after December 31, 2009, would have been allowed to follow the evidence-based standard of care and coverage practices for treatment of morbid obesity for enrollees over the age of eighteen. Insurance carriers would have been allowed to develop a policy that allows a conditional waiver of contractual benefit exclusions for nonexperimental, medically necessary, surgical treatment when the condition has persisted for at least five years and nonsurgical treatment that has been supervised by a physician has been unsuccessful for at least six consecutive months. The bill was approved by the Senate, but was not considered in the House Health Care & Wellness Committee. HB 1396Vision Care Benefits Each health carrier would have been required to provide enrollees with direct access to a participating medical eye care provider of the enrollee's choice without the necessity of prior referral. A medical eye provider would have been defined to include all providers licensed to provide services within the scope of optometry practice, whether provided by an optometrist, a physician, or an osteopathic physician. The bill was considered at hearing, but was not brought to a vote. HB 2377Sales Tax Increase for Health Care This bill would have increased the sales and use taxes by 0.3 percent from January 1, 2010, through December 31, 2012. It would have established and made appropriations from the Health Care Trust Account to fund the Basic Health Plan, public health services, health care, mental health care, hospitals, and long-term care nursing homes. It would have referred the sales and use tax provisions to voters. The bill was approved by the House Health & Human Services Appropriations Committee, but was not brought to a vote on the House Floor.     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