2012 Revised Code of Washington
Title 43 - STATE GOVERNMENT — EXECUTIVE
43.71 Washington health benefit exchange.
43.71.040 Authority, joint select committee on health reform, and board -- Collaboration -- Report -- Responsibilities and duties.

RCW 43.71.040 Authority, joint select committee on health reform, and board — Collaboration — Report — Responsibilities and duties.

(1) In collaboration with the joint select committee on health reform implementation, the authority shall:

     (a) Apply for and implement grants under the affordable care act. Whenever possible, grant applications shall allow for the possibility of partially funding the activities of the joint select committee on health reform implementation;

     (b) Develop and submit to the federal department of health and human services:

     (i) A complete budget for the development and operation of an exchange through 2014;

     (ii) An initial plan discussing the means to achieve financial sustainability of the exchange by 2015;

     (iii) A plan outlining steps to prevent fraud, waste, and abuse; and

     (iv) A plan describing how capacity for providing assistance to individuals and small businesses in the state will be created, continued, or expanded, including provision for a call center.

     (2) Consistent with the work plan developed in subsection (3) of this section, but in no case later than January 1, 2012, the authority, in collaboration with the joint select committee on health reform implementation and the board, shall develop a broad range of options for operating the exchange and report the options to the governor and the legislature on an ongoing basis. The report must include analysis and recommendations on the following:

     (a) The operations and administration of the exchange, including:

     (i) The goals and principles of the exchange;

     (ii) The creation and implementation of a single state-administered exchange for all geographic areas in the state that operates as the exchange for both the individual and small employer markets by January 1, 2014;

     (iii) Whether and under what circumstances the state should consider establishment of, or participation in, a regionally administered multistate exchange;

     (iv) Whether the role of an exchange includes serving as an aggregator of funds that comprise the premium for a health plan offered through the exchange;

     (v) The administrative, fiduciary, accounting, contracting, and other services to be provided by the exchange;

     (vi) Coordination of the exchange with other state programs;

     (vii) Development of sustainable funding for administration of the exchange as of January 1, 2015; and

     (viii) Recognizing the need for expedience in determining the structure of needed information technology, the necessary information technology to support implementation of exchange activities;

     (b) Whether to adopt and implement a federal basic health plan option as authorized in the affordable care act, whether the federal basic health plan option should be administered by the entity that administers the exchange or by a state agency, and whether the federal basic health plan option should merge risk pools for rating with any portion of the state's medicaid program;

     (c) Individual and small group market impacts, including whether to:

     (i) Merge the risk pools for rating the individual and small group markets in the exchange and the private health insurance markets; and

     (ii) Increase the small group market to firms with up to one hundred employees;

     (d) Creation of uniform requirements, standards, and criteria for the creation of qualified health plans offered through the exchange, including promoting participation by carriers and enrollees in the exchange to a level sufficient to provide sustainable funding for the exchange;

     (e) Certifying, selecting, and facilitating the offer of individual and small group plans through an exchange, to include designation of qualified health plans and the levels of coverage for the plans;

     (f) The role and services provided by producers and navigators, including the option to use private insurance market brokers as navigators;

     (g) Effective implementation of risk management methods, including: Reinsurance, risk corridors, risk adjustment, to include the entity designated to operate reinsurance and risk adjustment, and the continuing role of the Washington state health insurance pool;

     (h) Participation in innovative efforts to contain costs in Washington's markets for public and private health care coverage;

     (i) Providing federal refundable premium tax credits and reduced cost-sharing subsidies through the exchange, including the processes and entity responsible for determining eligibility to participate in the exchange and the cost-sharing subsidies provided through the exchange;

     (j) The staff, resources, and revenues necessary to operate and administer an exchange for the first two years of operation;

     (k) The extent and circumstances under which benefits for spiritual care services that are deductible under section 213(d) of the internal revenue code as of January 1, 2010, will be made available under the exchange; and

     (l) Any other areas identified by the joint select committee on health reform implementation.

     (3) In collaboration with the joint select committee on health reform implementation, the authority shall develop a work plan for the development of options under subsection (2) of this section in discrete, prioritized stages.

     (4) The authority and the board shall consult with the commissioner, the joint select committee on health reform implementation, and stakeholders relevant to carrying out the activities required under this section, including: (a) Educated health care consumers who are enrolled in commercial health insurance coverage and publicly subsidized health care programs; (b) individuals and entities with experience in facilitating enrollment in health insurance coverage, including health carriers, producers, and navigators; (c) representatives of small businesses, employees of small businesses, and self-employed individuals; (d) advocates for enrolling hard to reach populations and populations enrolled in publicly subsidized health care programs; (e) facilities and providers of health care; (f) representatives of publicly subsidized health care programs; and (g) members in good standing of the American academy of actuaries.

     (5) Beginning March 15, 2012, the exchange shall be responsible for the duties of the authority under this section. Prior to March 15, 2012, the board may make independent recommendations regarding the options developed under subsection (2) of this section to the governor and the legislature.

[2011 c 317 § 5.]