reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.430 - Plan of health care coverage—Immediate postpartum contraception devices.

RCW 41.05.430
Plan of health care coverage—Immediate postpartum contraception devices.
(1) For births taking place in a licensed hospital or birthing center, a health plan offered to employees and their covered dependents must allow a provider to separately bill for devices, implants, professional services, or a combination thereof, associated with immediate postpartum contraception and may not consider such devices, implants, services, or combinations thereof to be part of any payments for general obstetric procedures.
(2) For purposes of this section, "immediate postpartum contraception" means the postpartum insertion of intrauterine devices or contraceptive implants performed before the patient is discharged from the hospital or birthing center and includes the devices or implants themselves.
(3) This section does not apply to facility services associated with immediate postpartum contraception.
(4) Nothing in this section affects an enrollee's right to directly access women's health care services, including contraceptive services.
(5) This section applies to health plans issued or renewed on or after January 1, 2023.
[ 2022 c 122 § 2.]
NOTES:
Findings—Intent—2022 c 122: "The legislature finds that healthy birth spacing helps reduce adverse health outcomes for both parents and babies. The legislature further finds that increasing immediate postpartum access to contraception, before a patient is discharged from the hospital or birthing center, is critical to maternal and newborn health and that immediate postpartum contraception is associated with longer contraceptive coverage, fewer unintended pregnancies, and cost savings for payers and health care systems. To help achieve these outcomes, it is the intent of the legislature to increase access to immediate postpartum contraception by requiring commercial health insurers to pay for immediate postpartum contraception separately from the maternity bundle in a manner that mirrors the payment process for immediate postpartum contraception used by the state's medicaid program." [ 2022 c 122 § 1.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.520 - Pharmacy connection program—Notice.

RCW 41.05.520
Pharmacy connection program—Notice.
(1) The director shall establish and advertise a pharmacy connection program through which health care providers and members of the public can obtain information about manufacturer-sponsored prescription drug assistance programs. The director shall ensure that the program has staff available who can assist persons in procuring free or discounted medications from manufacturer-sponsored prescription drug assistance programs by:
(a) Determining whether an assistance program is offered for the needed drug or drugs;
(b) Evaluating the likelihood of a person obtaining drugs from an assistance program under the guidelines formulated;
(c) Assisting persons with the application and enrollment in an assistance program;
(d) Coordinating and assisting physicians and others authorized to prescribe medications with communications, including applications, made on behalf of a person to a participating manufacturer to obtain approval of the person in an assistance program; and
(e) Working with participating manufacturers to simplify the system whereby eligible persons access drug assistance programs, including development of a single application form and uniform enrollment process.
(2) Notice regarding the pharmacy connection program shall initially target senior citizens, but the program shall be available to anyone, and shall include a toll-free telephone number, available during regular business hours, that may be used to obtain information.
(3) The director may apply for and accept grants or gifts and may enter into interagency agreements or contracts with other state agencies or private organizations to assist with the implementation of this program including, but not limited to, contracts, gifts, or grants from pharmaceutical manufacturers to assist with the direct costs of the program.
(4) The director shall notify pharmaceutical companies doing business in Washington of the pharmacy connection program. Any pharmaceutical company that does business in this state and that offers a pharmaceutical assistance program shall notify the director of the existence of the program, the drugs covered by the program, and all information necessary to apply for assistance under the program.
(5) For purposes of this section, "manufacturer-sponsored prescription drug assistance program" means a program offered by a pharmaceutical company through which the company provides a drug or drugs to eligible persons at no charge or at a reduced cost. The term does not include the provision of a drug as part of a clinical trial.
[ 2023 c 51 § 20; 2003 1st sp.s. c 29 § 7.]
NOTES:
Finding—Intent—Severability—Conflict with federal requirements—Effective date—2003 1st sp.s. c 29: See notes following RCW 74.09.650.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.525 - Treatment of opioid use disorder—Prior authorization.

RCW 41.05.525
Treatment of opioid use disorder—Prior authorization.
A health plan offered to employees, school employees, and their covered dependents under this chapter issued or renewed on or after January 1, 2020, shall provide coverage without prior authorization of at least one federal food and drug administration approved product for the treatment of opioid use disorder in the drug classes opioid agonists, opioid antagonists, and opioid partial agonists.
[ 2019 c 314 § 36.]
NOTES:
Declaration—2019 c 314: See note following RCW 18.22.810.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.527 - Opioid overdose reversal medication bulk purchasing and distribution program.

RCW 41.05.527
Opioid overdose reversal medication bulk purchasing and distribution program.
A health plan offered to public employees and their covered dependents under this chapter that is issued or renewed on or after January 1, 2023, must participate in the bulk purchasing and distribution program for opioid overdose reversal medication established in RCW 70.14.170 once the program is operational.
[ 2021 c 273 § 10.]
NOTES:
Rules—2021 c 273 §§ 7-12: See note following RCW 70.14.170.
Findings—Intent—2021 c 273: See note following RCW 70.41.480.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.528 - Standard set of criteria—Medical necessity for substance use disorder treatment—Substance use disorder levels of care—Rules.

RCW 41.05.528
Standard set of criteria—Medical necessity for substance use disorder treatment—Substance use disorder levels of care—Rules.
For the purposes of promoting standardized training for behavioral health professionals and facilitating communications between behavioral health agencies, executive agencies, managed care organizations, private health plans, and plans offered through the public employees' benefits board, it is the policy of the state to adopt a single standard set of criteria to define medical necessity for substance use disorder treatment and to define substance use disorder levels of care in Washington. The criteria selected must be comprehensive, widely understood and accepted in the field, and based on continuously updated research and evidence. The health care authority and the office of the insurance commissioner must independently review their regulations and practices by January 1, 2021. The health care authority may make rules if necessary to promulgate the selected standard set of criteria.
[ 2020 c 345 § 6.]
NOTES:
Findings—Intent—2020 c 345: See note following RCW 41.05.526.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.530 - Prescription drug assistance, education—Rules.

RCW 41.05.530
Prescription drug assistance, education—Rules.
The authority may adopt rules to implement chapter 29, Laws of 2003 1st sp. sess.
[ 2003 1st sp.s. c 29 § 10.]
NOTES:
Finding—Intent—Severability—Conflict with federal requirements—Effective date—2003 1st sp.s. c 29: See notes following RCW 74.09.650.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.533 - Medication synchronization policy required for health benefit plans covering prescription drugs—Requirements—Definitions.

RCW 41.05.533
Medication synchronization policy required for health benefit plans covering prescription drugs—Requirements—Definitions.
(1) A health benefit plan offered to public employees and their covered dependents under this chapter that is not subject to chapter 48.43 RCW, that is issued or renewed after December 31, 2015, and that provides coverage for prescription drugs must implement a medication synchronization policy for the dispensing of prescription drugs to the plan's enrollees.
(a) If an enrollee requests medication synchronization for a new prescription, the health [benefit] plan must permit filling the drug: (i) For less than a one-month supply of the drug if synchronization will require more than a fifteen-day supply of the drug; or (ii) for more than a one-month supply of the drug if synchronization will require a fifteen-day supply of the drug or less.
(b) The health benefit plan shall adjust the enrollee cost-sharing for a prescription drug subject to coinsurance that is dispensed for less than the standard refill amount for the purpose of synchronizing the medications.
(c) The health benefit plan shall adjust the enrollee cost-sharing for a prescription drug with a copayment that is dispensed for less than the standard refill amount for the purpose of synchronizing the medications by:
(i) Discounting the copayment rate by fifty percent;
(ii) Discounting the copayment rate based on fifteen-day increments; or
(iii) Any other method that meets the intent of this section and is approved by the office of the insurance commissioner.
(2) Upon request of an enrollee, the prescribing provider or pharmacist shall:
(a) Determine that filling or refilling the prescription is in the best interest of the enrollee, taking into account the appropriateness of synchronization for the drug being dispensed;
(b) Inform the enrollee that the prescription will be filled to less than the standard refill amount for the purpose of synchronizing his or her medications; and
(c) Deny synchronization on the grounds of threat to patient safety or suspected fraud or abuse.
(3) For purposes of this section, the following terms have the following meanings unless the context clearly requires otherwise:
(a) "Medication synchronization" means the coordination of medication refills for a patient taking two or more medications for a chronic condition such that the patient's medications are refilled on the same schedule for a given time period.
(b) "Prescription" has the same meaning as in RCW 18.64.011.
[ 2015 c 213 § 2.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.540 - State employee health program—Requirements.

RCW 41.05.540
State employee health program—Requirements.
(1) The health care authority, in coordination with the department of health, health plans participating in public employees' benefits board programs, and the University of Washington's center for health promotion, shall establish and maintain a state employee health program focused on reducing the health risks and improving the health status of state employees, dependents, and retirees enrolled in the public employees' benefits board. The program shall use public and private sector best practices to achieve goals of measurable health outcomes, measurable productivity improvements, positive impact on the cost of medical care, and positive return on investment. The program shall establish standards for health promotion and disease prevention activities, and develop a mechanism to update standards as evidence-based research brings new information and best practices forward.
(2) The state employee health program shall:
(a) Provide technical assistance and other services as needed to wellness staff in all state agencies and institutions of higher education;
(b) Develop effective communication tools and ongoing training for wellness staff;
(c) Contract with outside vendors for evaluation of program goals;
(d) Strongly encourage the widespread completion of online health assessment tools for all state employees, dependents, and retirees. The health assessment tool must be voluntary and confidential. Health assessment data and claims data shall be used to:
(i) Engage state agencies and institutions of higher education in providing evidence-based programs targeted at reducing identified health risks;
(ii) Guide contracting with third-party vendors to implement behavior change tools for targeted high-risk populations; and
(iii) Guide the benefit structure for state employees, dependents, and retirees to include covered services and medications known to manage and reduce health risks.
[ 2023 c 51 § 21; 2007 c 259 § 40; 2005 c 360 § 8.]
NOTES:
Subheadings not law—2007 c 259: See note following RCW 7.70.060.
Findings—Intent—2005 c 360: See note following RCW 36.70A.070.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.601 - Mental health services—Rules.

RCW 41.05.601
Mental health services—Rules.
The director may adopt rules to implement RCW 41.05.600.
[ 2023 c 51 § 23; 2005 c 6 § 12.]
NOTES:
Findings—Intent—Severability—2005 c 6: See notes following RCW 41.05.600.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.630 - Annual report of customer service complaints and appeals.

RCW 41.05.630
Annual report of customer service complaints and appeals.
Beginning in 2011, the state health care authority must process as a complaint an enrollee's expression of dissatisfaction about customer service or the quality or availability of a health service. The agency must require that each health plan that provides medical insurance offered under this chapter, including plans created by insuring entities, plans not subject to the provisions of Title 48 RCW, and plans created under RCW 41.05.140 must submit a summary of customer service complaints and appeals to the agency to be included in an annual report to the legislature. Each annual report must summarize the complaints and appeals processed by the state health care authority and contracted carriers in the preceding twelve months, and include an analysis of any trends identified. The report must be complete by September 30th of each year.
[ 2010 c 293 § 1.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.650 - Community health care collaborative grant program—Grants—Administrative support—Eligibility.

RCW 41.05.650
Community health care collaborative grant program—Grants—Administrative support—Eligibility.
(1) The community health care collaborative grant program is established to further the efforts of community-based coalitions to increase access to appropriate, affordable health care for Washington residents, particularly employed low-income persons and children in school who are uninsured and underinsured, through local programs addressing one or more of the following: (a) Access to medical treatment; (b) the efficient use of health care resources; and (c) quality of care.
(2) Consistent with funds appropriated for community health care collaborative grants specifically for this purpose, two-year grants may be awarded pursuant to RCW 41.05.660 by the director of the health care authority.
(3) The health care authority shall provide administrative support for the program. Administrative support activities may include health care authority facilitation of statewide discussions regarding best practices and standardized performance measures among grantees, or subcontracting for such discussions.
(4) Eligibility for community health care collaborative grants shall be limited to nonprofit organizations established to serve a defined geographic region or organizations with public agency status under the jurisdiction of a local, county, or tribal government. To be eligible, such entities must have a formal collaborative governance structure and decision-making process that includes representation by the following health care providers: Hospitals, public health, behavioral health, community health centers, rural health clinics, and private practitioners that serve low-income persons in the region, unless there are no such providers within the region, or providers decline or refuse to participate or place unreasonable conditions on their participation. The nature and format of the application, and the application procedure, shall be determined by the director of the health care authority. At a minimum, each application shall: (a) Identify the geographic region served by the organization; (b) show how the structure and operation of the organization reflects the interests of, and is accountable to, this region and members providing care within this region; (c) indicate the size of the grant being requested, and how the money will be spent; and (d) include sufficient information for an evaluation of the application based on the criteria established in RCW 41.05.660.
[ 2023 c 51 § 24; 2009 c 299 § 1.]
NOTES:
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.651 - Rules—2009 c 299.

RCW 41.05.651
Rules—2009 c 299.
The health care authority may adopt rules to implement chapter 299, Laws of 2009.
[ 2009 c 299 § 4.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.670 - Chronic care management incentives—Provider reimbursement methods.

RCW 41.05.670
Chronic care management incentives—Provider reimbursement methods.
(1) Effective January 1, 2013, the authority must contract with all of the public employees' benefits board managed care plans and the self-insured plan or plans to include provider reimbursement methods that incentivize chronic care management within health homes resulting in reduced emergency department and inpatient use.
(2) Health home services contracted for under this section may be prioritized to enrollees with complex, high cost, or multiple chronic conditions.
(3) For the purposes of this section, "chronic care management" and "health home" have the same meaning as in RCW 74.09.010.
(4) Contracts with fully insured plans and with any third-party administrator for the self-funded plan that include the items in subsection (1) of this section must be funded within the resources provided by employer funding rates provided for employee health benefits in the omnibus appropriations act.
(5) Nothing in this section shall require contracted third-party health plans administering the self-insured contract to expend resources to implement items in subsection (1) of this section beyond the resources provided by employer funding rates provided for employee health benefits in the omnibus appropriations act or from other sources in the absence of these provisions.
(6) The school employees' benefits board, under RCW 41.05.740, shall implement the provisions of this section, effective January 1, 2020.
[ 2017 3rd sp.s. c 13 § 812; 2011 c 316 § 6.]
NOTES:
Intent—2017 3rd sp.s. c 13: See note following RCW 28A.150.410.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.742 - Single enrollment requirement.

RCW 41.05.742
Single enrollment requirement.
Beginning with the 2022 plan year, individuals are limited to a single enrollment in medical, dental, and vision plans in either the school employees' benefits board or the public employees' benefits board. The school employees' benefits board and the public employees' benefits board shall adopt policies to reflect this single enrollment requirement.
[ 2021 c 18 § 1; 2020 c 8 § 4.]
NOTES:
Effective date—2020 c 8: See note following RCW 41.05.744.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.743 - School board members—Eligibility for health benefits.

RCW 41.05.743
School board members—Eligibility for health benefits.
(1) For purposes of this section, "school board member" means the board of directors of a school district as governed by chapter 28A.343 RCW or the board of directors of an educational service district as governed by chapter 28A.310 RCW.
(2) As of January 1, 2024, a school board member may participate in the benefit plans offered by and subject to the terms and conditions determined by the school employees' benefits board. A school board member may enroll in medical, dental, and vision benefits and shall be responsible for premium rates developed by the authority. A school board member shall be responsible for submitting the full self-pay premium amount for the benefits the member elects to enroll in for each month the member is covered.
(3) A school board member may participate in the school employees' benefits board program for the duration of the member's elected term as a school board member and may renew the member's participation at the start of each subsequent term as a school board member.
(4) If a school board member voluntarily ends the member's enrollment in the school employees' benefits board program prior to the end of their elected term, the member is no longer eligible under this section to participate in the school employees' benefits board program for the remainder of the member's elected term.
(5) This section does not create any eligibility for school board members to participate in retiree benefits provided by the public employees' benefits board program.
[ 2023 c 13 § 8.]
NOTES:
Finding—Intent—2023 c 13: See note following RCW 41.05.011.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.744 - School employee eligibility during COVID-19 state of emergency.

RCW 41.05.744
School employee eligibility during COVID-19 state of emergency.
(1) A school employee eligible as of February 29, 2020, for the employer contribution towards benefits offered by the school employees' benefits board shall maintain their eligibility for the employer contribution under the following circumstances directly related or in response to the governor's February 29, 2020, proclamation of a state of emergency existing in all counties in the state of Washington related to the novel coronavirus (COVID-19):
(a) During any school closures or changes in school operations for the school employee;
(b) While the school employee is quarantined or required to care for a family member, as defined by RCW 49.46.210(2), who is quarantined; and
(c) In order to take care of a child as defined by RCW 49.46.210(2), when the child's:
(i) School is closed;
(ii) Regular day care facility is closed; or
(iii) Regular child care provider is unable to provide services.
(2) Requirements in subsection (1) of this section expires when the governor's state of emergency related to the novel coronavirus (COVID-19) ends.
(3) When regular school operations resume, school employees shall continue to maintain their eligibility for the employer contribution for the remainder of the school year so long as their work schedule returns to the schedule in place before February 29, 2020, or, if there is a change in schedule, so long as the new schedule, had it been in effect at the start of the school year, would have resulted in the employee being anticipated to work the minimum hours to meet benefits eligibility.
(4) Quarantine, as used in subsection (1)(b) [of this section] includes only periods of isolation required by the federal government, a foreign national government, a state or local public health official, a health care provider, or an employer.
[ 2020 c 8 § 5.]
NOTES:
Effective date—2020 c 8: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately [March 17, 2020]." [ 2020 c 8 § 6.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.745 - School employees' benefits board—Employee-paid, voluntary benefits—Optional benefits.

RCW 41.05.745
School employees' benefits board—Employee-paid, voluntary benefits—Optional benefits.
(1) In addition to the benefits offering authority under this chapter, the school employees' benefits board may study and, subject to the availability of funding, offer the following employee-paid, voluntary benefits:
(a) Emergency transportation;
(b) Identity protection;
(c) Legal aid;
(d) Long-term care insurance;
(e) Noncommercial personal automobile insurance;
(f) Personal homeowner's or renter's insurance;
(g) Pet insurance;
(h) Specified disease or illness-triggered fixed payment insurance, hospital confinement fixed payment insurance, or other fixed payment insurance offered as an independent, noncoordinated benefit regulated by the office of the insurance commissioner;
(i) Travel insurance; and
(j) Voluntary employees' beneficiary association accounts.
(2) The health care authority, in consultation with the school employees' benefits board, shall review the optional benefits reported by school districts as required in RCW 28A.400.280 and determine if the optional benefits are in competition with benefits currently offered under either the authority's or the board's authorities. If a school district benefit offering is determined to be in competition with the benefits offered under either the authority's or the board's authorities, the health care authority must inform the school district of the benefits conflict and work with the school district, and the applicable carrier, to either modify and remove competing components of the district-based benefit or end the district-based offering. If a carrier is in the process of modifying benefits, including seeking any required regulatory approval, a school district may continue to offer the original benefit.
(3) Specified disease or illness-triggered fixed payment insurance, hospital confinement fixed payment insurance, or other fixed payment insurance offered pursuant to this section as an independent, noncoordinated benefit is not a health plan as defined in RCW 48.43.005.
[ 2020 c 231 § 3.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.751 - Problem gambling account.

RCW 41.05.751
Problem gambling account.
The problem gambling account is created in the state treasury. Money in the account may be spent only after appropriation. Expenditures from the account may be used only for the purposes of the program established under RCW 41.05.750.
[ 2018 c 201 § 2005; 2005 c 369 § 3. Formerly RCW 43.20A.892.]
NOTES:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
Findings—Intent—Severability—Effective date—2005 c 369: See notes following RCW 41.05.750.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.761 - Recovery residences—Technical assistance for residences seeking certification.

RCW 41.05.761
Recovery residences—Technical assistance for residences seeking certification. (Expires July 1, 2025.)
(1) Subject to the availability of amounts appropriated for this specific purpose, the authority shall contract with the nationally recognized recovery residence organization based in Washington that is approved by the authority in RCW 41.05.760 to provide technical assistance to recovery residences actively seeking certification. The technical assistance shall include, but not be limited to:
(a) New manager training;
(b) Assistance preparing facility operations documents and policies; and
(c) Support for working with residents on medication-assisted treatment.
(2) This section expires July 1, 2025.
[ 2019 c 264 § 3.]
NOTES:
Findings—2019 c 264: See note following RCW 41.05.760.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.762 - Recovery residences—Revolving fund.

RCW 41.05.762
Recovery residences—Revolving fund. (Expires July 1, 2025.)
(1) The authority shall establish a revolving fund for loans to operators of new recovery residences or existing recovery residences actively seeking certification and registration under RCW 41.05.760. Approved uses of the funds include, but are not limited to:
(a) Facility modifications necessary to achieve certification; and
(b) Operating start-up costs, including rent or mortgage payments, security deposits, salaries for on-site staff, and minimal maintenance costs.
(2) This section expires July 1, 2025.
[ 2019 c 264 § 4.]
NOTES:
Findings—2019 c 264: See note following RCW 41.05.760.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.820 - Qualified requirement for health carrier in insurance holding company to offer silver and gold health plans.

RCW 41.05.820
Qualified requirement for health carrier in insurance holding company to offer silver and gold health plans.
(1) For plan years beginning January 1, 2020, at least one health carrier in an insurance holding company system must offer in the exchange at least one silver and one gold qualified health plan in any county in which any health carrier in that insurance holding company system offers a fully insured health plan that was approved, on or after June 7, 2018, by the school employees' benefits board or the public employees' benefits board to be offered to employees and their covered dependents under this chapter.
(2) The rates for a health plan approved by the school employees' benefits board or the public employees' benefits board may not include the administrative costs or actuarial risks associated with a qualified health plan offered under subsection (1) of this section.
(3) The authority shall perform an actuarial review during the annual rate setting process for plans approved by the school employees' benefits board or the public employees' benefits board to ensure compliance with subsection (2) of this section.
(4) For purposes of this section, "exchange" and "health carrier" have the same meaning as in RCW 48.43.005.
(5) For purposes of this section, "insurance holding company system" has the same meaning as in RCW 48.31B.005.
[ 2018 c 219 § 2.]
NOTES:
Findings—Intent—2018 c 219: "(1) The legislature finds that:
(a) Access to health care is fundamental to the health and safety of the citizens of Washington state;
(b) Health insurance coverage is necessary for most people to access health care;
(c) Due to uncertainty in the health insurance marketplace, volatility in the current federal regulatory environment, and rising health care costs, ensuring access to the private health insurance market in every county in Washington state is becoming more difficult;
(d) The consequences of losing private health insurance coverage in a county would be catastrophic, leading to deteriorating health outcomes, lost productivity, and lower quality of life; and
(e) If the private market fails to provide coverage in a county, the state must intervene.
(2) The legislature therefore intends to:
(a) Leverage the provider networks used by private insurers offering coverage to state and school employees to ensure private insurance coverage is available in all counties where those insurers offer coverage to state and school employees; and
(b) Until such coverage is available, make coverage in the Washington state health insurance pool more affordable to persons residing in counties where no private insurance is available." [ 2018 c 219 § 1.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.830 - Coverage for hearing instruments—Definitions.

RCW 41.05.830
Coverage for hearing instruments—Definitions. (Expires December 31, 2023.)
(1) Subject to appropriation, a health plan offered to employees and their covered dependents under this chapter issued or renewed on or after January 1, 2019, must include coverage for hearing instruments. Coverage must include a new hearing instrument every five years and services and supplies such as the initial assessment, fitting, adjustment, and auditory training.
(2) The hearing instrument must be recommended by a licensed audiologist, hearing aid specialist, or a licensed physician or osteopathic physician who specializes in otolaryngology and dispensed by a licensed audiologist, hearing aid specialist, or a licensed physician or osteopathic physician who specializes in otolaryngology.
(3) For the purposes of this section, "hearing instrument" and "hearing aid specialist" have the same meaning as defined in RCW 18.35.010.
(4) This section expires December 31, 2023.
[ 2023 c 245 § 2; 2018 c 159 § 1.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.831 - Coverage for hearing instruments.

RCW 41.05.831
Coverage for hearing instruments.
A health plan offered to public employees and their covered dependents under this chapter issued or renewed on or after January 1, 2024, is subject to RCW 48.43.135.
[ 2023 c 245 § 3.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.850 - Abortion coverage—Cost sharing.

RCW 41.05.850
Abortion coverage—Cost sharing.
(1) Except as provided in subsection (2) of this section, a health plan offered to public employees and their covered dependents under this chapter issued or renewed on or after January 1, 2024, that provides coverage for abortion may not impose cost sharing for the abortion of a pregnancy.
(2) For a health plan that provides coverage for abortion of a pregnancy and is offered as a qualifying health plan for a health savings account, the health plan shall establish the plan's cost sharing for the coverage required by this section at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions and withdrawals from the enrollee's health savings account under internal revenue service laws and regulations.
[ 2023 c 194 § 2.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.890 - Certain health care and financial related data provided to authority—Exempt from disclosure.

RCW 41.05.890
Certain health care and financial related data provided to authority—Exempt from disclosure.
(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.
[ 2018 c 260 § 31.]
NOTES:
Effective date—2018 c 260 §§ 14, 22, 23, 31, and 32: See note following RCW 41.05.075.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.901 - Implementation—Effective dates—1988 c 107.

RCW 41.05.901
Implementation—Effective dates—1988 c 107.
(1) The state health care authority shall be established and shall take such steps as are necessary to ensure that this act is fully implemented on October 1, 1988.
There is hereby appropriated for the biennium ending June 30, 1989, the sum of one million three hundred thousand dollars, or as much thereof as is necessary, to the office of the governor from the state employees' insurance administrative account, for the purposes of implementing this subsection.
(2) Subsection (1) of this section, RCW 48.14.027 and 82.04.4331, and sections 13 and 31, chapter 107, Laws of 1988 are necessary for the immediate preservation of the public peace, health, and safety, the support of the state government and its existing public institutions, and shall take effect March 16, 1988.
(3) The remainder of this act shall take effect on October 1, 1988.
[ 1988 c 107 § 36.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.950 - Retired or disabled public employees—Special health coverage enrollment opportunity.

RCW 41.05.950
Retired or disabled public employees—Special health coverage enrollment opportunity.
(1) A retired or disabled employee who: (a) Is receiving a retirement allowance under chapters [chapter] 41.32, 41.35, 41.37, or 41.40 RCW; (b) was previously denied coverage solely for failure to timely notify the authority of their plan to defer coverage; and (c) appealed the denial of benefits to the authority on or before December 31, 2022, may enroll in medical and dental plans under the authority, provided they apply no later than the end of the open enrollment period for the plan year beginning January 1, 2024.
(2) A retired or disabled employee enrolling in benefits under this section may only enroll in a fully insured medicare advantage or medicare supplement plan.
(3) Retired or disabled employees and their dependents are responsible for payment of rates developed by the authority, and must include any amounts necessary for administration in accordance with this chapter. Premium rates charged to retired or disabled employees and their dependents shall be based on the experience of the community-rated risk pools established under RCW 41.05.022 and 41.05.080 and must be reduced by the amount of the subsidy provided under RCW 41.05.085.
(4) The authority may establish rules to implement the enrollment opportunity under this section.
[ 2023 c 15 § 1.]
NOTES:
Effective date—2023 c 15: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately [March 30, 2023]." [ 2023 c 15 § 2.]
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05 - State Health Care Authority. › 41.05.951 - Retired or disabled employees of employer groups—Return following termination of employer's agreement—2023 c 312.

RCW 41.05.951
Retired or disabled employees of employer groups—Return following termination of employer's agreement—2023 c 312.
Any retired or disabled employee whose participation in insurance plans or contracts under RCW 41.05.080(1)(a)(i) ended due to the termination of the contractual agreement between the authority and an employer group on or before January 1, 2023, must be allowed to return and participate in insurance plans and contracts as described in RCW 41.05.080(1)(a)(ii) so long as the retired or disabled employee notifies the health care authority in writing by December 31, 2023, after which participation will begin on the first day of the month following the date the authority receives the retired or disabled employee's written notice.
[ 2023 c 312 § 3.]
NOTES:
Effective date—2023 c 312: See note following RCW 41.05.083.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05A - Overpayments of Assistance and Coordination of Benefits. › 41.05A.005 - Purpose—Collaboration with other agencies—Construction.

RCW 41.05A.005
Purpose—Collaboration with other agencies—Construction.
The purpose of this chapter is to provide the health care authority with the powers, duties, and authority with respect to the collection of overpayments and the coordination of benefits that are currently provided to the department of social and health services in chapter 43.20B RCW. Providing the health care authority with these powers is necessary for the authority to administer medical services programs established under chapter 74.09 RCW currently administered by the department of social and health services programs but transferred to the authority under chapter 15, Laws of 2011 1st sp. sess., and programs transferred to the authority under chapter 201, Laws of 2018. The authority is authorized to collaborate with other state agencies in carrying out its duties under this chapter and, to the extent appropriate, may enter into agreements with such other agencies. Nothing in this chapter may be construed as diminishing the powers, duties, and authority granted to the department of social and health services in chapter 43.20B RCW with respect to the programs that will remain under its jurisdiction following enactment of chapter 15, Laws of 2011 1st sp. sess. and chapter 201, Laws of 2018.
[ 2018 c 201 § 7003; 2011 1st sp.s. c 15 § 88.]
NOTES:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05A - Overpayments of Assistance and Coordination of Benefits. › 41.05A.010 - Definitions.

RCW 41.05A.010
Definitions.
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise:
(1) "Assistance" means all programs administered by the authority.
(2) "Authority" means the Washington state health care authority.
(3) "Director" means the director of the Washington state health care authority.
(4) "Overpayment" means any payment or benefit to a recipient or to a vendor in excess of that to which is entitled by law, rule, or contract, including amounts in dispute.
(5) "Vendor" means a person or entity that provides goods or services to or for clientele of the authority and that controls operational decisions.
[ 2011 1st sp.s. c 15 § 89.]
NOTES:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05A - Overpayments of Assistance and Coordination of Benefits. › 41.05A.030 - Fees for services—Reimbursement collection.

RCW 41.05A.030
Fees for services—Reimbursement collection.
The authority is authorized to charge fees for services provided unless otherwise prohibited by law. The fees may be sufficient to cover the full cost of the service provided if practical or may be charged on an ability-to-pay basis if practical. This section does not supersede other statutory authority enabling the assessment of fees by the authority. Whenever the authority is authorized by law to collect total or partial reimbursement for the cost of its providing care of or exercising custody over any person, the authority shall collect the reimbursement to the extent practical.
[ 2011 1st sp.s. c 15 § 90.]
NOTES:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05A - Overpayments of Assistance and Coordination of Benefits. › 41.05A.040 - Time limit for collection of overpayments or other debts—Write-offs of debts.

RCW 41.05A.040
Time limit for collection of overpayments or other debts—Write-offs of debts.
(1) Except as otherwise provided by law, including subsection (2) of this section, there may be no collection of overpayments and other debts due the authority after the expiration of six years from the date of notice of such overpayment or other debt unless the authority has commenced recovery action in a court of law or unless an administrative remedy authorized by statute is in place. However, any amount due in a case thus extended ceases to be a debt due the authority at the expiration of ten years from the date of the notice of the overpayment or other debt unless a court-ordered remedy would be in effect for a longer period.
(2) There may be no collection of debts due the authority after the expiration of twenty years from the date a lien is recorded pursuant to RCW 41.05A.090.
(3) The authority, at any time, may accept offers of compromise of disputed claims or may grant partial or total write-off of any debt due the authority if it is no longer cost-effective to pursue. The authority shall adopt rules establishing the considerations to be made in the granting or denial of a partial or total write-off of debts.
[ 2011 1st sp.s. c 15 § 91.]
NOTES:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
2023 Revised Code of Washington › Title 41 - Public Employment, Civil Service, and Pensions › Chapter 41.05A - Overpayments of Assistance and Coordination of Benefits. › 41.05A.050 - Form of lien.

RCW 41.05A.050
Form of lien.
The form of the lien in RCW 41.05A.070 must be substantially as follows:
STATEMENT OF LIEN
Notice is hereby given that the State of Washington, Health Care Authority, has rendered assistance to . . . . . ., a person who was injured on or about the . . . . day of . . . . . . in the county of . . . . . . state of . . . . . ., and the said authority hereby asserts a lien, to the extent provided in RCW 41.05A.070, for the amount of such assistance, upon any sum due and owing . . . . . . (name of injured person) from . . . . . ., alleged to have caused the injury, and/or his or her insurer and from any other person or insurer liable for the injury or obligated to compensate the injured person on account of such injuries by contract or otherwise.
STATE OF WASHINGTON, HEALTH
CARE AUTHORITY
By: . . . . (Title)
STATE OF WASHINGTON





ss.
COUNTY OF
I, . . . . . ., being first duly sworn, on oath state: That I am . . . . . . (title); that I have read the foregoing Statement of Lien, know the contents thereof, and believe the same to be true.
. . . .
Signed and sworn to or affirmed before me this . . . . day of . . . . . ., . . . .
by . . . .
(name of person making statement).
(Seal or stamp)
. . . .
Notary Public in and for the State
of Washington
My appointment expires: . . . .
[ 2011 1st sp.s. c 15 § 92.]
NOTES:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.