Bill > SB5083

This bill establishes new reimbursement requirements for health insurance contractors providing medical coverage to public employees in Washington state, effective January 1, 2027. The legislation sets specific guidelines for how hospitals and healthcare providers will be reimbursed, including caps on reimbursement rates for in-network and out-of-network hospitals. For most in-network hospitals, reimbursement will be limited to the lesser of billed charges, the contractor's contracted rate, or 200% of Medicare's reimbursement rate, with special provisions for children's hospitals in King and Pierce counties. The bill also mandates that primary care and behavioral health services be reimbursed at no less than 150% of Medicare rates. Critical access hospitals receive a slightly different reimbursement calculation, and the law includes protections to prevent additional patient billing beyond the specified rates. The legislation requires health insurance premiums to reflect these new reimbursement changes and mandates that contractors provide cost and quality data to state authorities. Additionally, the Washington State Health Care Authority is required to produce two comprehensive reports (by December 2030 and December 2034) analyzing the impact of these new reimbursement rules on network access, employee premiums, and state healthcare expenditures, with potential recommendations for future legislative changes.

Budget and Finance, Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=5083&Year=2025&Initiative=false