Bill > HB1123

This bill aims to ensure access to primary care, behavioral health, and affordable hospital services by establishing new reimbursement requirements for health carriers providing medical insurance to public employees. The bill defines a "contractor" as a health carrier or third-party administrator providing medical coverage to public employees. Starting January 1, 2027, contractors must adhere to specific reimbursement guidelines: for most in-network hospital services in Washington, reimbursement cannot exceed 200% of Medicare rates, with a higher 350% cap for children's specialty hospitals. Rural critical access and sole community hospitals receive special considerations. Primary care and behavioral health services must be reimbursed at least 150% of Medicare rates. By January 1, 2029, the hospital service reimbursement cap decreases to 190% for most facilities. The bill allows alternative payment methodologies that incentivize quality care and requires that premiums reflect these reimbursement changes. Contractors must provide cost and quality data to state authorities, and by December 31, 2030, a report will analyze the policy's initial impacts on network access, premiums, and healthcare costs. The Washington State Health Care Authority is authorized to adopt rules and enforce compliance with these new requirements.

Budget and Finance

https://app.leg.wa.gov/billsummary?BillNumber=1123&Year=2025&Initiative=false