wa-law.org > bill > 2025-26 > SB 6159 > Original Bill
The legislature finds that hospitals owned and operated by public entities play unique roles in their communities, serving as safety net providers, treating all patients, even those who are medically complex, low income, uninsured, or underinsured. Often these patients cannot access care at other nonpublic facilities and must rely on public hospitals as a result. These hospitals' adherence to this public mission imperils their financial stability, especially as access to public reimbursement programs and other forms of financial support decline. The continued viability of public hospitals and the access to care they provide for all members of their communities are a matter of significant public concern. The legislature finds that competition between public hospitals is not practical or desirable and instead may harm these hospitals' ability to fulfill their public mission. It is the intent of this act to foster the development of cooperative and collaborative arrangements among all public hospitals to support their public mission. To this end, the legislature intends to authorize these entities to enter agreements, contracts, and other arrangements on a noncompetitive basis.
In addition to other powers granted to public hospital districts by chapter 39.34 RCW, public hospital districts that are not affiliated with a nonpublic entity under RCW 70.44.240 may enter into cooperative agreements and contracts with other public hospital districts and publicly owned or operated health care entities in order to provide for the health care needs of the people served by the hospital districts. These agreements and contracts are specifically authorized to include:
Allocation of health care services among the different facilities owned and operated by the districts;
Combined purchases and allocations of medical equipment and technologies;
Joint agreements and contracts for health care service delivery and payment with public and private entities; and
Other cooperative arrangements consistent with the intent of chapter 161, Laws of 1992. The provisions of chapter 39.34 RCW shall apply to the development and implementation of the cooperative contracts and agreements.
As used in this chapter, the following words and terms have the following meanings, unless the context indicates or requires another or different meaning or intent and the singular of any term shall encompass the plural and the plural the singular unless the context indicates otherwise:
"Authority" means the Washington health care facilities authority created by RCW 70.37.030 or any board, body, commission, department or officer succeeding to the principal functions thereof or to whom the powers conferred upon the authority shall be given by law.
"Bonds" mean bonds, notes or other evidences of indebtedness of the authority issued pursuant hereto.
"Health care facility" means any land, structure, system, machinery, equipment or other real or personal property or appurtenances useful for or associated with delivery of inpatient or outpatient health care service or support for such care or any combination thereof which is operated or undertaken in connection with hospital, clinic, health maintenance organization, diagnostic or treatment center, extended care facility, or any facility providing or designed to provide therapeutic, convalescent or preventive health care services, and shall include research and support facilities of a comprehensive cancer center, but excluding, however, any facility which is maintained by a participant primarily for rental or lease to self-employed health care professionals or as an independent nursing home or other facility primarily offering domiciliary care.
"Participant" means :
Any city, county or other municipal corporation or agency or political subdivision of the state or any corporation, hospital, comprehensive cancer center, or health maintenance organization authorized by law to operate nonprofit health care facilities, or any affiliate, as defined by regulations promulgated by the director of the department of financial institutions pursuant to RCW 21.20.450, which is a nonprofit corporation acting for the benefit of any entity described in this subsection;
Any public hospital district as authorized in chapter 70.44 RCW; or
Any publicly owned or operated health care entity.
"Project" means a specific health care facility or any combination of health care facilities, constructed, purchased, acquired, leased, used, owned or operated by a participant, and alterations, additions to, renovations, enlargements, betterments and reconstructions thereof.
In addition to any other taxes or other charges imposed under this chapter, each authorized insurer or taxpayer subject to tax under RCW 48.14.020 or 48.14.0201 shall, on or before the first day of March of each year, pay to the state treasurer through the commissioner's office an annual coverage assessment. The assessment equals $0.75 per coverage month in the prior calendar year. The initial assessment imposed under this subsection (1) is due and payable on or before March 1, 2027.
Each insurer or taxpayer subject to the assessment under this section must file with the commissioner on or before the first day of March of each year, an annual coverage month assessment statement indicating the number of coverage months associated with premiums or prepayments for health care services subject to tax under RCW 48.14.020 or 48.14.0201, in a form and manner required by the commissioner. The statement under this subsection is in addition to the statement required under RCW 48.14.030.
Any insurer or taxpayer failing to file its annual coverage month assessment statement under subsection (2) of this section and pay the assessment by the last day of the month in which the assessment becomes due, shall be assessed a penalty of five percent of the amount of the assessment. If the assessment is not paid within 45 days after the due date, the insurer or taxpayer must be assessed a total penalty of 10 percent of the amount of the assessment. If the assessment is not paid within 60 days of the due date, the insurer or taxpayer must be assessed a total penalty of 20 percent of the amount of the assessment. The assessment may be collected by distraint, and the penalty recovered by any action instituted by the commissioner in any court of competent jurisdiction. The amount of any penalty collected must be paid to the state treasurer and credited to the public hospital infrastructure account.
In addition to the penalties set forth in subsection (3) of this section, interest accrues on the amount of the unpaid assessment at the maximum legal rate of interest permitted under RCW 19.52.020 commencing 61 days after the assessment is due until paid.
The commissioner may revoke the certificate of authority or registration of any delinquent insurer or taxpayer, and the certificate of authority or registration will not be reissued, until all assessments, interest, and penalties imposed under this section have been fully paid and the insurer or taxpayer has otherwise qualified for the certificate of authority or registration.
In the event that any insurer or taxpayer has paid to the commissioner any assessment under this section in error or in excess of that which it is lawfully obligated to pay, the commissioner shall upon written request make a refund thereof. An insurer or taxpayer may only request a refund of assessments within six years of the end of the calendar year for which the assessments are owed. Refunds may be made either by crediting the amount toward payment of taxes, assessments, or other charges due or to become due from such insurer or taxpayer, or by making a cash refund.
All revenues collected under this section must be deposited in the public hospital infrastructure account created in section 5 of this act.
The assessment required under this section must be borne solely by the insurer or taxpayer and may not be passed through to enrollees in premiums, rates, plan design, or otherwise.
Carriers shall demonstrate their compliance with this section through the rate filing review process of the commissioner, as directed by the commissioner. The commissioner also may adopt rules to implement this section.
For the purpose of this section, "coverage month" means each month of coverage under an insurance policy or each month of prepayment for health care services where premiums or prepayments are subject to tax under RCW 48.14.020 or 48.14.0201.
The public hospital infrastructure account is created in the state treasury. All receipts from the assessment outlined in section 4 of this act must be deposited into the public hospital infrastructure account. Moneys in the account may be spent only after appropriation. Expenditures from the account may be used only for providing funding assistance to public district hospitals, or any publicly owned or operated health care entity undertaking a major new construction or modernization project.