Health Care Authority-backed bill would cap hospital payments for public employee plans to lower premiums, critics warn rural hospitals could lose revenue

Senate Bill 5083, a Health Care Authority-sponsored substitute bill, was heard Jan. 31 in Senate Health and Long Term Care. The bill would require hospitals that receive Medicaid payments and receive a good-faith offer from a carrier for medical coverage through the Public Employees Benefits Board (PEBB) or School Employees Benefits Board (SEBB) to contract with that carrier or its third-party administrator. It also sets reimbursement ceilings tied to Medicare rates and floors for primary care and non-facility behavioral health providers.

Key provisions in the proposed substitute: beginning in 2027 reimbursements for in-network inpatient and outpatient facility charges in Washington could not exceed the lesser of billed charges, the contracted rate, or 200 percent of Medicare; children—s hospitals would be capped at…