On April 17, 2015, Gov. Inslee signed SB 5165 into law, creating Chapter 22, Laws of 2015. The law requires health insurance issuers that provide coverage for hospitalization to offer plan participants who are homebound and would otherwise require hospitalization coverage for home health care and hospice care. Plan participants who need home health care for palliative care in conjunction with management or treatment of serious or life-threatening illnesses do not need to be homebound to be eligible for coverage. Home health care and hospice care coverage can:
Include reasonable coinsurance provisions, deductibles and internal maximums;
Create incentives for use of home health care or hospice care as an alternative to hospitalization;
Contain provisions for quality assurance and utilization review;
Require home health agencies and hospices to have written treatment plans approved by licensed physicians and that the treatment plans be reviewed at designated intervals;
Provide benefits for, and restrict benefits to, services rendered by licensed home health and hospice agencies; and
Be structured so that services or supplies included in the primary plan are not duplicated in the optional home health-care or hospice coverage.
For home health care, plans must provide coverage for a minimum of 130 health care visits per calendar year. A visit of any duration by home health agency employees for the purpose of providing treatment or services under the plan equals one visit. For hospice care, plans must provide coverage for hospice care services for terminally ill plan participants for an initial period of not less than six months and can provide coverage for an additional six months of care if plan participants are facing imminent death or entering remission if certified in writing by attending physicians. The law is effective for insured health plans issued or renewed on or after Dec. 31, 2016.
Chapter 22, Laws of 2015 »