Long-term services trust

AN ACT Relating to strengthening the WACares program by 1
implementing the recommendations of the long-term services and 2
supports trust commission; amending RCW 50B.04.180, 50B.04.010, 3
50B.04.020, 50B.04.030, 50B.04.050, 50B.04.055, 50B.04.060, 4
50B.04.070, 50B.04.085, 50B.04.100, 50B.04.140, 74.39.007, and 5
70.127.040; reenacting and amending RCW 50B.04.080; adding new 6
sections to chapter 50B.04 RCW; adding a new section to chapter 48.83 7
RCW; adding a new chapter to Title 48 RCW; creating a new section; 8
repealing RCW 50B.04.040; providing an effective date; and providing 9
an expiration date. 10
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:11
Sec. 1. RCW 50B.04.180 and 2024 c 120 s 2 are each amended to 12
read as follows: 13
(1) Beginning July 1, 2026, an employee or self-employed person, 14
who has elected coverage under RCW 50B.04.090, who relocates outside 15
of Washington may elect to continue participation in the program if:16
(a) The employee or self-employed person has been assessed 17
premiums by the employment security department for at least three 18
years in which the employee or self-employed person has worked at 19
least 500 hours in each of those years in Washington; and20
S-0135.3
SENATE BILL 5291
State of Washington 69th Legislature 2025 Regular Session
By Senators Conway, Saldaña, Cleveland, Frame, Nobles, Stanford,
Valdez, and C. Wilson
Read first time 01/15/25. Referred to Committee on Labor & Commerce.
p. 1 SB 5291
(b) The employee or self-employed person notifies the employment 1
security department within one year of establishing a primary 2
residence outside of Washington that the employee or self-employed 3
person is no longer a resident of Washington and elects to continue 4
participation in the program. 5
(2) Out-of-state participants under subsection (1) of this 6
section must report their wages or self-employment earnings to the 7
employment security department according to standards for manner and 8
timing of reporting and documentation submission, as adopted by rule 9
by the employment security department. An out-of-state participant 10
must submit documentation to the employment security department 11
whether or not the out-of-state participant earned wages or self-12
employment earnings, as applicable, during the applicable reporting 13
period. When an out-of-state participant reaches the age of 67, the 14
participant is no longer required to provide the documentation of 15
their wages or self-employment earnings, but if the participant earns 16
wages or self-employment earnings, the participant must submit 17
reports of those wages or self-employment earnings and remit the 18
required premiums. 19
(3) Out-of-state participants under subsection (1) of this 20
section must provide documentation of wages and self-employment 21
earnings earned at the time that they report their wages or self-22
employment earnings to the employment security department.23
(4) An out-of-state participant who has elected to continue 24
participation in the program under subsection (1) of this section may 25
not withdraw from coverage under the program. The employment security 26
department ((may)) shall cancel out-of-state elective coverage if the 27
out-of-state participant fails to make required payments or submit 28
reports. ((The employment security department may collect due and 29
unpaid premiums and may levy an additional premium for the remainder 30
of the period of coverage. )) The cancellation must be effective no 31
later than 30 days from the date of the notice in writing advising 32
the out-of-state participant of the cancellation. 33
(5) The employment security department shall: 34
(a) Adopt standards by rule for the manner and timing of 35
reporting and documentation submission for out-of-state participants. 36
The employment security department must consider user experience with 37
the wage and self-employment earnings reporting process and the 38
document submission process and regularly update the standards to 39
minimize the procedural burden on out-of-state participants and 40
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support the accurate reporting of wages and self-employment earnings 1
at the time of the payment of premiums; 2
(b) Collect premiums from out-of-state participants as provided 3
in RCW 50B.04.080 and 50B.04.090, as relevant to out-of-state 4
participants; and 5
(c) Verify the wages or self-employment earnings as reported by 6
an out-of-state participant. 7
(6) For the purposes of this section, "wages" includes 8
remuneration for services performed within or without or both within 9
and without this state. 10
(7) Entities providing services to an eligible beneficiary 11
outside Washington are subject to RCW 50B.04.200 and may not 12
discriminate based upon race, gender, age, or preexisting condition.13
(8) ((An employee or self-employed person who has elected 14
coverage under RCW 50B.04.090 who relocates outside of Washington may 15
elect to opt out of coverage by no longer reporting wages to the 16
department, rather than become an out-of-state participant in the 17
program.18
(9))) By extending the premium base to out-of-state participants 19
under subsection (1) of this section, chapter 120, Laws of 2024 will 20
increase the state's investment in long-term care services.21
Sec. 2. RCW 50B.04.010 and 2024 c 120 s 3 are each amended to 22
read as follows: 23
The definitions in this section apply throughout this chapter 24
unless the context clearly requires otherwise. 25
(1) "Account" means the long-term services and supports trust 26
account created in RCW 50B.04.100. 27
(2) "Approved service" means long-term services and supports 28
including, but not limited to: 29
(a) Adult day services; 30
(b) Care transition coordination; 31
(c) Memory care; 32
(d) Adaptive equipment and technology; 33
(e) Environmental modification; 34
(f) Personal emergency response system; 35
(g) Home safety evaluation; 36
(h) Respite for family caregivers; 37
(i) Home delivered meals; 38
(j) Transportation; 39
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(k) Dementia supports; 1
(l) Education and consultation; 2
(m) Eligible relative care; 3
(n) Professional services; 4
(o) Services that assist paid and unpaid family members caring 5
for eligible individuals, including training for individuals 6
providing care who are not otherwise employed as long-term care 7
workers under RCW 74.39A.074; 8
(p) In-home personal care; 9
(q) Assisted living services; 10
(r) Adult family home services; and 11
(s) Nursing home services. 12
(3) "Benefit unit" means up to $100 paid by the department of 13
social and health services to a long-term services and supports 14
provider as reimbursement for approved services provided to an 15
eligible beneficiary on a specific date. The benefit unit must be 16
adjusted annually ((at a rate no greater than the Washington state 17
consumer price index, as determined solely by the council. Any 18
changes adopted by the council shall be subject to revision by the 19
legislature)) for inflation by the consumer price index. The adjusted 20
benefit unit must be calculated to the nearest cent/dollar using the 21
consumer price index for the Seattle, Washington area for urban wage 22
earners and clerical workers, all items, CPI-W, or a successor index, 23
for the 12 months before each September 1st compiled by the United 24
States department of labor's bureau of labor statistics. Each 25
adjusted benefit unit calculated under this subsection takes effect 26
on the following January 1st. 27
(4) "Commission" means the long-term services and supports trust 28
commission established in RCW 50B.04.030. 29
(5) (("Council" means the long-term services and supports trust 30
council established in RCW 50B.04.040.31
(6))) "Eligible beneficiary" means a qualified individual who is 32
age 18 or older, resides in the state of Washington or has elected to 33
keep coverage when they relocate out-of-state under RCW 50B.04.180, 34
has been determined to meet the minimum level of assistance with 35
activities of daily living necessary to receive benefits through the 36
trust program, as ((established in this chapter )) provided in RCW 37
50B.04.060, and has not exhausted the lifetime limit of benefit 38
units. 39
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(((7))) (6) "Employee" has the meaning provided in RCW 1
50A.05.010. 2
(((8))) (7) "Employer" has the meaning provided in RCW 3
50A.05.010. 4
(((9))) (8) "Employment" has the meaning provided in RCW 5
50A.05.010. 6
(((10))) (9) "Exempt employee" means a person who has been 7
granted a premium assessment exemption by the employment security 8
department. 9
(((11))) (10) "Long-term services and supports provider" means:10
(a) For entities providing services to an eligible beneficiary in 11
Washington, an entity that meets the qualifications applicable in law 12
to the approved service they provide, including a qualified or 13
certified home care aide, licensed assisted living facility, licensed 14
adult family home, licensed nursing home, licensed in-home services 15
agency, adult day services program, vendor, instructor, qualified 16
family member, or other entities as registered by the department of 17
social and health services; and 18
(b) For entities providing services to an eligible beneficiary 19
outside Washington, an entity that meets minimum standards for care 20
provision and program administration, as established by the 21
department of social and health services, and that is appropriately 22
credentialed in the jurisdiction in which the services are being 23
provided as established by the department of social and health 24
services. 25
(((12))) (11) "Premium" or "premiums" means the payments required 26
by RCW 50B.04.080 and paid to the employment security department for 27
deposit in the account created in RCW 50B.04.100. 28
(((13))) (12) "Program" means the long-term services and supports 29
trust program established in this chapter. 30
(((14))) (13) "Qualified family member" means a relative of an 31
eligible beneficiary qualified to meet requirements established ((in 32
state law )) by the department of social and health services for the 33
approved service they provide ((that would be required of any other 34
long-term services and supports provider to receive payments from the 35
state)). 36
(((15))) (14) "Qualified individual" means an individual who 37
meets the duration of payment requirements, as established in this 38
chapter. 39
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(((16))) (15) "State actuary" means the office of the state 1
actuary created in RCW 44.44.010. 2
(((17))) (16) "Wage or wages" means all remuneration paid by an 3
employer to an employee. Remuneration has the meaning provided in RCW 4
50A.05.010. All wages are subject to a premium assessment and not 5
limited by the commissioner of the employment security department, as 6
provided under RCW 50A.10.030(4). 7
Sec. 3. RCW 50B.04.020 and 2024 c 120 s 4 are each amended to 8
read as follows: 9
(1) The health care authority, the department of social and 10
health services, the office of the state actuary, and the employment 11
security department each have distinct responsibilities in the 12
implementation and administration of the program. In the performance 13
of their activities, they shall actively collaborate to realize 14
program efficiencies and provide persons served by the program with a 15
well-coordinated experience. 16
(2) The health care authority shall: 17
(a) Track the use of lifetime benefit units to verify the 18
individual's status as an eligible beneficiary as determined by the 19
department of social and health services; 20
(b) Ensure approved services are provided through audits or 21
service verification processes within the service provider payment 22
system for registered long-term services and supports providers and 23
recoup any inappropriate payments; 24
(c) Establish criteria for the payment of benefits to 25
((registered)) long-term services and supports providers under RCW 26
50B.04.070; 27
(d) Establish rules and procedures for benefit coordination when 28
the eligible beneficiary is also funded for medicaid and other long-29
term services and supports, including medicare, coverage through the 30
department of labor and industries, and private long-term care 31
coverage; ((and))32
(e) Assist the department of social and health services with the 33
leveraging of existing payment systems for the provision of approved 34
services to beneficiaries under RCW 50B.04.070; and35
(f) Adopt rules and procedures necessary to implement and 36
administer the activities specified in this section related to the 37
program. 38
(3) The department of social and health services shall:39
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(a) Make determinations regarding an individual's status as an 1
eligible beneficiary under RCW 50B.04.060; 2
(b) Approve long-term services and supports eligible for payment 3
as approved services under the program, as informed by the 4
commission; 5
(c) Register long-term services and supports providers that meet 6
minimum qualifications; 7
(d) Discontinue the registration of long-term services and 8
supports providers that: (i) Fail to meet the minimum qualifications 9
applicable in law to the approved service that they provide; or (ii) 10
violate the operational standards of the program; 11
(e) Disburse payments of benefits to registered long-term 12
services and supports providers, utilizing and leveraging existing 13
payment systems for the provision of approved services to eligible 14
beneficiaries under RCW 50B.04.070; 15
(f) Prepare and distribute written or electronic materials to 16
qualified individuals, eligible beneficiaries, and the public as 17
deemed necessary by the commission to inform them of program design 18
and updates; 19
(g) Provide customer service and address questions and 20
complaints, including referring individuals to other appropriate 21
agencies; 22
(h) Provide administrative and operational support to the 23
commission; 24
(i) Track data useful in monitoring and informing the program, as 25
identified by the commission; 26
(j) Develop criteria to deem a family member as qualified when 27
providing approved services outside of Washington; and28
(k) Adopt rules and procedures necessary to implement and 29
administer the activities specified in this section related to the 30
program. 31
(4) The employment security department shall: 32
(a) Collect and assess employee premiums as provided in RCW 33
50B.04.080, 50B.04.090, and 50B.04.180; 34
(b) Assist the commission ((, council, )) and state actuary in 35
monitoring the solvency and financial status of the program;36
(c) Perform investigations to determine the compliance of premium 37
payments in RCW 50B.04.080, 50B.04.090, and 50B.04.180 in 38
coordination with the same activities conducted under the family and 39
medical leave act, Title 50A RCW, to the extent possible;40
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(d) Make determinations regarding an individual's status as a 1
qualified individual under RCW 50B.04.050, including criteria to 2
determine the status of persons receiving partial benefit units under 3
RCW 50B.04.050(2) and out-of-state participants under RCW 50B.04.180; 4
and 5
(e) Adopt rules and procedures necessary to implement and 6
administer the activities specified in this section related to the 7
program. 8
(5) The office of the state actuary shall: 9
(a) Beginning July 1, 2025, and biennially thereafter, perform an 10
actuarial audit and valuation of the long-term services and supports 11
trust fund. Additional or more frequent actuarial audits and 12
valuations may be performed at the request of the ((council)) 13
commission; 14
(b) Make recommendations to the ((council)) commission and the 15
legislature on actions necessary to maintain trust solvency. The 16
recommendations must include options to redesign or reduce benefit 17
units, approved services, or both, to prevent or eliminate any 18
unfunded actuarially accrued liability in the trust or to maintain 19
solvency; and 20
(c) Select and contract for such actuarial, research, technical, 21
and other consultants as the actuary deems necessary to perform its 22
duties under chapter 363, Laws of 2019. 23
(6) By October 1, 2021, the employment security department and 24
the department of social and health services shall jointly conduct 25
outreach to provide employers with educational materials to ensure 26
employees are aware of the program and that the premium assessments 27
will begin on July 1, 2023. In conducting the outreach, the 28
employment security department and the department of social and 29
health services shall provide on a public website information that 30
explains the program and premium assessment in an easy to understand 31
format. Outreach information must be available in English and other 32
primary languages as defined in RCW 74.04.025. 33
Sec. 4. RCW 50B.04.030 and 2022 c 1 s 2 are each amended to read 34
as follows: 35
(1) The long-term services and supports trust commission is 36
established. The commission's recommendations and decisions must be 37
guided by the joint goals of maintaining benefit adequacy and 38
maintaining fund solvency and sustainability. 39
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(2) The commission includes: 1
(a) Two members from each of the two largest caucuses of the 2
house of representatives, appointed by the speaker of the house of 3
representatives; 4
(b) Two members from each of the two largest caucuses of the 5
senate, appointed by the president of the senate; 6
(c) The commissioner of the employment security department, or 7
the commissioner's designee; 8
(d) The secretary of the department of social and health 9
services, or the secretary's designee; 10
(e) The director of the health care authority, or the director's 11
designee, who shall serve as a nonvoting member; 12
(f) One representative of the organization representing the area 13
agencies on aging; 14
(g) One representative of a home care association that represents 15
caregivers who provide services to private pay and medicaid clients;16
(h) One representative of a union representing long-term care 17
workers; 18
(i) One representative of an organization representing retired 19
persons; 20
(j) One representative of an association representing skilled 21
nursing facilities and assisted living providers; 22
(k) One representative of an association representing adult 23
family home providers; 24
(l) Two individuals receiving long-term services and supports, or 25
their designees, or representatives of consumers receiving long-term 26
services and supports under the program; 27
(m) One member who is a worker who is, or will likely be, paying 28
the premium established in RCW 50B.04.080 and who is not employed by 29
a long-term services and supports provider; and 30
(n) One representative of an organization of employers whose 31
members collect, or will likely be collecting, the premium 32
established in RCW 50B.04.080. 33
(3)(a) Other than the legislators and agency heads identified in 34
subsection (2) of this section, members of the commission are 35
appointed by the governor for terms of two years, except that the 36
governor shall appoint the initial members identified in subsection 37
(2)(f) through (n) of this section to staggered terms not to exceed 38
four years. 39
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(b) The secretary of the department of social and health 1
services, or the secretary's designee, shall serve as chair of the 2
commission. Meetings of the commission are at the call of the chair. 3
A majority of the voting members of the commission shall constitute a 4
quorum for any votes of the commission. Approval of ((sixty)) 60 5
percent of those voting members of the commission who are in 6
attendance is required for the passage of any vote.7
(c) Members of the commission and the subcommittee established in 8
subsection (6) of this section must be compensated in accordance with 9
RCW 43.03.250 and must be reimbursed for their travel expenses while 10
on official business in accordance with RCW 43.03.050 and 43.03.060.11
(4) Beginning January 1, 2021, the commission shall propose 12
recommendations to the appropriate executive agency or the 13
legislature regarding: 14
(a) The establishment of criteria for determining that an 15
individual has met the requirements to be a qualified individual as 16
established in RCW 50B.04.050 or an eligible beneficiary as 17
established in RCW 50B.04.060; 18
(b) The establishment of criteria for minimum qualifications for 19
the registration of long-term services and supports providers who 20
provide approved services to eligible beneficiaries;21
(c) The establishment of payment maximums for approved services 22
consistent with actuarial soundness which shall not be lower than 23
medicaid payments for comparable services. A service or supply may be 24
limited by dollar amount, duration, or number of visits. The 25
commission shall engage affected stakeholders to develop this 26
recommendation; 27
(d) Changes to rules or policies to improve the operation of the 28
program; 29
(e) ((Providing a recommendation to the council for the annual 30
adjustment of the benefit unit in accordance with RCW 50B.04.010 and 31
50B.04.040;32
(f))) A refund of premiums for a deceased qualified individual 33
with a dependent who is an individual with a developmental disability 34
who is dependent for support from a qualified individual. The 35
qualified individual must not have been determined to be an eligible 36
beneficiary by the department of social and health services. The 37
refund shall be deposited into an individual trust account within the 38
developmental disabilities endowment trust fund for the benefit of 39
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the dependent with a developmental disability. The commission shall 1
consider: 2
(i) The value of the refund to be ((one hundred)) 100 percent of 3
the current value of the qualified individual's lifetime premium 4
payments at the time that certification of death of the qualified 5
individual is submitted, less any administrative process fees; and6
(ii) The criteria for determining whether the individual is 7
developmentally disabled. The determination shall not be based on 8
whether or not the individual with a developmental disability is 9
receiving services under Title 71A RCW, or another state or local 10
program; and11
(((g))) (f) Assisting the state actuary with the preparation of 12
regular actuarial reports on the solvency and financial status of the 13
program and advising the legislature on actions necessary to maintain 14
trust solvency. The commission shall provide the office of the state 15
actuary with all actuarial reports for review. The office of the 16
state actuary shall provide any recommendations to the commission and 17
the legislature on actions necessary to maintain trust solvency((;18
(h) For the January 1, 2021, report only, recommendations on 19
whether and how to extend coverage to individuals who became disabled 20
before the age of eighteen, including the impact on the financial 21
status and solvency of the trust. The commission shall engage 22
affected stakeholders to develop this recommendation; and23
(i) For the January 1, 2021, report only, the commission shall 24
consult with the office of the state actuary on the development of an 25
actuarial report of the projected solvency and financial status of 26
the program. The office of the state actuary shall provide any 27
recommendations to the commission and the legislature on actions 28
necessary to achieve trust solvency)). 29
(5) The commission shall monitor agency administrative expenses 30
over time. Beginning November 15, 2020, the commission must annually 31
report to the governor and the fiscal committees of the legislature 32
on agency spending for administrative expenses and anticipated 33
administrative expenses as the program shifts into different phases 34
of implementation and operation. The November 15, 2027, report must 35
include recommendations for a method of calculating future agency 36
administrative expenses to limit administrative expenses while 37
providing sufficient funds to adequately operate the program. The 38
agency heads identified in subsection (2) of this section may advise 39
the commission on the reports prepared under this subsection, but 40
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must recuse themselves from the commission's process for review, 1
approval, and submission to the legislature. 2
(6) The commission shall establish an investment strategy 3
subcommittee consisting of the members identified in subsection 4
(2)(a) through (d) of this section as voting members of the 5
subcommittee. In addition, four members appointed by the governor who 6
are considered experienced and qualified in the field of investment 7
shall serve as nonvoting members. The subcommittee shall provide 8
guidance and advice to the state investment board on investment 9
strategies for the account, including seeking counsel and advice on 10
the types of investments that are constitutionally permitted.11
(7) The commission shall work with insurers to develop long-term 12
care insurance products that supplement the program's benefit.13
Sec. 5. RCW 50B.04.050 and 2024 c 120 s 5 are each amended to 14
read as follows: 15
(1) Except as provided in subsection (2) of this section, the 16
employment security department shall deem a person to be a qualified 17
individual as provided in this chapter if the person has paid the 18
long-term services and supports premiums required by RCW 50B.04.080 19
for the equivalent of either: 20
(a) A total of ten years ((without interruption of five or more 21
consecutive years)); or 22
(b) Three years within the last six years from the date of 23
application for benefits. 24
(2) A person born before January 1, 1968, who has not met the 25
duration requirements under subsection (1)(a) of this section may 26
become a qualified individual with fewer than the number of years 27
identified in subsection (1)(a) of this section if the person has 28
paid the long-term services and supports premiums required by RCW 29
50B.04.080 for at least one year. A person becoming a qualified 30
individual pursuant to this subsection (2) may receive one-tenth of 31
the maximum number of benefit units available under RCW 32
50B.04.060(3)(b) for each year of premium payments. In accordance 33
with RCW 50B.04.060, benefits for eligible beneficiaries in 34
Washington will not be available until July 1, 2026, and benefits for 35
out-of-state participants who become eligible beneficiaries will not 36
be available until July 1, 2030, and nothing in this section requires 37
the department of social and health services to accept applications 38
for determining an individual's status as an eligible beneficiary 39
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prior to July 1, 2026. Nothing in this subsection (2) prohibits a 1
person born before January 1, 1968, who meets the conditions of 2
subsection (1)(b) of this section from receiving the maximum number 3
of benefit units available under RCW 50B.04.060(3)(b).4
(3) When deeming a person to be a qualified individual, the 5
employment security department shall require that the person have 6
worked at least 500 hours during each of the ten years in subsection 7
(1)(a) of this section, each of the three years in subsection (1)(b) 8
of this section, or each of the years identified in subsection (2) of 9
this section. 10
(4) An exempt employee may never be deemed to be a qualified 11
individual, unless the employee's exemption was discontinued under 12
RCW 50B.04.055 or rescinded under RCW 50B.04.085.13
(5) An out-of-state resident whose elective coverage has been 14
canceled by the employment security department under RCW 50B.04.180 15
may not be deemed to be a qualified individual. 16
Sec. 6. RCW 50B.04.055 and 2022 c 2 s 2 are each amended to read 17
as follows: 18
(1) ((Beginning January 1, 2023, the )) The employment security 19
department shall accept and approve applications for voluntary 20
exemptions from the premium assessment under RCW 50B.04.080 for any 21
employee who meets criteria established by the employment security 22
department for an exemption based on the employee's status as:23
(a) A veteran of the United States military who has been rated by 24
the United States department of veterans affairs as having a service-25
connected disability of 70 percent or greater; 26
(b) A spouse or registered domestic partner of an active duty 27
service member in the United States armed forces whether or not 28
deployed or stationed within or outside of Washington;29
(c) An employee who holds a nonimmigrant visa for temporary 30
workers, as recognized by federal law, and is employed by an employer 31
in Washington; ((or))32
(d) An employee who is employed by an employer in Washington, but 33
maintains a permanent address outside of Washington as the employee's 34
primary location of residence; or35
(e) Beginning January 1, 2026, an active duty service member in 36
the United States armed forces, whether or not deployed or stationed 37
within or outside of Washington, who is concurrently engaged in off-38
duty civilian employment as an employee of an employer.39
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(2) The employment security department shall adopt criteria, 1
procedures, and rules for verifying the information submitted by the 2
applicant for an exemption under subsection (1) of this section.3
(3) An employee who receives an exemption under subsection (1) of 4
this section may not become a qualified individual or eligible 5
beneficiary and is permanently ineligible for coverage under this 6
title, unless the exemption has been discontinued as provided in 7
subsection (4), (5), or (6) of this section. 8
(4)(a) An exemption granted in accordance with the conditions 9
under subsection (1)(b) of this section must be discontinued within 10
90 days of: 11
(i) The discharge or separation from military service of the 12
employee's spouse or registered domestic partner; or13
(ii) The dissolution of the employee's marriage or registered 14
domestic partnership with the active duty service member.15
(b) An exemption granted in accordance with the conditions under 16
subsection (1)(d) of this section must be discontinued within 90 days 17
of establishing a permanent address within Washington as the 18
employee's primary location of residence.19
(c) An exemption granted in accordance with the conditions under 20
subsection (1)(e) of this section must be discontinued within 90 days 21
of the discharge or separation from military service.22
(5)(a) Within 90 days of the occurrence of ((either of )) the 23
events described in (((a) of this )) subsection (4) of this section , 24
an employee who has received an exemption under subsection (1) of 25
this section shall: 26
(i) Notify the employment security department that the exemption 27
must be discontinued because of the occurrence of ((either of )) the 28
events described in (((a) of this )) subsection (4) of this section ; 29
and 30
(ii) Notify the employee's employer that the employee is no 31
longer exempt and that the employer must begin collecting premiums 32
from the employee in accordance with RCW 50B.04.080.33
(((c))) (b) Upon notification to the employment security 34
department and the employer, premium assessments established under 35
RCW 50B.04.080 must begin and the employee may become a qualified 36
individual or eligible beneficiary upon meeting the requirements 37
established in this chapter. 38
(((d))) (c) Failure to begin paying the premium established under 39
RCW 50B.04.080 within 90 days of the occurrence of ((either of)) the 40
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events described in (((a) of this )) subsection (4) of this section 1
shall result in the payment of any unpaid premiums from the employee, 2
with interest at the rate of one percent per month or fraction 3
thereof, by the employee to the employment security department from 4
the date on which the payment should have begun. 5
(((5))) (6)(a) An exemption granted in accordance with the 6
conditions under subsection (1)(((c))) (d) of this section must be 7
discontinued within 90 days of an employee changing the employee's 8
nonimmigrant visa for temporary workers status to become a permanent 9
resident or citizen employed in Washington.10
(b) Within 90 days of the employee changing the employee's 11
nonimmigrant visa for temporary workers status to become a permanent 12
resident or citizen employed in Washington, the employee who has 13
received an exemption under subsection (1)(((c))) (d) of this section 14
shall:15
(i) Notify the employment security department that the employee 16
no longer holds a nonimmigrant visa for temporary workers and is a 17
permanent resident or citizen employed in Washington and the 18
exemption must be discontinued; and19
(ii) Notify the employee's employer that the employee no longer 20
holds a nonimmigrant visa for temporary workers and is a permanent 21
resident or citizen employed in Washington, and that the employer 22
must begin collecting premiums from the employee in accordance with 23
RCW 50B.04.080.24
(c) Upon notification to the employment security department and 25
the employer, premium assessments established under RCW 50B.04.080 26
must begin and the employee may become a qualified individual or 27
eligible beneficiary upon meeting the requirements established in 28
this chapter.29
(d) Failure to begin paying the premium established under RCW 30
50B.04.080 within 90 days of an employee no longer holding a 31
nonimmigrant visa for temporary workers and becoming a permanent 32
resident or citizen employed in Washington shall result in the 33
payment of any unpaid premiums from the employee, with interest at 34
the rate of one percent per month or fraction thereof, by the 35
employee to the employment security department from the date on which 36
the payment should have begun.37
(((6))) (7)(a) An exemption granted in accordance with the 38
conditions under subsection (1)(((d))) (e) of this section must be 39
discontinued within 90 days of an employee establishing a permanent 40
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address within Washington as the employee's primary location of 1
residence. 2
(b) Within 90 days of the employee establishing a permanent 3
address within Washington as the employee's primary location of 4
residence, the employee who has received an exemption under 5
subsection (1)(((d))) (e) of this section shall:6
(i) Notify the employment security department that the employee 7
is residing in Washington and the exemption must be discontinued; and8
(ii) Notify the employee's employer that the employee is no 9
longer exempt and that the employer must begin collecting premiums 10
from the employee in accordance with RCW 50B.04.080.11
(c) Upon notification to the employment security department and 12
the employer, premium assessments established under RCW 50B.04.080 13
must begin and the employee may become a qualified individual or 14
eligible beneficiary upon meeting the requirements established in 15
this chapter.16
(d) Failure to begin paying the premium established under RCW 17
50B.04.080 within 90 days of an employee establishing a permanent 18
address within Washington as the employee's primary location of 19
residence shall result in the payment of any unpaid premiums from the 20
employee, with interest at the rate of one percent per month or 21
fraction thereof, by the employee to the employment security 22
department from the date on which the payment should have begun.23
(((7))) (8) Exempt employees are not entitled to a refund of any 24
premium deductions made before the effective date of an approved 25
exemption, except for premiums collected prior to the effective date 26
of the premium assessment under RCW 50B.04.080. 27
(((8))) (9) An employee who has received an exemption pursuant to 28
this section shall provide written notification to all current and 29
future employers of an approved exemption. 30
(((9))) (10) If an exempt employee fails to notify an employer of 31
an exemption, the exempt employee is not entitled to a refund of any 32
premium deductions made before notification is provided, except for 33
premiums collected prior to the effective date of the premium 34
assessment under RCW 50B.04.080. 35
(((10))) (11) Employers may not deduct premiums after being 36
notified by an employee of an approved exemption issued under this 37
section. 38
(a) Employers shall retain written notifications of exemptions 39
received from employees. 40
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(b) An employer who deducts premiums after being notified by the 1
employee of an exemption is solely responsible for refunding to the 2
employee any premiums deducted after the notification.3
(c) The employer is not entitled to a refund from the employment 4
security department for any premiums remitted to the employment 5
security department that were deducted from exempt employees.6
(((11))) (12) The provisions of RCW 50B.04.085 do not apply to 7
the exemptions issued pursuant to this section. 8
(((12))) (13) The employment security department shall adopt 9
rules necessary to implement and administer the activities specified 10
in this section related to the program, including rules on the 11
submission and processing of applications under this section.12
Sec. 7. RCW 50B.04.060 and 2024 c 120 s 6 are each amended to 13
read as follows: 14
(1) Beginning July 1, 2026, approved services must be available 15
and benefits payable to a ((registered)) long-term services and 16
supports provider on behalf of an eligible beneficiary under this 17
section. 18
(2)(a)(i) Except for qualified individuals residing outside of 19
Washington as provided in (a)(ii) of this subsection, beginning July 20
1, 2026, a qualified individual may become an eligible beneficiary by 21
filing an application with the department of social and health 22
services and undergoing an eligibility determination which includes 23
an evaluation that the individual requires assistance with at least 24
three activities of daily living , as defined by the department of 25
social and health services for long-term services and supports 26
programs, which is expected to last for at least 90 days.27
(ii) For a qualified individual residing outside of Washington, 28
beginning ((January)) July 1, 2030, the out-of-state qualified 29
individual may become an eligible beneficiary by filing an 30
application with the department of social and health services and 31
undergoing an eligibility determination. The eligibility 32
determination must include an evaluation that the individual either 33
(A) is unable to perform, without substantial assistance from another 34
individual, at least two of the following activities of daily living 35
for a period of at least 90 days due to a loss of functional 36
capacity: Eating, toileting, transferring, bathing, dressing, or 37
continence, or (B) requires substantial supervision to protect such 38
p. 17 SB 5291
individual from threats to health and safety due to severe cognitive 1
impairments. 2
(b) The department of social and health services must engage 3
sufficient qualified assessor capacity, including via contract, so 4
that the determination may be made within 45 days from receipt of a 5
request by a beneficiary to use a benefit. 6
(3)(a) An eligible beneficiary may receive approved services and 7
benefits through the program in the form of a benefit unit payable to 8
a ((registered)) long-term services and supports provider.9
(b) Except as limited in RCW 50B.04.050(2), an eligible 10
beneficiary may not receive more than the dollar equivalent of 365 11
benefit units over the course of the eligible beneficiary's lifetime.12
(i) If the department of social and health services reimburses a 13
long-term services and supports provider for approved services 14
provided to an eligible beneficiary and the payment is less than the 15
benefit unit, only the portion of the benefit unit that is used shall 16
be taken into consideration when calculating the person's remaining 17
lifetime limit on receipt of benefits. 18
(ii) Eligible beneficiaries may combine benefit units to receive 19
more approved services per day as long as the total number of 20
lifetime benefit units has not been exceeded. 21
Sec. 8. RCW 50B.04.070 and 2024 c 120 s 7 are each amended to 22
read as follows: 23
(1)(a) Benefits provided under this chapter shall be paid 24
periodically and promptly to long-term services and supports 25
providers who provide approved services to: 26
(((a))) (i) Eligible beneficiaries in Washington if the long-term 27
services and supports provider is registered with the department of 28
social and health services; and 29
(((b))) (ii) Eligible beneficiaries outside Washington if the 30
long-term services and supports providers meet minimum standards 31
established by the department. 32
(((2))) (b) The department of social and health services may 33
contract with a third party to administer payments to long-term 34
services and supports providers providing services to eligible 35
beneficiaries whether inside or outside of Washington.36
(c) Qualified family members may be paid for approved personal 37
care services in the same way as individual providers, through a 38
licensed home care agency, or through a third option ((if)) as 39
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recommended by the commission ((and)) if adopted by the department of 1
social and health services. 2
(2) The department of social and health services shall establish 3
payment methods and procedures that are most appropriate and 4
efficient for the different categories of service providers 5
identified in subsection (1) of this section, including collaboration 6
with other agencies and contracting with third parties, as necessary.7
Sec. 9. RCW 50B.04.080 and 2022 c 2 s 1 and 2022 c 1 s 5 are 8
each reenacted and amended to read as follows: 9
(1) Unless otherwise exempted pursuant to this chapter, beginning 10
July 1, 2023, the employment security department shall assess for 11
each individual in employment with an employer a premium based on the 12
amount of the individual's wages. The initial premium rate is .58 13
percent of the individual's wages. Beginning January 1, 2026, and 14
biennially thereafter, the premium rate shall be set by the pension 15
funding council at a rate no greater than .58 percent. In addition, 16
the pension funding council must set the premium rate at the lowest 17
amount necessary to maintain the actuarial solvency of the long-term 18
services and supports trust account created in RCW 50B.04.100 in 19
accordance with recognized insurance principles and designed to 20
attempt to limit fluctuations in the premium rate. To facilitate the 21
premium rate setting the office of the state actuary must perform a 22
biennial actuarial audit and valuation of the fund and make 23
recommendations to the pension funding council. 24
(2)(a) The employer must collect from the employees the premiums 25
provided under this section through payroll deductions and remit the 26
amounts collected to the employment security department.27
(b) In collecting employee premiums through payroll deductions, 28
the employer shall act as the agent of the employees and shall remit 29
the amounts to the employment security department as required by this 30
chapter. 31
(3) ((Nothing in this chapter requires any party to a collective 32
bargaining agreement in existence on October 19, 2017, to reopen 33
negotiations of the agreement or to apply any of the responsibilities 34
under this chapter unless and until the existing agreement is 35
reopened or renegotiated by the parties or expires.36
(4)))(a) Premiums shall be collected in the manner and at such 37
intervals as provided in this chapter and directed by the employment 38
security department. 39
p. 19 SB 5291
(b) To the extent feasible, the employment security department 1
shall use the premium assessment, collection, and reporting 2
procedures in Title 50A RCW. 3
(((5))) (4) The employment security department shall deposit all 4
premiums collected in this section in the long-term services and 5
supports trust account created in RCW 50B.04.100. 6
(((6))) (5) Premiums collected in this section are placed in the 7
trust account for the individuals who become eligible for the 8
program. 9
(((7))) (6) If the premiums established in this section are 10
increased, the legislature shall notify each qualified individual by 11
mail that the person's premiums have been increased, describe the 12
reason for increasing the premiums, and describe the plan for 13
restoring the funds so that premiums are returned to .58 percent of 14
the individual's wages. 15
Sec. 10. RCW 50B.04.085 and 2021 c 113 s 5 are each amended to 16
read as follows: 17
(1) An employee who attests that the employee has long-term care 18
insurance purchased before November 1, 2021, may apply for an 19
exemption from the premium assessment under RCW 50B.04.080. ((An 20
exempt employee may not become a qualified individual or eligible 21
beneficiary and is permanently ineligible for coverage under this 22
title.))23
(2)(a) The employment security department must accept 24
applications for exemptions only from October 1, 2021, through 25
December 31, 2022. 26
(b) Only employees who are eighteen years of age or older may 27
apply for an exemption. 28
(3) The employment security department is not required to verify 29
the attestation of an employee that the employee has long-term care 30
insurance. 31
(4) Approved exemptions will take effect on the first day of the 32
quarter immediately following the approval of the exemption.33
(5) Exempt employees are not entitled to a refund of any premium 34
deductions made before the effective date of an approved exemption.35
(6) An exempt employee must provide written notification to all 36
current and future employers of an approved exemption.37
p. 20 SB 5291
(7) If an exempt employee fails to notify an employer of an 1
exemption, the exempt employee is not entitled to a refund of any 2
premium deductions made before notification is provided.3
(8) Employers must not deduct premiums after being notified by an 4
employee of an approved exemption. 5
(a) Employers must retain written notifications of exemptions 6
received from employees. 7
(b) An employer who deducts premiums after being notified by the 8
employee of an exemption is solely responsible for refunding to the 9
employee any premiums deducted after the notification.10
(c) The employer is not entitled to a refund from the employment 11
security department for any premiums remitted to the employment 12
security department that were deducted from exempt employees.13
(9)(a) Except as provided in (b) of this subsection, an exempt 14
employee may not become a qualified individual or eligible 15
beneficiary and is permanently ineligible for coverage under this 16
title.17
(b) Prior to July 1, 2028, an employee who has received an 18
approved exemption pursuant to this section may rescind the exemption 19
and participate in the program. The employee must notify the 20
employment security department of the rescission according to 21
procedures established by the employment security department. The 22
employee will be subject to premium assessments under RCW 50B.04.080 23
or 50B.04.090 upon notification to the employment security department 24
of the rescission. The employee is not responsible for any premiums 25
that would have been assessed prior to the rescission. When deeming a 26
person to be a qualified individual under RCW 50B.04.050, the 27
employment security department may not consider any years in which 28
the rescinding employee had been in exempt status unless the employee 29
had been assessed the premium for a part of the year and the number 30
of hours worked while being assessed met the minimum hour 31
requirement.32
(10) The employment security department must adopt rules 33
necessary to implement and administer the activities specified in 34
this section related to the program, including rules on the 35
submission and processing of applications and the rescission of an 36
exemption under this section. 37
Sec. 11. RCW 50B.04.100 and 2024 c 120 s 8 are each amended to 38
read as follows: 39
p. 21 SB 5291
(1) The long-term services and supports trust account is created 1
in the custody of the state treasurer. All receipts from employers 2
under RCW 50B.04.080 and from out-of-state participants under RCW 3
50B.04.180, delinquent premiums, penalties, and interest received 4
pursuant to sections 12 and 13 of this act, and any funds 5
attributable to savings derived through a waiver with the federal 6
centers for medicare and medicaid services pursuant to RCW 50B.04.130 7
must be deposited in the account. Expenditures from the account may 8
be used for the administrative activities of the department of social 9
and health services, the health care authority, and the employment 10
security department. Benefits associated with the program must be 11
disbursed from the account by the department of social and health 12
services. Only the secretary of the department of social and health 13
services or the secretary's designee may authorize disbursements from 14
the account. The account is subject to the allotment procedures under 15
chapter 43.88 RCW. An appropriation is required for administrative 16
expenses, but not for benefit payments. The account must provide 17
reimbursement of any amounts from other sources that may have been 18
used for the initial establishment of the program.19
(2) The revenue generated pursuant to this chapter shall be 20
utilized to expand long-term care in the state. These funds may not 21
be used either in whole or in part to supplant existing state or 22
county funds for programs that meet the definition of approved 23
services. 24
(3) The moneys deposited in the account must remain in the 25
account until expended in accordance with the requirements of this 26
chapter. If moneys are appropriated for any purpose other than 27
supporting the long-term services and supports program, the 28
legislature shall notify each qualified individual by mail that the 29
person's premiums have been appropriated for an alternate use, 30
describe the alternate use, and state its plan for restoring the 31
funds so that premiums are not increased and benefits are not 32
reduced. 33
NEW SECTION. Sec. 12. A new section is added to chapter 50B.04 34
RCW to read as follows: 35
(1) In the form and at the times specified in this chapter and by 36
the commissioner of the employment security department, an employer 37
shall make reports, furnish information, and collect and remit 38
premiums as required by this chapter to the employment security 39
p. 22 SB 5291
department. If the employer is a temporary help company that provides 1
employees on a temporary basis to its customers, the temporary help 2
company is considered the employer for purposes of this section.3
(2)(a) An employer must keep at the employer's place of business 4
a record of employment, for a period of six years, from which the 5
information needed by the employment security department for purposes 6
of this chapter may be obtained. This record shall at all times be 7
open to the inspection of the commissioner of the employment security 8
department. 9
(b) Information obtained under this chapter from employer records 10
is confidential and not open to public inspection, other than to 11
public employees in the performance of their official duties. An 12
interested party, however, shall be supplied with information from 13
employer records to the extent necessary for the proper presentation 14
of the case in question. An employer may authorize inspection of the 15
employer's records by written consent. 16
(3) The requirements relating to the collection of long-term 17
services and supports trust program premiums are as provided in this 18
chapter. Before issuing a warning letter or collecting penalties, the 19
employment security department shall enforce the collection of 20
premiums through conference and conciliation. These requirements 21
apply to: 22
(a) An employer that fails under this chapter to make the 23
required reports, or fails to remit the full amount of the premiums 24
when due; 25
(b) An employer that willfully makes a false statement or 26
misrepresentation regarding a material fact, or willfully fails to 27
report a material fact, to avoid making the required reports or 28
remitting the full amount of the premiums when due under this 29
chapter; 30
(c) A successor in the manner specified in employment security 31
department rules; and 32
(d) An officer, member, or owner having control or supervision of 33
payment or reporting of long-term services and supports trust program 34
premiums, or who is charged with the responsibility for the filing of 35
returns, in the manner specified in subsection (4) of this section.36
(4)(a) An employer who willfully fails to make the required 37
reports is subject to penalties as follows: (i) For the second 38
occurrence, the penalty is $75; (ii) for the third occurrence, the 39
p. 23 SB 5291
penalty is $150; and (iii) for the fourth occurrence and for each 1
occurrence thereafter, the penalty is $250. 2
(b) An employer who willfully fails to remit the full amount of 3
the premiums when due is liable, in addition to the full amount of 4
premiums due and amounts assessed as interest under subsection (5) of 5
this section, to a penalty equal to the premiums and interest.6
(c) Any penalties under this section shall be deposited into the 7
account. 8
(d) For the purposes of this subsection, "willful" means a 9
knowing and intentional action that is neither accidental nor the 10
result of a bona fide dispute. 11
(e) The employment security department shall enforce the 12
collection of penalties through conference and conciliation.13
(5) Appeals of actions under this section are governed by RCW 14
50B.04.120. 15
NEW SECTION. Sec. 13. A new section is added to chapter 50B.04 16
RCW to read as follows: 17
(1) At any time after the commissioner of the employment security 18
department finds that any premiums, interest, or penalties have 19
become delinquent, the commissioner of the employment security 20
department may issue an order and notice of assessment specifying the 21
amount due. The order and notice of assessment shall be served upon 22
the delinquent employer in the manner prescribed for the service of a 23
summons in a civil action, or using a method by which the mailing can 24
be tracked or the delivery can be confirmed. Failure of the employer 25
to receive the notice or order, whether served or mailed, shall not 26
release the employer from any tax, or any interest or penalties.27
(2) If the commissioner of the employment security department has 28
reason to believe that an employer is insolvent or if any reason 29
exists why the collection of any premiums accrued will be jeopardized 30
by delaying collection, the commissioner of the employment security 31
department may make an immediate assessment of the premiums and may 32
proceed to enforce collection immediately, but interest and penalties 33
shall not begin to accrue upon any premiums until the date when such 34
premiums would normally have become delinquent. 35
(3) If premiums are not paid on the date on which they are due 36
and payable as prescribed by the commissioner of the employment 37
security department, the whole or part thereof remaining unpaid shall 38
bear interest at the rate of one percent per month or fraction 39
p. 24 SB 5291
thereof from and after such date until payment plus accrued interest 1
is received by the commissioner of the employment security 2
department. The date as of which payment of premiums, if mailed, is 3
deemed to have been received may be determined by such regulations as 4
the commissioner of the employment security department may prescribe. 5
Interest collected pursuant to this section shall be paid into the 6
account. Interest shall not accrue on premiums from any estate in the 7
hands of a receiver, executor, administrator, trustee in bankruptcy, 8
common law assignee, or other liquidating officer subsequent to the 9
date when such receiver, executor, administrator, trustee in 10
bankruptcy, common law assignee, or other liquidating officer 11
qualifies as such, but premiums accruing with respect to employment 12
of persons by any receiver, executor, administrator, trustee in 13
bankruptcy, common law assignee, or other liquidating officer shall 14
become due and shall draw interest in the same manner as premiums due 15
from other employers. Where adequate information has been furnished 16
to the employment security department and the employment security 17
department has failed to act or has advised the employer of no 18
liability or inability to decide the issue, interest may be waived.19
(4)(a) If the amount of premiums, interest, or penalties assessed 20
by the commissioner of the employment security department by order 21
and notice of assessment provided in this chapter is not paid within 22
10 days after the service or mailing of the order and notice of 23
assessment, the commissioner of the employment security department or 24
a duly authorized representative may collect the amount stated in the 25
assessment by the distraint, seizure, and sale of the property, 26
goods, chattels, and effects of the delinquent employer. Goods and 27
property that are exempt from execution under the laws of this state 28
are exempt from distraint and sale under this section.29
(b) The commissioner of the employment security department, upon 30
making a distraint, shall seize the property and shall make an 31
inventory of the distrained property, a copy of which shall be mailed 32
to the owner of the property or personally delivered to the owner, 33
and shall specify the time and place when the property shall be sold. 34
A notice specifying the property to be sold and the time and place of 35
sale shall be posted in at least two public places in the county in 36
which the seizure has been made. The time of sale shall be not less 37
than 10 nor more than 20 days from the date of posting of the 38
notices. The sale may be adjourned from time to time at the 39
discretion of the commissioner of the employment security department, 40
p. 25 SB 5291
but not for a time to exceed a total of 60 days. The sale shall be 1
conducted by the commissioner of the employment security department 2
or a representative who shall proceed to sell the property by parcel 3
or by lot at a public auction, and who may set a minimum price to 4
include the expenses of making a levy and of advertising the sale, 5
and if the amount bid for such property at the sale is not equal to 6
the minimum price so fixed, the commissioner of the employment 7
security department or a representative may declare the property to 8
be purchased by the employment security department for the minimum 9
price. In such event the delinquent account shall be credited with 10
the amount for which the property has been sold. Property acquired by 11
the employment security department as prescribed in this subsection 12
(4) may be sold by the commissioner of the employment security 13
department or a representative at public or private sale, and the 14
amount realized shall be placed in the account. In all cases of sale 15
under this subsection (4), the commissioner of the employment 16
security department shall issue a bill of sale or a deed to the 17
purchaser and the bill of sale or deed shall be prima facie evidence 18
of the right of the commissioner of the employment security 19
department to make the sale and conclusive evidence of the regularity 20
of the commissioner of the employment security department proceeding 21
in making the sale, and shall transfer to the purchaser all right, 22
title, and interest of the delinquent employer in the property. The 23
proceeds of any sale under this subsection (4), except in those cases 24
in which the property has been acquired by the employment security 25
department, shall be first applied by the commissioner of the 26
employment security department in satisfaction of the delinquent 27
account, and out of any sum received in excess of the amount of 28
delinquent premiums, interest, and penalties the account shall be 29
reimbursed for the costs of distraint and sale. Any excess amounts 30
held by the commissioner of the employment security department shall 31
be refunded to the delinquent employer. Amounts held by the 32
commissioner of the employment security department that are 33
refundable to a delinquent employer may be subject to seizure or 34
distraint by any other taxing authority of the state or its political 35
subdivisions. 36
(5) The commissioner of the employment security department may 37
issue to any person, firm, corporation, political subdivision, or 38
department of the state, a notice and order to withhold and deliver 39
property of any kind when the commissioner of the employment security 40
p. 26 SB 5291
department has reason to believe that there is in the possession of 1
such person, firm, corporation, political subdivision, or department, 2
property which is due, owing, or belonging to any person, firm, or 3
corporation upon whom the employment security department has served a 4
notice and order of assessment for premiums, interest, or penalties. 5
The effect of a notice to withhold and deliver shall be continuous 6
from the date the notice and order to withhold and deliver is first 7
made until the liability is satisfied or becomes unenforceable 8
because of a lapse of time. The notice and order to withhold and 9
deliver shall be served by the sheriff or the sheriff's deputy of the 10
county in which the service is made, using a method by which the 11
mailing can be tracked or the delivery can be confirmed, or by any 12
duly authorized representative of the commissioner of the employment 13
security department. Any person, firm, corporation, political 14
subdivision, or department upon whom service has been made must 15
answer the notice within 20 days exclusive of the day of service, 16
under oath and in writing, and must truthfully answer the matters 17
inquired of in the notice. In the event there is in the possession of 18
any such person, firm, corporation, political subdivision, or 19
department, any property which may be subject to the claim of the 20
employment security department of the state, the property must be 21
delivered immediately to the commissioner of the employment security 22
department or a representative upon demand to be held in trust by the 23
commissioner of the employment security department for application on 24
the indebtedness involved or for return, without interest, in 25
accordance with final determination of liability or nonliability, or 26
in the alternative, a good and sufficient bond satisfactory to the 27
commissioner of the employment security department must be provided 28
conditioned upon final determination of liability. If any person, 29
firm, or corporation fails to answer an order to withhold and deliver 30
within the time prescribed in this subsection (5), it shall be lawful 31
for the court, after the time to answer the order has expired, to 32
render judgment by default against such person, firm, or corporation 33
for the full amount claimed by the commissioner in the notice to 34
withhold and deliver, together with costs. 35
(6) Whenever any order and notice of assessment or jeopardy 36
assessment has become final in accordance with the provisions of this 37
chapter the commissioner of the employment security department may 38
file with the clerk of any county within the state a warrant in the 39
amount of the notice of assessment plus interest, penalties, and a 40
p. 27 SB 5291
filing fee under RCW 36.18.012(10). The clerk of the county in which 1
the warrant is filed shall immediately designate a superior court 2
cause number for the warrant, and the clerk shall cause to be entered 3
in the judgment docket under the superior court cause number assigned 4
to the warrant, the name of the employer mentioned in the warrant, 5
the amount of the tax, interest, penalties, and filing fee and the 6
date when such warrant was filed. The aggregate amount of the warrant 7
as docketed shall become a lien upon the title to, and interest in 8
all real and personal property of the employer against whom the 9
warrant is issued, the same as a judgment in a civil case duly 10
docketed in the office of such clerk. The warrant so docketed shall 11
be sufficient to support the issuance of writs of execution and writs 12
of garnishment in favor of the state in the manner provided by law in 13
the case of civil judgment, wholly or partially unsatisfied. The 14
clerk of the court shall be entitled to a filing fee under RCW 15
36.18.012(10), which shall be added to the amount of the warrant, and 16
charged by the commissioner of the employment security department to 17
the employer. A copy of the warrant shall be mailed to the employer 18
using a method by which the mailing can be tracked or the delivery 19
can be confirmed within five days of filing with the clerk.20
(7) The claim of the employment security department for any 21
premiums, interest, or penalties not paid when due, shall be a lien 22
prior to all other liens or claims and on a parity with prior tax 23
liens against all property and rights to property, whether real or 24
personal, belonging to the employer. In order to avail itself of the 25
lien hereby created, the employment security department shall file 26
with any county auditor where property of the employer is located a 27
statement and claim of lien specifying the amount of delinquent 28
premiums, interest, and penalties claimed by the employment security 29
department. From the time of filing for record, the amount required 30
to be paid shall constitute a lien upon all property and rights to 31
property, whether real or personal, in the county, owned by the 32
employer or acquired by the employer. The lien shall not be valid 33
against any purchaser, holder of a security interest, mechanic's 34
lien, or judgment lien creditor until notice thereof has been filed 35
with the county auditor. This lien shall be separate and apart from, 36
and in addition to, any other lien or claim created by, or provided 37
for in, this chapter. When any such notice of lien has been so filed, 38
the commissioner of the employment security department may release 39
the lien by filing a certificate of release when it appears that the 40
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amount of delinquent premiums, interest, and penalties have been 1
paid, or when the assurance of payment shall be made as the 2
commissioner of the employment security department may deem to be 3
adequate. Fees for filing and releasing the lien provided herein may 4
be charged to the employer and may be collected from the employer 5
utilizing the remedies provided in this chapter for the collection of 6
premiums. 7
(8) In the event of any distribution of an employer's assets 8
pursuant to an order of any court, including any receivership, 9
probate, legal dissolution, or similar proceeding, or in case of any 10
assignment for the benefit of creditors, composition, or similar 11
proceeding, premiums, interest, or penalties due shall be a lien upon 12
all the assets of such employer. The lien is prior to all other liens 13
or claims except prior tax liens, other liens provided by this 14
chapter, and claims for remuneration for services of not more than 15
$250 to each claimant earned within six months of the commencement of 16
the proceeding. The mere existence of a condition of insolvency or 17
the institution of any judicial proceeding for legal dissolution or 18
of any proceeding for distribution of assets shall cause such a lien 19
to attach without action on behalf of the commissioner of the 20
employment security department or the state. In the event of an 21
employer's adjudication in bankruptcy, judicially confirmed extension 22
proposal, or composition, under the federal bankruptcy act of 1898, 23
as amended, premiums, interest, or penalties due shall be entitled to 24
such priority as provided in that act, as amended.25
(9)(a) If after due notice, any employer defaults in any payment 26
of premiums, interest, or penalties, the amount due may be collected 27
by civil action in the name of the state, and the employer adjudged 28
in default shall pay the cost of such action. Any lien created by 29
this chapter may be foreclosed by decree of the court in any such 30
action. Civil actions brought under this chapter to collect premiums, 31
interest, or penalties from an employer shall be heard by the court 32
at the earliest possible date and shall be entitled to preference 33
upon the calendar of the court over all other civil actions except 34
petitions for judicial review under this chapter, cases arising under 35
the unemployment compensation laws of this state, and cases arising 36
under the industrial insurance laws of this state.37
(b) Any employer that is not a resident of this state and that 38
exercises the privilege of having one or more individuals perform 39
service for it within this state, and any resident employer that 40
p. 29 SB 5291
exercises that privilege and thereafter removes from this state, 1
shall be deemed thereby to appoint the secretary of state as its 2
agent and attorney for the acceptance of process in any action under 3
this chapter. In instituting such an action against any such employer 4
the commissioner of the employment security department shall cause 5
process or notice to be filed with the secretary of state and the 6
service shall be sufficient service upon the employer, and shall be 7
of the same force and validity as if served upon it personally within 8
this state: PROVIDED, That the commissioner of the employment 9
security department shall immediately send notice of the service of 10
the process or notice, together with a copy thereof, by registered 11
mail, return receipt requested, to such employer at its last known 12
address and the return receipt, the commissioner's affidavit of 13
compliance with the provisions of this section, and a copy of the 14
notice of service shall be appended to the original of the process 15
filed in the court in which such action is pending.16
(10) Any employer who is delinquent in the payment of premiums, 17
interest, or penalties may be enjoined upon the suit of the state of 18
Washington from continuing in business in this state or employing 19
persons herein until the delinquent premiums, interest, and penalties 20
have been paid, or until the employer has furnished a good and 21
sufficient bond in a sum equal to double the amount of premiums, 22
interest, and penalties already delinquent, plus further sums as the 23
court deems adequate to protect the employment security department in 24
the collection of premiums, interest, and penalties which will become 25
due from the employer during the next ensuing calendar year, the bond 26
to be conditioned upon payment of all premiums, interest, and 27
penalties due and owing within thirty days after the expiration of 28
the next ensuing calendar year or at an earlier date as the court may 29
fix. Action under this section may be instituted in the superior 30
court of any county of the state in which the employer resides, has 31
its principal place of business, or where it has anyone performing 32
services for it, whether or not those services constitute employment.33
(11) The commissioner of the employment security department may 34
compromise any claim for premiums, interest, or penalties due and 35
owing from an employer, and any amount owed by an individual because 36
of benefit overpayments existing or arising under this chapter in any 37
case in which collection of the full amount due and owing, whether 38
reduced to judgment or otherwise, would be against equity and good 39
conscience. Whenever a compromise is made by the commissioner of the 40
p. 30 SB 5291
employment security department in the case of a claim for premiums, 1
interest, or penalties, whether reduced to judgment or otherwise, the 2
employment security department shall file a statement of the amount 3
of premiums, interest, and penalties imposed by law and claimed due, 4
attorneys' fees and costs, if any, a complete record of the 5
compromise agreement, and the amount actually paid in accordance with 6
the terms of the compromise agreement. If any such compromise is 7
accepted by the commissioner of the employment security department, 8
within the time stated in the compromise or agreed to, that 9
compromise shall be final and conclusive and except upon showing of 10
fraud or malfeasance or misrepresentation of a material fact the case 11
shall not be reopened as to the agreed upon matters. In any suit, 12
action, or proceeding, such agreement or any determination, 13
collection, payment, adjustment, refund, or credit made in accordance 14
therewith shall not be annulled, modified, set aside, or disregarded.15
(12) The commissioner of the employment security department may 16
charge off as uncollectible and no longer an asset of the account, 17
any delinquent premiums, interest, penalties, credits, or benefit 18
overpayments if the commissioner of the employment security 19
department is satisfied that there are no cost-effective means of 20
collecting the premiums, interest, penalties, credits, or benefit 21
overpayments. 22
NEW SECTION. Sec. 14. A new section is added to chapter 50B.04 23
RCW to read as follows: 24
(1) When a qualified individual applies for benefits as provided 25
in RCW 50B.04.060, the department of social and health services must: 26
(a) Ask whether the qualified individual has supplemental long-term 27
care insurance as provided in chapter 48.--- RCW (the new chapter 28
created in section 40 of this act); and (b) request written consent 29
and the policy issuer's contact information from the qualified 30
individual to share information with the policy issuer for any 31
potential care coordination. 32
(2) If the individual provides written consent and the policy 33
issuer's contact information, the department of social and health 34
services must notify the policy issuer that the qualified individual 35
has applied for benefits under this chapter and may share information 36
for any potential care coordination. 37
(3) Only basic demographic information that would allow a person 38
to be identified in the program may be shared if the qualified 39
p. 31 SB 5291
individual consents to sharing information. No health information or 1
data on claims may be shared. 2
NEW SECTION. Sec. 15. (1) The department of social and health 3
services, the employment security department, and the health care 4
authority may design and conduct a pilot project to assess the 5
administrative processes and system capabilities for managing 6
eligibility determinations for qualified individuals and distributing 7
payments to long-term services and supports providers. The pilot 8
project may identify persons who are eligible to be qualified 9
individuals and offer them access to benefit units under the program 10
in return for their participation in the pilot project. The pilot 11
project may only be conducted between January 1, 2026, and June 30, 12
2026. The pilot project may not have more than 500 participants.13
(2) When designing and implementing the pilot project, the 14
agencies identified in subsection (1) of this section must provide 15
regular updates to and consider recommendations from the long-term 16
services and supports trust commission. Upon completion of the pilot 17
project, the agencies must provide a summary of the pilot project, 18
including key operational challenges, to the commission. The 19
commission may include any outstanding concerns identified by the 20
pilot project that require a legislative response in the commission's 21
2027 report. 22
(3) The employment security department, the department of social 23
and health services, and the department of health may adopt rules 24
necessary to implement this section. 25
(4) This section expires July 1, 2027. 26
NEW SECTION. Sec. 16. The intent of this chapter is to promote 27
the public interest, support the availability of supplemental long-28
term care coverage, establish standards for supplemental long-term 29
care coverage, facilitate public understanding and comparison of 30
supplemental long-term care contract benefits, protect persons 31
insured under supplemental long-term care insurance policies and 32
certificates, protect applicants for supplemental long-term care 33
policies from unfair or deceptive sales or enrollment practices, and 34
provide for flexibility and innovation in the development of 35
supplemental long-term care insurance coverage.36
p. 32 SB 5291
NEW SECTION. Sec. 17. (1) This chapter applies to all 1
supplemental long-term care insurance policies, contracts, or riders 2
delivered or issued for delivery in this state on or after January 1, 3
2026. This chapter does not supersede the obligations of entities 4
subject to this chapter to comply with other applicable laws to the 5
extent that they do not conflict with this chapter, except that laws 6
and regulations designed and intended to apply to medicare supplement 7
insurance policies shall not be applied to supplemental long-term 8
care insurance.9
(2) Coverage advertised, marketed, or offered as supplemental 10
long-term care insurance must comply with this chapter. Any coverage, 11
policy, or rider advertised, marketed, or offered as supplemental 12
long-term care or nursing home insurance shall comply with this 13
chapter. 14
(3) This chapter is not intended to prohibit approval of 15
supplemental long-term care funded through life insurance policies, 16
contracts, or riders, provided the policy meets the definition of 17
supplemental long-term care insurance and provides all required 18
benefits of this chapter. 19
NEW SECTION. Sec. 18. The definitions in this section apply 20
throughout this chapter unless the context clearly requires 21
otherwise.22
(1) "Applicant" means: (a) In the case of an individual 23
supplemental long-term care insurance policy, the person who seeks to 24
contract for benefits; and (b) in the case of a group supplemental 25
long-term care insurance policy, the proposed certificate holder.26
(2) "Certificate" includes any certificate issued under a group 27
supplemental long-term care insurance policy that has been delivered 28
or issued for delivery in this state. 29
(3) "Commissioner" means the insurance commissioner of Washington 30
state. 31
(4) "Issuer" includes insurance companies, fraternal benefit 32
societies, health care service contractors, health maintenance 33
organizations, or other entity delivering or issuing for delivery any 34
supplemental long-term care insurance policy, contract, or rider.35
(5) "Group supplemental long-term care insurance" means a 36
supplemental long-term care insurance policy or contract that is 37
delivered or issued for delivery in this state and is issued to:38
p. 33 SB 5291
(a) One or more employers; one or more labor organizations; or a 1
trust or the trustees of a fund established by one or more employers 2
or labor organizations for current or former employees, current or 3
former members of the labor organizations, or a combination of 4
current and former employees or members, or a combination of such 5
employers, labor organizations, trusts, or trustees; or6
(b) A professional, trade, or occupational association for its 7
members or former or retired members, if the association:8
(i) Is composed of persons who are or were all actively engaged 9
in the same profession, trade, or occupation; and 10
(ii) Has been maintained in good faith for purposes other than 11
obtaining insurance; or 12
(c)(i) An association, trust, or the trustees of a fund 13
established, created, or maintained for the benefit of members of one 14
or more associations. Before advertising, marketing, or offering 15
supplemental long-term care coverage in this state, the association 16
or associations, or the insurer of the association or associations, 17
must file evidence with the commissioner that the association or 18
associations have at the time of such filing at least 100 persons who 19
are members and that the association or associations have been 20
organized and maintained in good faith for purposes other than that 21
of obtaining insurance; have been in active existence for at least 22
one year; and have a constitution and bylaws that provide that:23
(A) The association or associations hold regular meetings at 24
least annually to further the purposes of the members;25
(B) Except for credit unions, the association or associations 26
collect dues or solicit contributions from members; and27
(C) The members have voting privileges and representation on the 28
governing board and committees of the association.29
(ii) Thirty days after filing the evidence in accordance with 30
this section, the association or associations will be deemed to have 31
satisfied the organizational requirements, unless the commissioner 32
makes a finding that the association or associations do not satisfy 33
those organizational requirements; or 34
(d) A group other than as described in (a), (b), or (c) of this 35
subsection subject to a finding by the commissioner that:36
(i) The issuance of the group policy is not contrary to the best 37
interest of the public; 38
(ii) The issuance of the group policy would result in economies 39
of acquisition or administration; and 40
p. 34 SB 5291
(iii) The benefits are reasonable in relation to the premiums 1
charged. 2
(6) "Policy" includes a document such as an insurance policy, 3
contract, subscriber agreement, rider, or endorsement delivered or 4
issued for delivery in this state by an insurer, fraternal benefit 5
society, health care service contractor, health maintenance 6
organization, or any similar entity authorized by the insurance 7
commissioner to transact the business of supplemental long-term care 8
insurance. 9
(7) "Qualified supplemental long-term care insurance contract" or 10
"federally tax-qualified supplemental long-term care insurance 11
contract" means: 12
(a) An individual or group insurance contract that meets the 13
requirements of section 7702B (b) of the internal revenue code of 14
1986, as amended; or 15
(b) The portion of a life insurance contract that provides 16
supplemental long-term care insurance coverage by rider or as part of 17
the contract and that satisfies the requirements of sections 7702B (b) 18
and (e) of the internal revenue code of 1986, as amended.19
(8) "Supplemental long-term care insurance" means an insurance 20
policy, contract, or rider that is advertised, marketed, offered, or 21
designed to provide coverage for at least 12 consecutive months for a 22
covered person after benefits provided under chapter 50B.04 RCW have 23
been exhausted. Supplemental long -term care insurance may be on an 24
expense incurred, indemnity, prepaid, or other basis, for one or more 25
necessary or medically necessary diagnostic, preventive, therapeutic, 26
rehabilitative, maintenance, or personal care services, provided in a 27
setting other than an acute care unit of a hospital. Supplemental 28
long-term care insurance includes any policy, contract, or rider that 29
provides for payment of benefits based upon cognitive impairment or 30
the loss of functional capacity that supplements benefits provided in 31
chapter 50B.04 RCW. 32
(a) Supplemental long-term care insurance includes group and 33
individual life insurance policies or riders that provide directly or 34
supplement long-term care insurance and that supplements benefits 35
provided in chapter 50B.04 RCW. However, supplemental long-term care 36
insurance does not include life insurance policies that: (i) 37
Accelerate the death benefit specifically for one or more of the 38
qualifying events of terminal illness, medical conditions requiring 39
extraordinary medical intervention, or permanent institutional 40
p. 35 SB 5291
confinement; (ii) provide the option of a lump sum payment for those 1
benefits; and (iii) do not condition the benefits or the eligibility 2
for the benefits upon the receipt of long-term care.3
(b) Supplemental long-term care insurance also includes qualified 4
supplemental long-term care insurance contracts. 5
(c) Supplemental long-term care insurance does not include any 6
insurance policy, contract, or rider that is offered primarily to 7
provide coverage for basic medicare supplement, basic hospital 8
expense, basic medical-surgical expense, hospital confinement 9
indemnity, major medical expense, disability income, related income, 10
asset protection, accident only, specified disease, specified 11
accident, or limited benefit health. These may not be marketed to 12
consumers as providing coverage that is supplemental to the long-term 13
care benefits provided in chapter 50B.04 RCW. 14
NEW SECTION. Sec. 19. (1) A supplemental long-term care 15
insurance policy, contract, rider, or certificate form or application 16
form shall not be issued, delivered, or used unless it has been filed 17
with and approved by the commissioner.18
(2) Rates, or modification of rates, for supplemental long-term 19
care policies or certificates shall not be used until filed with and 20
approved by the commissioner. 21
(3) A form or rate shall not knowingly be issued, delivered, or 22
used if the commissioner's approval does not then exist.23
NEW SECTION. Sec. 20. A group supplemental long-term care 24
insurance policy may not be offered to a resident of this state under 25
a group policy issued in another state to a group described in 26
section 18 (5)(d) of this act, unless this state or another state 27
having statutory and regulatory supplemental long-term care insurance 28
requirements substantially similar to those adopted in this state has 29
made a determination that such requirements have been met.30
NEW SECTION. Sec. 21. (1) A supplemental long-term care 31
insurance policy or certificate may not define "preexisting 32
condition" more restrictively than as a condition for which medical 33
advice or treatment was recommended by or received from a provider of 34
health care services, within six months preceding the effective date 35
of coverage of an insured person, unless the policy or certificate 36
p. 36 SB 5291
applies to group supplemental long-term care insurance under section 1
18(5) (a), (b), or (c) of this act. 2
(2) A supplemental long-term care insurance policy or certificate 3
may not exclude coverage for a loss or confinement that is the result 4
of a preexisting condition unless the loss or confinement begins 5
within six months following the effective date of coverage of an 6
insured person, unless the policy or certificate applies to a group 7
as defined in section 18(5)(a) of this act. 8
(3) The commissioner may extend the limitation periods for 9
specific age group categories in specific policy forms upon finding 10
that the extension is in the best interest of the public.11
(4) An issuer may use an application form designed to elicit the 12
complete health history of an applicant and underwrite in accordance 13
with that issuer's established underwriting standards, based on the 14
answers on that application. Unless otherwise provided in the policy 15
or certificate and regardless of whether it is disclosed on the 16
application, a preexisting condition need not be covered until the 17
waiting period expires. 18
(5) A supplemental long-term care insurance policy or certificate 19
may not exclude or use waivers or riders to exclude, limit, or reduce 20
coverage or benefits for specifically named or described preexisting 21
diseases or physical conditions beyond the waiting period.22
NEW SECTION. Sec. 22. (1) No supplemental long-term care 23
insurance policy may:24
(a) Be canceled, nonrenewed, or otherwise terminated on the 25
grounds of the age or the deterioration of the mental or physical 26
health of the insured individual or certificate holder;27
(b) Contain a provision establishing a new waiting period in the 28
event existing coverage is converted to or replaced by a new or other 29
form within the same company, except with respect to an increase in 30
benefits voluntarily selected by the insured individual or group 31
policyholder; 32
(c) Provide coverage for skilled nursing care only or provide 33
significantly more coverage for skilled care in a facility than 34
coverage for lower levels of care; 35
(d) Condition eligibility for any benefits on a prior 36
hospitalization requirement; 37
p. 37 SB 5291
(e) Condition eligibility for benefits provided in an 1
institutional care setting on the receipt of a higher level of 2
institutional care; 3
(f) Condition eligibility for any benefits other than waiver of 4
premium, postconfinement, postacute care, or recuperative benefits on 5
a prior institutionalization requirement; 6
(g) Include a postconfinement, postacute care, or recuperative 7
benefit unless: 8
(i) Such requirement is clearly labeled in a separate paragraph 9
of the policy or certificate entitled "Limitations or Conditions on 10
Eligibility for Benefits"; and 11
(ii) Such limitations or conditions specify any required number 12
of days of preconfinement or postconfinement; 13
(h) Condition eligibility for noninstitutional benefits on the 14
prior receipt of institutional care; 15
(i)(i) Provide for a deductible that is greater than the maximum 16
dollar equivalent provided in RCW 50B.04.060(3)(b), including 17
inflation adjustments provided in RCW 50B.04.010(3), without the 18
limitation provided in RCW 50B.04.050(2). The issuer may provide for 19
a deductible that is less than the maximum dollar equivalent provided 20
in RCW 50B.04.060(3)(b), especially for a policyholder born before 21
1968; 22
(ii) The issuer must accept notice from the department of social 23
and health services that the policyholder has exhausted the benefits 24
provided under chapter 50B.04 RCW as evidence of satisfying the 25
deductible. However, for a policyholder born before 1968, the 26
department must provide the amount of benefits paid under chapter 27
50B.04 RCW as evidence of payment toward the deductible;28
(j) Include an elimination period of greater than 12 months. Any 29
period of time the policyholder is considered an eligible beneficiary 30
as defined in RCW 50B.04.010 must count toward any elimination period 31
in a supplemental long-term care insurance policy. If the policy 32
includes a deductible and an elimination period, the policy may 33
provide that the elimination period is satisfied after the later of 34
when the deductible or the elimination period has been met; and35
(k) Require a policyholder to undergo a functional assessment to 36
satisfy a benefit trigger to determine that the elimination period 37
has begun or ended. However, the issuer may require the policyholder 38
to undergo a functional assessment and apply a benefit trigger for 39
purposes of approving a claim and authorizing benefits.40
p. 38 SB 5291
(2) A supplemental long-term care insurance policy or certificate 1
may be field-issued if the compensation to the field issuer is not 2
based on the number of policies or certificates issued. For purposes 3
of this section, "field-issued" means a policy or certificate issued 4
by a producer or a third-party administrator of the policy pursuant 5
to the underwriting authority by an issuer and using the issuer's 6
underwriting guidelines. 7
NEW SECTION. Sec. 23. (1) Supplemental long-term care insurance 8
applicants may return a policy or certificate for any reason within 9
30 days after its delivery and to have the premium refunded.10
(2) All supplemental long-term care insurance policies and 11
certificates must have a notice prominently printed on or attached to 12
the first page of the policy stating that the applicant may return 13
the policy or certificate within 30 days after its delivery and to 14
have the premium refunded. 15
(3) Refunds or denials of applications must be made within 30 16
days of the return or denial. 17
(4) This section does not apply to certificates issued pursuant 18
to a policy issued to a group defined in section 18 (5)(a) of this 19
act. 20
NEW SECTION. Sec. 24. (1) An outline of coverage must be 21
delivered to a prospective applicant for supplemental long-term care 22
insurance at the time of initial solicitation through means that 23
prominently direct the attention of the recipient to the document and 24
its purpose.25
(a) The commissioner must prescribe a standard format, including 26
style, arrangement, overall appearance, and the content of an outline 27
of coverage. The outline of coverage must also include a disclosure:28
(i) Of how the supplemental long-term care insurance interacts 29
with benefits provided in chapter 50B.04 RCW and any potential gaps 30
in coverage or discontinuities of care between benefits provided 31
under chapter 50B.04 RCW and the policy; 32
(ii) That the premiums may increase over time and an explanation 33
of the conditions that may result in an increase in premiums;34
(iii) If the policyholder's circumstances change or premiums 35
increase and the policyholder is unable or unwilling to pay the 36
increased premiums, the options available to the consumer, including 37
a reduction in benefits and nonforfeiture of premiums;38
p. 39 SB 5291
(iv) That premiums continue after retirement; 1
(v) When premium payments are no longer required under the 2
policy, known as a waiver of premiums; and 3
(vi) That the purchase of the policy does not qualify the 4
policyholder to apply to be exempt from premium assessments under RCW 5
50B.04.085. 6
(b) When an insurance producer makes a solicitation in person, 7
the insurance producer must deliver an outline of coverage before 8
presenting an application or enrollment form. 9
(c) In a direct response solicitation, the outline of coverage 10
must be presented with an application or enrollment form. The 11
disclosures required under (a) of this subsection are required in any 12
marketing materials. 13
(d) If a policy is issued to a group as defined in section 14
18(5)(a) of this act, an outline of coverage is not required to be 15
delivered, if the information that the commissioner requires to be 16
included in the outline of coverage is in other materials relating to 17
enrollment. Upon request, any such materials must be made available 18
to the commissioner. 19
(2) If an issuer approves an application for a supplemental long-20
term care insurance contract or certificate, the issuer must deliver 21
the contract or certificate of insurance to the applicant within 30 22
days after the date of approval. A policy summary must be delivered 23
with an individual life insurance policy that provides supplemental 24
long-term care benefits within the policy or by rider. In a direct 25
response solicitation, the issuer must deliver the policy summary, 26
upon request, before delivery of the policy, if the applicant 27
requests a summary. 28
(a) The policy summary must include: 29
(i) An explanation of how the supplemental long-term care benefit 30
interacts with other components of the policy, including deductions 31
from any applicable death benefits; 32
(ii) An illustration of the amount of benefits, the length of 33
benefits, and the guaranteed lifetime benefits if any, for each 34
covered person; 35
(iii) Any exclusions, reductions, and limitations on benefits of 36
supplemental long-term care; 37
(iv) A statement that any supplemental long-term care inflation 38
protection option required by section 31 of this act is not available 39
under this policy; and 40
p. 40 SB 5291
(v) If applicable to the policy type, the summary must also 1
include: 2
(A) A disclosure of the effects of exercising other rights under 3
the policy; 4
(B) A disclosure of guarantees related to long-term care costs of 5
insurance charges; and 6
(C) Current and projected maximum lifetime benefits.7
(b) The provisions of the policy summary may be incorporated into 8
a basic illustration required under chapter 48.23A RCW, or into the 9
policy summary which is required under rules adopted by the 10
commissioner. 11
NEW SECTION. Sec. 25. A supplemental long-term care insurance 12
policy, contract, or rider must:13
(1) Allow the policyholder options for reduction of benefits or 14
nonforfeiture of premiums as provided in section 31 of this act if 15
the premiums increase or the policyholder's circumstances change and 16
the policyholder is unable or unwilling to pay the increased 17
premiums; 18
(2) Allow for continuity of coverage of care settings and 19
providers, including family providers, that the policyholder was 20
receiving as benefits under the program provided in chapter 50B.04 21
RCW unless there is substantial clinical or other information showing 22
that the current care setting or provider cannot meet the care and 23
safety needs of the policyholder. If the issuer makes a determination 24
that the care setting or providers are not suited to meeting the care 25
and safety needs of the policyholder, the issuer may require a change 26
of care setting or provider under the policy, effective 90 days after 27
the transition from the benefits provided under chapter 50B.04 RCW. 28
The policyholder may appeal the determination through an independent 29
third-party review as tracked by the commissioner. The issuer may 30
audit for fraudulent claims where the care being claimed is not being 31
provided; and 32
(3) Cover family providers, provided they are suited to meet the 33
care and safety needs of the policyholder. 34
NEW SECTION. Sec. 26. (1) When a policyholder purchases a 35
supplemental long-term care insurance policy, the issuer must request 36
written consent from the policyholder to share information with the 37
department of social and health services. If the policyholder 38
p. 41 SB 5291
provides written consent, the issuer must inform the department of 1
social and health services that the policyholder has purchased a 2
supplemental long-term care insurance policy and share any 3
information with the department for the purposes of any potential 4
care coordination. 5
(2) Only basic demographic information that would allow a person 6
to be identified in the program provided in chapter 50B.04 RCW may be 7
shared if the individual consents to sharing information. No health 8
care information as defined in RCW 70.02.010 or data on claims may be 9
shared. 10
NEW SECTION. Sec. 27. If a supplemental long-term care benefit 11
funded through a life insurance policy by the acceleration of the 12
death benefit is in benefit payment status, a monthly report must be 13
provided to the policyholder. The report must include:14
(1) A record of all supplemental long-term care benefits paid out 15
during the month; 16
(2) An explanation of any changes in the policy resulting from 17
paying the supplemental long-term care benefits, such as a change in 18
the death benefit or cash values; and 19
(3) The amount of supplemental long-term care benefits that 20
remain to be paid. 21
NEW SECTION. Sec. 28. All supplemental long-term care denials 22
must be made within 30 days after receipt of a written request made 23
by a policyholder or certificate holder, or the policyholder's 24
representative. All denials of supplemental long-term care claims by 25
the issuer must provide a written explanation of the reasons for the 26
denial and make available to the policyholder or certificate holder 27
all information directly related to the denial.28
NEW SECTION. Sec. 29. (1) An issuer may rescind a supplemental 29
long-term care insurance policy or certificate or deny an otherwise 30
valid supplemental long-term care insurance claim if:31
(a) A policy or certificate has been in force for less than six 32
months and upon a showing of misrepresentation that is material to 33
the acceptance for coverage; or 34
(b) A policy or certificate has been in force for at least six 35
months but less than two years, upon a showing of misrepresentation 36
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that is both material to the acceptance for coverage and that 1
pertains to the condition for which benefits are sought.2
(2) After a policy or certificate has been in force for two years 3
it is not contestable upon the grounds of misrepresentation alone. 4
Such a policy or certificate may be contested only upon a showing 5
that the insured knowingly and intentionally misrepresented relevant 6
facts relating to the insured's health. 7
(3) An issuer's payments for benefits under a supplemental long-8
term care insurance policy or certificate may not be recovered by the 9
issuer if the policy or certificate is rescinded. 10
(4) This section does not apply to the remaining death benefit of 11
a life insurance policy that accelerates benefits for supplemental 12
long-term care that are governed by RCW 48.23.050 the state's life 13
insurance incontestability clause. In all other situations, this 14
section applies to life insurance policies that accelerate benefits 15
for supplemental long-term care. 16
NEW SECTION. Sec. 30. (1) The commissioner must establish 17
minimum standards for inflation protection features.18
(2) An issuer must comply with the rules adopted by the 19
commissioner that establish minimum standards for inflation 20
protection features. 21
NEW SECTION. Sec. 31. (1) Except as provided by this section, a 22
supplemental long-term care insurance policy may not be delivered or 23
issued for delivery in this state unless the policyholder or 24
certificate holder has been offered the option of purchasing a policy 25
or certificate that includes a nonforfeiture benefit. The offer of a 26
nonforfeiture benefit may be in the form of a rider that is attached 27
to the policy. If a policyholder or certificate holder declines the 28
nonforfeiture benefit, the issuer must provide a contingent benefit 29
upon lapse that is available for a specified period of time following 30
a substantial increase in premium rates.31
(2) If a group supplemental long-term care insurance policy is 32
issued, the offer required in subsection (1) of this section must be 33
made to the group policyholder. However, if the policy is issued as 34
group supplemental long-term care insurance as defined in section 35
18(5)(d) of this act other than to a continuing care retirement 36
community or other similar entity, the offering must be made to each 37
proposed certificate holder. 38
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(3) The commissioner must adopt rules specifying the type or 1
types of nonforfeiture benefits to be offered as part of supplemental 2
long-term care insurance policies and certificates, the standards for 3
nonforfeiture benefits, and the rules regarding contingent benefit 4
upon lapse, including a determination of the specified period of time 5
during which a contingent benefit upon lapse will be available and 6
the substantial premium rate increase that triggers a contingent 7
benefit upon lapse. 8
NEW SECTION. Sec. 32. (1) A person may not sell, solicit, or 9
negotiate supplemental long-term care insurance unless the person is 10
appropriately licensed as an insurance producer and has successfully 11
completed supplemental long -term care coverage education that meets 12
the requirements of this section and:13
(a) Has successfully completed long-term care coverage education 14
that meets the requirements of RCW 48.83.130; and 15
(b) Has completed an approved one-hour course on supplemental 16
long-term care insurance that includes education on:17
(i) The provisions of chapter 50B.04 RCW and any rules adopted to 18
implement the long-term services and supports trust program;19
(ii) The relationship between benefits offered under chapter 20
50B.04 RCW, qualified state long-term care insurance partnership 21
programs, and other public and private coverage of long-term care 22
services, including medicaid; and 23
(iii) This chapter. 24
(2) The insurance producer education required by this section may 25
not include training that is issuer or company product-specific or 26
that includes any sales or marketing information, materials, or 27
training, other than those required by state or federal law.28
(3) Issuers must obtain verification that an insurance producer 29
receives training required by this section before that producer is 30
permitted to sell, solicit, or otherwise negotiate the issuer's 31
supplemental long-term care insurance products. 32
(4) Issuers must maintain records subject to the state's record 33
retention requirements and make evidence of that verification 34
available to the commissioner upon request. 35
(5)(a) Issuers must maintain records with respect to the training 36
of its producers concerning the distribution of its long-term care 37
partnership policies that will allow the commissioner to provide 38
assurance to the state department of social and health services, 39
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medicaid division, that insurance producers engaged in the sale of 1
supplemental long-term care insurance contracts have received the 2
training required by this section and any rules adopted by the 3
commissioner, and that producers have demonstrated an understanding 4
of the partnership policies and their relationship to benefits 5
offered under chapter 50B.04 RCW and public and private coverage of 6
long-term care, including medicaid, in this state. 7
(b) These records must be maintained in accordance with the 8
state's record retention requirements and be made available to the 9
commissioner upon request. 10
NEW SECTION. Sec. 33. (1) Issuers and their agents, if any, 11
must determine whether issuing supplemental long-term care insurance 12
coverage to a particular person is appropriate, except in the case of 13
a life insurance policy that accelerates benefits for supplemental 14
long-term care.15
(2) An issuer must: 16
(a) Develop and use suitability standards to determine whether 17
the purchase or replacement of supplemental long-term care coverage 18
is appropriate for the needs of the applicant or insured, using a 19
best interest standard. The issuers and their agents must act in the 20
best interests of the applicant or policyholder under the 21
circumstances known at the time the recommendation is made, without 22
putting the issuer or agent's financial interests ahead of the 23
interests of the applicant or policyholder; 24
(b) Train its agents in the use of the issuer's suitability 25
standards; and 26
(c) Maintain a copy of its suitability standards and make the 27
standards available for inspection, upon request. 28
(3) The following must be considered when determining whether the 29
applicant meets the issuer's suitability standards:30
(a) The ability of the applicant to pay for the proposed coverage 31
and any other relevant financial information related to the purchase 32
of or payment for coverage; 33
(b) The applicant's goals and needs with respect to supplemental 34
long-term care and the advantages and disadvantages of supplemental 35
long-term care coverage to meet those goals or needs; and36
(c) The values, benefits, and costs of the applicant's existing 37
health or long-term care coverage, if any, when compared to the 38
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values, benefits, and costs of the recommended purchase or 1
replacement. 2
(4) The sale or transfer of any suitability information provided 3
to the issuer or agent by the applicant to any other person or 4
business entity is prohibited. 5
(5)(a) The commissioner must adopt rules on forms of consumer-6
friendly personal worksheets that issuers and their agents must use 7
for applications for supplemental long-term care coverage.8
(b) The commissioner may require each issuer to file its current 9
forms of suitability standards and personal worksheets with the 10
commissioner. 11
NEW SECTION. Sec. 34. A person engaged in the issuance or 12
solicitation of supplemental long-term care coverage may not engage 13
in unfair methods of competition or unfair or deceptive acts or 14
practices, as such methods, acts, or practices are defined in chapter 15
48.30 RCW, or as defined by the commissioner.16
NEW SECTION. Sec. 35. An issuer or an insurance producer who 17
violates a law or rule relating to the regulation of supplemental 18
long-term care insurance or its marketing is subject to a fine of up 19
to three times the amount of the commission paid for each policy 20
involved in the violation or $10,000, whichever is greater.21
NEW SECTION. Sec. 36. (1) The commissioner must adopt rules 22
that include standards for full and fair disclosure setting forth the 23
manner, content, and required disclosures for the sale of 24
supplemental long-term care insurance policies, terms of 25
renewability, initial and subsequent conditions of eligibility, 26
nonduplication of coverage provisions, coverage of dependents, 27
preexisting conditions, termination of insurance, continuation or 28
conversion, probationary periods, limitations, exceptions, 29
reductions, elimination periods, requirements for replacement, 30
recurrent conditions, and definitions of terms. The commissioner must 31
adopt rules establishing loss ratio standards for supplemental long-32
term care insurance policies. The commissioner must adopt rules to 33
promote premium adequacy and to protect policyholders in the event of 34
proposed substantial rate increases, and to establish minimum 35
standards for producer education, marketing practices, producer 36
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compensation, producer testing, penalties, and reporting practices 1
for supplemental long-term care insurance. 2
(2) The commissioner must adopt rules establishing standards 3
protecting patient privacy rights, rights to receive confidential 4
health care services, and standards for an issuer's timely review of 5
a claim denial upon request of a covered person. 6
(3) The commissioner must adopt by rule prompt payment 7
requirements for supplemental long -term care insurance. The rules 8
must include a definition of a "claim" and a definition of "clean 9
claim." In adopting the rules, the commissioner must consider the 10
prompt payment requirements in long-term care insurance model acts 11
developed by the national association of insurance commissioners.12
(4) The commissioner may adopt reasonable rules to carry out this 13
chapter. 14
NEW SECTION. Sec. 37. (1) The commissioner must:15
(a) Develop a consumer education guide designed to educate 16
consumers and help them make informed decisions as to the purchase of 17
supplemental long-term care insurance policies provided under this 18
chapter; and 19
(b) Expand programs to educate consumers as to the supplemental 20
long-term care insurance policies provided under this chapter, with a 21
focus on the middle-income market. If allowable under federal law, 22
the commissioner must expand the statewide health insurance benefits 23
advisor program to provide the consumer education.24
(2) The guide and programs should: 25
(a) Provide additional information and counseling for consumers 26
born before 1968. This information and counseling should educate 27
these consumers as to potential out-of-pocket costs they may be 28
subject to before supplemental long-term care insurance will begin 29
paying claims and strategies for managing the gap between benefits 30
payable under chapter 50B.04 RCW and coverage under supplemental 31
long-term care insurance. 32
(b) Support consumers in assessing the tradeoffs between various 33
elimination period options and premium rates. 34
(c) Educate consumers on budgeting any benefits available under 35
chapter 50B.04 RCW carefully to reduce the likelihood and size of any 36
potential gap between those benefits and the supplemental long-term 37
care insurance. 38
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NEW SECTION. Sec. 38. A new section is added to chapter 48.83 1
RCW to read as follows: 2
This chapter does not apply to supplemental long-term care 3
insurance as defined in section 18 of this act. 4
NEW SECTION. Sec. 39. RCW 50B.04.040 (Long-term services and 5
supports council— Benefit unit adjustment) and 2019 c 363 s 5 are each 6
repealed.7
NEW SECTION. Sec. 40. Sections 16 through 37 of this act 8
constitute a new chapter in Title 48 RCW.9
NEW SECTION. Sec. 41. If any provision of this act or its 10
application to any person or circumstance is held invalid, the 11
remainder of the act or the application of the provision to other 12
persons or circumstances is not affected.13
Sec. 42. RCW 50B.04.140 and 2022 c 1 s 7 are each amended to 14
read as follows: 15
Beginning December 1, 2028, and annually thereafter, and in 16
compliance with RCW 43.01.036, the commission must report to the 17
legislature on the program, including: 18
(1) Projected and actual program participation;19
(2) Adequacy of premium rates; 20
(3) Fund balances; 21
(4) Benefits paid; 22
(5) Demographic information on program participants, including 23
age, gender, race, ethnicity, geographic distribution by county, and 24
legislative district((, and employment sector)); and25
(6) The extent to which the operation of the program has resulted 26
in savings to the medicaid program by avoiding costs that would have 27
otherwise been the responsibility of the state. 28
NEW SECTION. Sec. 43. A new section is added to chapter 50B.04 29
RCW to read as follows: 30
If Washington is successful in obtaining a waiver from the 31
federal centers for medicare and medicaid services that results in 32
shared savings because of long-term services and supports spending, 33
the amount of shared savings shall be deposited into the long-term 34
services and supports trust account created in RCW 50B.04.100.35
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Sec. 44. RCW 74.39.007 and 2022 c 86 s 1 are each amended to 1
read as follows: 2
The definitions in this section apply throughout this section, 3
RCW ((74.39.007,)) 74.39.050, 74.39.070, 43.190.060, and section 1, 4
chapter 336, Laws of 1999 unless the context clearly requires 5
otherwise. 6
(1) "Self-directed care" means the process in which an adult 7
person, who is prevented by a functional disability from performing a 8
manual function related to health care that an individual would 9
otherwise perform for himself or herself, chooses to direct and 10
supervise a paid personal aide to perform those tasks.11
(2) "Personal aide" means an individual, working privately 12
((or)), as an individual provider as defined in RCW 74.39A.240, or as 13
a qualified family member paid through the long-term services and 14
supports trust as described in RCW 50B.04.010, who acts at the 15
direction of an adult person with a functional disability living in 16
his or her own home to assist with the physical performance of a 17
health care task, as described in RCW 74.39.050, that persons without 18
a functional disability can perform themselves. 19
Sec. 45. RCW 70.127.040 and 2024 c 259 s 4 are each amended to 20
read as follows: 21
The following are not subject to regulation for the purposes of 22
this chapter: 23
(1) A family member providing home health, hospice, or home care 24
services; 25
(2) A person who provides only meal services in an individual's 26
permanent or temporary residence; 27
(3) An individual providing home care through a direct agreement 28
with a recipient of care in an individual's permanent or temporary 29
residence; 30
(4) A person furnishing or delivering home medical supplies or 31
equipment that does not involve the provision of services beyond 32
those necessary to deliver, set up, and monitor the proper 33
functioning of the equipment and educate the user on its proper use;34
(5) A person who provides services through a contract with a 35
licensed agency; 36
(6) An employee or volunteer of a licensed agency who provides 37
services only as an employee or volunteer; 38
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(7) Facilities and institutions, including but not limited to 1
nursing homes under chapter 18.51 RCW, hospitals under chapter 70.41 2
RCW, adult family homes under chapter 70.128 RCW, assisted living 3
facilities under chapter 18.20 RCW, developmental disability 4
residential programs under chapter 71A.12 RCW, other entities 5
licensed under chapter 71.12 RCW, or other licensed facilities and 6
institutions, only when providing services to persons residing within 7
the facility or institution; 8
(8) Local and combined city-county health departments providing 9
services under chapters 70.05 and 70.08 RCW; 10
(9) An individual providing care to ill individuals, individuals 11
with disabilities, or vulnerable individuals through a contract with 12
the department of social and health services; 13
(10) Nursing homes, hospitals, or other institutions, agencies, 14
organizations, or persons that contract with licensed home health, 15
hospice, or home care agencies for the delivery of services;16
(11) In-home assessments of an ill individual, an individual with 17
a disability, or a vulnerable individual that does not result in 18
regular ongoing care at home; 19
(12) Services conducted by and for the adherents of a church or 20
religious denomination that rely upon spiritual means alone through 21
prayer for healing in accordance with the tenets and practices of 22
such church or religious denomination and the bona fide religious 23
beliefs genuinely held by such adherents; 24
(13) A medicare-approved dialysis center operating a medicare-25
approved home dialysis program; 26
(14) A person providing case management services. For the 27
purposes of this subsection, "case management" means the assessment, 28
coordination, authorization, planning, training, and monitoring of 29
home health, hospice, and home care, and does not include the direct 30
provision of care to an individual; 31
(15) Pharmacies licensed under RCW 18.64.043 that deliver 32
prescription drugs and durable medical equipment that does not 33
involve the use of professional services beyond those authorized to 34
be performed by licensed pharmacists pursuant to chapter 18.64 RCW 35
and those necessary to set up and monitor the proper functioning of 36
the equipment and educate the person on its proper use;37
(16) A volunteer hospice complying with the requirements of RCW 38
70.127.050; 39
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(17) A person who provides home care services without 1
compensation; 2
(18) Nursing homes that provide telephone or web-based 3
transitional care management services; 4
(19) A rural health clinic providing health services in a home 5
health shortage area as declared by the department pursuant to 42 6
C.F.R. Sec. 405.2416; ((and))7
(20) Hospital at-home services provided by a hospital pursuant to 8
RCW 70.41.550;9
(21) A consumer directed employer as described in RCW 74.39A.500; 10
and11
(22) An entity contracted with the department of social and 12
health services as a financial services agency and who only serves 13
clients of in-home long-term care workers who are qualified family 14
members as described in RCW 50B.04.010. 15
NEW SECTION. Sec. 46. This act takes effect January 1, 2026.16
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