Pregnancy/emerg. treatment

AN ACT Relating to codifying emergency rules to protect the right 1
of a pregnant person to access treatment for emergency medical 2
conditions in hospital emergency departments; amending RCW 3
70.170.060; reenacting and amending RCW 70.41.020; adding a new 4
section to chapter 70.41 RCW; and declaring an emergency.5
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:6
Sec. 1. RCW 70.41.020 and 2021 c 157 s 3 and 2021 c 61 s 1 are 7
each reenacted and amended to read as follows: 8
Unless the context clearly indicates otherwise, the following 9
terms, whenever used in this chapter, shall be deemed to have the 10
following meanings: 11
(1) "Aftercare" means the assistance provided by a lay caregiver 12
to a patient under this chapter after the patient's discharge from a 13
hospital. The assistance may include, but is not limited to, 14
assistance with activities of daily living, wound care, medication 15
assistance, and the operation of medical equipment. "Aftercare" 16
includes assistance only for conditions that were present at the time 17
of the patient's discharge from the hospital. "Aftercare" does not 18
include: 19
S-0754.2
SENATE BILL 5557
State of Washington 69th Legislature 2025 Regular Session
By Senators Krishnadasan, Dhingra, Kauffman, Slatter, C. Wilson,
Saldaña, Orwall, Lovelett, Stanford, Cortes, Frame, Hasegawa, Liias,
Nobles, Pedersen, Trudeau, and Valdez
Read first time 01/28/25. Referred to Committee on Health & Long-
Term Care.
p. 1 SB 5557
(a) Assistance related to conditions for which the patient did 1
not receive medical care, treatment, or observation in the hospital; 2
or 3
(b) Tasks the performance of which requires licensure as a health 4
care provider. 5
(2)(a) "Audio-only telemedicine" means the delivery of health 6
care services through the use of audio-only technology, permitting 7
real-time communication between the patient at the originating site 8
and the provider, for the purpose of diagnosis, consultation, or 9
treatment. 10
(b) "Audio-only telemedicine" does not include:11
(i) The use of facsimile or email; or 12
(ii) The delivery of health care services that are customarily 13
delivered by audio-only technology and customarily not billed as 14
separate services by the provider, such as the sharing of laboratory 15
results. 16
(3) "Department" means the Washington state department of health.17
(4) "Discharge" means a patient's release from a hospital 18
following the patient's admission to the hospital.19
(5) "Distant site" means the site at which a physician or other 20
licensed provider, delivering a professional service, is physically 21
located at the time the service is provided through telemedicine.22
(6) "Emergency care to victims of sexual assault" means medical 23
examinations, procedures, and services provided by a hospital 24
emergency room to a victim of sexual assault following an alleged 25
sexual assault. 26
(7) "Emergency contraception" means any health care treatment 27
approved by the food and drug administration that prevents pregnancy, 28
including but not limited to administering two increased doses of 29
certain oral contraceptive pills within seventy-two hours of sexual 30
contact. 31
(8) "Emergency medical condition" means:32
(a) A condition of such severity that the absence of immediate 33
medical attention could result in: (i) Placing the health of an 34
individual (or, with respect to a pregnant person, the health of the 35
pregnant person or their embryo or fetus) in serious jeopardy; (ii) 36
serious impairment to bodily functions; or (iii) serious dysfunction 37
of a bodily organ or part; or38
(b) With respect to a pregnant person who is having contractions: 39
(i) That there is inadequate time to affect a safe transfer to 40
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another hospital before delivery; or (ii) that transfer may pose a 1
threat to the health or safety of the pregnant person or their embryo 2
or fetus. 3
(9) "Hospital" means any institution, place, building, or agency 4
which provides accommodations, facilities and services over a 5
continuous period of twenty-four hours or more, for observation, 6
diagnosis, or care, of two or more individuals not related to the 7
operator who are suffering from illness, injury, deformity, or 8
abnormality, or from any other condition for which obstetrical, 9
medical, or surgical services would be appropriate for care or 10
diagnosis. "Hospital" as used in this chapter does not include 11
hotels, or similar places furnishing only food and lodging, or simply 12
domiciliary care; nor does it include clinics, or physician's offices 13
where patients are not regularly kept as bed patients for twenty-four 14
hours or more; nor does it include nursing homes, as defined and 15
which come within the scope of chapter 18.51 RCW; nor does it include 16
birthing centers, which come within the scope of chapter 18.46 RCW; 17
nor does it include ((psychiatric)) behavioral health hospitals, 18
which come within the scope of chapter 71.12 RCW; nor any other 19
hospital, or institution specifically intended for use in the 20
diagnosis and care of those suffering from mental illness, 21
intellectual disability, convulsive disorders, or other abnormal 22
mental condition. Furthermore, nothing in this chapter or the rules 23
adopted pursuant thereto shall be construed as authorizing the 24
supervision, regulation, or control of the remedial care or treatment 25
of residents or patients in any hospital conducted for those who rely 26
primarily upon treatment by prayer or spiritual means in accordance 27
with the creed or tenets of any well recognized church or religious 28
denominations. 29
(((9))) (10) "Immediate jeopardy" means a situation in which the 30
hospital's noncompliance with one or more statutory or regulatory 31
requirements has placed the health and safety of patients in its care 32
at risk for serious injury, serious harm, serious impairment, or 33
death. 34
(((10))) (11) "Lay caregiver" means any individual designated as 35
such by a patient under this chapter who provides aftercare 36
assistance to a patient in the patient's residence. "Lay caregiver" 37
does not include a long-term care worker as defined in RCW 38
74.39A.009. 39
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(((11))) (12) "Originating site" means the physical location of a 1
patient receiving health care services through telemedicine.2
(((12))) (13) "Person" means any individual, firm, partnership, 3
corporation, company, association, or joint stock association, and 4
the legal successor thereof. 5
(((13))) (14) "Secretary" means the secretary of health.6
(((14))) (15) "Sexual assault" has the same meaning as in RCW 7
70.125.030. 8
(((15))) (16) "Telemedicine" means the delivery of health care 9
services through the use of interactive audio and video technology, 10
permitting real-time communication between the patient at the 11
originating site and the provider, for the purpose of diagnosis, 12
consultation, or treatment. "Telemedicine" includes audio-only 13
telemedicine, but does not include facsimile or email.14
(((16))) (17) "Victim of sexual assault" means a person who 15
alleges or is alleged to have been sexually assaulted and who 16
presents as a patient. 17
NEW SECTION. Sec. 2. A new section is added to chapter 70.41 18
RCW to read as follows: 19
When providing emergency services, hospitals shall:20
(1) Comply with 42 U.S.C. Sec. 1395dd and its implementing 21
regulations as they existed on January 1, 2025, provided that, for 22
purposes of this subsection, "emergency medical condition" shall have 23
the meaning provided in RCW 70.41.020 and "unborn child" shall mean 24
"embryo or fetus" where those terms are used in 42 U.S.C. Sec. 1395dd 25
and its implementing regulations as they existed on January 1, 2025. 26
Hospitals must comply with any requirements of this chapter or any 27
other law that provide greater access to care or are otherwise more 28
favorable to patients than the requirements of 42 U.S.C. Sec. 1395dd 29
and its implementing regulations as they existed on January 1, 2025; 30
and 31
(2) Provide treatment to a pregnant person who comes to the 32
hospital with an emergency medical condition that is consistent with 33
the applicable standard of care for such condition or, if authorized 34
by law, transfer the patient to another hospital capable of providing 35
the treatment, with the informed consent of the patient. If 36
termination of the pregnancy is the treatment that is consistent with 37
the applicable standard of care, the hospital must provide such 38
treatment following and as promptly as dictated by the standard of 39
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care or, if authorized by law, transfer the patient to another 1
hospital capable of providing the treatment, with the informed 2
consent of the patient. Neither the continuation of the pregnancy nor 3
the health of any embryo or fetus shall be a basis for withholding 4
care from the pregnant person, and neither the continuation of the 5
pregnancy nor the health of any embryo or fetus shall be prioritized 6
over the health or safety of the pregnant person absent the informed 7
consent of the pregnant person. 8
Sec. 3. RCW 70.170.060 and 2022 c 197 s 2 are each amended to 9
read as follows: 10
(1) No hospital or its medical staff shall adopt or maintain 11
admission practices or policies which result in: 12
(a) A significant reduction in the proportion of patients who 13
have no third-party coverage and who are unable to pay for hospital 14
services; 15
(b) A significant reduction in the proportion of individuals 16
admitted for inpatient hospital services for which payment is, or is 17
likely to be, less than the anticipated charges for or costs of such 18
services; or 19
(c) The refusal to admit patients who would be expected to 20
require unusually costly or prolonged treatment for reasons other 21
than those related to the appropriateness of the care available at 22
the hospital. 23
(2) No hospital shall adopt or maintain practices or policies 24
which would deny access to emergency care based on ability to pay. No 25
hospital which maintains an emergency department shall transfer a 26
patient with an emergency medical condition or who is in active 27
labor, in such circumstances and as promptly as dictated by the 28
standard of care, unless the transfer is performed at the request of 29
the patient or is due to the limited medical resources of the 30
transferring hospital. Hospitals must follow reasonable procedures in 31
making transfers to other hospitals including confirmation of 32
acceptance of the transfer by the receiving hospital.33
(3) The department shall develop definitions by rule, as 34
appropriate, for subsection (1) of this section and, with reference 35
to federal requirements, subsection (2) of this section. The 36
department shall monitor hospital compliance with subsections (1) and 37
(2) of this section. The department shall report individual instances 38
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of possible noncompliance to the state attorney general or the 1
appropriate federal agency. 2
(4) The department shall establish and maintain by rule, 3
consistent with the definition of charity care in RCW 70.170.020, the 4
following: 5
(a) Uniform procedures, data requirements, and criteria for 6
identifying patients receiving charity care; and 7
(b) A definition of residual bad debt including reasonable and 8
uniform standards for collection procedures to be used in efforts to 9
collect the unpaid portions of hospital charges that are the 10
patient's responsibility. 11
(5) For the purpose of providing charity care, each hospital 12
shall develop, implement, and maintain a policy which shall enable 13
indigent persons access to charity care. The policy shall include 14
procedures for identifying patients who may be eligible for health 15
care coverage through medical assistance programs under chapter 74.09 16
RCW or the Washington health benefit exchange and actively assisting 17
patients to apply for any available coverage. If a hospital 18
determines that a patient or their guarantor is qualified for 19
retroactive health care coverage through the medical assistance 20
programs under chapter 74.09 RCW, a hospital shall assist the patient 21
or guarantor with applying for such coverage. If a hospital 22
determines that a patient or their guarantor qualifies for 23
retroactive health care coverage through the medical assistance 24
programs under chapter 74.09 RCW, a hospital is not obligated to 25
provide charity care under this section to any patient or their 26
guarantor if the patient or their guarantor fails to make reasonable 27
efforts to cooperate with the hospital's efforts to assist them in 28
applying for such coverage. Hospitals may not impose application 29
procedures for charity care or for assistance with retroactive 30
coverage applications which place an unreasonable burden upon the 31
patient or guarantor, taking into account any physical, mental, 32
intellectual, or sensory deficiencies, or language barriers which may 33
hinder the responsible party's capability of complying with 34
application procedures. It is an unreasonable burden to require a 35
patient to apply for any state or federal program where the patient 36
is obviously or categorically ineligible or has been deemed 37
ineligible in the prior 12 months. 38
(a) At a minimum, a hospital owned or operated by a health system 39
that owns or operates three or more acute hospitals licensed under 40
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chapter 70.41 RCW, an acute care hospital with over 300 licensed beds 1
located in the most populous county in Washington, or an acute care 2
hospital with over 200 licensed beds located in a county with at 3
least 450,000 residents and located on Washington's southern border 4
shall grant charity care per the following guidelines:5
(i) All patients and their guarantors whose income is not more 6
than 300 percent of the federal poverty level, adjusted for family 7
size, shall be deemed charity care patients for the full amount of 8
the patient responsibility portion of their hospital charges;9
(ii) All patients and their guarantors whose income is between 10
301 and 350 percent of the federal poverty level, adjusted for family 11
size, shall be entitled to a 75 percent discount for the full amount 12
of the patient responsibility portion of their hospital charges, 13
which may be reduced by amounts reasonably related to assets 14
considered pursuant to (c) of this subsection; 15
(iii) All patients and their guarantors whose income is between 16
351 and 400 percent of the federal poverty level, adjusted for family 17
size, shall be entitled to a 50 percent discount for the full amount 18
of the patient responsibility portion of their hospital charges, 19
which may be reduced by amounts reasonably related to assets 20
considered pursuant to (c) of this subsection. 21
(b) At a minimum, a hospital not subject to (a) of this 22
subsection shall grant charity care per the following guidelines:23
(i) All patients and their guarantors whose income is not more 24
than 200 percent of the federal poverty level, adjusted for family 25
size, shall be deemed charity care patients for the full amount of 26
the patient responsibility portion of their hospital charges;27
(ii) All patients and their guarantors whose income is between 28
201 and 250 percent of the federal poverty level, adjusted for family 29
size, shall be entitled to a 75 percent discount for the full amount 30
of the patient responsibility portion of their hospital charges, 31
which may be reduced by amounts reasonably related to assets 32
considered pursuant to (c) of this subsection; and33
(iii) All patients and their guarantors whose income is between 34
251 and 300 percent of the federal poverty level, adjusted for family 35
size, shall be entitled to a 50 percent discount for the full amount 36
of the patient responsibility portion of their hospital charges, 37
which may be reduced by amounts reasonably related to assets 38
considered pursuant to (c) of this subsection. 39
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(c)(i) If a hospital considers the existence, availability, and 1
value of assets in order to reduce the discount extended, it must 2
establish and make publicly available a policy on asset 3
considerations and corresponding discount reductions.4
(ii) If a hospital considers assets, the following types of 5
assets shall be excluded from consideration: 6
(A) The first $5,000 of monetary assets for an individual or 7
$8,000 of monetary assets for a family of two, and $1,500 of monetary 8
assets for each additional family member. The value of any asset that 9
has a penalty for early withdrawal shall be the value of the asset 10
after the penalty has been paid; 11
(B) Any equity in a primary residence; 12
(C) Retirement plans other than 401(k) plans; 13
(D) One motor vehicle and a second motor vehicle if it is 14
necessary for employment or medical purposes; 15
(E) Any prepaid burial contract or burial plot; and16
(F) Any life insurance policy with a face value of $10,000 or 17
less. 18
(iii) In considering assets, a hospital may not impose procedures 19
which place an unreasonable burden on the responsible party. 20
Information requests from the hospital to the responsible party for 21
the verification of assets shall be limited to that which is 22
reasonably necessary and readily available to substantiate the 23
responsible party's qualification for charity sponsorship and may not 24
be used to discourage application for such sponsorship. Only those 25
facts relevant to eligibility may be verified and duplicate forms of 26
verification may not be demanded. 27
(A) In considering monetary assets, one current account statement 28
shall be considered sufficient for a hospital to verify a patient's 29
assets. 30
(B) In the event that no documentation for an asset is available, 31
a hospital shall rely upon a written and signed statement from the 32
responsible party. 33
(iv) Asset information obtained by the hospital in evaluating a 34
patient for charity care eligibility shall not be used for collection 35
activities. 36
(v) Nothing in this section prevents a hospital from considering 37
assets as required by the centers for medicare and medicaid services 38
related to medicare cost reporting. 39
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(6) Each hospital shall post and prominently display notice of 1
charity care availability. Notice must be posted in all languages 2
spoken by more than ten percent of the population of the hospital 3
service area. Notice must be displayed in at least the following 4
locations: 5
(a) Areas where patients are admitted or registered;6
(b) Emergency departments, if any; and 7
(c) Financial service or billing areas where accessible to 8
patients. 9
(7) Current versions of the hospital's charity care policy, a 10
plain language summary of the hospital's charity care policy, and the 11
hospital's charity care application form must be available on the 12
hospital's website. The summary and application form must be 13
available in all languages spoken by more than ten percent of the 14
population of the hospital service area. 15
(8)(a) All hospital billing statements and other written 16
communications concerning billing or collection of a hospital bill by 17
a hospital must include the following or a substantially similar 18
statement prominently displayed on the first page of the statement in 19
both English and the second most spoken language in the hospital's 20
service area: 21
You may qualify for free care or a discount on your hospital 22
bill, whether or not you have insurance. Please contact our 23
financial assistance office at (([website] and [phone 24
number])) ...(website)... and ...(phone number)....25
(b) Nothing in (a) of this subsection requires any hospital to 26
alter any preprinted hospital billing statements existing as of 27
October 1, 2018. 28
(9) Hospital obligations under federal and state laws to provide 29
meaningful access for limited English proficiency and non-English-30
speaking patients apply to information regarding billing and charity 31
care. Hospitals shall develop standardized training programs on the 32
hospital's charity care policy and use of interpreter services, and 33
provide regular training for appropriate staff, including the 34
relevant and appropriate staff who perform functions relating to 35
registration, admissions, or billing. 36
(10) Each hospital shall make every reasonable effort to 37
determine: 38
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(a) The existence or nonexistence of private or public 1
sponsorship which might cover in full or part the charges for care 2
rendered by the hospital to a patient; 3
(b) The annual family income of the patient as classified under 4
federal poverty income guidelines as of the time the health care 5
services were provided, or at the time of application for charity 6
care if the application is made within two years of the time of 7
service, the patient has been making good faith efforts towards 8
payment of health care services rendered, and the patient 9
demonstrates eligibility for charity care; and 10
(c) The eligibility of the patient for charity care as defined in 11
this chapter and in accordance with hospital policy. An initial 12
determination of sponsorship status shall precede collection efforts 13
directed at the patient. 14
(11) At the hospital's discretion, a hospital may consider 15
applications for charity care at any time, including any time there 16
is a change in a patient's financial circumstances.17
(12) The department shall monitor the distribution of charity 18
care among hospitals, with reference to factors such as relative need 19
for charity care in hospital service areas and trends in private and 20
public health coverage. The department shall prepare reports that 21
identify any problems in distribution which are in contradiction of 22
the intent of this chapter. The report shall include an assessment of 23
the effects of the provisions of this chapter on access to hospital 24
and health care services, as well as an evaluation of the 25
contribution of all purchasers of care to hospital charity care.26
(13) The department shall issue a report on the subjects 27
addressed in this section at least annually, with the first report 28
due on July 1, 1990. 29
NEW SECTION. Sec. 4. This act is necessary for the immediate 30
preservation of the public peace, health, or safety, or support of 31
the state government and its existing public institutions, and takes 32
effect immediately.33
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