Public hospitals

AN ACT Relating to strengthening public hospitals; amending RCW 1
70.44.450 and 70.37.020; adding new sections to chapter 48.14 RCW; 2
and creating a new section. 3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
NEW SECTION. Sec. 1. The legislature finds that hospitals owned 5
and operated by public entities play unique roles in their 6
communities, serving as safety net providers, treating all patients, 7
even those who are medically complex, low income, uninsured, or 8
underinsured. Often these patients cannot access care at other 9
nonpublic facilities and must rely on public hospitals as a result. 10
These hospitals' adherence to this public mission imperils their 11
financial stability, especially as access to public reimbursement 12
programs and other forms of financial support decline. The continued 13
viability of public hospitals and the access to care they provide for 14
all members of their communities are a matter of significant public 15
concern. The legislature finds that competition between public 16
hospitals is not practical or desirable and instead may harm these 17
hospitals' ability to fulfill their public mission. It is the intent 18
of this act to foster the development of cooperative and 19
collaborative arrangements among all public hospitals to support 20
their public mission. To this end, the legislature intends to 21
S-3915.2
SENATE BILL 6159
State of Washington 69th Legislature 2026 Regular Session
By Senators Dhingra, Cleveland, Bateman, Cortes, Lovelett, Nobles,
Robinson, Saldaña, Shewmake, Valdez, and Wellman
Read first time 01/15/26. Referred to Committee on Health & Long-
Term Care.
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authorize these entities to enter agreements, contracts, and other 1
arrangements on a noncompetitive basis. 2
Sec. 2. RCW 70.44.450 and 1992 c 161 s 3 are each amended to 3
read as follows: 4
In addition to other powers granted to public hospital districts 5
by chapter 39.34 RCW, ((rural)) public hospital districts that are 6
not affiliated with a nonpublic entity under RCW 70.44.240 may enter 7
into cooperative agreements and contracts with other ((rural)) public 8
hospital districts and publicly owned or operated health care 9
entities in order to provide for the health care needs of the people 10
served by the hospital districts. These agreements and contracts are 11
specifically authorized to include: 12
(1) Allocation of health care services among the different 13
facilities owned and operated by the districts; 14
(2) Combined purchases and allocations of medical equipment and 15
technologies; 16
(3) Joint agreements and contracts for health care service 17
delivery and payment with public and private entities; and18
(4) Other cooperative arrangements consistent with the intent of 19
chapter 161, Laws of 1992. The provisions of chapter 39.34 RCW shall 20
apply to the development and implementation of the cooperative 21
contracts and agreements. 22
Sec. 3. RCW 70.37.020 and 1994 c 92 s 505 are each amended to 23
read as follows: 24
As used in this chapter, the following words and terms have the 25
following meanings, unless the context indicates or requires another 26
or different meaning or intent and the singular of any term shall 27
encompass the plural and the plural the singular unless the context 28
indicates otherwise: 29
(1) "Authority" means the Washington health care facilities 30
authority created by RCW 70.37.030 or any board, body, commission, 31
department or officer succeeding to the principal functions thereof 32
or to whom the powers conferred upon the authority shall be given by 33
law. 34
(2) "Bonds" mean bonds, notes or other evidences of indebtedness 35
of the authority issued pursuant hereto. 36
(3) "Health care facility" means any land, structure, system, 37
machinery, equipment or other real or personal property or 38
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appurtenances useful for or associated with delivery of inpatient or 1
outpatient health care service or support for such care or any 2
combination thereof which is operated or undertaken in connection 3
with hospital, clinic, health maintenance organization, diagnostic or 4
treatment center, extended care facility, or any facility providing 5
or designed to provide therapeutic, convalescent or preventive health 6
care services, and shall include research and support facilities of a 7
comprehensive cancer center, but excluding, however, any facility 8
which is maintained by a participant primarily for rental or lease to 9
self-employed health care professionals or as an independent nursing 10
home or other facility primarily offering domiciliary care.11
(4) "Participant" means ((any)):12
(a) Any city, county or other municipal corporation or agency or 13
political subdivision of the state or any corporation, hospital, 14
comprehensive cancer center, or health maintenance organization 15
authorized by law to operate nonprofit health care facilities, or any 16
affiliate, as defined by regulations promulgated by the director of 17
the department of financial institutions pursuant to RCW 21.20.450, 18
which is a nonprofit corporation acting for the benefit of any entity 19
described in this subsection;20
(b) Any public hospital district as authorized in chapter 70.44 21
RCW; or22
(c) Any publicly owned or operated health care entity.23
(5) "Project" means a specific health care facility or any 24
combination of health care facilities, constructed, purchased, 25
acquired, leased, used, owned or operated by a participant, and 26
alterations, additions to, renovations, enlargements, betterments and 27
reconstructions thereof. 28
NEW SECTION. Sec. 4. A new section is added to chapter 48.14 29
RCW to read as follows: 30
(1) In addition to any other taxes or other charges imposed under 31
this chapter, each authorized insurer or taxpayer subject to tax 32
under RCW 48.14.020 or 48.14.0201 shall, on or before the first day 33
of March of each year, pay to the state treasurer through the 34
commissioner's office an annual coverage assessment. The assessment 35
equals $0.75 per coverage month in the prior calendar year. The 36
initial assessment imposed under this subsection (1) is due and 37
payable on or before March 1, 2027. 38
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(2) Each insurer or taxpayer subject to the assessment under this 1
section must file with the commissioner on or before the first day of 2
March of each year, an annual coverage month assessment statement 3
indicating the number of coverage months associated with premiums or 4
prepayments for health care services subject to tax under RCW 5
48.14.020 or 48.14.0201, in a form and manner required by the 6
commissioner. The statement under this subsection is in addition to 7
the statement required under RCW 48.14.030. 8
(3) Any insurer or taxpayer failing to file its annual coverage 9
month assessment statement under subsection (2) of this section and 10
pay the assessment by the last day of the month in which the 11
assessment becomes due, shall be assessed a penalty of five percent 12
of the amount of the assessment. If the assessment is not paid within 13
45 days after the due date, the insurer or taxpayer must be assessed 14
a total penalty of 10 percent of the amount of the assessment. If the 15
assessment is not paid within 60 days of the due date, the insurer or 16
taxpayer must be assessed a total penalty of 20 percent of the amount 17
of the assessment. The assessment may be collected by distraint, and 18
the penalty recovered by any action instituted by the commissioner in 19
any court of competent jurisdiction. The amount of any penalty 20
collected must be paid to the state treasurer and credited to the 21
public hospital infrastructure account. 22
(4) In addition to the penalties set forth in subsection (3) of 23
this section, interest accrues on the amount of the unpaid assessment 24
at the maximum legal rate of interest permitted under RCW 19.52.020 25
commencing 61 days after the assessment is due until paid.26
(5) The commissioner may revoke the certificate of authority or 27
registration of any delinquent insurer or taxpayer, and the 28
certificate of authority or registration will not be reissued, until 29
all assessments, interest, and penalties imposed under this section 30
have been fully paid and the insurer or taxpayer has otherwise 31
qualified for the certificate of authority or registration.32
(6) In the event that any insurer or taxpayer has paid to the 33
commissioner any assessment under this section in error or in excess 34
of that which it is lawfully obligated to pay, the commissioner shall 35
upon written request make a refund thereof. An insurer or taxpayer 36
may only request a refund of assessments within six years of the end 37
of the calendar year for which the assessments are owed. Refunds may 38
be made either by crediting the amount toward payment of taxes, 39
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assessments, or other charges due or to become due from such insurer 1
or taxpayer, or by making a cash refund. 2
(7) All revenues collected under this section must be deposited 3
in the public hospital infrastructure account created in section 5 of 4
this act. 5
(8) The assessment required under this section must be borne 6
solely by the insurer or taxpayer and may not be passed through to 7
enrollees in premiums, rates, plan design, or otherwise.8
(9) Carriers shall demonstrate their compliance with this section 9
through the rate filing review process of the commissioner, as 10
directed by the commissioner. The commissioner also may adopt rules 11
to implement this section. 12
(10) For the purpose of this section, "coverage month" means each 13
month of coverage under an insurance policy or each month of 14
prepayment for health care services where premiums or prepayments are 15
subject to tax under RCW 48.14.020 or 48.14.0201. 16
NEW SECTION. Sec. 5. A new section is added to chapter 48.14 17
RCW to read as follows: 18
The public hospital infrastructure account is created in the 19
state treasury. All receipts from the assessment outlined in section 20
4 of this act must be deposited into the public hospital 21
infrastructure account. Moneys in the account may be spent only after 22
appropriation. Expenditures from the account may be used only for 23
providing funding assistance to public district hospitals, or any 24
publicly owned or operated health care entity undertaking a major new 25
construction or modernization project. 26
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