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WashingtonSB 50832025-2026 Regular SessionSenateWALLET

Ensuring access to primary care, behavioral health, and affordable hospital services.

Sponsored By: June Robinson (Democratic)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 2 benefits, 0 costs, 1 mixed.

Public Employees Gain Extra-Bill Protections

Beginning January 1, 2027, Washington public employee plans and covered dependents gain protection against extra provider bills. Providers paid under the out-of-network hospital rules cannot collect charges beyond the allowed payment from patients or financially responsible people. This protection also applies to providers paid under the law's primary care and behavioral health minimums. Patients still owe deductibles, copays, and other cost-sharing authorized by their health plan.

Public Employee Health Plans Face Oversight

Insurers and third-party administrators for Washington public employee plans must share cost and care-quality data when the Health Care Authority requests it; contracts cannot block disclosure. The authority can issue rules, levy fines, and take contract actions to enforce compliance. Medicare comparisons include applicable settlements, rebates, incentives, and adjustments, using current-year federal claim modifiers; the authority can set equivalents for services with little or no Medicare experience. Plans can use global budgets, fixed per-person payments, or value-based payments if they meet payment requirements and required quality incentives. Working with the insurance commissioner, the authority must report by December 31, 2030, and December 31, 2034, on provider access, premiums, patient cost-sharing, and state spending, and may recommend legislative changes.

Public Employee Plans Get Payment Limits

Beginning January 1, 2027, new payment rules apply to Washington public employee medical plans and covered dependents. In-network primary care and behavioral health outside facilities must receive at least 150% of Medicare payment. For Washington hospitals, in-network payments cannot exceed the lowest of billed charges, the contracted rate, or 200% of Medicare. Out-of-network hospital payments cannot exceed the lower of billed charges or 185% of Medicare; these hospital limits exclude physician charges. Children's hospitals have special caps based on each hospital's Medicaid inpatient cost-to-charge ratio: King County uses 150% in-network and 135% out-of-network; Pierce County uses 190% and 175%, respectively. Those caps also cannot exceed billed charges or, for in-network care, the contracted rate. Critical access hospitals subject to the rules must receive at least 101% of Medicare-defined allowable costs. Rural sole community and critical access hospitals are exempt unless their health system owns or operates more than two acute care hospitals. Exemptions also cover island hospitals in public hospital districts in Skagit County and tribal-land hospitals that lack critical access status, fail current federal designation requirements, and have more than 60% Medicare and Medicaid inpatient days combined. Plan premiums must reflect expected payment changes, but the law does not specify whether premiums rise or fall, or by how much.

Sponsors & Cosponsors

Sponsor

  • June Robinson

    Democratic • Senate

Cosponsors

  • Javier Valdez

    Democratic • Senate

  • Jesse Salomon

    Democratic • Senate

  • Marko Liias

    Democratic • Senate

  • Paul Harris

    Republican • Senate

  • T'wina Nobles

    Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 116 • No: 77

Senate vote • 4/24/2025

Final Passage as Amended by the House

Yes: 29 • No: 19

House vote • 4/22/2025

Final Passage as Amended by the House

Yes: 57 • No: 39 • Other: 2

Senate vote • 3/11/2025

3rd Reading & Final Passage

Yes: 30 • No: 19

Actions Timeline

  1. Effective date 7/27/2025.

    5/20/2025Senate

  2. Chapter 373, 2025 Laws.

    5/20/2025Senate

  3. Governor signed.

    5/20/2025legislature

  4. Delivered to Governor.

    4/27/2025legislature

  5. Speaker signed.

    4/26/2025legislature

  6. President signed.

    4/25/2025legislature

  7. Passed final passage; yeas, 29; nays, 19; absent, 0; excused, 0.

    4/24/2025Senate

  8. Senate concurred in House amendments.

    4/24/2025House

  9. Third reading, passed; yeas, 57; nays, 39; absent, 0; excused, 2.

    4/22/2025Senate

  10. Rules suspended. Placed on Third Reading.

    4/22/2025Senate

  11. Floor amendment(s) adopted.

    4/22/2025Senate

  12. Rules Committee relieved of further consideration. Placed on second reading.

    4/22/2025Senate

  13. Referred to Rules 2 Review.

    3/27/2025Senate

  14. Minority; without recommendation.

    3/24/2025Senate

  15. Minority; do not pass.

    3/24/2025Senate

  16. APP - Majority; do pass.

    3/24/2025Senate

  17. APP - Executive action taken by committee.

    3/24/2025Senate

  18. First reading, referred to Appropriations.

    3/13/2025Senate

  19. Third reading, passed; yeas, 30; nays, 19; absent, 0; excused, 0.

    3/11/2025Senate

  20. Rules suspended. Placed on Third Reading.

    3/11/2025Senate

  21. Floor amendment(s) adopted.

    3/11/2025Senate

  22. 2nd substitute bill substituted.

    3/11/2025Senate

  23. Placed on second reading by Rules Committee.

    3/7/2025Senate

  24. Passed to Rules Committee for second reading.

    2/28/2025Senate

  25. Minority; without recommendation.

    2/27/2025Senate

Bill Text

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