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Bill

SB 5084

Concerning health carrier reporting.

2025-2026 Regular Session Introduced by Manka Dhingra and 6 co-sponsors

The bill requires health carriers to annually report their primary care expenditures, aligned with HCA definitions, with reports made public.

Effective date 7/27/2025.
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WeVote Research Nonpartisan
Bill Summary · SB 5084

Summary: Senate Bill 5084 — Health Carrier Reporting on Primary Care Spending

Overview and Purpose

SB 5084 authorizes the Washington State Office of the Insurance Commissioner (OIC) to require health carriers to annually report primary care expenditures. The bill ensures reporting aligns with definitions and data practices developed by the Health Care Authority (HCA) and its Health Care Cost Transparency Board, promoting consistency across state agencies in measuring primary care spending. The data reported by carriers would be public information.

Key Provisions

  • Authority to require reporting: The OIC may require health carriers to annually report primary care expenditures for prior calendar years or projected expenditures for upcoming calendar years.
  • Form and content: In developing the reporting requirements, the OIC must consider:
    • The Board’s definition of primary care expenditures and any targets (including the goal of increasing primary care expenditure share).
    • Primary care expenditure reporting systems used by the HCA for medical assistance and employee benefits coverage programs.
  • Public disclosure: Primary care expenditure reports submitted by carriers are public information.
  • No appropriation: The bill does not authorize new spend; fiscal note is available.
  • Effective date: The act takes effect 90 days after adjournment of the 2025 legislative session, with an effective date listed as July 27, 2025.

Definitions and Interagency Context

  • Primary care spending measurement: The Health Care Cost Transparency Board, within the HCA, develops a definition of primary care expenditure and tracks progress toward a 12% share of total health care expenditures.
  • Contracting and data practices: The HCA uses a single primary care definition in contracts with managed care organizations and health carriers for Medicaid and employee benefits; it also collects a standard set of primary care data.
  • Interagency alignment: The bill requires the OIC to harmonize its reporting framework with the HCA’s definitions and reporting systems, promoting consistent measurement across programs.

Affected Parties

  • Health carriers (commercial health insurance carriers operating in Washington)
  • Office of the Insurance Commissioner (regulator and producer of the reporting requirements)
  • Health Care Authority and its programs (Medicaid/medical assistance and employee benefits coverage)
  • General public (through public availability of the reports)

Timeline and Legislative History

  • Prefiled: December 19, 2024
  • Introduced: December 19, 2024
  • Passed Senate: February 12, 2025
  • Passed House: March 26, 2025
  • Governor signed: April 4, 2025
  • Effective date: July 27, 2025 (90 days post adjournment)

Impact and Implications

  • Increased transparency of primary care spending by health carriers.
  • Data alignment between the OIC and HCA facilitates assessment of progress toward primary care goals.
  • Potential for carriers to adjust reporting systems to meet harmonized definitions and timelines.

Compiled from official sources — confirm details with the bill’s official record.

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