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SB 5581

Developing strategies to reduce or eliminate deductibles for maternal support services and postpartum care.

2023-2024 Regular Session Introduced by John Braun and 12 co-sponsors

Directs WA OIC to study maternity care cost sharing (deductibles, copays, coinsurance), propose reductions/elimination, and estimate premium impact; report due July 1, 2024.

Effective date 7/23/2023.
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Bill Summary · SB 5581

Summary — SB 5581 (2023) — Strategies to reduce or eliminate deductibles for maternity care

Status: Chapter 444, 2023 Laws. Governor signed 5/11/2023. Effective date: July 23, 2023.
Primary action: Directed the Washington Office of the Insurance Commissioner (OIC) to analyze health plan coverage of maternity care and recommend methods to reduce or eliminate deductibles and other cost sharing.

Purpose / intent

To identify practical strategies for reducing or eliminating patient cost sharing (deductibles, copays, coinsurance) for maternity care — including prenatal, delivery, and postpartum services — and to estimate the financial impact of doing so on health plan rates. The analysis is intended to inform legislative or regulatory action to improve affordability and access to maternal support services.

Key provisions

  • OIC must conduct an analysis of how health plans define, cover, and reimburse maternity care services (prenatal, delivery, postpartum), and produce recommendations to reduce or eliminate deductibles and other cost sharing.
  • OIC must obtain information from:
    • Carriers with more than 1% accident & health market share (based on OIC’s most recent market report); and
    • Health plans offered to public employees (chapter 41.05 RCW).
  • Specific items OIC must evaluate:
    • How benefit designs define “maternity care services”;
    • Whether and to what extent such services are subject to deductibles or other cost sharing;
    • Which services qualify as federal preventive services (Section 2713 of the Public Health Service Act) and are already exempt from cost sharing;
    • The five most-used maternity reimbursement methodologies per carrier; and
    • For bundled/maternity bundle payments, exactly which services are included.
  • OIC must estimate the total and per-member-per-month (PMPM) impact on health plan rates of eliminating cost sharing either:
    • For all maternity care services, or
    • For prenatal care only, across these market segments: individual (non–Cascade Select), Cascade Select individual plans, small group, large group, public employee plans, and all plans in aggregate.
  • OIC must consult with health carriers, health care providers, and consumers in conducting the work and may contract for all or part of the analysis.
  • Deliverable: a written report of findings, cost estimates, and recommendations to the appropriate legislative committees by July 1, 2024.

Who is affected

  • Office of the Insurance Commissioner (responsible agency).
  • Health carriers with >1% market share and public-employee plans (data/reporting subjects).
  • Enrollees receiving maternity care — potential changes to out‑of‑pocket obligations in the future.
  • Employers and public employers (if plan design or premiums are adjusted based on recommendations).
  • Health care providers involved in maternity care and payers (reimbursement/bundling implications).

Timeline / procedural notes

  • Report due to the Legislature by July 1, 2024.
  • OIC may use contracted research or actuarial services to complete the analysis.
  • No new appropriation was attached to the law; a fiscal note was prepared.

Potential impact (informational)

  • Eliminating or reducing cost sharing would lower direct out‑of‑pocket costs for pregnant people and may improve access and postpartum follow-up.
  • Such changes would likely shift costs to premiums or payers; OIC’s PMPM and total cost estimates are meant to quantify that tradeoff.
  • The analysis identifies how current plan designs and reimbursement practices (including bundled payments) affect where and how cost sharing applies, which is necessary to design feasible policy options.

Additional context

  • Federal law already requires most plans to cover certain maternity-related preventive services without cost sharing (e.g., prenatal visits, screenings, breastfeeding support). This bill focuses on services and cost sharing not already covered by that federal preventive-services exemption.
  • Testimony recorded in committee indicated general support and OIC cooperation; proponents acknowledged the likely cost-shift but viewed it as worthwhile.

For the full statutory text, see Substitute Senate Bill 5581 (Chapter 444, 2023 Laws) or the OIC report to the Legislature (due July 1, 2024).

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

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