November 6th UHCC Finance Technical Advisory Committee (FTAC) Discusses Provider and Hospital Pricing
Washington's Finance Technical Advisory Committee (subcommittee of Universal Health Care Committee) convened to advance implementation of universal health care, with key focus on hospital reference pricing and provider reimbursement strategy.
SB 5083 Reference Pricing (2027 Implementation)
The Health Care Authority briefed on SB 5083, which caps hospital payments at 200% of Medicare rates for public/school employee plans (PEBB/SEBB) covering 500,000+ employees and dependents. Simultaneously, the law establishes payment floors of 150% of Medicare for primary care and behavioral health—shifting resources from inflated hospital spending toward preventive and mental health services. Preliminary modeling projects 2–3% premium growth reduction and approximately $200 million in state savings over four years. Enforcement includes annual claim repricing, carrier repayment obligations, corrective action plans for repeat violations, and new balance-billing protections.
Provider Reimbursement Framework (In Development)
FTAC defined scope for its provider reimbursement straw proposal: guiding principles, hospital payment approach, physician/provider frameworks, and participation incentives are in-scope. Outside the initial scope are detailed rate-setting methodologies, delivery system choices (carrier-based vs. ASO vs. fee-for-service), and operational/administrative details—topics for separate tracks.
Two critical guiding principles emerged: (1) uniform reimbursement across all enrolled individuals (no separate Medicaid/Medicare rates), and (2) site-neutral payment (same compensation for same clinical services regardless of setting or provider type). Members cautioned against conflating administrative simplification with reimbursement design, noting these deserve their own governance path.
Incomplete Foundational Work & New Funding
Members flagged that benefit design costing remains unfinished—the selected UMP Classic Plus Dental was never fully costed, and cost-sharing principles lack detailed modeling. Since calculating per-member premiums requires knowing benefit costs, this must be completed in parallel with reimbursement work. $250,000 funding from the Office of the Insurance Commissioner (OIC) can address these analytic gaps; staff will identify priorities at the January meeting.
Next Steps
A working group (Bob and Roger leading) will refine reimbursement principles and scope before the next full meeting on January 15, 2026, aiming for more efficient deliberation. The Commission expects FTAC to integrate Milliman analyses, SB 5083 findings, and rural/administrative work into its recommendations—though expectations for high-level guidance versus detailed financial modeling still require clarification.
The next FTAC meeting is Thurs., Jan 15, 2026 from 2-4:30 pm. Details available here closer to the date.
There are two ways to share input:
- Speak during the designated public comment time at FTAC meetings. Sign up to provide public comment by 5 p.m. the day before the meeting occurs.
- Submit written comments at any time. If you submit your comments less than two weeks before a meeting, we’ll include them in the following meeting’s materials.
The next UHCC meeting is Thurs., Dec 11, 2025 from 2-5:00pm. Details available here closer to the date.
There are two ways to share input:
- Speak during the designated public comment time at FTAC meetings. Sign up to provide public comment by 5 p.m. the day before the meeting occurs.
- Submit written comments at any time. If you submit your comments less than two weeks before a meeting, we’ll include them in the following meeting’s materials.
We urge our members to push for a single payer plan in their public comments.
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