This bill creates a new, ongoing "covered lives" per-member-per-month assessment on specified covered entities (health carriers, self-funded multiple employer welfare arrangements, employer-sponsored self-funded plans, and Taft-Hartley plans) beginning January 1, 2027. For calendar year 2027 the assessment rate is set at $0.58 per covered life; the insurance commissioner must annually set the PMPM amount, issue notices of total assessment and payment obligations, and may contract to calculate covered lives. Covered entities must report covered-life data, payments may be collected no more frequently than quarterly, payments are due within 45 days of notice (interest on late amounts per RCW 43.17.240), payment plans may be approved, and nonpayment after 90 days triggers a civil penalty equal to 150% of the assessment plus interest and allows collection by distraint or court action and potential revocation of a carrier certificate or registration until paid. The commissioner must adopt rules to implement reporting, audits, collection, and related processes. The bill creates a new "behavioral health emergency services account" in the state treasury to receive all assessments, interest, and penalties and limits expenditures to specified behavioral health emergency services administered through behavioral health administrative services organizations or federally recognized tribes, administrative costs to the Health Care Authority, and refunds of erroneous payments; the account may not be used to reimburse services provided to Medicaid or CHIP enrollees. The commissioner must calculate biennial assessment adjustments each June of even-numbered years using an "adjustment factor" (inflation change plus population change) with increases capped at 10%. The insurance commissioner must also review and revise network, contracting, and claims-payment rules to support transitioning payment for the specified services to a prospective covered-lives assessment, including permitting carriers to submit alternate access delivery requests under defined conditions and deeming carriers that are current on the covered-lives assessment as having an adequate behavioral health emergency services network beginning January 1, 2027. The act also reenacts and amends provisions of RCW 43.84.092 to establish a treasury income account for earnings on invested surplus balances; the state treasurer will distribute those earnings monthly, crediting the general fund except that a long list of specified state accounts and funds receive a proportionate share based on average daily balances. The treasury income account may be used to implement federal Cash Management Improvement Act (CMIA) obligations and to pay purchased banking services; the Office of Financial Management determines CMIA amounts and may direct transfers. The bill makes several statutory amendments and adds a new chapter in Title 48 RCW, contains specified effective and expiration dates tied in part to RCW 74.76.040, declares the act not severable, and conditions the act on specific funding being provided in the omnibus appropriations act by June 30, 2026. Some provision text is incomplete in the available extracts (for example a limitation in section 4(3)(b) about billed-and-reimbursed services and full amendment texts for certain RCWs), so full details of those provisions are not available here.

If enacted, insurers and self-funded employer plans that cover people in Washington will start paying a new per-member fee that begins at $0.58 per member per month in 2027 and will be reassessed regularly. Those covered entities will have to report enrollment data, face new auditing and reporting duties, and make payments at least quarterly; payments are due within 45 days, late interest applies, very large penalties (150% of unpaid assessments) and even loss of a carrier’s certificate are possible for long nonpayment, and the insurance commissioner will write rules and can audit or contract out those functions. A practical upside for carriers is that those who pay the assessment on time are treated as having adequate behavioral health emergency networks starting in 2027, which can ease some network contracting pressure. The money collected will be placed in a new behavioral health emergency services account to pay for crisis and emergency behavioral health services run through regional behavioral health administrative organizations or federally recognized tribes, plus some state administrative costs and refunds of errors; it may not be used for services covered by Medicaid/CHIP and there is an apparent further exclusion for services that were directly billed and already reimbursed (the bill text cuts off so the exact limitation is unclear). The state treasurer and OFM gain responsibilities to manage and distribute investment earnings and to handle federal cash management priorities, and the whole act is contingent on specific budget language by June 30, 2026 and tied to other statutes for its timing and expiration, so the final start date, scope, and duration have some important uncertainties.