NoHLA Legislative Update 2018 - #1
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Northwest Health Law Advocates
Health Care Access in the Washington Legislature - Bills of Interest
Update #1 (February 7, 2018)
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Bill NameHouse Bill/ main sponsor Senate Bill/ main sponsorSummary DescriptionStatus
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PUBLIC PROGRAMS
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Health care for Pacific Islanders residing in WA under a compact of free association2SHB 1291 (Santos)SSB 5683 (Saldaña)Creates the COFA premium assistance program for enrollment in Qualified Health Plans in the WA Health Benefit Exchange.The program would pay premiums for persons from the compact of free association (COFA) islands (Palau, Marshall Islands, and Micronesia) who have income less than 133% of the federal poverty level and enroll in Silver plans. These persons generally do not qualify for Medicaid due to their specific immigration status. The Senate bill also allows for payment of out-of-pocket costs, subject to appropriation. Comprehensive community education and outreach is required to facilitate applications, starting no later than 9/1/18. An advisory committee to HCA and a report on implementation are required.House; Senate
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Charity care and notice requirements without restricting charity careSHB 2836
(Jinkins)
SSB 6273 (Cleveland)Hospitals must develop training programs on the hospital's charity care policy and use of interpreter services, and must post and prominently display notice of charity care availability in areas where patients are admitted or registered, in emergency departments, and financial service or billing areas where accessible to patients. Current versions of the hospital's charity care policy, a plain language summary of the policy, and the application form must be available on the hospital's website. Notice must be posted in all languages spoken by more than 10% of the population of the hospital service area. All hospital billing statements/written communications about billing/collection must include a statement prominently displayed on the first page, in English and the second most spoken language in the hospital's service area, informing people about charity care, in these or similar words: "You may qualify for free care or a discount on your hospital bill, whether or not you have insurance. Please contact our financial assistance office at [website] and [phone number]." Definitions of charity care and third party coverage are revised. Clarifies that the provision regarding charity care coverage for the full amount of hospital charges for persons with a family income below 100 % FPL: except to the extent that the patient has third-party coverage for the charges. In the Senate version, subsection (10), which describes what hospitals must attempt to do, including determinations of income, adds that this income is "as of the time the health care services were provided." House; Senate
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Increasing the personal needs allowance for people in residential and institutional care settingsSHB 2651 (Stanford)

SSB 6237 (Keiser)

Addresses the amount of the Personal Needs Allowance (PNA) for those on Medicaid Long-term Care programs, raising it effective January 1 2019 to $70/month from the current $57/month (for nursing home residents) and $63/month (for residents in alternate living facilities - Assisted Living and Adult Family Homes). The PNA is the amount of the person's own income they can keep for personal expenditures (clothing, shoes, cell phone, etc.) after required allocations of their income to their cost of care and certain other categories. Delays last year's Cost of Living Increase provision to start in January 2020 instead of July 2017.Senate Rules
House Rules
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Concerning foster youth health care benefitsSHB 2530 (Senn)Allows the parent or guardian of a child who is no longer a dependent child to continue enrollment in the integrated managed health care plan for foster children for up to twelve months following reunification with the child's parents or guardian if the child meets certain criteria.House Rules
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Expanding the access to baby and child dentistry program to serve children with disabilitiesSSB 6549 (Rolfes)Expands access to the baby and child dentistry program to include children with disabilities as eligible clients until their thirteenth birthday.Senate Rules
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Requiring coverage for hearing instruments under public employee and medicaid programs.E2SSB 5179 (Bailey)Requires coverage for hearing instruments under public employee and Medicaid programs as of 1-1-19. For Medicaid, must include coverage for hearing instruments when medically necessary. Coverage must include a new hearing instrument every five years, a new hearing instrument when alterations to the existing hearing instrument cannot meet the needs of the patient, and services and supplies such as the initial assessment, fitting, adjustment, and auditory training. The public employee benefit does not include the requirement it be "medically necessary" (that may be addressed elsewhere in the public benefit laws), and it does not provide for a new instrument when alterations cannot meet the needs of the patient. The Medicaid program, but not the public employees program, is null and void unless funded in the budget.
Passed Senate; in House Health
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PRIVATE INSURANCE AND HEALTH BENEFIT EXCHANGE
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Updating Health Benefit Exchange statutesSHB 2516 (Cody)Removes all references to the Affordable Care Act found in the Health Benefit Exchange (HBE) statutes. Repeals or consolidates any responsibilities and duties that were only needed to establish the Exchange. Requires members of the HBE Board to serve until a successor has assumed office, following the expiration of their term. Amends language concerning the assessment on insurers to fund exchange operations for the following calendar year, to include three months of additional operating costs. Allows HBE to offer information to consumers and small businesses about qualified small employer health reimbursement arrangements.House Rules
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Preserving access to individual market health care coverage throughout Washington state.SHB 2408 (Cody)Beginning in 2020, requires a health carrier offering a health plan approved by the School Employees' Benefits Board (SEBB) to offer qualified health plans (QHPs) at both silver and gold levels in any county where it offers a SEBB-approved health plan. where that county has no other QHPs offered on the Health Benefit Exchange. Reduces the premiums for individuals who may enroll in the Washington Health Insurance Pool because no other individual market coverage is available in that county. Rates are reduced by: 80% for people below 200% FPL, 60% for people between 200-300% FPL, 50% for people between 300-400% FPL, and 30% for people over 400% FPL.House Rules
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Protecting consumers from charges for out-of-network health servicesESHB 2114 (Cody) Insurance Commissioner requestProhibits "balance billing" for emergency services and surgeries provided at an in-network hospital, when the patient receives treatment from an out-of-network provider - one who does not have a contract with the patient's health insurer. Emergency services is defined to include treatment for mental health and substance abuse disorder conditions. Non-emergency hospital services covered by the bill are limited to surgery and ancillary services: anesthesiology, pathology, radiology, laboratory, and hospitalist services. Protections exist only in situations in which either (a) an in-network provider was unavailable; (b) the need for the services arose at the time the services were rendered and was unforeseen; or (c) the services were provided without the patient's consent. In situations covered by the bill, the patient may not be charged higher "out-of-network" copayments, coinsurance and deductibles; providers are limited to billing patients only at their insurer's in-network rates. A written explanation of benefits must be provided and various other consumer protections apply in the billing process. A dispute resolution process is available for providers and insurers to resolve payment in these situations. Detailed individual notices must be provided by the hospital 10 days before the date service is scheduled, regarding out-of-network status of their providers, insurance treatment of out-of-network costs, and other information. Provider groups and facilities must notify carriers of their network status and carriers must update provider directories within 30 days. Penalties and remedies apply for violations.House
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Exploring enforcement of a requirement to maintain minimum essential health care coverageESSB 6084 (Cleveland)States legislative intent to avoid individual market collapse by exploring options on implementing and enforcing a state "individual mandate" to maintain minimum essential health care coverage. Establishes a task force on exploring creation of individual mandate enforcement mechanisms and other options to incentivize maintaining minimum essential coverage, to report to the legislature by 12/1/18. The task force is to be open to the public and provide an opportunity for public comment.Passed Senate
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Requiring health plans to cover, with no cost sharing, all preventive services required to be covered under federal law as of 12/31/16ESHB 1523 (Robinson)Requires health plans to provide coverage for the preventive services required under the Affordable Care Act as of 12/31/16, without cost-sharing.Passed House; in Senate Health
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Establishment of an individual health insurance market claims-based reinsurance programSHB 2355 (Cody) Insurance Commissioner request 2SSB 6062 (Cleveland) Insurance Commissioner request Requires a reinsurance program for the individual market, contingent on getting a federal state innovation waiver to implement the program by 4/1/18, with the goal of mitigating health insurance premium increases. Program to be operated by Washington Vaccine Association and overseen by a Reinsurance Program Board. Funds collected through assessments and the federal waiver are used to reimburse insurance carriers for claims for individual enrollees that exceed an amount determined by OIC, with a total cap of $200 million per year. House bill requires assessments on all health carriers and third-party administrators (TPAs) to fund the reinsurance program, with limited exceptions. The Senate bill removed the assessment financing provision. Both bills require OIC to conduct study of alternative financing mechanisms for the program and submit recommendations to the Legislature. Additional details in bills.House; Senate Rules
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Health plan prior authorizationSSB 6157 (Short)Health carriers are prohibited from requiring prior authorization for initial evaluation and management visits; and up to eight consecutive treatment visits in a new episode of care of chiropractic, physical therapy, occupational therapy, east Asian medicine, massage therapy, and speech and hearing therapies that meet the standards of medical necessity and are subject to quantitative treatment limits of the health plan. (The original bill prohibited PA for up to 12 visits in a new episode of care.) Senate Rules


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Insurance coverage of tomosynthesis or three-dimensional mammographySB 5912 (Kuderer)Directs OIC and HCA to clarify that existing mandates for mammography include three-dimensional mammography.Passed Senate; in House Health
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Explanation of Benefits for stand-alone dental plansSHB 2502 (Caldier)Requires the Insurance Commissioner to set minimum standards for dental explanation of benefits forms. Prohibits dental-only plans from using explanation of benefits forms disapproved by the Insurance Commissioner.House Rules
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PUBLIC HEALTH
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Defining community health workers and their roles2SHB 2436 (Robinson)Defines "community health worker" and their roles to create consistency across the state.House Rules
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HEALTH CARE PROVIDERS AND FACILITIES
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Consumer directed employment programSSB 6199 (Cleveland) Authorizes DSHS to establish a program to contract with a "Consumer Directed Employer" to be the legal employer of individual care providers (serving Medicaid clients in long term care programs) for purposes of performing administrative functions. The "CDE" would address tax withholding and filing, verifying employee qualifications, and other administrative functions. The CDE and the consumer (care recipient) are "coemployers" of the worker, with the CDE the "legal employer" and the consumer the "managing employer." Establishes a rate-setting board to determine IP labor rates and CDE administrative rates. Modifies the IP overtime expenditure requirements. The CDE can refuse to employ an individual provider (IP) who may not be able to meet the needs of a particular consumer; assign an IP who has been dismissed by a consumer to a different consumer who selects the IP; provide information to a consumer about an IP's work history as an employee of the CDE; terminate the provider's employment when the individual is not meeting the needs of the consumer. Senate Rules
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Respite provider trainingHB 2435 (Kilduff) People working as IPs for personal care services as respite, and work 300 hours per year maximum, can meet training qualifications with only 14 hours of training during first 120 days after starting work as an IP (people working more than 300 hours per year must get 35 hours of training in that time period). This provision already applies to respite workers serving DD clients, but the legislation broadens this to other LTC clients.Passed House





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Requiring training for long-term care providers on the needs of the LGBTQ populationSSB 5700 (Ranker)Requires long-term care workers to complete one hour of training on the needs of the LGBTQ population and requires all administrators or owners of adult family homes, assisted living facilities, and nursing homes to complete a two hour training on the needs of the LGBTQ population.Senate
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Notice of material changes to the operations or governance structure of a health care provider or provider organizationSHB 1811 (Jinkins) Requires that a 30-day notice be given to the Attorney General before the effective date of a proposed material change, such as a merger or acquisition, involving a health care provider or other health care organization. Specifies information to be provided in notice, including a description of the anticipated impact of the proposed material change, including on
reimbursement rates, care referral patterns, access to services, quality of care, and market share.
House Rules
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Concerning health care provider and health care facility whistleblower protectionsSHB 2258 (Macri)SSB 5998 (Keiser)Requires the identity of a whistleblower be kept confidential under certain circumstances and allows non-employees to bring a civil action if subject to reprisal/retaliatory action as a result of being a whistleblower.House Rules; Senate Rules
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PATIENT HEALTH INFORMATION, PRIVACY AND CONSENT
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Stem cell therapies not approved by USFDASHB 2356 (Cody) Requires notice to patient when non-FDA approved stem cell therapy is performed; establishes definition of unprofessional conduct.House Rules
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Better access to medical records and telemedicine for injured workersSSB 6226 (Keiser)Requires a self-insured employer to ensure that relevant medical records of an injured worker scheduled for an independent medical exam are provided as electronic medical records, if possible, to the independent medical exam physician or physicians; L&I to develop access to telemedicine, reimburse physicians.Senate Rules
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Protecting agricultural workers and community from pesticide2SSB 6529 (Saldana)Pesticide user to provide written notice of intended application in accordance with requirements provided by DOH; DOH develops list of individuals who want notice; DOH power to investigate and assess civil fine not more than $7500.Senate Rules
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Discovery of privileged health care information in civil rights claimsSB 6027 (Kuderer)Provides that health is not an issue under WA Law Against Discrimination except where claimant alleges diagnosable injury, relies on testimony of health care provider, or alleges disability-related discrimination.Senate Rules
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Spoken language interpreter services 2SSB 6245 (Saldana) Requires consolidation of the procurement of spoken language interpreter services for state agencies and limits testing of new interpreters by DSHS based on language. Excludes interpreters for sensory-impaired persons. Senate Rules
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Providing women with timely information regarding their breast health.ESSB 5084 (Rolfes)Requires information that identifies the patient's individual breast density classification to be included in the summary of mammography report provided to patients.Passed Senate; in House Health
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REPRODUCTIVE HEALTH
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Enacting the employee reproductive choice actSSB 6102 (Ranker)Requires employers who provide health insurance to its employees as part of an employee's benefit package to provide contraceptive coverage at no cost to the employee. Prohibits a health plan, issued on or after January 1, 2019, that includes coverage for contraceptive coverage, from imposing a deductible, coinsurance, copayment, or other cost-sharing requirement on the contraceptive coverage provided.
Senate Rules
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Concerning health plan coverage of reproductive health careSSB 6219 (Hobbs)Requires a health plan, issued on or after January 1, 2019, to cover: all FDA approved contraceptive methods and voluntary sterilization free of deductibles, coinsurance, copayment, or other cost-sharing requirements; all FDA approved over-the-counter contraceptives without a prescription; abortion services in a substantially equivalent manner as maternity care and services, subject to the same cost-sharing as maternity coverage. Requires the governor's interagency coordinating council on health disparities to conduct a literature review and report its findings by January 1, 2019 on disparities in access to reproductive health care.
Passed Senate; in House Health
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BEHAVIORAL HEALTH--MENTAL HEALTH AND SUBSTANCE USE DISORDERS
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Restricting the practice of conversion therapySB 5722 (Liias)Makes it unprofessional conduct for a licensed healthcare provider to perform conversion therapy on a patient under the age of 18. Conversion therapy involves seeking to change an individual's sexual orientation or gender identity, including efforts to change behaviors or gender expressions or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex.Passed Senate; in House Health
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Concerning opioid use disorder treatment, prevention, and related servicesSHB 2489 (Cody) Governor request2SSB 6150 (Cleveland) Governor requestDeclares opioid use disorder is a public health crisis and requires providers inform patients of all evidence-based treatment options including medication, counseling, and social supports.House Rules; Senate Rules
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Removing health coverage barriers to accessing substance use disorder treatment services2SHB 2572 (Cody)Requires health plans and behavioral health organizations cover certain types of substance use disorder treatment without prior authorization or utilization management barriers for the first 24 hours after an enrollee presents for is referred to the services.House Rules
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Concerning suicide prevention and behavioral health in higher education, with enhanced services to student veteransSSB 6514 (Brown)Creates a statewide resource for behavioral health and suicide prevention for the state's post-secondary institutions and establishes the suicide prevention in higher education grant.Senate Rules
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Strengthening school district plans for recognition, screening, and response to emotional or behavioral distress in studentsSSB 6141 (McCoy)Requires the office of the superintendent of public instruction to develop and make available a one-hour online training module for school staff on recognition, screening, and response to emotional or behavioral distress in students. Requires each educational service district to identify a regional mental health coordinator.
Senate Rules
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Improving the behavioral health of people in the agricultural industry2SHB 2671 (Wilcox)Requires the state office of rural health to convene a task force to review issues specific to behavioral health and suicide prevention in the agricultural industry. The task force is to report its findings and recommendations to the governor and the legislature by December 1, 2018. Establishes a pilot program by March 1, 2019 to support behavioral health improvement and suicide prevention efforts for members of the agricultural industry workforce. House Rules
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Improving access to mental health services for children and youth2SHB 2779 (Senn)Reestablishes the Children's Mental Health workgroup through December 2020, adds eating disorders in children and youth as an area of focus, adds an additional child/adolescent residency position at University of Washington, and requires DSHS convene an advisory group of stakeholders to review and provide recommendations on the parent-initiated treatment process. House Rules
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PRESCRIPTION DRUGS
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Protecting consumers from excess charges for prescription medications (compare to 2SSB 5586)SHB 2296 (Slatter)Prohibits a contract between a pharmacy benefit manager or insurer and a pharmacist or pharmacy from penalizing their disclosure of certain information to a customer regarding: (1) the cost of the medication to the person, and (2) the availability of therapeutically equivalent alternative medications or alternative methods of purchasing the medication. As of 1/1/19, the maximum a person is required to pay for a covered medication is the lesser of the applicable cost-sharing or the amount the person would pay if they purchased it without using a health plan or any other source of prescription medication benefits or discounts. Requires OIC to study and report to the Legislature on the impact of laws in other states that include the allowable reimbursement or claim amount as one of the amounts to be considered. If no adverse impact, Legislature intends to amend the law to enact a similar provision.House
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Rx drug cost transparency (compare to SHB 2296)2SSB 5586 (Ranker)Requires drug manufacturers and insurers to report certain Rx drug pricing data on a yearly basis to a data organization contracted by the WA Office of Financial Management, (OFM) that must summarize the data and report to the legislature. Requires drug manufacturers to report price increases and written justification for the increases to purchasers. Requires reporting by pharmacy benefit managers regarding acquisition costs, discounts, rebates, reimbursements to retail pharmacies, negotiated prices with health plans, ownership interests, and appeal results. Requires Rx wholesalers to report discounts and rebates for 25 most frequently sold Rx drugs, and wholesale price for 25 most frequently sold Rx drugs to pharmacies and hospitals. Fines up to $1000 per day for failure to comply.Senate Rules
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Prescription drug insurance continuity of careSSB 6147 (Rivers)For health plans that include prescription drug coverage, an issuer may not, outside of an open enrollment period, deny continued coverage or increase the copayment or coinsurance for a prescription drug to a medically stable enrollee under certain conditions. Issuers may require generic substitution during the plan year and may add new drugs to its formulary, but the changed formulary would apply only to new prescriptions. A prescribing provider may prescribe a different drug that is covered by the plan and medically appropriate. The issuer may remove a drug from its formulary for reasons of patient safety, drug recall, or removal from the market. A pharmacist may substitute a generically equivalent drug or interchangeable biologic in accordance with existing law. Effective 1/1/19.Senate Rules
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OTHER HEALTH CARE ACCESS RELATED BILLS
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Concerning long term services and supports2SHB 2533 (Jinkins)Creates a new public program to pay for long term services and supports, with benefits starting in 2025, and a Trust Commission for governance. Sets eligibility standards. Funding is from premiums collected by Employment Security from employees in WA, with "wages" as defined in the Family Medical Leave Act except that there is no limit on the amount of wages subject to a premium assessment. Self-employed people can participate beginning in 2023 and can opt out later or be terminated for non payment. An appropriation is required for administrative expenses but not for benefit payments. Conditions are placed if the legislature removes funds from the Trust for another use.
House Rules
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Uniform emergency volunteer health practitioners act.SSB 5990 (Van De Wege)Establishes the uniform emergency volunteer health practitioners act which applies to volunteer health practitioners registered with a volunteer health practitioner registration system, who provide health or veterinary services in WA for a host entity while an emergency declaration is in effect. Addresses out-of-state licensed practitioners, registration, sanctions/discipline, worker's compensation, liability. Senate
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Northwest Health Law Advocates | 206.325.6464 | nohla@nohla.org
February 7, 2018
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