State of Washington              52nd Legislature             1991 Regular Session


By Senate Committee on Ways & Means (originally sponsored by Senators Barr, Hansen, Snyder, L. Smith and Amondson).


Read first time March 11, 1991.Providing for rural health care services programs.

     AN ACT Relating to rural health care; amending RCW 70.175.020 and 70.175.030; adding a new section to chapter 70.175 RCW; and creating new sections. 




     NEW SECTION.  Sec. 1.      The legislature finds that there are barriers to providing residents of rural areas with access to affordable health care coverage through both public and private programs.  The legislature further finds that the report on these barriers requested by the legislature in 1990 was prepared by the insurance commissioner's committee on the availability of affordable health insurance in rural areas of Washington state and declares that the regulatory and voluntary actions identified in this report should be pursued within the public and private sectors.  The legislature intends through this act to foster the development and implementation of one community-based pilot project aimed at demonstrating the viability of providing health care services to residents of a rural area within the state.


     NEW SECTION.  Sec. 2.  A new section is added to chapter 70.175 RCW to read as follows:

     In administering and making awards for rural health projects under RCW 70.175.050, the secretary shall establish a process for selecting and making an award to a single participant for the development, design, and implementation of a project designed to provide a rural health care services program to residents of a rural community.  Applications for rural health care services pilot programs shall include only contiguous health care catchment areas of the state that are designated as rural.  Project funds may be used for any purposes related to the development, design, implementation, or introduction of a rural health care services program except that funds shall not be used to directly contribute to any program reserves used to assure the financial viability of the program.  Final approval of a project funded and authorized under this section must be obtained from the secretary before final implementation.  No liability may attach or otherwise accrue to the state for the provision of or charges for services under the rural health care services program authorized under this chapter.


     Sec. 3.  RCW 70.175.020 and 1989 1st ex.s. c 9 s 702 are each amended to read as follows:

     Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

     (1) "Administrative structure" means a system of contracts or formal agreements between organizations and persons providing health services in an area that establishes the roles and responsibilities each will assume in providing the services of the rural health care facility.

     (2) "Department" means the department of health.

     (3) "Health care delivery system" means services and personnel involved in providing health care to a population in a geographic area.

     (4) "Health care facility" means any land, structure, system, machinery, equipment, or other real or personal property or appurtenances useful for or associated with delivery of inpatient or outpatient health care service or support for such care or any combination thereof which is operated or undertaken in connection with a hospital, clinic, health maintenance organization, diagnostic or treatment center, extended care facility, or any facility providing or designed to provide therapeutic, convalescent or preventive health care services.

     (5) "Health care system strategic plan" means a plan developed by the participant and includes identification of health care service needs of the participant, services and personnel necessary to meet health care service needs, identification of health status outcomes and outcome measures, identification of funding sources, and strategies to meet health care needs including measures of effectiveness.

     (6) "Institutions of higher education" means educational institutions as defined in RCW 28B.10.016.

     (7) "Local administrator" means an individual or organization representing the participant who may enter into legal agreements on behalf of the participant.

     (8) "Participant" means communities, counties, and regions that serve as a health care catchment area where the project site is located.

     (9) "Project" means the Washington rural health system project.

     (10) "Project site" means a site selected to participate in the project.

     (11) "Rural health care facility" means a facility, group, or other formal organization or arrangement of facilities, equipment, and personnel capable of providing or assuring availability of health services in a rural area.  The services to be provided by the rural health care facility may be delivered in a single location or may be geographically dispersed in the community health service catchment area so long as they are organized under a common administrative structure or through a mechanism that provides appropriate referral, treatment, and follow-up.

     (12) "Secretary" means the secretary of health.

     (13) "Rural health care services program" means an arrangement sponsored by a health care organization, municipal corporation, or combination of public and private entities that provides, exclusively for rural residents of its health care catchment area, access to primary, acute, or secondary health care services, either by contract or through the direct delivery of the services.


     Sec. 4.  RCW 70.175.030 and 1989 1st ex.s. c 9 s 703 are each amended to read as follows:

     (1) The department shall establish the Washington rural health system project to provide financial and technical assistance to participants.  The goal of the project is to help assure access to affordable health care services to citizens in the rural areas of Washington state.

     (2) Administrative costs necessary to implement this project shall be kept at a minimum to insure the maximum availability of funds for participants.

     (3) The secretary may appoint such technical or advisory committees as he or she deems necessary consistent with the provisions of RCW 43.70.040.  In appointing an advisory committee the secretary should assure representation by health care professionals, health care providers, and those directly involved in the purchase, provision, or delivery of health care services as well as consumers, rural community leaders, and those knowledgeable of the issues involved with health care public policy.  Individuals appointed to any technical advisory committee shall serve without compensation for their services as members, but may be reimbursed for their travel expenses pursuant to RCW 43.03.050 and 43.03.060.

     (4) The secretary may contract with third parties for services necessary to carry out activities to implement this chapter where this will promote economy, avoid duplication of effort, and make the best use of available expertise.

     (5) The secretary may apply for, receive, participate in, and accept gifts, grants, and other payments, including property and service, from any governmental or other public or private entity or person, and may make arrangements as to the use of these receipts, including the undertaking of special studies and other projects related to the delivery of health care in rural areas.

     (6) In designing and implementing the project the secretary shall consider the report of the Washington rural health care commission established under chapter 207, Laws of 1988, and for purposes of section 2 of this act, the report of the committee on the availability of affordable health insurance in rural areas of Washington state established under chapter 271, Laws of 1990.  Nothing in this chapter requires the secretary to follow any specific recommendation contained in that report except as it may also be included in this chapter.

     (7) The secretary shall appoint a special advisory committee for the purpose of assisting in establishing standards, making awards, designing the final project, coordinating technical assistance, and providing oversight of the demonstration project authorized under section 2 of this act.  This committee shall include the director of the medical assistance program of the department of social and health services, the administrator of the state health care authority, the administrator of the basic health plan, and the director of the department of labor and industries, and may include any other representatives deemed necessary by the secretary.

     (8) The successful applicant for implementation of a project under section 2 of this act is exempt from all provisions of Title 48 RCW after the secretary makes a specific determination that the applicant:

     (a) Has obtained an actuarial study through a consultant approved by the secretary which concludes that the rural health care services program is financially viable;

     (b) Has demonstrated public support from the citizens residing within the catchment area of the rural health care services program through an affirmative vote on that issue presented to them at a general or special election; and

     (c) Has verified that all provider contracts within the rural health care services program hold individual beneficiaries harmless for charges for services arising in the event of a failure of the plan.

     (9) The secretary, in consultation with the special advisory committee authorized in subsection (7) of this section, shall evaluate the project authorized under section 2 of this act.  The secretary shall report to the legislature and the governor within four years of the initial commencement of health care service delivery.  The evaluation shall assess whether the program has maintained financial viability, improved access to health care services, and increased utilization of local health care providers.  The evaluation shall also include recommendations to continue or expand the program, including any necessary legislative changes.

     (10) The secretary may authorize enrollment limits to the program provided such limits do not jeopardize its financial viability.


     NEW SECTION.  Sec. 5.      If specific funding for the purposes of this act, referencing this act by bill number, is not provided by June 30, 1991, in the omnibus appropriations act, this act shall be null and void.