SENATE BILL REPORT
SB 5912
As of February 5, 2022
Title: An act relating to improving health outcomes for children on medicaid by ensuring early and periodic screening, diagnosis, and treatment.
Brief Description: Improving health outcomes for children on medicaid. [Revised for 1st Substitute: Improving health outcomes for children on medicaid by ensuring early and periodic screening, diagnosis, and treatment.]
Sponsors: Senators Sefzik, Braun, Fortunato, Honeyford, Muzzall, Nguyen, Randall, Robinson and Short.
Brief History:
Committee Activity: Health & Long Term Care: 1/24/22, 1/28/22 [DPS-WM].
Ways & Means: 2/05/22.
Brief Summary of First Substitute Bill
  • Requires the Health Care Authority to align Apple Health's schedule for providing early and periodic screening, diagnosis, and treatment benefits with the Bright Future Guidelines of the American Academy of Pediatrics.
SENATE COMMITTEE ON HEALTH & LONG TERM CARE
Majority Report: That Substitute Senate Bill No. 5912 be substituted therefor, and the substitute bill do pass and be referred to Committee on Ways & Means.
Signed by Senators Cleveland, Chair; Frockt, Vice Chair; Muzzall, Ranking Member; Conway, Holy, Keiser, Padden, Randall, Rivers, Robinson, Sefzik and Van De Wege.
Staff: LeighBeth Merrick (786-7445)
SENATE COMMITTEE ON WAYS & MEANS
Staff: Sandy Stith (786-7710)
Background:

The Health Care Authority (HCA) administers the Medicaid program, which is a state-federal program that pays for health care for low-income state residents who meet certain eligibility criteria.  Washington's Medicaid program, known as Apple Health, offers a complete medical benefits package, including prescription drug coverage, to eligible families, children under age 19, low-income adults, certain disabled individuals, and pregnant women.  The majority of Apple Health enrollees receive their coverage through managed care organizations (MCOs).  The remainder receive their care through fee-for-service (FFS).

 

Early Periodic Screening, Diagnosis, and Treatment (EPSDT), also known as well-child checkups, are regular, complete health exams for children and youth intended to help identify and treat health issues early.  EPSDT is a free health program for individuals, under the age of 21, enrolled in Apple Health coverage.  The American Academy of Pediatrics' Bright Future Guidelines recommended schedule provides a total of 31 EPSDT visits from birth through age 20, whereas Apple Health only covers 22 EPSDT visits for the FFS enrollees.  MCOs may exceed the FFS benefit and currently all five of the MCOs align their EPSDT benefit schedule with the Bright Future Guidelines.  

Summary of Bill (First Substitute):

Beginning July 1, 2022, HCA must ensure their schedule for covering Apple Health's EPSDT benefit aligns with the Bright Future Guidelines or a comparable standard.

EFFECT OF CHANGES MADE BY HEALTH & LONG TERM CARE COMMITTEE (First Substitute):
  • Moves the required start date up 6 months to July 1, 2022 for aligning the EPSDT benefit schedule with the Bright Futures Guidelines.
Appropriation: None.
Fiscal Note: Available.
Creates Committee/Commission/Task Force that includes Legislative members: No.
Effective Date: Ninety days after adjournment of session in which bill is passed.
Staff Summary of Public Testimony on Proposed Substitute (Health & Long Term Care):

The committee recommended a different version of the bill than what was heard.  PRO:  Children on medicaid, regardless if their coverage is managed care or fee-for-service, should all receive the same EPSDT benefit schedule.  Early screening can lead to better detection which can provide better health outcomes.  The current Apple Health EPSDT benefit schedule is inadequate.  The nine additional well-child visits this bill provides are critical.  An additional visit from 0-6 weeks, so there are two total visits during this time frame, is necessary for monitoring a baby's weight gain and addressing any breastfeeding challenges.  Adding a check-up when a child is two and a half years old is crucial for catching developmental delays and referring the child to for necessary therapies and interventions.   The seven additional well-child visits this bill would cover for ages three and up will provide annual well-visits that are important for addressing obesity, mental health, and vision issues many children face.  We request moving up the start date to July 1, 2022.
 
CON:  We are concerned about the mental health components of this bill and how it results in children and adolescents being unnecessarily screened, diagnosed and treated for mental health issues.  Help support the mental health component.  We request changes to the informed consent process and that all youth have the ability to opt-out of invasive and mental health treatment.

Persons Testifying (Health & Long Term Care): PRO: Senator Simon Sefzik, Prime Sponsor; Maria Huang, Washington Chapter of the AAP.
CON: Kathleen Wedemeyer, Citizens Commission on Human Rights.
Persons Signed In To Testify But Not Testifying (Health & Long Term Care): No one.
Staff Summary of Public Testimony (Ways & Means):

CON:  We are concerned about the mental health components of this bill and how it results in children and adolescents being unnecessarily screened, diagnosed and treated for mental health issues.  We request the bill be amended to remove funding for the behavioral health portion of EPSDT and amended to allow parents to opt out of mental health screening at any level.

Persons Testifying (Ways & Means): CON: Kathleen Wedemeyer, Citizens Commission on Human Rights.
Persons Signed In To Testify But Not Testifying (Ways & Means): No one.