AN ACT Relating to a study of rural health delivery; creating new sections; and providing an expiration date.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The legislature finds that:

(1) Rural health facilities, including but not limited to hospitals, health clinics, and community clinics, are an integral part of the communities and geographic area in which they are located. Demographic, economic, and financial changes have greatly affected the viability of rural health facilities and the delivery of their services. The problems faced by rural health facilities include erratic fluctuations or general decline in rural economies, the aging of rural populations, older physical plants, lack of physicians, nurses, and other health professionals, burdensome government regulations, inappropriate standards for licensure and certification, and poor financial outlook;

(2) Rural health facilities help ensure access to and the availability of preventive, primary, and emergency health care services to rural residents and tourist populations in rural areas. A large percentage of rural health resources are used to provide services to government-sponsored patients. The availability of health care services in rural areas is essential to the integrity of the medicare and medicaid programs;

(3) Rural health facilities affect the economic well-being of rural areas. Not only are these facilities a source of employment for rural residents, the existence of health care services in a rural community is important to its economic development and ability to attract businesses;

(4) Government regulations and standards for facility and professional licensure and certification are typically appropriate to urban facilities and are, in some cases, inordinately burdensome for rural health care facilities. Such regulations and standards can create barriers to the delivery of innovative, efficient, and cost-effective change of health care services to better meet the health needs of the rural communities; and

(5) The changing environment in health care delivery has changed how and where health care is provided and includes an increased emphasis on outpatient services, preventive care, and home health care.

NEW SECTION. Sec. 2. (1) The department of social and health services, in consultation with the senate committee on health care and corrections, the house of representatives committee on health care, the state hospital commission, the office of financial management, and the department of trade and economic development, shall establish a rural health facility advisory committee composed of ten members. Four members shall be health facility administrators from counties of class three or smaller, at least two of whom shall be employed by hospital districts. One member shall be a representative from a class three or smaller county health department. One member shall represent the department of community development. One member shall represent the department of licensing's office of business and professional licensing. One member shall represent the department of social and health services' office of licensing and certification. One member shall represent the department of social and health services' division of medical assistance. One member shall represent the state health coordinating council and also serve as chairperson.

(2) The members of the committee shall receive no additional compensation for their service as members, but shall be reimbursed for travel expenses as provided by RCW 43.03.050 and 43.03.060.

(3) The committee shall:

(a) Review current statutes and regulations governing the licensure, certification, and operation of rural health facilities, including hospital districts, health districts, rural health clinics, rural community health centers, and rural ambulatory surgical centers. The purpose of the review shall be to identify barriers to cost-effective and efficient health care delivery that are created by statute or regulation. The review shall include, but not be limited to:

(i) Licensure and certification survey processes conducted by both federal and state agencies;

(ii) Processes for review and approval of proposed facility construction or remodeling or establishing new services;

(iii) Mandated personnel requirements; and

(iv) Mandatory information gathering and reporting requirements;

(b) Review existing models for rural health delivery. The purpose of the review shall be to recognize innovative approaches to rural health delivery currently in use or under development in the state and to identify regulatory anomalies that frustrate effective and efficient delivery options;

(c) Establish operational guidelines or standards for a model alternative rural health facility. The standards shall include, but are not limited to:

(i) The basic array of health services that is appropriate in rural areas;

(ii) Minimum staffing requirements for safe, efficient, and effective operation of these services, commensurate with community practice standards; and

(iii) Other such requirements for operation as the committee deems appropriate to establish minimum standards for licensure;

(d) Develop measurements of the economic impact of rural health care facilities on the communities which they serve. The purpose of the study shall be to establish the role health facilities play in determining the economic viability and development of rural communities;

(e) Review the impact of existing government payment policies and methods on rural health facilities. The purpose of the review shall be to identify current payment practices or standards, make recommendations for change as appropriate, and establish guidelines for payment to model rural health facilities as described in this section; and

(f) Recommend, as deemed appropriate by the committee, that the department of social and health services convey to the federal health care financing administration interest in testing new models of institutional health care delivery in rural areas, and seek such waivers as may be necessary and appropriate to such demonstrations.

(4) The committee shall submit a report to the legislature by December 1, 1988. The report shall include such findings of the committee as are related to the responsibilities identified in this section. The report shall make recommendations to the legislature regarding changes to licensure, certification, and payment systems that will enhance the likelihood that high quality rural health care delivery occurs in a cost-effective and efficient manner.

NEW SECTION. Sec. 3. This act shall expire on December 31, 1988.