E2SHB 2572 -
By Committee on Health Care
OUT OF ORDER 03/13/2014
Strike everything after the enacting clause and insert the following:
"NEW SECTION. Sec. 1 (1) The legislature finds that the state of
Washington has an opportunity to transform its health care delivery
system.
(2) The state health care innovation plan establishes the following
primary drivers of health transformation, each with individual key
actions that are necessary to achieve the objective:
(a) Improve health overall by stressing prevention and early
detection of disease and integration of behavioral health;
(b) Developing linkages between the health care delivery system and
community; and
(c) Supporting regional collaboratives for communities and
populations, improve health care quality, and lower costs.
NEW SECTION. Sec. 2 (1) The health care authority is responsible
for coordination, implementation, and administration of interagency
efforts and local collaborations of public and private organizations to
implement the state health care innovation plan.
(2) Prior to the authority submitting a grant application for
innovation plan funding, the authority must consult a neutral actuarial
firm not currently contracted with the agency to review the estimated
savings with the innovation plan prior to application submission. The
plan and the actuarial information must be presented to the joint
select committee on health care oversight, including the scope and
details of the grant application and any request for proposal, prior to
an application submission. The joint committee must approve the
application prior to submission.
(3) The grant application cannot commit the state to any financial
obligations beyond the actual grant award amount.
(4) In the event a grant is awarded, the agency must come before
the joint committee and seek approval for the implementation of the
plan included in the grant application. The agency must provide
quarterly updates and status reports on the implementation effort to
the joint committee.
(5) All required federal reporting related to a grant award must be
shared with the joint committee at the same time it is submitted to the
federal government.
(6) By January 1, 2015, and January 1st of each year through
January 1, 2019, the health care authority shall coordinate and submit
a status report to the appropriate committees of the legislature
regarding implementation of the innovation plan. The report must
summarize any actions taken to implement the innovation plan, progress
toward achieving the aims of the innovation plan, and anticipated
future implementation efforts. In addition, the health care authority
shall submit any recommendations for legislation necessary to implement
the innovation plan.
NEW SECTION. Sec. 3 (1) The joint select committee on health
care oversight is established in statute, continuing the committee
created in Engrossed Substitute Senate Concurrent Resolution No. 8401
passed in 2013.
(2) The membership of the joint select committee on health care
oversight must consist of the following: (a) The chairs of the health
care committees of the senate and the house of representatives, who
must serve as cochairs; (b) four additional members of the senate, two
each appointed by the leadership of the two largest political parties
in the senate; and (c) four additional members of the house of
representatives, two each appointed by the leadership of the two
largest political parties in the house of representatives. The
governor must be invited to appoint, as a liaison to the joint select
committee, a person who must be a nonvoting member.
(3) The joint select committee on health care oversight must
provide oversight between the health care authority, health benefit
exchange, the office of the insurance commissioner, the department of
health, and the department of social and health services. The goal
must be to ensure that these entities are not duplicating their efforts
and are working toward a goal of increased quality of services which
will lead to reduced costs to the health care consumer.
(4) The joint select committee on health care oversight must, as
necessary, propose legislation to the health care committees and budget
recommendations to the ways and means committees of the legislature
that aids in their coordination of activities and that leads to better
quality and cost savings.
(5) The joint select committee on health care oversight expires on
December 31, 2022.
NEW SECTION. Sec. 4 A new section is added to chapter 41.05 RCW
to read as follows:
(1) A community of health is a regionally based, voluntary
collaborative. The purpose of the collaborative is to align actions to
achieve healthy communities and populations, improve health care
quality, and lower costs. "Communities of health" is a term used to
recognize entities that are currently active and those that may become
active that perform the functions described in this section. This term
is used only to assist in directing funding or other support that may
be available to these local entities. The designation of an entity as
a community of health is not intended to create an additional
government entity.
(2) By September 1, 2014, the authority shall establish boundaries
for up to nine regions for accountable collaboratives for health as
provided in this subsection. Counties, through the Washington state
association of counties, must be given the opportunity to propose the
boundaries of the regions. The boundaries must be based on county
borders and must be consistent with medicaid procurement regions.
(3) The authority shall develop a process for designating an entity
as a community of health. An entity seeking designation is eligible
if:
(a) It is a nonprofit or public-private partnership;
(b) Its membership is broad and incorporates key stakeholders, such
as the long-term care system, the health care delivery system,
behavioral health, social supports and services, primary care and
specialty providers, hospitals, consumers, small and large employers,
health plans, and public health, with no single entity or
organizational cohort serving in a majority capacity; and
(c) It demonstrates an ongoing capacity to:
(i) Lead health improvement activities within the region with other
local systems to improve health outcomes and the overall health of the
community, improve health care quality, and lower costs; and
(ii) Distribute tools and resources from the health extension
program created in section 7 of this act.
(4) The authority may designate more than one community of health
in any region that consists of more than one county, but the community
of health may not cross the regional boundaries defined by the
authority or overlap with another community of health.
(5) An entity designated by the authority as a community of health
must convene key stakeholders to:
(a) Review existing data, including data collected through the
community health assessment process;
(b) Assess the region's capacity to address chronic care needs;
(c) Review available funding and resources; and
(d) Identify and prioritize or reaffirm regional health care needs
and prevention strategies and develop a plan or use an existing plan to
address those needs.
(6) For purposes of this section and section 5 of this act, the
authority may only adopt rules that are necessary to implement this
section and section 5 of this act.
NEW SECTION. Sec. 5 A new section is added to chapter 41.05 RCW
to read as follows:
(1) The authority shall, subject to the availability of amounts
appropriated or grants received for this specific purpose, award grants
to support the development of a community of health. Grants may only
be used for start-up costs.
(2) An entity may be eligible for a grant under this section once
designated in section 4 of this act. A grant application must, at a
minimum:
(a) Identify the geographic region served by the applicant;
(b) Demonstrate how the applicant's structure and operation; and
(c) Indicate the size of the grant being requested and describe how
the money will be spent.
(3) In awarding grants under this section, the authority shall
consider the extent to which the applicant will:
(a) Base decisions on public input and an active collaboration
among key community partners, including, but not limited to, local
governments, housing providers, school districts, early learning
regional coalitions, large and small businesses, labor organizations,
health and human service organizations, tribal governments, health
carriers, providers, hospitals, public health agencies, and consumers;
(b) Match the grant funding with funds from other sources; and
(c) Demonstrate capability for sustainability without reliance on
state general fund appropriations.
(4) The authority may prioritize applications that commit to
providing at least one dollar in matching funds for each grant dollar
awarded.
(5) Before grant funds are disbursed, the authority and the
applicant must agree on performance requirements.
NEW SECTION. Sec. 6 A new section is added to chapter 41.05 RCW
to read as follows:
Any entity designated as a community of health pursuant to sections
4 and 5 of this act shall submit a report to the appropriate committees
of the legislature and the authority beginning December 1, 2015, and
December 1st of each year through December 1, 2019. The report must:
(1) Describe the regional health care needs identified by the
entity and key stakeholders including the plan to address needs,
actions taken by the plan, and any measurable progress toward meeting
those needs;
(2) Identify any grant funds received by the entity pursuant to
section 5 of this act; and
(3) For the final report, demonstrate the entity's capability for
sustainability without reliance on state general fund appropriations.
NEW SECTION. Sec. 7 A new section is added to chapter 43.70 RCW
to read as follows:
(1) Subject to the availability of amounts appropriated for this
specific purpose, the department shall establish a health extension
program to provide training, tools, and technical assistance to primary
care, behavioral health, and other providers. The program must
emphasize high quality preventive, chronic disease, and behavioral
health care that is comprehensive and evidence-based.
(2) The health extension program must coordinate dissemination of
evidence-based tools and resources that promote:
(a) Integration of physical and behavioral health;
(b) Clinical decision support to promote evidence-based care;
(c) Methods of formal assessment;
(d) Support for patients managing their own conditions; and
(e) Identification and use of resources that are available in the
community for patients and their families, including community health
workers.
(3) The department may adopt rules necessary to implement this
section, but may not adopt rules, policies, or procedures beyond the
scope of authority granted in this section.
NEW SECTION. Sec. 8 A new section is added to chapter 74.09 RCW
to read as follows:
(1) The authority and the department shall restructure medicaid
procurement of health care services and agreements with managed care
systems on a phased basis to better support integrated physical health,
mental health, and chemical dependency treatment. By January 1, 2019,
medicaid services provided under this chapter and chapters 71.24,
71.36, and 70.96A RCW may be fully integrated in a managed health care
system that provides mental health, chemical dependency, and medical
care services to medicaid clients. The authority and the department
may develop and utilize innovative mechanisms to promote and sustain
integrated clinical models of physical and behavioral health care.
(2) The authority and the department may incorporate the following
principles into future medicaid procurement efforts aimed at
integrating the delivery of physical and behavioral health services:
(a) Medicaid purchasing must support delivery of integrated,
person-centered care that addresses the spectrum of individuals' health
needs in the context of the communities in which they live and with the
availability of care continuity as their health needs change;
(b) Accountability for the client outcomes established in RCW
43.20A.895 and 71.36.025 and performance measures linked to those
outcomes;
(c) Medicaid benefit design must recognize that adequate preventive
care, crisis intervention, and support services promote a recovery-focused approach;
(d) Evidence-based care interventions and continuous quality
improvement must be enforced through contract specifications and
performance measures that provide meaningful integration at the patient
care level with broadly distributed accountability for results;
(e) Active purchasing and oversight of medicaid managed care
contracts is a state responsibility;
(f) A deliberate and flexible system change plan with identified
benchmarks to promote system stability, provide continuity of treatment
for patients, and protect essential existing behavioral health system
infrastructure and capacity; and
(g) Community and organizational readiness are key determinants of
implementation timing; a phased approach is therefore desirable.
(3) The principles identified in subsection (2) of this section are
not intended to create an individual entitlement to services.
NEW SECTION. Sec. 9 Section 3 of this act constitutes a new
chapter in Title 44 RCW.
NEW SECTION. Sec. 10 Sections 4 through 6 of this act expire
July 1, 2020."
E2SHB 2572 -
By Committee on Health Care
OUT OF ORDER 03/13/2014
On page 1, line 5 of the title, after "supports" strike the remainder of the title and insert "adding new sections to chapter 41.05 RCW; adding a new section to chapter 43.70 RCW; adding a new section to chapter 74.09 RCW; adding a new chapter to Title 44 RCW; creating new sections; and providing an expiration date."
EFFECT: Modifies intent section.
Removes all references to the all-payer claims database and related
data protections.
HCA must have a neutral actuarial firm review the estimated savings
in the innovation plan prior to application.
Before the HCA applies for a federal innovation grant, the
application and actuarial review must be presented to the Joint Select
Committee on Health Care Oversight for review and approval.
If an innovation grant is awarded, HCA must come before the Joint
Committee and seek approval for implementation of the plan, and the
agency must provide quarterly status reports to the Joint Committee.
All required federal reporting related to the grant award must be
shared with the Joint Committee at the same time it is submitted to the
federal government.
The Joint Select Committee on Health Care Oversight is established
in statute, and continued to December 31, 2022 (from December 31, 2017,
established in Engrossed Substitute Senate Concurrent Resolution No.
8401, in 2013).
Changes the "accountable collaborative for health" to "community of
health" and modifies some components for the community of health grant
criteria and reporting requirements.
Modifies the elements the Health Extension Program disseminates to
providers, and removes the reference to contract limitations.
Removes the performance measures committee to recommend statewide
measures and benchmarks.
Modifies the Medicaid purchasing, changing the integration of
behavioral health from shall to may, modifies guiding principles and
makes them permissive.