House of Representatives
Office of Program Research
Health Care & Wellness Committee
This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.
Brief Description: Concerning quality assurance standards for medicaid purchasing.
Sponsors: Senators Bailey and Rivers.
Hearing Date: 3/13/15
Staff: Chris Blake (786-7392).
Managed care is a prepaid, comprehensive system of medical and health care delivery, including preventive, primary, specialty, and ancillary health services. Washington Apple Health is the Medicaid managed care program for low-income people in Washington. Washington Apple Health offers eligible families, children under age 19, pregnant women, and certain blind or disabled individuals a complete medical benefits package.
The Health Care Authority establishes standards for managed care organizations that seek to contract to provide services to clients in the Washington Apple Health program. The standards include:
obtaining a certificate of registration from the Office of the Insurance Commissioner to provide the health care services;
accepting the Authority's managed care contract;
demonstrating the ability to meet the Authority's network and quality standards; and
being awarded a contract through a competitive process or an application process.
There are currently six managed care organizations participating in Washington Apple Health. The 2015 Washington Apple Health contract requires that all contractors be accredited with the National Committee on Quality Assurance (NCQA) by December 31, 2015. The NCQA is a private, non-profit organization that maintains accreditation programs for several types of health care entities, including health plans, managed behavioral healthcare organizations, accountable care organizations, and wellness and health promotion programs.
Summary of Bill:
The "National Committee for Quality Assurance" (NCQA) is defined as an organization responsible for developing and managing health care measures that assess the quality of care and services that managed care clients receive.
Current Medicaid managed care contractors must be accredited by the National Committee for Quality Assurance by December 2015. New Medicaid managed care contractors must be accredited within 18 months of the start date of the contract. Medicaid purchasing must support NCQA standards.
Fiscal Note: Available.
Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.