SENATE BILL REPORT

SB 5147

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.

Background: The Legislature has passed a number of bills related to performance measures for Medicaid coverage:

The 2013 Legislative budget included a requirement that the Health Care Authority (HCA) contracts with managed care organizations must incorporate accountability measures that monitor patient health and improved health outcomes, with an expectation that each patient receive a wellness examination that documents the baseline health status and allows for monitoring of health improvements and outcome measures;

The 2013 Legislature also passed ESHB 1519 requiring outcomes and performance measures for the array of Medicaid programs contracted by HCA and the Department of Social and Health Services, which include medical, behavioral health services, chemical dependency services, and long-term care services and supports. The agencies are required to include common measures in contracts by July 1, 2015; and

The 2014 Legislature passed E2SHB 2572 to improve health care purchasing and transform the health care delivery system. The bill created a Performance Measure Coordinating Committee to recommend standard statewide measures of health performance by January 1, 2015, that can be used to inform public and private health care purchasers.

The Performance Measure Coordinating Committee provided recommendations to the HCA in December that include measures for prevention, chronic illness, and acute care. There are 52 different measures categorized by population measures; clinical measures for children, adolescents, and adults by health plans, primary care medical groups, and hospitals; and measures related to health care costs.

Summary of Bill: The HCA contracts with Medicaid managed care organizations must incorporate accountability measures that monitor patient health and improved health outcomes and must include the expectation that each patient receive a wellness examination that documents the baseline health status and allows for monitoring of health improvements and outcome measures.

By December 1, 2015, and annually thereafter, HCA must report the the Legislature with the following:

an analysis of strengths, weaknesses, opportunities, and threats associated with the baseline health status and monitoring;

the number of Medicaid clients enrolled over the previous year;
the number of enrollees who received a baseline health status measurement over the previous year;
an analysis of the Medicaid population's health; and
recommendations for improving the Medicaid population's health.

Staff Summary of Public Testimony: PRO: It is important to capture a baseline health assessment for Medicaid enrollees. The intent is to ensure people get care and measure at the end of the year that their health condition, like diabetes, was treated. It is important that we measure the outcomes or we won't know if there is a health improvement.

OTHER: We want to make sure the bill relates to the common performance measure set that was just recommended by the Performance Measure Coordinating Committee. It is the intent that the standard measures will be used statewide, with a public process to periodically update the measure set. It is the intent to report on the common measure set and maybe we just need to clarify how the measure set relates to the reporting in the bill. It is envisioned that there will be voluntary reporting of the measures. Collecting the common measure set will help providers with alignment since we will all be collecting and reporting on the same outcomes.