1523-S2 AMH CODY MORI 083
2SHB 1523 - H AMD 272
By Representative Cody
ADOPTED 03/08/2019
On page 3, line 17, after "plan" strike "must" and insert "may"
On page 3, line 19, after "appropriate;" strike "and"
On page 3, line 20, after "(e)" insert "The qualified health plan must meet additional participation requirements to reduce barriers to maintaining and improving health and align to state agency value-based purchasing. These requirements may include, but are not limited to, standards for population health management; high-value, proven care; health equity; primary care; care coordination and chronic disease management; wellness and prevention; prevention of wasteful and harmful care; and patient engagement;
(f) To reduce administrative burden and increase transparency, the qualified health plan's utilization review processes must:
(i) Be focused on care that has high variation, high cost, or low evidence of clinical effectiveness;
(ii) Meet national accreditation standards; and
(iii) Align with published criteria published by the authority;
(g) The qualified health plan's medical loss ratio must meet or exceed ninety percent, as determined by the insurance commissioner in the rate review process; and
(h)"
On page 3, beginning on line 28, after "(2)" strike all material through "qualifications" on line 34 and insert "The director, after consultation with the exchange, shall conduct procurement negotiations with health carriers and selectively contract with a health carrier or carriers to offer a qualified health plan or plans that offer the optimal combination of choice, affordability, quality, and service. A health carrier contracting with the authority under this section may offer a qualified health plan or plans in a single county or multiple counties. The goal of the procurement conducted under this section is to have health carriers contracting with the authority under this section offering at least one qualified health plan in every county in the state"
| EFFECT: Allows, instead of requires, a qualified health plan offered pursuant to a Health Care Authority (HCA) contract to use a managed care model. Requires a qualified health plan offered pursuant to a HCA contract to: (a) meet additional participation requirements to reduce barriers to maintaining and improving health and align to state agency value-based purchasing; (b) employ utilization review processes that meet national accreditation standards, align with HCA-published criteria, and are focused on care that has high variation, high cost, or low evidence of clinical effectiveness; and (c) have a medical loss ratio of at least 90%. Removes the request for qualifications process in which the HCA must contract with all health carriers that meet the minimum qualifications. Instead, requires the HCA, after consulting with the Health Benefit Exchange, to selectively contract with a health carrier or carriers to offer a qualified health plan or plans that offer the optimal combination of choice, affordability, quality, and service. Allows a health carrier contracting with the HCA to offer qualified health plans in single or multiple counties. States that the goal of the procurement is to have health carriers contracting with the HCA to offer at least one qualified health plan in every county of the state.
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