6089 AMS BAIL S4191.1
SB 6089 - S AMD TO WM COMM AMD (S-4141.1/92)
By Senator Bailey
WITHDRAWN 3/5/92
On page 64, after line 21, insert the following:
"Sec. 53. RCW 41.05.011 and 1990 c 222 s 2 are each amended to read as follows:
Unless the context clearly requires otherwise, the definitions in this section shall apply throughout this chapter.
(1) "Administrator" means the administrator of the authority.
(2) "State purchased health care" or "health care" means medical and health care, pharmaceuticals, and medical equipment purchased with state and federal funds by the department of social and health services, the department of health, the basic health plan, the state health care authority, the department of labor and industries, the department of corrections, the department of veterans affairs, and local school districts.
(3) "Authority" means the Washington state health care authority.
(4) "Insuring entity" means an insurance carrier as defined in chapter 48.21 or 48.22 RCW, a health care service contractor as defined in chapter 48.44 RCW, or a health maintenance organization as defined in chapter 48.46 RCW.
(5) "Flexible benefit plan" means a benefit plan that allows employees to choose the level of health care coverage provided and the amount of employee contributions from among a range of choices offered by the authority.
(6) "Employee" includes all full-time and career seasonal employees of the state, whether or not covered by civil service; elected and appointed officials of the executive branch of government, including full-time members of boards, commissions, or committees; and includes any or all part-time and temporary employees under the terms and conditions established under this chapter by the authority; justices of the supreme court and judges of the court of appeals and the superior courts; and members of the state legislature or of the legislative authority of any county, city, or town who are elected to office after February 20, 1970. "Employee" also includes employees of a county, municipality, or other political subdivision of the state if the legislative authority of the county, municipality, or other political subdivision of the state seeks and receives the approval of the authority to provide any of its insurance programs by contract with the authority, as provided in RCW 41.04.205, and employees of a school district if the board of directors of the school district seeks and receives the approval of the authority to provide any of its insurance programs by contract with the authority as provided in RCW 28A.400.350.
(7) "Board" means the state employees' benefits board established under RCW 41.05.055.
(8) "Organized delivery system" means a health care organization, composed of health care providers, health care facilities, insurers, health care service contractors, health maintenance organizations, or a combination thereof, that provides directly or by contract, an employee health benefits plan under this chapter to a defined group of employees, for a prepaid, capitated rate on or after July 1, 1992. Health care practitioners participating in an organized delivery system shall be financially at risk for health care services by the patients of such system, or the employer of such health care practitioners shall be financially at risk for such services."
"NEW SECTION. Sec. 54. A new section is added to chapter 41.05 RCW to read as follows:
LEGISLATIVE INTENT. The legislature finds that:
(1) The rising costs of state purchased health care is an unsustainable burden to state government;
(2) State employee health benefits comprise a substantial portion of state health care expenditures;
(3) There are financial incentives that can be implemented to encourage prudent patient utilization of health care services; and
(4) Organized delivery system health care can be an effective way to efficiently and cost-effectively deliver health care services.
The legislature declares additional incentives should be developed to encourage state employees to enroll in organized delivery systems."
"Sec. 55. RCW 41.05.065 and 1988 c 107 s 8 are each amended to read as follows:
(1) The board shall study all matters connected with the provision of health care coverage, life insurance, liability insurance, accidental death and dismemberment insurance, and disability income insurance or any of, or a combination of, the enumerated types of insurance for employees and their dependents on the best basis possible with relation both to the welfare of the employees and to the state: PROVIDED, That liability insurance shall not be made available to dependents.
(2) The state employees' benefits board shall develop employee benefit plans that include comprehensive health care benefits for all employees. In developing these plans, the board shall consider the following elements:
(a) Methods of maximizing cost containment while ensuring access to quality health care;
(b) Development of provider arrangements that encourage cost containment and ensure access to quality care, including but not limited to prepaid delivery systems and prospective payment methods;
(c) Wellness incentives that focus on proven strategies, such as smoking cessation, exercise, and automobile and motorcycle safety;
(d) Utilization review procedures including, but not limited to prior authorization of services, hospital inpatient length of stay review, requirements for use of outpatient surgeries and second opinions for surgeries, review of invoices or claims submitted by service providers, and performance audit of providers; and
(e) Effective coordination of benefits.
(3) The board shall design benefits and determine the terms and conditions of employee participation and coverage, including establishment of eligibility criteria.
(4) The board shall utilize financial incentives to encourage employee enrollments in organized delivery systems. Such incentives shall include required employee financial contributions in the form of employee insurance premium contributions, deductibles, and copayments for employees who enroll in other than organized delivery systems. To encourage income equity, employee financial contributions may be structured on a sliding-scale basis based upon the income of the employee. These incentives shall result in at least seventy-five percent enrollment of employees and retirees in organized delivery systems by July 1994. The board may authorize premium contributions for an employee and the employee's dependents. Such authorization shall require a vote of five members of the board for approval.
(5) Employees may choose participation in only one of the health care benefit plans developed by the board.
(6) The board shall review plans proposed by insurance carriers that desire to offer property insurance and/or accident and casualty insurance to state employees through payroll deduction. The board may approve any such plan for payroll deduction by carriers holding a valid certificate of authority in the state of Washington and which the board determines to be in the best interests of employees and the state. The board shall promulgate rules setting forth criteria by which it shall evaluate the plans.
(7) The board shall report to the appropriate policy and fiscal committees of the legislature by December 1, 1993, on the following:
(a) The progress in meeting the organized delivery system target enrollment rate established in (4) of this section and recommendations for increasing future participation above the target rate;
(b) The current financial participation requirements of employees in organized delivery systems and other than organized delivery systems; and
(c) The impact on the growth of state employee benefit costs as the result of establishing organized delivery system target rates and required financial incentives to encourage enrollment in cost-efficient organized delivery systems."
Renumber the remaining sections and correct internal references.
SB 6089 - S AMD TO WM COMM AMD (S-4141.1/92)
By Senator Bailey
On page 66, beginning on line 6 of the title amendment, strike "and 48.14.022" and insert "48.14.022, 41.05.011, and 41.05.065"