AN ACT Relating to medical assistance reimbursement for health-related services provided in schools; amending RCW 74.09.520; adding a new section to chapter 28A.210 RCW; creating new sections; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. (1) The legislature recognizes that the state of Washington currently offers medical assistance benefits to children in the state with family incomes below certain fixed levels, and that the scope of these benefits is defined in state and federal law. The medical assistance program allows the state to use federal funds to finance more than one-half of the cost of providing health care services to these children. The legislature finds that school districts are currently providing health and mental health-related services, such as counseling, therapies, and screening, to children eligible for medical assistance, that may qualify for federal matching funds under the state's medical assistance program.

(2) It is the intent of the legislature to leverage state education dollars by generating federal medical assistance matching funds for health and mental health-related services provided by school districts. The children served will be those who are eligible for medical assistance under the existing program, and the categories of services provided will be those that are covered under the existing medical assistance program.

Sec. 2. RCW 74.09.520 and 1991 sp.s. c 8 s 9 are each amended to read as follows:

(1) The term "medical assistance" may include the following care and services: (a) Inpatient hospital services; (b) outpatient hospital services; (c) other laboratory and x-ray services; (d) nursing facility services; (e) physicians' services, which shall include prescribed medication and instruction on birth control devices; (f) medical care, or any other type of remedial care as may be established by the secretary; (g) home health care services; (h) private duty nursing services; (i) dental services; (j) physical and occupational therapy and related services; (k) prescribed drugs, dentures, and prosthetic devices; and eyeglasses prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the individual may select; (l) personal care services, as provided in this section; (m) hospice services; (n) other diagnostic, screening, preventive, and rehabilitative services; and (o) like services when furnished to a ((~~handicapped~~)) child by a school district ((~~as part of an individualized education program established pursuant to RCW 28A.155.010 through 28A.155.100~~)) in a manner consistent with the requirements of this chapter. For the purposes of this section, the department may not cut off any prescription medications, oxygen supplies, respiratory services, or other life-sustaining medical services or supplies.

"Medical assistance," notwithstanding any other provision of law, shall not include routine foot care, or dental services delivered by any health care provider, that are not mandated by Title XIX of the social security act unless there is a specific appropriation for these services. ((Services included in an individualized education program for a handicapped child under RCW 28A.155.010 through 28A.155.100 shall not qualify as medical assistance prior to the implementation of the funding process developed under RCW 74.09.524.))

(2) The department shall amend the state plan for medical assistance under Title XIX of the federal social security act to include personal care services, as defined in 42 C.F.R. 440.170(f), in the categorically needy program.

(3) The department shall adopt, amend, or rescind such administrative rules as are necessary to ensure that Title XIX personal care services are provided to eligible persons in conformance with federal regulations.

(a) These administrative rules shall include financial eligibility indexed according to the requirements of the social security act providing for medicaid eligibility.

(b) The rules shall require clients be assessed as having a medical condition requiring assistance with personal care tasks. Plans of care must be approved by a physician and reviewed by a nurse every ninety days.

(4) The department shall design and implement a means to assess the level of functional disability of persons eligible for personal care services under this section. The personal care services benefit shall be provided to the extent funding is available according to the assessed level of functional disability. Any reductions in services made necessary for funding reasons should be accomplished in a manner that assures that priority for maintaining services is given to persons with the greatest need as determined by the assessment of functional disability.

(5) The department shall report to the appropriate fiscal committees of the legislature on the utilization and associated costs of the personal care option under Title XIX of the federal social security act, as defined in 42 C.F.R. 440.170(f), in the categorically needy program. This report shall be submitted by January 1, 1990, and submitted on a yearly basis thereafter.

(6) Effective July 1, 1989, the department shall offer hospice services in accordance with available funds. The hospice benefit under this section shall terminate on June 30, 1993, unless extended by the legislature.

NEW SECTION. Sec. 3. A new section is added to chapter 28A.210 RCW to read as follows:

(1) Funding for health and mental health-related services, provided by local school districts in a manner consistent with the requirements of RCW 74.09.500 through 74.09.910, may include payments from state and federal funds for medical assistance. To the greatest extent possible, the provision of mental health-related services under this section shall be consistent with the applicable children's mental health delivery system developed under chapter 71.36 RCW. The superintendent of public instruction shall reimburse the department of social and health services from state appropriations for education programs for the state-funded portion of any medical assistance payment made by the department for health or mental health-related services provided to children eligible for medical assistance by local school districts pursuant to this section, except to the extent that such payment is for case management or support services provided through the maternity care access program, as provided in RCW 74.09.760 through 74.09.810. The amount of the interagency reimbursement shall be deducted by the superintendent of public instruction in determining additional allocations to districts for education programs under this section.

(2) Federal medical assistance funds received by school districts for services provided under individualized education programs established pursuant to chapter 28A.155 RCW shall be expended by the school district solely for special education services pursuant to chapter 28A.155 RCW.

NEW SECTION. Sec. 4. On or before January 1, 1993, the office of the superintendent of public instruction and the department of social and health services, in consultation with representatives of educational service districts, local public health departments, and school directors, shall develop a marketing and technical assistance plan to increase the provision of medical assistance funded health and mental health-related services by local school districts.

NEW SECTION. Sec. 5. On or before May 1, 1992, the department of social and health services and the office of the superintendent of public instruction shall establish a medical assistance billing agent contract review committee. The committee's function shall be to review each proposed contract between one or more school districts and a public or private entity for medical assistance billing agent services. In reviewing the proposed contracts, the committee shall consider:

(1) The experience and qualifications of the proposed billing agent;

(2) The proposed fees of the billing agent in relation to the services proposed to be performed under the contract; and

(3) The goal of maximizing federal medical assistance funds available to school districts for the provision of health and mental health-related services to children eligible for medical assistance.

The committee shall report the results of its review of each proposed contract to the school district and its directors within thirty days of its receipt of the proposed contract for review. Review of proposed contracts under this section shall be a precondition to execution of any final contract between one or more school districts and a public or private entity for medical assistance billing agent services.

NEW SECTION. Sec. 6. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately.