BP BHEAD INT S

AN ACT Relating to health reform; and adding a new chapter to Title 48 RCW.

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

NEW SECTION. Sec. 1. FINDINGS. We the people of the state of Washington find that our health and financial security are jeopardized by current health insurance and health system practices. These practices result in unaffordable costs and cost increases that far exceed ordinary inflation. Current total health care expenditures are more than sufficient to provide access to all within a reformed, efficient system.

We find that too many of our state's residents are without health insurance, that each year many individuals and families are forced into poverty because of serious illness and that many must leave gainful employment to be eligible for publicly funded health services. Additionally, thousands of us are at risk of losing adequate health insurance, or have had insurance canceled in the past year, or cannot afford to renew existing coverage.

We find that businesses can no longer afford to pay for health insurance and remain competitive in a global economy, and that individuals and small businesses bear an inequitable insurance burden.

NEW SECTION. Sec. 2. PURPOSES, GOALS, AND INTENT. Be it enacted by the people of the state of Washington that we intend that the state government establish health care policy that will reduce and stabilize costs, assure access for all residents, improve the public's health, and ensure that health care cost increases do not endanger business viability.

We intend that total health care costs be stabilized and kept within increases similar to the rates of general economic inflation by encouraging consumers, providers, and insurers to make more cost-effective health care decisions.

We intend that all state residents be enrolled in an insurance plan of their choice so long as the plan offers affordable, accessible, cost-effective, and comprehensive health services.

We intend that individuals and businesses have the option to purchase any health services they may choose in addition to those defined in the benefits package referenced in this chapter.

We intend that all state residents, all businesses, employees, and government participate in payment for health services, and that individual premium costs and access to service fees be on a sliding scale based on income with the lowest-income citizens exempt from premium payments.

We intend that these goals be accomplished within a reformed system using available private providers and facilities, and that consumers be free to choose among competing plans operating within total budget limits.

NEW SECTION. Sec. 3. ENROLLMENT IN A CERTIFIED INSURANCE PLAN REQUIRED. By November 1, 1997, all Washington state residents, as defined by the governor in rule, shall be enrolled in the certified insurance plan of their choice.

NEW SECTION. Sec. 4. POWERS OF THE GOVERNOR AND THE INSURANCE COMMISSIONER. The governor, in consultation with the insurance commissioner, shall:

(1) By January 1, 1995, determine in rule a comprehensive package of cost-effective health and long-term care services that shall be known as "the benefits package." In determining the benefits package, the health services offered to Washington state employees through the state health care authority during 1992 shall be used as an example, and the benefits package recommendations of the health care commission shall also be considered. The benefits package shall include, but not be limited to, inpatient services, outpatient services, preventive services, and community residential services for physical, mental, and developmental illnesses and disabilities.

(2) By July 1, 1996, establish and make public the maximum total funds that a certified insurance plan may receive per enrollee during each year for the benefits package. In establishing these maximum levels, all Washington state residents must be considered as a single community. However, regional variations may be allowed in total funds received by a certified insurance plan based on documented demographic factors, or other factors established by rule that predict utilization within a community. The annual increase in the per enrollee costs of the benefits package may not exceed one and one-half times the percentage increase in the annual average wage in the state for the previous year. Annual average wage shall mean that wage calculated by the employment security department for unemployment insurance contributions purposes as defined in RCW 50.04.355.

(3) By July 1, 1997, establish and implement requirements according to section 5 of this act.

(4) Establish by rule requirements for all residents, all businesses, and government to make payments that shall be received by certified insurance plans and that will be sufficient to implement this chapter while providing the comprehensive benefits package to all state residents. The payment requirements must result in as little change in current aggregate payment levels for health services as is possible within each of these groups. The payment levels must give consideration to the financial viability of small low-wage businesses and to low-income families and individuals. Payment requirements established under this subsection may be modified or replaced by an alternative set of payment requirements that fulfills the intent of this chapter, and that is approved by two-thirds of each house of the state legislature.

(5) Reorganize state government as needed to implement this chapter; however no more than fifty new, full-time equivalent employees shall be hired for this purpose. Additional employees who may be needed must be added by reassigning personnel employed by the state on the effective date of this act.

(6) Determine, in conjunction with the medical community, practice parameters and peer review mechanisms for reducing malpractice. Also, apply the malpractice reform recommendations of the health care commission, as appropriate, to reform the system.

(7) Ensure that an amount equal to at least five percent of total funds received by certified insurance plans for the benefits package is allocated to state and local public health departments to provide public health status assessment, policy development, and other services to protect the public health, including vital records, infectious and contagious disease control, assurance of the safety of food and drinking water, and protection from contamination by pollutants or toxic substances.

(8) Negotiate with congress and federal agencies to obtain waivers or exemptions from federal rules or statutes as needed to implement this chapter without losing federal funds that now come to the state.

(9) Establish rules, appoint advisory commissions, conduct research, receive grants or gifts, convene task forces, or engage in any other actions that may be needed to implement this chapter.

(10) Establish, if certified plans are insufficient or unable to meet a populations's health service needs, contracts with local health departments, community or migrant health centers, or other nonprofit health service entities for all or part of the benefits package, and recognize the unique ability of community and migrant health centers to serve populations within their communities.

(11) Apply all mechanisms as necessary, including those recommended by the health care commission, to control costs and assure quality of care consistent with this chapter.

NEW SECTION. Sec. 5. REQUIREMENTS FOR CERTIFIED INSURANCE PLANS. A health maintenance organization, health care service contractor, group disability insurer, or other entity is qualified to be a certified insurance plan if they meet requirements established by the governor in consultation with the insurance commissioner.

These requirements must include that a certified insurance plan:

(1) Accept enrollment from any Washington state resident regardless of preexisting health condition, employment, or income.

(2) Provide the benefits package to all of its enrollees.

(3) Receive payments for the benefits package only in the form of fixed, prepaid, per capita payments, and access to service fees so long as these limited fees do not become a barrier to appropriate and timely access.

(4) Receive from all sources no more than the maximum funding levels per enrollee established by the state for the benefits package and prohibit balance billing or unauthorized cost sharing.

(5) Comply with uniform billing, reporting, and inspection requirements, monitoring processes and standards for continuous quality improvement and total quality management as determined by rule.

(6) Promote community health education to increase awareness of injury and illness prevention; encourage enrollees to take responsibility for protecting their own health; and stimulate community discussion about the use and limits of medical care in improving the health of individuals and communities.

(7) Comply with rules established by the governor, consistent with this chapter, for freedom of choice of plans and providers, consumer participation in policy development, portability of benefits, enrollee grievance procedures, uniform billing procedures, avoidance or elimination of barriers to access, and other rules, all of which shall be established through an open, public process.

NEW SECTION. Sec. 6. PROHIBITIONS AGAINST NONCERTIFIED ENTITIES RECEIVING PAYMENT FOR BENEFITS PACKAGE SERVICES.-‑NO RESTRICTION ON SERVICES NOT INCLUDED WITHIN THE BENEFITS PACKAGE. It is unlawful for a person or corporation to receive payments for services for an enrollee covered within the benefits package unless they are within a certified plan or qualify as an exception, established in rule, under section 4(10) of this act. However nothing in this chapter precludes an entity from insuring, providing, contracting, or receiving payment for health services not included in the benefits package, nor does anything in this chapter restrict an employer from offering, and an employee representative from negotiating for, or an individual from purchasing, services not included in the benefits package.

NEW SECTION. Sec. 7. PUBLIC REPORTS AND DETAILED PLAN REQUIRED; MORE SWIFT ACTION NOT PROHIBITED. Quarterly, beginning in January 1994, the governor and insurance commissioner or their designees, shall report to the people on progress in implementing this chapter by making presentations to local boards of health in public meetings. Local boards may convene joint, regional meetings for this purpose.

By July 1994, the governor and the insurance commissioner shall present to the public a detailed plan to implement this chapter. All rules proposed for implementation of this chapter must be adopted in accordance with statues that ensure public scrutiny and an ability for public response and must conform to the requirements of chapter 34.05 RCW. Nothing in this chapter prevents the government from taking action to contain health care costs, or to expand access more quickly than required in this chapter, or to adopt recommendations of the health care commission, so long as these actions are consistent with sections 3 through 6 of this act, and do not conflict with the intent of this chapter.

NEW SECTION. Sec. 8. SEVERABILITY. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.

NEW SECTION. Sec. 9. CAPTIONS NOT LAW. Captions as used in this act constitute no part of the law.

NEW SECTION. Sec. 10. Sections 1 through 9 of this act shall constitute a new chapter in Title 48 RCW.