BP BHEAD INT H

AN ACT Relating to quality assurance; adding new sections to chapter 43.70 RCW; creating a new section; repealing RCW 70.170.100, 70.170.110, 70.170.120, 70.170.130, and 70.170.140; providing an effective date; and declaring an emergency.

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

NEW SECTION. Sec. 1. (1) To promote the public interest consistent with the purposes of chapter 492, Laws of 1993 as amended by chapter . . ., Laws of 1995 (this act), the department shall continue to require hospitals to submit hospital financial and patient discharge information, which shall be collected, maintained, analyzed, and disseminated by the department. Data elements shall be reported in conformance with a uniform reporting system established by the department. This includes data elements identifying each hospital's revenues, expenses, contractual allowances, charity care, bad debt, other income, total units of inpatient and outpatient services, and other financial information reasonably necessary to fulfill the purposes of chapter 492, Laws of 1993 as amended by chapter . . ., Laws of 1995 (this act). Data elements relating to use of hospital services by patients shall be the same as those currently compiled by hospitals through inpatient discharge abstracts. The department shall encourage and permit reporting by electronic transmission or hard copy as is practical and economical to reporters.

(2) In identifying financial reporting requirements, the department may require both annual reports and condensed quarterly reports from reporters, so as to achieve both accuracy and timeliness in reporting, but shall craft such requirements with due regard of the data reporting burdens of reporters.

(3) The health care data collected, maintained, and studied by the department shall only be available for retrieval in original or processed form to public and private requestors and shall be available within a reasonable period of time after the date of request. The cost of retrieving data for state officials and agencies shall be funded through the state general appropriation. The cost of retrieving data for individuals and organizations engaged in research or private use of data or studies shall be funded by a fee schedule developed by the department which reflects the direct cost of retrieving the data or study in the requested form.

(4) All persons subject to chapter 492, Laws of 1993 shall comply with departmental requirements established by rule in the acquisition of data.

NEW SECTION. Sec. 2. DATA STANDARDS. (1) To promote the public interest consistent with the purposes of chapter 492, Laws of 1993 as amended by chapter . . ., Laws of 1995 (this act), the department of health, in cooperation with the joint committee on health systems oversight and the information services board established under RCW 43.105.032, shall develop health care data standards to be used by, and developed in collaboration with, consumers, purchasers, health carriers, providers, and state government as consistent with the intent of chapter 492, Laws of 1993 as amended by chapter . . ., Laws of 1995 (this act). The data standards shall include content, coding, and transmission standards for all health care data elements necessary to support the intent of this section, and to improve administrative efficiency and reduce cost. Purchasers, as allowed by federal law, health carriers, providers, and state government shall utilize the data set in establishing, operating, and maintaining their data systems. The joint committee on health systems oversight and the information services board shall oversee the standard setting process. The department shall adopt rules as necessary to implement this section.

(2) The department, in coordination with the joint committee on health systems oversight and the information services board, shall complete a thorough study of options for private and collaborative private-public implementation of health care information activities that improve protections for privacy and confidentiality of personal health information, reduce administrative burdens, enhance quality of care, and supply the information necessary to make health care markets more functional. On or before January 1, 1996, the department shall prepare a report to the legislature addressing the following issues:

(a) Methods to assure the confidentiality and privacy of personal health information regardless of record type or location;

(b) Applying data and technology standards to reduce administrative burden and allow for cost-effective exchange of health care information;

(c) Disseminating health information to consumers, providers, health carriers, purchasers, and other users for the purpose of improving quality of care, increasing personal responsibility for health status, and supporting informed decisionmaking to enhance personal choice of carrier, provider, and treatment.

(d) A financial and technology strategy for meeting the health information needs of the public and private sector in a standardized, secure, and confidential manner.

In order to complete this study, the department, in collaboration with the private sector may test proposed approaches to achieving the objectives defined in this section, subject to review by the joint committee on health systems oversight and the information services board.

NEW SECTION. Sec. 3. HEALTH CARE QUALITY‑-FINDINGS AND INTENT. Health care reform should not be pursued at the expense of the high quality of health services available to the citizens of this state. While some managed health care plans, health care purchasers, and state health care programs use a variety of systems to ensure that consumers have access to quality care, these systems lack uniformity, completeness, and common use. Health care providers and facilities often face conflicting demands from differing quality assurance programs of public and private health plans. Consumer protection and preservation of the health care provider/patient relationship requires the adoption of a uniform quality assurance program that meets the needs of consumer and employer purchasers of health plans; health care providers and facilities; and public and private health plans. Implementation of a uniform quality assurance program will preserve access to quality health care while eliminating wasteful duplication, increasing public accountability for state health programs, lowering the incidence of medical malpractice, and promoting competition among health plans.

The legislature intends to require health carriers, health care providers and facilities, and public agencies to participate in the development and implementation of a uniform quality assurance program. As the lead agency responsible for overseeing the development of the uniform quality assurance program, the department of health shall:

(1) Consider the needs of consumers, employers, health care providers and facilities, and public and private health plans;

(2) Take full advantage of existing national standards of quality assurance to extend to middle-income populations the protections required for state management of health programs for low-income populations;

(3) To the extent possible and consistent with state uniform quality assurance standards, rely upon private organizations to implement the program;

(4) Require health care providers and facilities to share responsibility for participation in a uniform quality assurance program; and

(5) Pursue a strategy of assisting health care providers, facilities, and health plans in developing and maintaining the quality assurance program rather than seeking only to enforce state rules.

NEW SECTION. Sec. 4. UNIFORM QUALITY ASSURANCE PROGRAM. (1) The department of health shall develop and implement a uniform quality assurance program for use by all public and private health plans and health care providers and facilities. In developing such program the department shall consult with:

(a) Public and private purchasers of health care services;

(b) Health carriers;

(d) Consumers of health services.

(2) In developing the quality assurance program, the department shall adopt standards that meet the needs of affected persons and organizations, whether public or private, without creation of differing levels of quality assurance. All consumers of health services should be afforded the same level of quality assurance.

(3) At a minimum, the uniform quality assurance program shall include the following components:

(a) Health care provider and facility credentialing and recredentialing standards;

(b) Health care provider and facility recordkeeping and reporting standards;

(c) Health care utilization management that monitors trends in health service under-utilization as well as over-utilization of services;

(d) Health monitoring that is responsive to consumer and purchaser needs;

(e) Assessment of consumer satisfaction;

(f) Health plan and consumer rights and responsibilities; and

(g) Systems to ensure implementation of necessary improvements in health service quality.

NEW SECTION. Sec. 5. QUALITY ASSURANCE‑-INTERAGENCY COOPERATION. (1) No later than July 1, 1995, the department of health together with the health care authority, the department of social and health services, the office of the insurance commissioner, and the department of labor and industries shall form an interagency group for coordination and consultation on quality assurance activities. To become effective, a rule of the department of health implementing the provisions of sections 1 through 7 of this act must be approved by a minimum of three agencies of the group.

(2) The department shall coordinate its development of the quality assurance program with rules adopted by the insurance commissioner governing subjects that affect quality assurance including any insurance commissioner rules governing health carrier utilization review, grievance procedures, and reporting requirements. The department of health and the insurance commissioner shall work together to ensure that requirements for quality assurance complement rules governing health carriers.

(3) The department shall not adopt any rule implementing the uniform quality assurance program with an effective date earlier than July 1, 1996.

NEW SECTION. Sec. 6. ELIMINATION AND COORDINATION OF DUPLICATE STATE PROGRAMS. The interagency group created under section 5 of this act shall review all state agency programs governing health service quality assurance and shall recommend the consolidation, coordination, or elimination of rules and programs made unnecessary through the adoption of a uniform quality assurance program.

NEW SECTION. Sec. 7. The secretary of health shall appoint a five-member health services effectiveness committee whose members possess a breadth of experience and knowledge in the treatment, research, and public and private funding of health care services. The committee shall have the following responsibilities:

(1) Advise the health care authority and joint committee on health systems oversight on the content of the standard benefits package and related matters;

(2) Determine that a particular procedure, treatment, drug, or other health care service is no longer experimental or investigative. Such determination shall be specific and binding to named procedures, treatments, drugs, or health services and shall apply without variation or modification to all carriers. Every health plan issued or renewed on or after the date upon which the health services effectiveness committee makes a determination that a particular procedure, treatment, drug, or other health care service is no longer experimental or investigative shall be interpreted in a manner consistent with the committee's determination. Carriers may appear before the committee, but shall have no appeal rights to the secretary. The office of the insurance commissioner may adopt rules enforcing the findings of the committee. The secretary shall adopt rules on these requirements no later than July 1, 1996; and

(3) Establish guidelines for providers dealing with terminal or static conditions, taking into consideration the ethics of providers, patient and family wishes, costs, and survival possibilities.

NEW SECTION. Sec. 8. The following acts or parts of acts are each repealed:

(1) RCW 70.170.100 and 1993 c 492 s 259, 1990 c 269 s 12, & 1989 1st ex.s. c 9 s 510;

(2) RCW 70.170.110 and 1993 c 492 s 260 & 1989 1st ex.s. c 9 s 511;

(3) RCW 70.170.120 and 1993 c 492 s 261;

(4) RCW 70.170.130 and 1993 c 492 s 262; and

(5) RCW 70.170.140 and 1993 c 492 s 263.

NEW SECTION. Sec. 9. Sections 1 through 7 of this act are each added to chapter 43.70 RCW.

NEW SECTION. Sec. 10. CAPTIONS. Captions as used in this act constitute no part of the law.

NEW SECTION. Sec. 11. 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 July 1, 1995.