H-1360.1  _______________________________________________

                          HOUSE BILL 1936

          _______________________________________________

State of Washington      54th Legislature     1995 Regular Session

By Representatives Hymes, Brumsickle, L. Thomas, Clements, Schoesler, Dyer, Cooke, Lisk, Sherstad, Mielke, Lambert, Backlund, McMorris, Thompson and Hargrove

Read first time 02/15/95.  Referred to Committee on Health Care.

Directing the department of social and health services to develop a plan to privatize medical assistance.

    AN ACT Relating to privatizing medical assistance; adding a new section to chapter 74.09 RCW; and creating new sections.

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

NEW SECTION. Sec. 1.  LEGISLATIVE FINDINGS.  The legislature finds that medicaid recipients need to be moved into the mainstream health care financing and delivery system as soon as possible.  A system of two tiers of medical delivery is antithetical to notions of elemental fairness as well as perpetuates cycles of dependency.  The legislature finds that it is desirable to privatize the medicaid system to the extent consistent with federal law and sound health care financing and delivery practice.

NEW SECTION. Sec. 2.  A new section is added to chapter 74.09 RCW to read as follows:

    PRIVATIZING MEDICAID.  (1) Notwithstanding any other provisions of this chapter, the secretary of social and health services is directed to develop a plan to privatize the medicaid system by January 1, 1997, or as soon as the federal government permits the state to do so, whichever is later.

    (2) The secretary is directed to apply for a federal waiver under the appropriate provisions of federal law to permit the privatization to go forward.

    (3) The privatization plan shall contain, at least, the following features:

    (a) All medicaid eligibles shall be given a voucher by the state, which shall be redeemable by any participating payer licensed to do business in the state pursuant to Title 48 RCW;

    (b) The plan may exclude long-term care;

    (c) The plan shall include copayments and other deterrents to unnecessary utilization commonly found in private sector health care insurance policies; but copayments and other deterrents may not be applied to preventive care specifically including childhood vaccinations;

    (d) The plan shall not permit payers to use provider panels that are not also available to a substantial portion of their nonmedicaid enrollees;

    (e) To the greatest extent possible, medicaid enrollees enrolled through this program shall have no distinguishing features in their payer identification cards or papers so that providers and other enrollees are unaware of their medicaid status;

    (f) Quality assurance programs that ensure that adverse financial incentives to providers are not resulting in medically necessary care being withheld;

    (g) Access to the financing mechanism of a medical savings account when and if they are permitted under either state or federal law;

    (h) Paperwork requirements on carriers shall be minimized so as to encourage as many payers as possible to participate thereby expanding the scope of choice for medicaid eligibles;

    (i) The plan may permit only some payers to participate if that is clearly necessary in order to attract payers to participate, but the secretary shall allow at least one carrier each regulated pursuant to chapters 48.20, 48.44, and 48.46 RCW in every geographic market;

    (j) Each policy issued by a payer must include at least the following services:  All of federal medicaid mandates, inpatient care for mental health, mental retardation, and substance abuse, prescription drugs, prenatal coverage, and childhood vaccinations;

    (k) No plan may impose waiting periods relating to preexisting conditions except as consistent with other requirements of law relating to the regulation of preexisting conditions and waiting periods.

    (4) The secretary shall file the plan for comment with the health services commission, insurance commissioner, department of health, and governor's office before adopting the plan by rule.

NEW SECTION. Sec. 3.  REPORTS TO THE LEGISLATURE.  The secretary shall file a report with the health committees of both houses of the legislature on December 1 of each year detailing the progress made toward implementing this program and thereafter on the success of the program with suggested legislative changes, if any.

NEW SECTION. Sec. 4.  CAPTIONS.  Captions as used in this act constitute no part of the law.

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