S-3729.2 _______________________________________________
SENATE BILL 6375
_______________________________________________
State of Washington 54th Legislature 1996 Regular Session
By Senators Quigley, Fairley and Sheldon
Read first time 01/12/96. Referred to Committee on Health & Long‑Term Care.
AN ACT Relating to the health care policy board; amending RCW 43.73.030, 41.05.021, 43.70.054, 43.70.068, and 43.72.320; adding a new section to chapter 48.02 RCW; adding a new section to chapter 74.42 RCW; adding a new section to chapter 41.05 RCW; adding a new section to chapter 43.70 RCW; recodifying RCW 43.73.030; and repealing RCW 43.73.010, 43.73.020, and 43.73.040.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1. RCW 43.73.030 and 1995 c 265 s 11 are each amended to read as follows:
The ((board)) department
of health shall have the following powers and duties:
(1) Periodically make recommendations to the appropriate committees of the legislature and the governor on issues including, but not limited to the following:
(a) ((The scope,
financing, and delivery of health care benefit plans including access for both
the insured and uninsured population;
(b) Long-term care
services including the finance and delivery of such services in conjunction with
the basic health plan by 1999;
(c) The use of
health care savings accounts including their impact on the health of
participants and the cost of health insurance;
(d))) Rural health care needs;
(((e) Whether
Washington is experiencing an increase in immigration as a result of health
insurance reforms and the availability of subsidized and unsubsidized health
care benefits;
(f))) (b) The status of medical education and
make recommendations regarding steps possible to encourage adequate
availability of health care professionals to meet the needs of the state's
populations with particular attention to rural areas; and
(((g) The
implementation of community rating and its impacts on the marketplace including
costs and access;
(h))) (c) The status of quality improvement
programs in both the public and private sectors;
(((i) Models for
billing and claims processing forms, ensuring that these procedures minimize
administrative burdens on health care providers, facilities, carriers, and
consumers. These standards shall also apply to state-purchased health services
where appropriate;
(j) Guidelines to
health carriers for utilization management and review, provider selection and
termination policies, and coordination of benefits and premiums; and
(k) Study the
feasibility of including long-term care services in a medicare supplemental
insurance policy offered according to RCW 41.05.197;))
(2) Review rules
prepared by the insurance commissioner, health care authority, department of
social and health services, and department of labor and industries, ((and
department of health,)) and make recommendations where appropriate to
facilitate consistency with the goals of health reform;
(3) Make recommendations on a system for managing health care services to children with special needs and report to the governor and the legislature on their findings by January 1, 1997;
(4) ((Conduct a
comparative analysis of individual and group insurance markets addressing:
Relative costs; utilization rates; adverse selection; and specific impacts upon
small businesses and individuals. The analysis shall address, also, the
necessity and feasibility of establishing explicit related policies, to
include, but not be limited to, establishing the maximum allowable individual
premium rate as a percentage of the small group premium rate. The board shall
submit an interim report on its findings to the governor and appropriate
committees of the legislature by December 15, 1995, and a final report on
December 15, 1996;
(5))) Develop sample enrollee satisfaction surveys
that may be used by health carriers.
NEW SECTION. Sec. 2. A new section is added to chapter 48.02 RCW to read as follows:
The insurance commissioner shall have the following powers and duties:
(1) Periodically make recommendations to the appropriate committees of the legislature and the governor on issues including, but not limited to the following:
(a) The scope, financing, and delivery of health care benefit plans including access for both the insured and uninsured population;
(b) The use of health care savings accounts including their impact on the health of participants and the cost of health insurance;
(c) Whether Washington is experiencing an increase in immigration as a result of health insurance reforms and the availability of subsidized and unsubsidized health care benefits;
(d) The implementation of community rating and its impacts on the marketplace including costs and access; and
(e) Guidelines to health carriers for utilization management and review, provider selection and termination policies, and coordination of benefits and premiums;
(2) Conduct a comparative analysis of individual and group insurance markets addressing: Relative costs; utilization rates; adverse selection; and specific impacts upon small businesses and individuals. The analysis shall address, also, the necessity and feasibility of establishing explicit related policies, to include, but not be limited to, establishing the maximum allowable individual premium rate as a percentage of the small group premium rate. The commissioner shall submit a final report on its findings to the governor and appropriate committees of the legislature by December 15, 1996.
NEW SECTION. Sec. 3. A new section is added to chapter 74.42 RCW to read as follows:
The department of social and health services, or successor agency administering payments to nursing homes on behalf of low-income adults, shall periodically make recommendations to the appropriate committees of the legislature and the governor on issues including, but not limited to, the following:
(1) Long-term care services including the finance and delivery of such services in conjunction with the basic health plan by 1999; and
(2) The feasibility of including long-term care services in a medicare supplemental insurance policy offered according to RCW 41.05.197.
NEW SECTION. Sec. 4. A new section is added to chapter 41.05 RCW to read as follows:
The health care authority shall periodically make recommendations to the appropriate committees of the legislature and the governor on models for billing and claims processing forms, ensuring that these procedures minimize administrative burdens on health care providers, facilities, carriers, and consumers. These standards shall also apply to state-purchased health services where appropriate.
Sec. 5. RCW 41.05.021 and 1995 1st sp.s. c 6 s 7 are each amended to read as follows:
(1) The Washington state health care authority is created within the executive branch. The authority shall have an administrator appointed by the governor, with the consent of the senate. The administrator shall serve at the pleasure of the governor. The administrator may employ up to seven staff members, who shall be exempt from chapter 41.06 RCW, and any additional staff members as are necessary to administer this chapter. The administrator may delegate any power or duty vested in him or her by this chapter, including authority to make final decisions and enter final orders in hearings conducted under chapter 34.05 RCW. The primary duties of the authority shall be to: Administer state employees' insurance benefits and retired or disabled school employees' insurance benefits; administer the basic health plan pursuant to chapter 70.47 RCW; study state-purchased health care programs in order to maximize cost containment in these programs while ensuring access to quality health care; and implement state initiatives, joint purchasing strategies, and techniques for efficient administration that have potential application to all state-purchased health services. The authority's duties include, but are not limited to, the following:
(a) To administer health care benefit programs for employees and retired or disabled school employees as specifically authorized in RCW 41.05.065 and in accordance with the methods described in RCW 41.05.075, 41.05.140, and other provisions of this chapter;
(b) To analyze state-purchased health care programs and to explore options for cost containment and delivery alternatives for those programs that are consistent with the purposes of those programs, including, but not limited to:
(i) Creation of economic incentives for the persons for whom the state purchases health care to appropriately utilize and purchase health care services, including the development of flexible benefit plans to offset increases in individual financial responsibility;
(ii) Utilization of provider arrangements that encourage cost containment, including but not limited to prepaid delivery systems, utilization review, and prospective payment methods, and that ensure access to quality care, including assuring reasonable access to local providers, especially for employees residing in rural areas;
(iii) Coordination of state agency efforts to purchase drugs effectively as provided in RCW 70.14.050;
(iv) Development of recommendations and methods for purchasing medical equipment and supporting services on a volume discount basis; and
(v) Development of data systems to obtain utilization data from state-purchased health care programs in order to identify cost centers, utilization patterns, provider and hospital practice patterns, and procedure costs, utilizing the information obtained pursuant to RCW 41.05.031;
(c) To analyze areas of public and private health care interaction;
(d) To provide information and technical and administrative assistance to the board;
(e) To review and approve or deny applications from counties, municipalities, and other political subdivisions of the state to provide state-sponsored insurance or self-insurance programs to their employees in accordance with the provisions of RCW 41.04.205, setting the premium contribution for approved groups as outlined in RCW 41.05.050;
(f) To appoint a health care policy technical advisory committee as required by RCW 41.05.150;
(g) To establish billing procedures and collect funds from school districts and educational service districts under RCW 28A.400.400 in a way that minimizes the administrative burden on districts; and
(h) To promulgate and adopt rules consistent with this chapter as described in RCW 41.05.160.
(2) On and after January 1, 1996, the public employees' benefits board may implement strategies to promote managed competition among employee health benefit plans. Strategies may include but are not limited to:
(a) Standardizing the benefit package;
(b) Soliciting competitive bids for the benefit package;
(c) Limiting the state's contribution to a percent of the lowest priced qualified plan within a geographical area;
(d) Monitoring the impact of the approach under this subsection with regards to: Efficiencies in health service delivery, cost shifts to subscribers, access to and choice of managed care plans state-wide, and quality of health services. The health care authority shall also advise on the value of administering a benchmark employer-managed plan to promote competition among managed care plans. The health care authority shall report its findings and recommendations to the legislature by January 1, 1997.
(3) The health care authority shall, no later than July 1, 1996, submit to the appropriate committees of the legislature, proposed methods whereby, through the use of a voucher-type process, state employees may enroll with any health carrier to receive employee benefits. Such methods shall include the employee option of participating in a health care savings account, as set forth in Title 48 RCW.
(4) The ((Washington
health care policy board)) insurance commissioner shall study the
necessity and desirability of the health care authority continuing as a
self-insuring entity and make recommendations to the appropriate committees of
the legislature by December 1, 1996.
Sec. 6. RCW 43.70.054 and 1995 c 267 s 2 are each amended to read as follows:
(1) To promote the
public interest consistent with chapter 267, Laws of 1995, the department of
health, in cooperation with ((the health care policy board 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
267, Laws of 1995, to promote the delivery of quality health services that
improve health outcomes for state residents. The data standards shall include
content, coding, confidentiality, 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, health facilities and providers as defined in
chapter 48.43 RCW, and state government shall utilize the data standards. The
information and data elements shall be reported as the department of health
directs by rule in accordance with data standards developed under this section.
(2) The health care
data collected, maintained, and studied by the department under this section((,
the health care policy board,)) or any other entity: (a) Shall include a
method of associating all information on health care costs and services with
discrete cases; (b) shall not contain any means of determining the personal
identity of any enrollee, provider, or facility; (c) shall only be available
for retrieval in original or processed form to public and private requesters;
(d) shall be available within a reasonable period of time after the date of
request; and (e) shall give strong consideration to data standards that achieve
national uniformity.
(3) The cost of retrieving data for state officials and agencies shall be funded through 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 that reflects the direct cost of retrieving the data or study in the requested form.
(4) All persons subject to this section shall comply with departmental requirements established by rule in the acquisition of data, however, the department shall adopt no rule or effect no policy implementing the provisions of this section without an act of law.
(5) The department shall submit developed health care data standards to the appropriate committees of the legislature by December 31, 1995.
Sec. 7. RCW 43.70.068 and 1995 c 267 s 5 are each amended to read as follows:
No later than July 1,
1995, the ((health care policy board together with the)) department of
health, 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 and collaboration on final
recommendations for the study required under RCW 43.70.066. By December 31,
1996, the group shall review all state agency programs governing health service
quality assurance, in light of legislative actions pursuant to RCW
43.70.066(6), and shall recommend to the legislature, the consolidation,
coordination, or elimination of rules and programs that would be made
unnecessary pursuant to the development of a uniform quality assurance and
improvement program.
Sec. 8. RCW 43.72.320 and 1995 c 267 s 10 are each amended to read as follows:
(((1)))
Effective ((July 1, 1995, except as provided in subsection (2) of this
section)) the effective date of this act, the duties of the health
services commission under RCW 43.72.310 shall be carried out by the ((health
care policy board established in section 9, chapter 265, Laws of 1995)) attorney
general.
(((2) For purposes
of the transfer of duties under this section to the health care policy board,
legislative members are not appointed to the board and are not members of the
board.))
NEW SECTION. Sec. 9. The following acts or parts of acts are each repealed:
(1) RCW 43.73.010 and 1995 c 265 s 9;
(2) RCW 43.73.020 and 1995 c 265 s 10; and
(3) RCW 43.73.040 and 1995 c 265 s 12.
NEW SECTION. Sec. 10. RCW 43.73.030 is recodified in chapter 43.70 RCW.
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