SSB 5416 - H AMD 0362 FAILED 04/25/99

By Representative Alexander

On page 1, line 18, strike Aand@

On page 1, line 19, after ATitle XXI@ strike A.@ and insert A; and (e)who has a special health care need. A child with a special health care need is: (i) one who has a chronic health condition that is expected to last at least one year and have significant sequelae requiring ongoing extensive medical care. Examples of such conditions may include but are not limited to: birth defects including genetic, congenital, or acquired disorders; developmental disabilities; and chronic illnesses such as diabetes, sickle cell disease, cystic fibrosis, muscular dystrophy, and cerebral palsy. A child who has any of these conditions, as diagnosed by their primary care or specialty physician, shall be eligible for the Washington state children's health insurance program with minimal ongoing evaluation; or (ii) one who has a condition that is initially severe but will improve over time as a result of appropriate treatment. Examples of these conditions may include but are not limited to: malignancies, chronic respiratory disease of prematurity, and severe injuries. A child who has any of these conditions, will require extensive medical services for a limited time, and will be initially eligible for the children's health insurance program. In order for such a child to remain eligible in the children's health insurance program, the health status of the child must be reviewed on an annual basis by a physician experienced in providing care to children with special health care needs.

(3) Upon notification to the Legislature that the department has exceeded by 10,000 the 1999-01 budget goal of the ongoing outreach project to enroll 21,500 additional children with family incomes at or below 200% of federal poverty level, the department may expand the children=s health insurance program to all children in families below 250 percent of the federal poverty level not otherwise eligible for Medicaid. Such expansion shall be contingent upon the Legislature=s acknowledgment of the achievement of this level of performance, at which time, subsection (2)(e)of this section shall no longer be applicable. The department shall report to the fiscal committees of the Legislature on December 1, 1999 and December 1, 2000 the incremental number of average monthly eligible children enrolled each month as a result of this outreach effort.

(4) By December 15, 1999, the Washington health care authority shall provide recommendations to the Legislature on the design of a state program to meet the health care coverage needs of children in families between 200 and 250 percent of the federal poverty level that meets the requirements of the federal Children=s Health Insurance Program. In preparing the recommendations the authority shall contract with an actuarial firm to develop the final recommendations reported to the Legislature. The firm must have extensive knowledge of the operations of health care coverage systems, both public and private, and must have experience in providing recommendations to at least one other state that has designed a state program that received approval by the federal government to serve children eligible for the Children=s Health Insurance Program as authorized by Congress. In preparing the final recommendations, the firm must evaluate and bring forward recommendations to implement all of the following program structures: employer partnership programs; premium payment assistance for eligible families; employer tax credits or other incentives to employers to provide family coverage; expansion of existing state programs other than Medicaid; and creation of a separate state program to specifically implement the Children=s Health Insurance Program.@

Renumber remaining subsections consecutively.