AN ACT Relating to primary health care providers; and creating new sections.

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

NEW SECTION. Sec. 1. The legislature declares that promoting and maintaining a financially viable health care system in all parts of the state is a paramount interest. The legislature finds that, especially in rural communities, demographics and economic conditions may result in a large number of people relying on public programs to pay for their health care. In cases where providers serve a disproportionately large number of low-income clients, the reimbursement rates from public programs to primary health care providers may prove insufficient to maintain their medical practices. The legislature further finds that determining where providers serve a disproportionately large number of low-income clients and developing strategies to provide additional compensation will help stabilize the current health care system, especially in rural areas.

NEW SECTION. Sec. 2. (1) The primary health care provider study is authorized.

(2) The medical assistance administration and the health care authority shall jointly conduct a state-wide study to determine payment sources for primary health care providers performing outpatient primary care services and primary care in hospital emergency rooms for the state's medical assistance programs, including healthy options and the basic health plan. The purpose of the study is to determine which providers serve a relatively high number of low-income clients, and how that affects their medical practice. The agencies are directed to use this data to develop proposals to support these providers' medical practices.

(3) The medical assistance administration and the health care authority shall conduct a study of individual primary care providers who perform outpatient primary care services. This includes primary care providers such as pediatricians, family practitioners, general practitioners, internists, physician assistants, or advanced registered nurse practitioners. The agencies will determine which regions of the state to include in the study, based on factors they determine will provide the most representative data state-wide. The agencies shall also consult with interested parties, including any organization or agency affected by this act. Interested and affected organizations and agencies include, but are not limited to, representatives of the medical society, representatives of hospitals employing primary care physicians, representatives of hospitals providing medical residency programs, representatives of health maintenance organizations employing primary care physicians, and representatives of the Washington rural health association. When consulting with interested and affected organizations and agencies, the medical assistance administration and the health care authority shall seek the input of these organizations and agencies concerning how best to construct the methodology or methodologies that are needed to successfully complete the primary health care provider study, including, but not limited to, how to calculate provider cost relative to a regional consumer price index, patient mix, and organizational variables. As the study develops, the medical assistance administration and the health care authority shall continue to consult with the affected organizations and agencies in order to produce final study methodologies that accurately reflect the impact of the issues on the affected organizations and agencies. To conduct the study, the agencies may seek information in relation to such factors as:

(a) The rates paid to primary care providers for their medical assistance programs, including healthy options, and basic health plan contracts;

(b) How these rates compare with nonpublic pay clients for the same services; and

(c) The payment sources for the providers examined in the study, the size of their medical practices, and other factors determined by the agencies that may be important in developing payment methods for such providers.

The agencies are authorized to attain this information from health plans or providers. The agencies will maintain the confidentiality of data collected for the purpose of the study.

(4) The medical assistance administration and the health care authority shall determine what constitutes a relatively high percentage of low-income clients for individual providers who contract for healthy options and the basic health plan, and recommend whether and at what point this disproportionately high percentage should result in additional compensation to the primary care provider.

(5) The medical assistance administration and the health care authority will recommend a method to calculate a payment adjustment designed to help support medical practices, according to the study's findings.

(6) The medical assistance administration and the health care authority shall report to the legislature by December 1, 2000, with the results of the primary health care provider study. The report will include recommendations on: (a) What constitutes a disproportionately high percentage of low-income clients; (b) possible payment adjustments for these providers; (c) methods to implement such a rate adjustment; and (d) what such a payment adjusted program will cost.