[atlas:bill]

AN ACT Relating to regional health care access demonstration projects; adding new sections to chapter 41.05 RCW; adding a new section to chapter 74.09 RCW; adding a new section to chapter 48.43 RCW; and creating a new section.

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

NEW SECTION. Sec. 1. The legislature finds that the state of Washington has made significant progress towards decreasing the number of persons in the state without health insurance coverage. However, despite these efforts, a substantial number of persons in Washington state remain uninsured. The legislature further finds that efforts are currently underway in local areas to identify and implement innovative approaches to increasing access to health coverage and health services for low-income families and people with disabilities or chronic health conditions. Some of these innovative approaches require flexibility on the part of the state in its health care purchasing, administration of eligibility determination and enrollment processes, or regulatory activities. The legislature intends to further local efforts by initiating an implementation planning process, and giving the department of social and health services, the health care authority, and the office of the insurance commissioner authority to waive certain statutory requirements needed to grant applications for regional health care access demonstration projects.

NEW SECTION. Sec. 2. (1) The health care authority shall establish a regional health care access demonstration project workgroup whose membership includes:

(a) The department of social and health services medical assistance administration;

(b) The office of the insurance commissioner;

(d) The health care authority;

(e) The office of the governor;

(f) Representatives of regional health care access organizations who have received grant funding from either the Robert Wood Johnson foundation or the federal health resources and services administration for local health care system redesign and access initiatives;

(g) The Washington health foundation; and

(h) The University of Washington health policy analysis program.

(2) The workgroup must develop a plan to implement section 3 of this act. The implementation plan shall be submitted to appropriate committees of the legislature and the governor by December 15, 2001.

NEW SECTION. Sec. 3. (1) The administrator must act as the lead agency for the purposes of receipt and review of grant applications for regional health care access demonstration projects under the terms and conditions set forth in sections 3 through 6 of this act. The review panel must include representatives of the health care authority, the department of social and health services, the department of health, and the office of the insurance commissioner.

(2) The administrator, with the consent of other affected state agencies, may grant regional health care access demonstration project applications in up to four sites around the state. To the extent necessary to implement a demonstration project, affected state agencies may exercise the authority granted in sections 4 through 6 of this act. The demonstration sites chosen must be representative of urban and rural communities in eastern and western Washington. The demonstration projects may have a duration of up to five years.

(3) Any application for a regional health care access demonstration project under this section must:

(a) Be designed to improve access to health care for uninsured low-income families and people with disabilities or chronic illness who live in the region included in the demonstration project;

(b) Not make modifications in medical assistance programs or the basic health plan that have the effect of disadvantaging, as a group, low-income families and people with disabilities or chronic illness who live in the region included in the demonstration project;

(c) Identify at least one goal of improved population-based health status that will result from the demonstration project's efforts;

(d) Include proposed steps to reduce duplication and simplify administration of medical assistance programs and the basic health plan;

(e) Coordinate eligibility, enrollment, and service delivery across medical assistance, the basic health plan, and other programs serving low-income families and people with disabilities or chronic illness who live in the region included in the demonstration project;

(f) Ensure the availability of an adequate number and type of health care providers in any provider network sponsored by or through the demonstration project; and

(g) Include a rigorous evaluation component. The evaluation must be designed to measure:

(i) The per capita health care expenditures for the populations targeted for coverage under the demonstration project;

(ii) The impact of the demonstration project upon the targeted population, measured in terms of health insurance coverage, either public or private, access to health services, and health status;

(iii) The impact of the demonstration project upon charity care expenses for hospitals in the region participating in the demonstration project;

(iv) The level of community and consumer input in the design and implementation of the demonstration project; and

(v) The adequacy of any health care provider network sponsored by or through the demonstration project.

(4) An entity submitting an application for a regional health care access demonstration project must:

(a) Demonstrate the capacity to undertake the demonstration project described in the application;

(b) Identify monetary and in-kind resources that will be brought to bear in support of the demonstration project, and the source of those resources;

(c) Demonstrate broad participation and support from the communities included in the region to be covered by the demonstration project. The participation should include support from health care providers, social services providers, employers, carriers, local public health departments or districts, city or county councils or commissions, and consumers;

(d) Identify the means through which the demonstration project will be accountable to the communities included in the region. Accountability may be achieved through, but would not be limited to: The lead agency of the demonstration project having a publicly elected board, such as a hospital district, or a board composed of elected officials, such as a local public health district; establishment of a project steering committee that is broadly representative of the communities included in the region; or processes for obtaining public input as to the demonstration project's design and implementation on a regular basis.

NEW SECTION. Sec. 4. In conjunction with granting an application for a regional health care access demonstration project under section 3 of this act, the administrator may modify the requirements of RCW 70.47.060 (7) and (11) and 70.47.100 relating to basic health plan contracting. In determining the extent to which modifications to statutory requirements are appropriate under this section, the administrator shall consider:

(1) The extent to which the modifications to statutory requirements are necessary to carry out the regional health care access demonstration project;

(2) The need to ensure that an adequate network of health care providers is available to meet the needs of consumers served by the demonstration project; and

(3) The need to ensure that consumers served by the demonstration projects are adequately protected in the event of financial failure or difficulties of any entity participating in the demonstration project.

NEW SECTION. Sec. 5. A new section is added to chapter 74.09 RCW to read as follows:

In conjunction with granting an application for a regional health care access demonstration project under section 3 of this act, the department may modify the requirements of RCW 74.09.522 relating to medicaid managed care contracting. In determining the extent to which modifications to statutory requirements are appropriate under this section, the department shall consider:

(1) The extent to which the modifications to statutory requirements are necessary to carry out the regional health care access demonstration project;

(2) The need to ensure that an adequate network of health care providers is available to meet the needs of consumers served by the demonstration project; and

NEW SECTION. Sec. 6. A new section is added to chapter 48.43 RCW to read as follows:

In conjunction with granting an application for a regional health care access demonstration project under section 3 of this act, the commissioner may modify the requirements of this title relating to rates, forms, and solvency. In determining the extent to which modifications to statutory requirements are appropriate under this section, the commissioner shall consider:

(1) The extent to which the modifications to statutory requirements are necessary to carry out the regional health care access demonstration project and will comply with the intent of this title to protect consumers of health services in the state of Washington;

(2) The need to ensure that an adequate network of health care providers is available to meet the needs of consumers served by the demonstration project; and

NEW SECTION. Sec. 7. Sections 1, 3, and 4 of this act are each added to chapter 41.05 RCW.