BILL REQ. #:  S-3430.1 

Read first time 01/27/2004.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to establishing a relationship and accountability among Washington state and American Indian tribes regarding health care services; adding a new chapter to Title 43 RCW; and repealing RCW 43.70.590.

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

NEW SECTION.  Sec. 1   Consistent with the centennial accord, the new millennium agreement, related treaties, and federal and state law, it is the intent of the legislature to establish a framework whereby the state and federally recognized tribes jointly establish operations and methods of accountability to provide health care services to maintain and improve the health status of American Indians residing in Washington state.

NEW SECTION.  Sec. 2   The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Agencies" or "agency" means the department of health, department of social and health services, state health care authority, department of labor and industries, state board of health, and office of the insurance commissioner.
     (2) "Plan" means the American Indian health care plan developed under section 6 of this act.
     (3) "Lead agency" means the agency appointed by the governor to meet the requirements set forth in section 4 of this act.
     (4) "Tribes" are those tribes federally recognized in accordance with the regulations of the United States department of the interior, bureau of Indian affairs.
     (5) "Subcabinet" means the subcabinet on health care or similar body created by the governor comprised of agencies, related governmental departments, and a tribal representative appointed under section 3 of this act.
     (6) "Indian health care system" means those tribal, Indian health service, and urban Indian health programs that receive funding from the federal Indian health service appropriation.

NEW SECTION.  Sec. 3   Upon a recommendation of the state's American Indian health organization representing the largest number of tribal leaders, the governor shall appoint the tribal representative to the subcabinet as an advocate for Indian health care needs.

NEW SECTION.  Sec. 4   (1) The subcabinet has the following responsibilities:
     (a) Recommend to the governor a lead agency to fulfill requirements as specified in subsection (2) of this section;
     (b) Review the plan prepared under section 6 of this act and make recommendations to the governor regarding its approval;
     (c) Convene, at least annually, a tribal health care management meeting to provide a public forum for review of tribal and agency plan performance and related issues;
     (d) Develop, in consultation with the tribes, specific health care performance measures.
     (2) The lead agency has the following responsibilities:
     (a) Consistent with funds identified for this purpose, provide and coordinate the necessary resources and technical support to implement this chapter;
     (b) Coordinate the plan development required in section 6 of this act;
     (c) Administer funds and grants specifically designated for the purpose of this chapter;
     (d) Appoint work groups and ad hoc committees, as necessary.

NEW SECTION.  Sec. 5   Each agency and tribe has the following responsibilities under this chapter:
     (1) Work with the governor to ensure the provisions of the centennial accord and new millennium agreement are implemented;
     (2) Participate in the development of the plan and performance measures standards;
     (3) Create separately, or integrate into an existing tribal or agency strategic plan, related objectives, strategies, and performance measures consistent with the standards established under section 6 of this act and strategic planning requirements set forth by the office of financial management;
     (4) Collect the necessary data to monitor plan performance and provide the data for review at Indian health care management meetings and for related purposes.

NEW SECTION.  Sec. 6   The American Indian health care delivery plan is established to be developed as follows:
     (1) The plan must encompass a six-year period but may be revised biennially consistent with the development of the state's biennial budget.
     (2) The plan must be developed in coordination with the state health report, as required by chapter 43.20 RCW, and similar reporting documents.
     (3) It is the responsibility of the lead agency to oversee the plan's development and to assure tribal consultation during the process.
     (4) The plan must include the following elements:
     (a) Background and analysis, to include:
     (i) Descriptions of all treaties, accords, agreements, statutes, regulations, case law governing tribal health care, and related major amendments and modifications during the previous biennium;
     (ii) Description of the state's Indian health care system;
     (iii) Forecasts and trends on: Indian morbidity, mortality, and other selected health status indicators; funding and service delivery issues; and adequacy of programs, providers, and facilities to meet needs;
     (iv) A summary of major Indian health care problems and issues, including methods and analyses of identification;
     (b) Strategies plan development, to include:
     (i) Goals and strategies of each tribe and agency on methods to address identified problems and issues;
     (ii) Statutory and regulatory changes necessary to implement strategies;
     (iii) Related budget requirements;
     (c) Performance measurements, including specific quantifiable outcome measures that are consistent with the standards developed by the subcabinet and of the office of financial management.

NEW SECTION.  Sec. 7   The governor has the following responsibilities:
     (1) Work with tribes and agencies to ensure the centennial accord and the new millennium agreement are implemented;
     (2) Appoint the tribal subcabinet member under section 3 of this act in a timely manner;
     (3) Attend an Indian health care management meeting at least annually;
     (4) Ensure that Indian health care issues received adequate deliberation in the preparation of the state budget or key health policy legislation, regulations, and executive orders.

NEW SECTION.  Sec. 8   RCW 43.70.590 (American Indian health care delivery plan) and 1995 c 43 s 4 & 1993 c 492 s 468 are each repealed.

NEW SECTION.  Sec. 9   Sections 1 through 7, 10, and 11 of this act constitute a new chapter in Title 43 RCW.

NEW SECTION.  Sec. 10   This act does not affect any existing right acquired or liability or obligation incurred under the sections amended or repealed in this act or under any rule or order adopted under those sections, nor does it affect any proceeding instituted under those sections.

NEW SECTION.  Sec. 11   This act may be known and cited as the Sue Crystal Indian health act.