BILL REQ. #:  H-0541.1 

Read first time 02/09/2005.   Referred to Committee on Health Care.

     AN ACT Relating to the prevention, diagnosis, and treatment of asthma; amending RCW 19.27.190, 41.05.013, and 74.09.520; adding a new section to chapter 28A.210 RCW; adding new sections to chapter 41.05 RCW; adding a new section to chapter 48.44 RCW; adding a new section to chapter 48.46 RCW; adding a new section to chapter 43.70 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:
     (1) Asthma is a dangerous disease that is growing in prevalence in Washington state. An estimated five hundred thousand residents of the state suffer from asthma. Since 1995, asthma has claimed more than five hundred lives, caused more than twenty-five thousand hospitalizations with costs of more than one hundred twelve million dollars, and resulted in seven million five hundred thousand missed school days. School nurses have identified over four thousand children with life-threatening asthma in the state's schools.
     (2) While asthma is found among all populations, its prevalence disproportionately affects low-income and minority populations. Untreated asthma affects worker productivity and results in unnecessary absences from work. In many cases, asthma triggers present in substandard housing and poorly ventilated workplaces contribute directly to asthma.
     (3) Although research continues into the causes and cures for asthma, national consensus has been reached on treatment guidelines. People with asthma who are being treated in accordance with these guidelines are far more likely to control the disease than those who are not being treated and therefore are less likely to experience debilitating or life-threatening asthma episodes, less likely to be hospitalized, and less likely to need to curtail normal school or work activities. With treatment, most people with asthma are able to live normal, active lives.
     (4) Up to one-third of the people with asthma have not had their disease diagnosed. Among those with diagnosed asthma, thirty to fifty percent are not receiving medicines that are needed to control the disease, and approximately eighty percent of diagnosed asthmatics are not getting yearly spirometry measurements that are a key element in monitoring the disease.

Sec. 2   RCW 19.27.190 and 1996 c 186 s 501 are each amended to read as follows:
     (1)(a) Not later than January 1, 1991, the state building code council, in consultation with the department of community, trade, and economic development, shall establish interim requirements for the maintenance of indoor air quality in newly constructed residential buildings. In establishing the interim requirements, the council shall take into consideration differences in heating fuels and heating system types. These requirements shall be in effect July 1, 1991, through June 30, 1993.
     (b) The interim requirements for new electrically space heated residential buildings shall include ventilation standards which provide for mechanical ventilation in areas of the residence where water vapor or cooking odors are produced. The ventilation shall be exhausted to the outside of the structure. The ventilation standards shall further provide for the capacity to supply outside air to each bedroom and the main living area through dedicated supply air inlet locations in walls, or in an equivalent manner. At least one exhaust fan in the home shall be controlled by a dehumidistat or clock timer to ensure that sufficient whole house ventilation is regularly provided as needed.
     (c)(i) For new single family residences with electric space heating systems, zero lot line homes, each unit in a duplex, and each attached housing unit in a planned unit development, the ventilation standards shall include fifty cubic feet per minute of effective installed ventilation capacity in each bathroom and one hundred cubic feet per minute of effective installed ventilation capacity in each kitchen.
     (ii) For other new residential units with electric space heating systems the ventilation standards may be satisfied by the installation of two exhaust fans with a combined effective installed ventilation capacity of two hundred cubic feet per minute.
     (iii) Effective installed ventilation capacity means the capability to deliver the specified ventilation rates for the actual design of the ventilation system. Natural ventilation and infiltration shall not be considered acceptable substitutes for mechanical ventilation.
     (d) For new residential buildings that are space heated with other than electric space heating systems, the interim standards shall be designed to result in indoor air quality equivalent to that achieved with the interim ventilation standards for electric space heated homes.
     (e) The interim requirements for all newly constructed residential buildings shall include standards for indoor air quality pollutant source control, including the following requirements: All structural panel components of the residence shall comply with appropriate standards for the emission of formaldehyde; the back-drafting of combustion by-products from combustion appliances shall be minimized through the use of dampers, vents, outside combustion air sources, or other appropriate technologies; and, in areas of the state where monitored data indicate action is necessary to inhibit indoor radon gas concentrations from exceeding appropriate health standards, entry of radon gas into homes shall be minimized through appropriate foundation construction measures. Standards for heating and ventilation systems shall be developed that minimize the presence of common asthma triggers such as dust mites and animal dander in recirculated air.
     (2) No later than January 1, 1993, the state building code council, in consultation with the department of community, trade, and economic development, shall establish final requirements for the maintenance of indoor air quality in newly constructed residences to be in effect beginning July 1, 1993. For new electrically space heated residential buildings, these requirements shall maintain indoor air quality equivalent to that provided by the mechanical ventilation and indoor air pollutant source control requirements included in the February 7, 1989, Bonneville power administration record of decision for the environmental impact statement on new energy efficient homes programs (DOE/EIS-0127F) built with electric space heating. In residential units other than single family, zero lot line, duplexes, and attached housing units in planned unit developments, ventilation requirements may be satisfied by the installation of two exhaust fans with a combined effective installed ventilation capacity of two hundred cubic feet per minute. For new residential buildings that are space heated with other than electric space heating systems, the standards shall be designed to result in indoor air quality equivalent to that achieved with the ventilation and source control standards for electric space heated homes. In establishing the final requirements, the council shall take into consideration differences in heating fuels and heating system types.

NEW SECTION.  Sec. 3   A new section is added to chapter 28A.210 RCW to read as follows:
     (1) The superintendent of public instruction and the secretary of the department of health shall develop a uniform policy for all school districts providing for the in-service training for school staff on symptoms, treatment, and monitoring of students with asthma and on the additional observations that may be needed in different situations that may arise during the school day and during school-sponsored events. The policy shall include the standards and skills that must be in place for in-service training of school staff.
     (2) All school districts shall adopt policies regarding asthma rescue procedures and asthma prevention policies for each school within the district.
     (3) All school districts must require that each public elementary school and secondary school grant to any student in the school authorization for the self-administration of medication to treat that student's asthma or anaphylaxis, if:
     (a) A health care practitioner prescribed the medication for use by the student during school hours and instructed the student in the correct and responsible use of the medication;
     (b) The student has demonstrated to the health care practitioner, or the practitioner's designee, and the school nurse, if available, the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed;
     (c) The health care practitioner formulates a written treatment plan for managing asthma or anaphylaxis episodes of the student and for medication use by the student during school hours; and
     (d) The student's parent or guardian has completed and submitted to the school any written documentation required by the school, including the treatment plan formulated under (c) of this subsection and other documents related to liability.
     (4) An authorization granted under subsection (3) of this section must allow the student involved to possess and use his or her medication:
     (a) While in school;
     (b) While at a school-sponsored activity, such as a sporting event; and
     (c) In transit to or from school or school-sponsored activities.
     (5) An authorization granted under subsection (3) of this section:
     (a) Must be effective only for the same school and school year for which it is granted; and
     (b) Must be renewed by the parent or guardian each subsequent school year in accordance with this subsection.
     (6) School districts must require that backup medication, if provided by a student's parent or guardian, be kept at a student's school in a location to which the student has immediate access in the event of an asthma or anaphylaxis emergency.
     (7) School districts must require that information described in subsection (3)(c) and (d) of this section be kept on file at the student's school in a location easily accessible in the event of an asthma or anaphylaxis emergency.
     (8) Nothing in this section creates a cause of action or in any other way increases or diminishes the liability of any person under any other law.

NEW SECTION.  Sec. 4   A new section is added to chapter 41.05 RCW to read as follows:
     (1) The authority shall coordinate among state agencies and health plans delivering state purchased health services for including asthma management, including development of individual asthma management plans, among the disease management programs that are encouraged by the authority.
     (2) The administrator shall establish a common asthma registry process for all providers of health care services purchased by the state.

Sec. 5   RCW 41.05.013 and 2003 c 276 s 1 are each amended to read as follows:
     (1) The authority shall coordinate state agency efforts to develop and implement uniform policies across state purchased health care programs that will ensure prudent, cost-effective health services purchasing, maximize efficiencies in administration of state purchased health care programs, improve the quality of care provided through state purchased health care programs, and reduce administrative burdens on health care providers participating in state purchased health care programs. The policies adopted should be based, to the extent possible, upon the best available scientific and medical evidence and shall endeavor to address:
     (a) Methods of formal assessment, such as health technology assessment. Consideration of the best available scientific evidence does not preclude consideration of experimental or investigational treatment or services under a clinical investigation approved by an institutional review board;
     (b) Monitoring of health outcomes, adverse events, quality, and cost-effectiveness of health services;
     (c) Development of a common definition of medical necessity; and
     (d) Exploration of common strategies for disease management and demand management programs, including asthma, diabetes, heart disease, and similar common chronic diseases. Strategies to be explored include individual asthma management plans.
     (2) The administrator may invite health care provider organizations, carriers, other health care purchasers, and consumers to participate in efforts undertaken under this section.
     (3) For the purposes of this section "best available scientific and medical evidence" means the best available external clinical evidence derived from systematic research.

NEW SECTION.  Sec. 6   A new section is added to chapter 41.05 RCW to read as follows:
     The legislature finds that asthma imposes a significant health risk and tremendous financial burden on the citizens and government of the state of Washington, and that access to the medically accepted standards of care for asthma, its treatment and supplies, and self-management training and education is crucial to prevent or delay the short and long-term complications of asthma and its attendant costs.
     (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
     (a) "Person with asthma" means a person diagnosed by a health care provider as having asthma; and
     (b) "Health care provider" means a health care provider as defined in RCW 48.43.005.
     (2) All state-purchased health care purchased or renewed after January 1, 2006, shall provide benefits for at least the following services and supplies for persons with asthma:
     (a) For state-purchased health care that includes coverage for pharmacy services, appropriate and medically necessary equipment and supplies, as prescribed by a health care provider, that includes but is not limited to asthma controller medicines, asthma rescue medicines, peak flow meters, spacers, covering for mattresses and pillows for sensitive populations, and smoking cessation services and medications for persons with asthma or others living in the same household, as prescribed by a health care provider;
     (b) For all state-purchased health care, outpatient self-management training and education, including development of an asthma plan and services of a certified asthma educator, as ordered by the health care provider. Asthma outpatient self-management training and education may be provided only by certified asthma educators. Nothing in this section prevents the health care service contractor from restricting patients to seeing only health care providers who have signed participating provider agreements with the health care service contractor or an insuring entity under contract with the health care service contractor.
     (3) Coverage required under this section may be subject to customary cost-sharing provisions established for all other similar services or supplies within a policy.
     (4) Health care coverage may not be reduced or eliminated due to this section.
     (5) Services required under this section shall be covered when deemed medically necessary by the medical director, or his or her designee or licensed health care provider with the appropriate training and education in the pathophysiology, treatment, and education required for asthma management, and is subject to any referral and formulary requirements.

NEW SECTION.  Sec. 7   A new section is added to chapter 48.44 RCW to read as follows:
     The legislature finds that asthma imposes a significant health risk and tremendous financial burden on the citizens and government of the state of Washington, and that access to the medically accepted standards of care for asthma, its treatment and supplies, and self-management training and education is crucial to prevent or delay the short and long-term complications of asthma and its attendant costs.
     (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
     (a) "Person with asthma" means a person diagnosed by a health care provider as having asthma; and
     (b) "Health care provider" means a health care provider as defined in RCW 48.43.005.
     (2) All health benefit plans offered by health care service contractors, issued or renewed after January 1, 2006, shall provide benefits for at least the following services and supplies for persons with asthma:
     (a) For health benefit plans that include coverage for pharmacy services, appropriate and medically necessary equipment and supplies, as prescribed by a health care provider, that includes but is not limited to asthma controller medicines, asthma rescue medicines, peak flow meters, spacers, covering for mattresses and pillows for sensitive populations, and smoking cessation services and medications for persons with asthma or others living in the same household, as prescribed by a health care provider;
     (b) For all health benefit plans, outpatient self-management training and education, including development of an asthma plan and services of a certified asthma educator, as ordered by the health care provider. Asthma outpatient self-management training and education may be provided only by certified asthma educators. Nothing in this section prevents the health care service contractor from restricting patients to seeing only health care providers who have signed participating provider agreements with the health care service contractor or an insuring entity under contract with the health care service contractor.
     (3) Coverage required under this section may be subject to customary cost-sharing provisions established for all other similar services or supplies within a policy.
     (4) Health care coverage may not be reduced or eliminated due to this section.
     (5) Services required under this section shall be covered when deemed medically necessary by the medical director, or his or her designee or licensed health care provider with the appropriate training and education in the pathophysiology, treatment, and education required for asthma management, and is subject to any referral and formulary requirements.
     (6) The health care service contractor need not include the coverage required in this section in a group contract offered to an employer or other group that offers to its eligible enrollees a self-insured health plan not subject to mandated benefits status under this title that does not offer coverage similar to that mandated under this section.
     (7) This section does not apply to the health benefit plans that provide benefits identical to the schedule of services covered by the basic health plan, as required by RCW 48.44.022 and 48.44.023.

NEW SECTION.  Sec. 8   A new section is added to chapter 48.46 RCW to read as follows:
     The legislature finds that asthma imposes a significant health risk and tremendous financial burden on the citizens and government of the state of Washington, and that access to the medically accepted standards of care for asthma, its treatment and supplies, and self-management training and education is crucial to prevent or delay the short and long-term complications of asthma and its attendant costs.
     (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
     (a) "Person with asthma" means a person diagnosed by a health care provider as having asthma; and
     (b) "Health care provider" means a health care provider as defined in RCW 48.43.005.
     (2) All health benefit plans offered by health maintenance organizations, issued or renewed after January 1, 2006, shall provide benefits for at least the following services and supplies for persons with asthma:
     (a) For health benefit plans that include coverage for pharmacy services, appropriate and medically necessary equipment and supplies, as prescribed by a health care provider, that includes but is not limited to asthma controller medicines, asthma rescue medicines, peak flow meters, spacers, covering for mattresses and pillows for sensitive populations, and smoking cessation services and medications for persons with asthma or others living in the same household, as prescribed by a health care provider;
     (b) For all health benefit plans, outpatient self-management training and education, including development of an asthma plan and services of a certified asthma educator, as ordered by the health care provider. Asthma outpatient self-management training and education may be provided only by certified asthma educators. Nothing in this section prevents the health care service contractor from restricting patients to seeing only health care providers who have signed participating provider agreements with the health care service contractor or an insuring entity under contract with the health care service contractor.
     (3) Coverage required under this section may be subject to customary cost-sharing provisions established for all other similar services or supplies within a policy.
     (4) Health care coverage may not be reduced or eliminated due to this section.
     (5) Services required under this section shall be covered when deemed medically necessary by the medical director, or his or her designee or licensed health care provider with the appropriate training and education in the pathophysiology, treatment, and education required for asthma management, and is subject to any referral and formulary requirements.
     (6) The health maintenance organization need not include the coverage required in this section in a group contract offered to an employer or other group that offers to its eligible enrollees a self-insured health plan not subject to mandated benefits status under this title that does not offer coverage similar to that mandated under this section.
     (7) This section does not apply to the health benefit plans that provide benefits identical to the schedule of services covered by the basic health plan, as required by RCW 48.44.022 and 48.44.023.

NEW SECTION.  Sec. 9   A new section is added to chapter 43.70 RCW to read as follows:
     The department of health shall collect data as authorized by RCW 43.70.050 regarding the prevalence of asthma, identify variations in practices of treatment of asthma, identify populations with disproportionate prevalence, and describe successful strategies for diagnosis, prevention, and treatment of asthma.

Sec. 10   RCW 74.09.520 and 2004 c 141 s 2 are each amended to read as follows:
     (1) The term "medical assistance" may include the following care and services: (a) Inpatient hospital services; (b) outpatient hospital services; (c) other laboratory and x-ray services; (d) nursing facility services; (e) physicians' services, which shall include prescribed medication and instruction on birth control devices; (f) medical care, or any other type of remedial care as may be established by the secretary; (g) home health care services; (h) private duty nursing services; (i) dental services; (j) physical and occupational therapy and related services; (k) prescribed drugs, dentures, and prosthetic devices; and eyeglasses prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the individual may select; (l) personal care services, as provided in this section; (m) hospice services; (n) other diagnostic, screening, preventive, and rehabilitative services; ((and)) (o) asthma-related community health services; and (p) like services when furnished to a child by a school district in a manner consistent with the requirements of this chapter. For the purposes of this section, the department may not cut off any prescription medications, oxygen supplies, respiratory services, or other life-sustaining medical services or supplies.
     "Medical assistance," notwithstanding any other provision of law, shall not include routine foot care, or dental services delivered by any health care provider, that are not mandated by Title XIX of the social security act unless there is a specific appropriation for these services.
     (2) The department shall amend the state plan for medical assistance under Title XIX of the federal social security act to include personal care services, as defined in 42 C.F.R. 440.170(f), in the categorically needy program.
     (3) The department shall adopt, amend, or rescind such administrative rules as are necessary to ensure that Title XIX personal care services are provided to eligible persons in conformance with federal regulations.
     (a) These administrative rules shall include financial eligibility indexed according to the requirements of the social security act providing for medicaid eligibility.
     (b) The rules shall require clients be assessed as having a medical condition requiring assistance with personal care tasks. Plans of care for clients requiring health-related consultation for assessment and service planning may be reviewed by a nurse.
     (c) The department shall determine by rule which clients have a health-related assessment or service planning need requiring registered nurse consultation or review. This definition may include clients that meet indicators or protocols for review, consultation, or visit.
     (4) The department shall design and implement a means to assess the level of functional disability of persons eligible for personal care services under this section. The personal care services benefit shall be provided to the extent funding is available according to the assessed level of functional disability. Any reductions in services made necessary for funding reasons should be accomplished in a manner that assures that priority for maintaining services is given to persons with the greatest need as determined by the assessment of functional disability.
     (5) Effective July 1, 1989, the department shall offer hospice services in accordance with available funds.
     (6) For Title XIX personal care services administered by aging and disability services administration of the department, the department shall contract with area agencies on aging:
     (a) To provide case management services to individuals receiving Title XIX personal care services in their own home; and
     (b) To reassess and reauthorize Title XIX personal care services or other home and community services as defined in RCW 74.39A.009 in home or in other settings for individuals consistent with the intent of this section:
     (i) Who have been initially authorized by the department to receive Title XIX personal care services or other home and community services as defined in RCW 74.39A.009; and
     (ii) Who, at the time of reassessment and reauthorization, are receiving such services in their own home.
     (7) In the event that an area agency on aging is unwilling to enter into or satisfactorily fulfill a contract or an individual consumer's need for case management services will be met through an alternative delivery system, the department is authorized to:
     (a) Obtain the services through competitive bid; and
     (b) Provide the services directly until a qualified contractor can be found.