BILL REQ. #:  Z-0663.1 

Read first time 03/28/2005.   Referred to Committee on Appropriations.

     AN ACT Relating to health insurance coverage for children; amending RCW 74.09.415; and creating a new section.

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

Sec. 1   RCW 74.09.415 and 2002 c 366 s 2 are each amended to read as follows:
     (((1))) There is hereby established a program to be known as the children's health program.
     To the extent of available funds:
     (((a))) (1) Health care services may be provided to persons who are under eighteen years of age with household incomes at or below the federal poverty level ((and)) not otherwise eligible for medical assistance or the limited casualty program for the medically needy.
     (((b))) (2) The determination of eligibility of recipients for health care services shall be the responsibility of the department. The application process shall be easy to understand and, to the extent possible, applications shall be made available at local schools and other appropriate locations. The department shall make eligibility determinations within the time frames for establishing eligibility for children on medical assistance, as defined by RCW 74.09.510.
     (((c))) (3) The amount, scope, and duration of health care services provided to eligible children under the children's health program ((shall)) may be the same as that provided to children under medical assistance, as defined in RCW 74.09.520.
     (((2) The legislature is interested in assessing the effectiveness of the prenatal care program. However, the legislature recognizes the cost and complexity associated with such assessment.
     The legislature accepts the effectiveness of prenatal and maternity care at improving birth outcomes when these services are received by eligible persons. Therefore, the legislature intends to focus scarce assessment resources to determine the extent to which support services such as child care, psychosocial and nutritional assessment and counseling, case management, transportation, and other support services authorized by chapter 296, Laws of 1990, result in receipt of prenatal and maternity care by eligible persons.
     The University of Washington shall conduct a study, based on a statistically significant statewide sampling of data, to evaluate the effectiveness of the maternity care access program set forth in RCW 74.09.760 through 74.09.820 based on the principles set forth in RCW 74.09.770.
     The University of Washington shall develop a plan and budget for the study in consultation with the joint legislative audit and review committee. The joint legislative audit and review committee shall also monitor the progress of the study.
     The department of social and health services shall make data and other information available as needed to the University of Washington as required to conduct this study.
     The study shall determine:
     (a) The characteristics of women receiving services, including health risk factors;
     (b) The extent to which access to maternity care and support services have improved in this state as a result of this program;
     (c) The utilization of services and birth outcomes for women and infants served by this program by type of practitioner;
     (d) The extent to which birth outcomes for women receiving services under this program have improved in comparison to birth outcomes of nonmedicaid mothers;
     (e) The impact of increased medicaid reimbursement to physicians on provider participation;
     (f) The difference between costs for services provided under this program and medicaid reimbursement for the services;
     (g) The gaps in services, if any, that may still exist for women and their infants as defined by RCW 74.09.790 (1) and (4) served by this program, excluding pregnant substance abusers, and women covered by private health insurance; and
     (h) The number and mix of services provided to eligible women as defined by subsection (2)(g) of this section and the effect on birth outcomes as compared to nonmedicaid birth outcomes.)) In the event that available funding is not sufficient to provide the amount, duration, and scope of services provided to children under medical assistance, the department shall make every effort to define covered services in a manner that provides coverage for clinically proven preventive services.
     (4) Enrollment in the children's health program shall not result in expenditures that exceed the amount that has been appropriated for the program in the operating budget. In order to keep expenditures within the appropriated amount, the department may manage enrollments, including imposition of an enrollment freeze.

NEW SECTION.  Sec. 2   If specific funding for the purposes of this act, referencing this act by bill or chapter number, is not provided by June 30, 2005, in the omnibus appropriations act, this act is null and void.