BILL REQ. #:  S-1292.2 

Read first time 02/08/2005.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to a person's right to have honored his or her decisions regarding health care; amending RCW 41.05.021 and 72.10.020; adding a new section to chapter 41.05 RCW; adding a new section to chapter 74.09 RCW; adding a new section to chapter 72.36 RCW; and adding a new section to chapter 51.04 RCW.

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

Sec. 1   RCW 41.05.021 and 2002 c 142 s 1 are each amended to read as follows:
     (1) The Washington state health care authority is created within the executive branch. The authority shall have an administrator appointed by the governor, with the consent of the senate. The administrator shall serve at the pleasure of the governor. The administrator may employ up to seven staff members, who shall be exempt from chapter 41.06 RCW, and any additional staff members as are necessary to administer this chapter. The administrator may delegate any power or duty vested in him or her by this chapter, including authority to make final decisions and enter final orders in hearings conducted under chapter 34.05 RCW. The primary duties of the authority shall be to: Administer state employees' insurance benefits and retired or disabled school employees' insurance benefits; administer the basic health plan pursuant to chapter 70.47 RCW; study state-purchased health care programs in order to maximize cost containment in these programs while ensuring access to quality health care; and implement state initiatives, joint purchasing strategies, and techniques for efficient administration that have potential application to all state-purchased health services. The authority's duties include, but are not limited to, the following:
     (a) To administer health care benefit programs for employees and retired or disabled school employees as specifically authorized in RCW 41.05.065 and in accordance with the methods described in RCW 41.05.075, 41.05.140, and other provisions of this chapter;
     (b) To analyze state-purchased health care programs and to explore options for cost containment and delivery alternatives for those programs that are consistent with the purposes of those programs, including, but not limited to:
     (i) Creation of economic incentives for the persons for whom the state purchases health care to appropriately utilize and purchase health care services, including the development of flexible benefit plans to offset increases in individual financial responsibility;
     (ii) Utilization of provider arrangements that encourage cost containment, including but not limited to prepaid delivery systems, utilization review, and prospective payment methods, and that ensure access to quality care, including assuring reasonable access to local providers, especially for employees residing in rural areas;
     (iii) Coordination of state agency efforts to purchase drugs effectively as provided in RCW 70.14.050;
     (iv) Development of recommendations and methods for purchasing medical equipment and supporting services on a volume discount basis; and
     (v) Development of data systems to obtain utilization data from state-purchased health care programs in order to identify cost centers, utilization patterns, provider and hospital practice patterns, and procedure costs, utilizing the information obtained pursuant to RCW 41.05.031;
     (c) To analyze areas of public and private health care interaction;
     (d) To provide information and technical and administrative assistance to the board;
     (e) To review and approve or deny applications from counties, municipalities, and other political subdivisions of the state to provide state-sponsored insurance or self-insurance programs to their employees in accordance with the provisions of RCW 41.04.205, setting the premium contribution for approved groups as outlined in RCW 41.05.050;
     (f) ((To appoint a health care policy technical advisory committee as required by RCW 41.05.150;
     (g) To establish billing procedures and collect funds from school districts and educational service districts under RCW 28A.400.400 in a way that minimizes the administrative burden on districts;
     (h))) To publish and distribute to nonparticipating school districts and educational service districts by October 1st of each year a description of health care benefit plans available through the authority and the estimated cost if school districts and educational service district employees were enrolled; ((and
     (i))) (g) To promulgate and adopt rules consistent with this chapter as described in RCW 41.05.160; and
     (h) To coordinate the development and distribution by agencies administering state purchased health care programs of comprehensive information about health care directives under chapter 70.122 RCW, durable power of attorney for health care decisions under chapters 7.70 and 11.94 RCW, and other matters that bear on the right of a person to have honored his or her decisions regarding health care, including the decision to have life-sustaining treatment withheld or withdrawn. The information shall include a copy of the directive set forth in RCW 70.122.030 with instructions on its proper execution.
     (2) On and after January 1, 1996, the public employees' benefits board may implement strategies to promote managed competition among employee health benefit plans. Strategies may include but are not limited to:
     (a) Standardizing the benefit package;
     (b) Soliciting competitive bids for the benefit package;
     (c) Limiting the state's contribution to a percent of the lowest priced qualified plan within a geographical area;
     (d) Monitoring the impact of the approach under this subsection with regards to: Efficiencies in health service delivery, cost shifts to subscribers, access to and choice of managed care plans statewide, and quality of health services. The health care authority shall also advise on the value of administering a benchmark employer-managed plan to promote competition among managed care plans.

NEW SECTION.  Sec. 2   A new section is added to chapter 41.05 RCW to read as follows:
     (1) The authority shall provide to each person enrolled in the basic health plan or a plan of the public employees' benefits board the information developed under RCW 41.05.021(1)(h) on the right of a person to have honored his or her decisions regarding health care. The information shall be provided to each person upon enrollment, and annually thereafter, as long as the person remains enrolled.
     (2) After January 1, 2007, to be eligible for enrollment in the basic health plan or a health benefit plan developed by the public employees' benefits board, any person eighteen years of age or older must execute a health care directive as provided in RCW 70.122.030, or indicate to the authority that he or she does not wish to execute such a directive.

NEW SECTION.  Sec. 3   A new section is added to chapter 74.09 RCW to read as follows:
     The department shall provide to each recipient of medical care services under this chapter the information developed under RCW 41.05.021(1)(h) on the right of a person to have honored his or her decisions regarding health care. The information shall be provided to each recipient upon enrollment, and annually thereafter, as long as the person remains a recipient of medical care services.

NEW SECTION.  Sec. 4   A new section is added to chapter 72.36 RCW to read as follows:
     (1) The department shall provide to each person admitted to a state veterans' home the information developed under RCW 41.05.021(1)(h) on the right of a person to have honored his or her decisions regarding health care. The information shall be provided to each person upon admission, and annually thereafter, as long as the person remains a resident of the home.
     (2) After January 1, 2007, to be eligible for admission to a state veterans' home, a person must execute a health care directive as provided in RCW 70.122.030, or indicate to the department that he or she does not wish to execute such a directive.

NEW SECTION.  Sec. 5   A new section is added to chapter 51.04 RCW to read as follows:
     The department shall provide to each worker, upon the determination that he or she is entitled to compensation under this title, the information developed under RCW 41.05.021(1)(h) on the right of a person to have honored his or her decisions regarding health care.

Sec. 6   RCW 72.10.020 and 1995 1st sp.s. c 19 s 17 are each amended to read as follows:
     (1) Upon entry into the correctional system, offenders shall receive an initial medical examination. The department shall prepare a health profile for each offender that includes at least the following information: (a) An identification of the offender's serious medical and dental needs; (b) an evaluation of the offender's capacity for work and recreation; and (c) a financial assessment of the offender's ability to pay for all or a portion of his or her health care services from personal resources or private insurance.
     (2) The department shall provide to each offender, upon entry into the correctional system, and annually thereafter, the information developed under RCW 41.05.021(1)(h) on the right of a person to have honored his or her decisions regarding health care.
     (3)(a) The department may develop and implement a plan for the delivery of health care services and personal hygiene items to offenders in the department's correctional facilities, at the discretion of the secretary, and in conformity with federal law.
     (b) To discourage unwarranted use of health care services caused by unnecessary visits to health care providers, offenders shall participate in the costs of their health care services by paying a nominal amount of no less than three dollars per visit, as determined by the secretary. Under the authority granted in RCW 72.01.050(2), the secretary may authorize the superintendent to collect this amount directly from an offender's institution account. All copayments collected from offenders' institution accounts shall be deposited into the general fund.
     (c) Offenders are required to make copayments for initial health care visits that are offender initiated and, by rule adopted by the department, may be charged a copayment for subsequent visits related to the medical condition which caused the initial visit. Offenders are not required to pay for emergency treatment or for visits initiated by health care staff or treatment of those conditions that constitute a serious health care need.
     (d) No offender may be refused any health care service because of indigence.
     (e) At no time shall the withdrawal of funds for the payment of a medical service copayment result in reducing an offender's institution account to an amount less than the level of indigency as defined in chapter 72.09 RCW.
     (((3)(a))) (4) The department shall report annually to the legislature the following information for the fiscal year preceding the report: (((i))) (a) The total number of health care visits made by offenders; (((ii))) (b) the total number of copayments assessed; (((iii))) (c) the total dollar amount of copayments collected; (((iv))) (d) the total number of copayments not collected due to an offender's indigency; and (((v))) (e) the total number of copayments not assessed due to the serious or emergent nature of the health care treatment or because the health care visit was not offender initiated.
     (((b) The first report required under this section shall be submitted not later than October 1, 1996, and shall include, at a minimum, all available information collected through the second half of fiscal year 1996. This subsection (3)(b) shall expire December 1, 1996.
     (4))) (5)(a) The secretary shall adopt, by rule, a uniform policy relating to the distribution and replenishment of personal hygiene items for inmates incarcerated in all department institutions. The policy shall provide for the initial distribution of adequate personal hygiene items to inmates upon their arrival at an institution.
     (b) The acquisition of replenishment personal hygiene items is the responsibility of inmates, except that indigent inmates shall not be denied adequate personal hygiene items based on their inability to pay for them.
     (c) The policy shall provide that the replenishment personal hygiene items be distributed to inmates only in authorized quantities and at intervals that reflect prudent use and customary wear and consumption of the items.
     (((5))) (6) The following become a debt and are subject to RCW 72.09.450:
     (a) All copayments under subsection (((2))) (3) of this section that are not collected when the visit occurs; and
     (b) All charges for replenishment personal hygiene items that are not collected when the item is distributed.