FINAL BILL REPORT

SSB 5891

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Background: The 2008 Legislature passed a primary care bill directing the Department of Social and Health Services (DSHS) and the Health Care Authority (HCA) to assess opportunities for changing payment practices in ways that would better support development and maintenance of primary care medical homes. The bill also directed the Department of Health (DOH) to develop a medical home learning collaborative to promote adoption of medical homes in a variety of primary care practice settings. The agencies submitted a progress report titled, "Payment Options and Learning Collaborative Work In Support of Primary Care Medical Homes" to the Legislature December 31, 2008.

Summary: Public payors, private health carriers, third party purchasers, and providers are encouraged to collaborate and identify appropriate reimbursement methods to align incentives to support primary care medical homes. The discussions and the determination of reimbursement methods are facilitated by state agencies and as such are exempt from antitrust laws through the state action doctrine.

HCA and DSHS must design, oversee implementation, and evaluate one or more primary care medical home reimbursement pilot projects. The agencies must determine the number and location of the pilots; determine criteria to select primary care clinics to serve as pilot sites; select pilot sites from those clinics that currently include activities typically associated with medical homes or from sites that have been selected by DOH to participate in the medical home collaboratives; determine reimbursement methods to be tested; and identify performance measures for clinical quality, chronic care management, cost, and patient experience. The agencies must coordinate planning and operation of the pilots with the DOH medical home collaboratives and other projects promoting the adoption of medical homes.

DSHS and HCA may select an additional pilot site with a direct patient-provider primary care practice and reimburse with a fixed monthly payment per person for preventive care, wellness counseling, primary care, coordination of primary care, and urgent care services. The agencies may determine whether the pilot should include a high deductible health plan or other health benefit plan that wraps around the primary care services.

The act expires July 1, 2013

Votes on Final Passage:

Senate	47	0
House	97	1	(House amended)
Senate	39	6	(Senate concurred)