1311-S AMH CODY BLAC 028

SHB 1311 - H AMD 313

By Representative Cody

WITHDRAWN 03/04/2011

    On page 4, line 20, after "(3)" strike all material through "outcomes" on line 26 and insert "For health care services identified by the collaborative for which evidence about benefit and harm is inadequate or unavailable, the collaborative may endorse coverage with evidence development.  Such coverage shall include items or services that have potential benefit but lack adequate evidence about either the extent of potential benefit or harm or the conditions or patients most likely to benefit or suffer adverse consequences.  In such cases, coverage may be conditioned on the collection of additional clinical data that will inform patient oriented outcomes.  Data collection must meet quality criteria such as clinical registry or trial standards.  Data collection must be designed to inform clinical outcomes relevant to establishing coverage and be time limited, with results available to the collaborative.  Funding for data collection must be obtained from sources other than the state general fund"

    On page 5, beginning on line 9, after "(d)" strike all material through "state" on line 15 and insert "Four physicians, selected from lists of nominees submitted by the Washington state medical association, as follows:
    (i) Two physicians, one of whom must be a primary care physician, representing large multispecialty clinics with fifty or more physicians, selected from a list of five nominees; and

    (ii) Two physicians, one of whom must be a primary care physician, representing clinics with less than fifty physicians, selected from a list of five nominees;

    (e) One osteopathic physician, selected from a list of five nominees submitted by the Washington state osteopathic medical association;

    (f) Two physicians representing the largest hospital-based physician systems in the state, selected from a list of five nominees submitted jointly by the Washington state medical association and the Washington state hospital association;

    (g) Three members representing hospital systems, at least one of whom is responsible for quality, submitted from a list of six nominees from the Washington state hospital association"

    Renumber the remaining subsections consecutively and correct any internal references accordingly.

    On page 6, line 1, after "(8)" insert "A person serving on the collaborative or any of its clinical committees shall be immune from civil liability, whether direct or derivative, for any decisions made in good faith while pursuing activities associated with the work of  collaborative or any of its clinical committees.

    (9)"

    Renumber the remaining subsections consecutively and correct any internal references accordingly.

    On page 7, line 3, after "programs." insert "If the collaborative fails to reach consensus within the time frames identified in this section and section 3 of this act, state purchased health care programs may pursue implementation of evidence-based strategies on their own initiative."

EFFECT:   Removes the Collaborative's authority to consider strategies to improve outcomes for services for high utilization trend services that lack evidence-based best practices approaches.  Authorizes the Collaborative to use coverage with evidence development approaches for health care services that have do not have adequate evidence about their benefits.  Coverage with evidence development allows for the collection of additional clinical data to inform patient-oriented outcomes.

Replaces the current physician and hospital representative membership of two physicians representing large multispecialty clinics and five representatives, including at least three physicians, of the largest hospital systems with

· Two physicians, one of whom is a primary care provider, from a multispecialty clinic with 50 or more physicians;

· Two physicians, one of whom is a primary care provider, from a clinic with fewer than 50 physicians;

· One osteopathic physician;

· Two physicians representing the largest hospital-physician systems in Washington; and

· Three representatives of hospitals, at least one of whom is responsible for quality.

Provides civil liability protection to collaborative and clinical committee members acting in good faith regarding work of the collaborative.

Allows state-purchased health care programs to pursue implementation of evidence-based strategies even if the collaborative does not reach consensus.

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