BILL REQ. #: S-1877.2
State of Washington | 62nd Legislature | 2011 Regular Session |
READ FIRST TIME 02/25/11.
AN ACT Relating to creating flexibility in the medicaid program; adding a new section to chapter 74.09 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 mounting budget
pressures combined with growth in enrollment and constraints in the
medicaid program have forced open discussion throughout the country and
in our state concerning complete withdrawal from the medicaid program.
The legislature recognizes that a better and more sustainable way
forward would involve new state flexibility for managing its medicaid
program built on the success of the basic health plan and Washington's
transitional bridge waiver, where elements of consumer participation
and choice, benefit design flexibility, and payment flexibility have
helped keep costs low. The legislature further finds that either a
centers for medicare and medicaid services' innovation center project
or a section 1115 demonstration project, or both, with capped
eligibility group per capita payments would allow the state to operate
as a laboratory of innovation for bending the cost curve, preserving
the safety net, and improving the management of care for low-income
populations.
NEW SECTION. Sec. 2 A new section is added to chapter 74.09 RCW
to read as follows:
(1) By October 1, 2011, the department shall submit a request to
the centers for medicare and medicaid services' innovation center and,
if needed to achieve one or all of the objectives outlined in this
section, a section 1115 demonstration waiver request to the federal
department of health and human services to revise the medical
assistance program as codified in Title XIX of the federal social
security act. The demonstration shall be known as the "medicaid
modernization" demonstration. The demonstration request shall be
designed to ensure the broadest federal financial participation under
Titles XIX and XXI of the federal social security act. To the extent
permitted under federal law, the demonstration shall include the
following components:
(a) Establishment of base-year, eligibility group per capita
payments for the state medicaid program, with maximum flexibility
provided to the state for managing the health care trend as well as
provisions for shared savings if per capita expenditures are below the
negotiated rates. The capped eligibility group per capita payments
shall be based on targeted per capita costs for the full duration of
the five-year demonstration period and shall include due consideration
and flexibility for unforeseen events, changes in the delivery of
health care, and changes in federal or state law. The capped
eligibility group per capita payments shall take into account any and
all provisions of the federal patient protection and affordable care
act which will have an impact on federal resources devoted to Titles
XIX and XXI of the federal social security act programs. Federal
payments for each eligibility group shall be based on the product of
the negotiated per capita payments for the eligibility group times the
actual caseload for the eligibility group;
(b) Flexibility over benefit design for all categories of
eligibility under Titles XIX and XXI to include:
(i) Alignment with the federal patient protection and affordable
care act's Sec. 1302(b) essential health benefits design; and
(ii) The ability to provide supplemental benefits beyond the
essential health benefits design for certain populations that meet
clinical criteria such as children, pregnant women, individuals with
disabilities, and elderly adults.
(c) The ability to implement limited, reasonable, and enforceable
cost sharing and premiums for all categories of eligibility under Title
XIX and XXI to encourage informed consumer behavior and lower
utilization of health services, while ensuring that access to evidence-based, preventative and primary care is not hindered;
(d) The ability to streamline eligibility determination and
administration of multiple categories of eligibility and to verify
eligibility information more frequently;
(e) The flexibility to adopt innovative reimbursement methods such
as bundled, global, and risk-bearing payment arrangements, that promote
effective purchasing, efficient use of health services, and support
health homes, accountable care organizations, and other innovations
intended to contain costs, improve health, and incent smart consumer
decision making;
(f) The ability for all medicaid and children's health insurance
program clients to voluntarily enroll in the insurance exchange and
broadened authority to enroll clients in employer-sponsored insurance
when available and deemed cost-effective for the state, with authority
to require clients to remain enrolled in their chosen plan for the
calendar year;
(g) An expedited process of forty-five days or less in which the
centers for medicare and medicaid services must respond to any state
request for certain changes to the demonstration once it is implemented
to ensure that the state has the necessary flexibility to manage within
its eligibility group per capita payment caps.
(2) The department shall evaluate the merits of moving to an
insurance subsidy model for certain medicaid populations and shall
explore any federal flexibility if and when it is provided to the
states for such purpose.
(3) The department shall report to the joint legislative select
committee on health reform implementation, if operational, on proposed
waiver provisions by August 1, 2011, and by September 15, 2011.
(4) The department shall hold ongoing stakeholder discussions as it
is developing the waiver request, and provide opportunities for public
review and comment as the request is being developed.
(5) The department and the health care authority shall identify
statutory changes that may be necessary to ensure successful and timely
implementation of the demonstration, submitted to the federal
department of health and human services as the medicaid modernization
demonstration.
(6) The legislature must authorize prior to its implementation any
demonstration approved by the federal department of health and human
services under this section.