ESSB 6228 -
By Committee on Health Care & Wellness
ADOPTED AND ENGROSSED 3/7/14
Strike everything after the enacting clause and insert the following:
"NEW SECTION. Sec. 1 Consumers face a challenge finding
reliable, consumer friendly information on health care pricing and
quality. Greater transparency of health care prices and quality leads
to engaged, activated consumers. Research indicates that engaged and
educated consumers help control costs and improve quality with lower
costs per patient, lower hospital readmission rates, and the use of
higher quality providers. Washington is a leader in efforts to develop
and publish provider quality information.
Although data is available today, research indicates the existing
information is not user friendly, consumers do not know which measures
are most relevant, and quality ratings are inconsistent or
nonstandardized. It is the intent of the legislature to ensure
consumer tools are available to educate and engage patients in managing
their care and understanding the costs and quality.
NEW SECTION. Sec. 2 A new section is added to chapter 41.05 RCW
to read as follows:
(1) There is created a performance measures committee, the purpose
of which is to identify and recommend standard statewide measures of
health performance to inform public and private health care purchasers
and to propose benchmarks to track costs and improvements in health
outcomes.
(2) Members of the committee must include representation from state
agencies, small and large employers, the two largest health plans by
enrollment, patient groups, federally recognized tribal members,
consumers, academic experts on health care measurement, hospitals,
physicians, and other providers. The governor shall appoint the
members of the committee, except that a statewide association
representing hospitals may appoint a member representing hospitals, a
statewide association representing physicians may appoint a member
representing physicians, and a statewide association representing
nurses may appoint a member representing nurses. The governor shall
ensure that members represent diverse geographic locations and both
rural and urban communities. The committee must be chaired by the
director of the authority.
(3) The committee shall develop a transparent process for selecting
performance measures, and the process must include opportunities for
public comment.
(4) By January 1, 2015, the committee shall submit the performance
measures to the authority. The measures must include dimensions of:
(a) Prevention and screening;
(b) Effective management of chronic conditions;
(c) Key health outcomes;
(d) Care coordination and patient safety; and
(e) Use of the lowest cost, highest quality care for preventive
care and chronic and acute conditions.
(5) The committee shall develop a measure set that:
(a) Is of manageable size;
(b) Gives preference to nationally reported measures and, where
nationally reported measures may not be appropriate or available,
measures used by state agencies that purchase health care or commercial
health plans;
(c) Focuses on the overall performance of the system, including
outcomes and total cost;
(d) Is aligned with the governor's performance management system
measures and common measure requirements specific to medicaid delivery
systems under RCW 70.320.020 and 43.20A.895;
(e) Considers the needs of different stakeholders and the
populations served; and
(f) Is usable by multiple payers, providers, hospitals, purchasers,
public health, and communities as part of health improvement, care
improvement, provider payment systems, benefit design, and
administrative simplification for providers and hospitals.
(6) State agencies shall use the measure set developed under this
section to inform and set benchmarks for their purchasing.
(7) The committee shall establish a public process to periodically
evaluate the measure set and make additions or changes to the measure
set as needed.
NEW SECTION. Sec. 3 A new section is added to chapter 48.43 RCW
to read as follows:
(1) Each carrier offering or renewing a health benefit plan on or
after January 1, 2016, must offer member transparency tools with
certain price and quality information to enable the member to make
treatment decisions based on cost, quality, and patient experience.
The transparency tools must aim for best practices and, at a minimum:
(a) Must display cost data for common treatments within the
following categories:
(i) In-patient treatments;
(ii) Outpatient treatments;
(iii) Diagnostic tests; and
(iv) Office visits;
(b) Recognizing integrated health care delivery systems focus on
total cost of care, carrier's operating integrated care delivery
systems may meet the requirement of (a) of this subsection by providing
meaningful consumer data based on the total cost of care. This
subsection applies only to the portion of enrollment a carrier offers
pursuant to chapter 48.46 RCW and as part of an integrated delivery
system, and does not exempt from (a) of this subsection coverage
offered pursuant to chapter 48.21, 48.44, or 48.46 RCW if not part of
an integrated delivery system;
(c) Are encouraged to display the cost for prescription medications
on their member web site or through a link to a third party that
manages the prescription benefits;
(d) Must include a patient review option or method for members to
provide a rating or feedback on their experience with the medical
provider that allows other members to see the patient review, the
feedback must be monitored for appropriateness and validity, and the
site may include independently compiled quality of care ratings of
providers and facilities;
(e) Must allow members to access the estimated cost of the
treatment, or the total cost of care, as set forth in (a) and (b) of
this subsection on a portable electronic device;
(f) Must display options based on the selected search criteria for
members to compare;
(g) Must display the estimated cost of the treatment, or total cost
of the care episode, and the estimated out-of-pocket costs of the
treatment for the member and display the application of personalized
benefits such as deductibles and cost-sharing;
(h) Must display quality information on providers when available;
and
(i) Are encouraged to display alternatives that are more cost-effective when there are alternatives available, such as the use of an
ambulatory surgical center when one is available or medical versus
surgical alternatives as appropriate.
(2) In addition to the required features on cost and quality
information, the member transparency tools must include information to
allow a provider and hospital search of in-network providers and
hospitals with provider information including specialists, distance
from patient, the provider's contact information, the provider's
education, board certification and other credentials, where to find
information on malpractice history and disciplinary actions, affiliated
hospitals and other providers in a clinic, and directions to provider
offices and hospitals.
(3) Each carrier offering or renewing a health benefit plan on or
after January 1, 2016, must provide enrollees with the performance
information required by section 2717 of the patient protection and
affordable care act, P.L. 111-148 (2010), as amended by the health care
and education reconciliation act, P.L. 111-152 (2010), and any federal
regulations or guidance issued under that section of the affordable
care act.
(4) Each carrier offering or renewing a health benefit plan on or
after January 1, 2016, must, within thirty days from the offer or
renewal date, attest to the office of the insurance commissioner that
the member transparency tools meet the requirements in this section and
access to the tools is available on the home page within the health
plan's secured member web site."
Correct the title.