BILL REQ. #:  H-1913.1 

READ FIRST TIME 03/01/13.   

     AN ACT Relating to establishing accountability measures for service coordination organizations; amending RCW 70.96A.320, 71.24.330, and 74.39A.090; adding a new section to chapter 74.09 RCW; and adding a new chapter to Title 70 RCW.

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

NEW SECTION.  Sec. 1   The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Authority" means the health care authority.
     (2) "Consensus-based" has the same meaning as in RCW 71.24.025.
     (3) "Department" means the department of social and health services.
     (4) "Evidence-based" has the same meaning as in RCW 71.24.025.
     (5) "Research-based" has the same meaning as in RCW 71.24.025.
     (6) "Service coordination organization" means an entity that arranges for a comprehensive delivery system of medical, behavioral, or social support services, including entities such as regional support networks as defined in RCW 71.24.025, managed care organizations that provide medical services to clients under chapter 74.09 RCW, counties providing chemical dependency services under chapter 74.50 RCW, and area agencies on aging providing case management services under chapter 74.39A RCW.

NEW SECTION.  Sec. 2   (1) The authority and the department shall base contract performance measures developed under section 3 of this act on the following outcomes when contracting with service coordination organizations: Improvements in client health status and wellness; increases in client participation in meaningful activities; reductions in client involvement with criminal justice systems; reductions in avoidable costs in hospitals, emergency rooms, crisis services, and jails and prisons; increases in stable housing in the community; improvements in client satisfaction with quality of life; and reductions in population-level health disparities.
     (2) The performance measures must demonstrate the manner in which the following principles are achieved within each of the outcomes under subsection (1) of this section:
     (a) The maximization of evidence-based practices in programs in which such practices exist. In programs in which evidence-based practices do not exist, the use of research-based practices must be maximized, including the adaptation of evidence-based practices to new situations. In programs in which neither evidence-based practices nor research-based practices exist, the use of consensus-based practices must be maximized;
     (b) The maximization of the client's independence, recovery, and employment;
     (c) The maximization of the client's participation in treatment decisions; and
     (d) The collaboration between consumer-based support programs in providing services to the client.
     (3) In developing performance measures under section 3 of this act, the authority and the department shall consider expected outcomes relevant to the general populations that each agency serves. The authority and the department may adapt the outcomes to account for the unique needs and characteristics of discrete subcategories of populations receiving services.
     (4) The authority and the department shall coordinate the establishment of the expected outcomes and the performance measures between each agency as well as each program to identify expected outcomes and performance measures that are common to the clients enrolled in multiple programs and to eliminate conflicting standards among the agencies and programs.
     (5) The authority and the department shall establish timelines and mechanisms for service coordination organizations to report data supporting each of the performance measures.

NEW SECTION.  Sec. 3   By September 1, 2014:
     (1) The authority shall adopt performance measures to determine whether service coordination organizations are achieving the outcomes described in section 2 of this act for clients enrolled in medical managed care programs operated according to Title XIX or XXI of the federal social security act.
     (2) The department shall adopt performance measures to determine whether service coordination organizations are achieving the outcomes described in section 2 of this act for clients receiving mental health, long-term care, or chemical dependency services.

NEW SECTION.  Sec. 4   (1) The authority and the department shall develop work groups of stakeholders particular to each program's efforts to develop expected outcomes and performance measures. The work groups shall provide support in the form of assistance and consultation in the development of the initial outcomes and performance measures. Each work group must include participants with expertise in evidence-based practices related to the program that the particular work group is supporting.
     (2) The authority and the department may contract with the Washington state institute for public policy and other entities that evaluate the evidence from clinical research studies, such as the Pacific Northwest evidence-based practice center, to provide advice, consultation services, and expertise to the work groups. Such services must include assistance developing performance measures and identifying evidence-based practices.

NEW SECTION.  Sec. 5   By July 1, 2015, the authority and the department shall require that contracts with service coordination organizations include provisions requiring the adoption of the outcomes and performance measures developed under this chapter and mechanisms for reporting data to support each of the outcomes and performance measures.

NEW SECTION.  Sec. 6   (1) By December 1, 2014, the department and the authority shall report jointly to the legislature on the expected outcomes and the performance measures. The report must identify the performance measures and the expected outcomes established for each program, the relationship between the performance measures and expected improvements in client outcomes, mechanisms for reporting outcomes and measuring performance, and options for applying the performance measures and expected outcomes development process to other health and social service programs.
     (2) By December 1, 2016, the department and the authority shall report to the legislature on the incorporation of the performance measures into contracts with service coordination organizations and progress toward achieving the identified outcomes.

NEW SECTION.  Sec. 7   The outcomes and performance measures established pursuant to this chapter do not establish a standard of care in any civil action brought by a recipient of services. The failure of a service coordination organization to meet the outcomes and performance measures established pursuant to this chapter does not create civil liability on the part of the service coordination organization in a claim brought by a recipient of services.

NEW SECTION.  Sec. 8   A new section is added to chapter 74.09 RCW to read as follows:
     The authority shall incorporate the expected outcomes and criteria to measure the performance of service coordination organizations as provided in chapter 70.-- RCW (the new chapter created in section 12 of this act) into contracts with managed care organizations that provide services to clients under this chapter.

Sec. 9   RCW 70.96A.320 and 1990 c 151 s 9 are each amended to read as follows:
     (1) A county legislative authority, or two or more counties acting jointly, may establish an alcoholism and other drug addiction program. If two or more counties jointly establish the program, they shall designate one county to provide administrative and financial services.
     (2) To be eligible for funds from the department for the support of the county alcoholism and other drug addiction program, the county legislative authority shall establish a county alcoholism and other drug addiction board under RCW 70.96A.300 and appoint a county alcoholism and other drug addiction program coordinator under RCW 70.96A.310.
     (3) The county legislative authority may apply to the department for financial support for the county program of alcoholism and other drug addiction. To receive financial support, the county legislative authority shall submit a plan that meets the following conditions:
     (a) It shall describe the services and activities to be provided;
     (b) It shall include anticipated expenditures and revenues;
     (c) It shall be prepared by the county alcoholism and other drug addiction program board and be adopted by the county legislative authority;
     (d) It shall reflect maximum effective use of existing services and programs; and
     (e) It shall meet other conditions that the secretary may require.
     (4) The county may accept and spend gifts, grants, and fees, from public and private sources, to implement its program of alcoholism and other drug addiction.
     (5) The department shall require that any agreement to provide financial support to a county that performs the activities of a service coordination organization for alcoholism and other drug addiction services must incorporate the expected outcomes and criteria to measure the performance of service coordination organizations as provided in chapter 70.-- RCW (the new chapter created in section 12 of this act).
     (6) The county may subcontract for detoxification, residential treatment, or outpatient treatment with treatment programs that are approved treatment programs. The county may subcontract for other services with individuals or organizations approved by the department.
     (((6))) (7) To continue to be eligible for financial support from the department for the county alcoholism and other drug addiction program, an increase in state financial support shall not be used to supplant local funds from a source that was used to support the county alcoholism and other drug addiction program before the effective date of the increase.

Sec. 10   RCW 71.24.330 and 2008 c 261 s 6 are each amended to read as follows:
     (1)(a) Contracts between a regional support network and the department shall include mechanisms for monitoring performance under the contract and remedies for failure to substantially comply with the requirements of the contract including, but not limited to, financial penalties, termination of the contract, and reprocurement of the contract.
     (b) The department shall incorporate the criteria to measure the performance of service coordination organizations into contracts with regional support networks as provided in chapter 70.-- RCW (the new chapter created in section 12 of this act).
     (2) The regional support network procurement processes shall encourage the preservation of infrastructure previously purchased by the community mental health service delivery system, the maintenance of linkages between other services and delivery systems, and maximization of the use of available funds for services versus profits. However, a regional support network selected through the procurement process is not required to contract for services with any county-owned or operated facility. The regional support network procurement process shall provide that public funds appropriated by the legislature shall not be used to promote or deter, encourage, or discourage employees from exercising their rights under Title 29, chapter 7, subchapter II, United States Code or chapter 41.56 RCW.
     (3) In addition to the requirements of RCW 71.24.035, contracts shall:
     (a) Define administrative costs and ensure that the regional support network does not exceed an administrative cost of ten percent of available funds;
     (b) Require effective collaboration with law enforcement, criminal justice agencies, and the chemical dependency treatment system;
     (c) Require substantial implementation of department adopted integrated screening and assessment process and matrix of best practices;
     (d) Maintain the decision-making independence of designated mental health professionals;
     (e) Except at the discretion of the secretary or as specified in the biennial budget, require regional support networks to pay the state for the costs associated with individuals who are being served on the grounds of the state hospitals and who are not receiving long-term inpatient care as defined in RCW 71.24.025;
     (f) Include a negotiated alternative dispute resolution clause; and
     (g) Include a provision requiring either party to provide one hundred eighty days' notice of any issue that may cause either party to voluntarily terminate, refuse to renew, or refuse to sign a mandatory amendment to the contract to act as a regional support network. If either party decides to voluntarily terminate, refuse to renew, or refuse to sign a mandatory amendment to the contract to serve as a regional support network they shall provide ninety days' advance notice in writing to the other party.

Sec. 11   RCW 74.39A.090 and 2004 c 141 s 3 are each amended to read as follows:
     (1) The legislature intends that any staff reassigned by the department as a result of shifting of the reauthorization responsibilities by contract outlined in this section shall be dedicated for discharge planning and assisting with discharge planning and information on existing discharge planning cases. Discharge planning, as directed in this section, is intended for residents and patients identified for discharge to long-term care pursuant to RCW 70.41.320, 74.39A.040, and 74.42.058. The purpose of discharge planning is to protect residents and patients from the financial incentives inherent in keeping residents or patients in a more expensive higher level of care and shall focus on care options that are in the best interest of the patient or resident.
     (2) The department shall contract with area agencies on aging:
     (a) To provide case management services to consumers receiving home and community services in their own home; and
     (b) To reassess and reauthorize home and community services in home or in other settings for consumers consistent with the intent of this section:
     (i) Who have been initially authorized by the department to receive home and community services; and
     (ii) Who, at the time of reassessment and reauthorization, are receiving home and community services in their own home.
     (3) In the event that an area agency on aging is unwilling to enter into or satisfactorily fulfill a contract or an individual consumer's need for case management services will be met through an alternative delivery system, the department is authorized to:
     (a) Obtain the services through competitive bid; and
     (b) Provide the services directly until a qualified contractor can be found.
     (4)(a) The department shall include, in its oversight and monitoring of area agency on aging performance, assessment of case management roles undertaken by area agencies on aging in this section. The scope of oversight and monitoring includes, but is not limited to, assessing the degree and quality of the case management performed by area agency on aging staff for elderly and ((disabled)) persons with disabilities in the community.
     (b) The department shall incorporate the expected outcomes and criteria to measure the performance of service coordination organizations into contracts with area agencies on aging as provided in chapter 70.-- RCW (the new chapter created in section 12 of this act).
     (5) Area agencies on aging shall assess the quality of the in-home care services provided to consumers who are receiving services under the medicaid personal care, community options programs entry system or chore services program through an individual provider or home care agency. Quality indicators may include, but are not limited to, home care consumers satisfaction surveys, how quickly home care consumers are linked with home care workers, and whether the plan of care under RCW 74.39A.095 has been honored by the agency or the individual provider.
     (6) The department shall develop model language for the plan of care established in RCW 74.39A.095. The plan of care shall be in clear language, and written at a reading level that will ensure the ability of consumers to understand the rights and responsibilities expressed in the plan of care.

NEW SECTION.  Sec. 12   Sections 1 through 7 of this act constitute a new chapter in Title 70 RCW.