AN ACT Relating to health care services for low-income persons; adding a new chapter to Title 74 RCW; making appropriations; providing an effective date; and declaring an emergency.

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

NEW SECTION. Sec. 1. The purpose of this chapter is to establish a program providing affordable primary health care services to low-income persons who lack sufficient financial resources to gain access to primary care services. To this end, this chapter establishes a community health center assistance program under which the department shall provide financial aid to public or private nonprofit entities to assist in meeting communities' public health needs. The program will increase access to primary health care services in communities and other areas which lack affordable health care and promote cost-effective linkages between primary care providers, medical specialty services, and hospitals which provide care to indigents.

NEW SECTION. Sec. 2. Unless the context clearly requires to the contrary, the definitions in this section apply throughout this chapter.

(1) "Community health center" means a private nonprofit clinic with tax exempt status under section 501(c)(3) of the internal revenue code whose primary purpose is the provision of primary health care services to indigents.

(2) "Public health department" means city or county divisions of the public health department.

(3) "Hospital" has the same meaning as defined in 42 U.S.C. Sec. 254(a)(2).

(4) "Department" means the department of social and health services.

(5) "Secretary" means the secretary of social and health services, or the secretary's designee.

(6) "Primary care" has the same meaning as defined in 42 U.S.C. Sec. 254c(b)(1).

(7) "Specialty services" means medical services which are deemed medically necessary for the care of a community health center patient as ordered by a primary care provider.

(8) "Indigent" means a person who, due to unemployment or other reasons, is unable to pay for primary health care services, is an individual or family with an income below two hundred percent of federal poverty guidelines, and is not covered by a third party payer that would compensate a health services provider for medical care.

(9) "Community health programs" means those entities established for the purpose of providing health services to low-income people.

NEW SECTION. Sec. 3. Within the limits of appropriated funds, the secretary shall take applications and make annual grants to entities operating community health programs with the following considerations:

(1) Funds shall be made available first to community health centers.

(2) Funds shall be made available, in the absence of a community health center, to public health departments that provide comprehensive primary care services effective January 1, 1986, and that have available on-site services of a physician.

(3) Funds shall be made available, in the absence of either of the entities specified in subsections (1) and (2) of this section, to hospitals that provide primary care effective January 1, 1986, through an organized out-patient department or through a program which the hospital has established for the specific purpose of providing comprehensive primary health care services to the indigent.

NEW SECTION. Sec. 4. Within the limits of appropriated funds, the secretary shall make annual grants to entities described in section 3 of this act. Project funds awarded under this section may be used for the following:

(1) Primary health care and specialty services purchased directly or by contract. The intent of this subsection is to increase access to primary care in communities where adequate primary health care is not available by funding operating costs on a line item reimbursement method for direct primary health care services and to promote appropriate use of specialty services by funding the health centers to purchase directly or by contract specialty services for patients; and

(2) Primary dental care services provided directly or by contract. The intent of this subsection is to increase access to primary dental care in communities where adequate dental care is not available by funding operating costs on a line item reimbursement method for direct primary dental care services and to promote appropriate use of preventive dental services by persons unable to afford dental care.

NEW SECTION. Sec. 5. The grants under section 4 of this act shall be in addition to any federal or local assistance, including state medical assistance program revenues, that is otherwise available to the entities. An entity shall not receive funds under this chapter if it:

(1) Fails or refuses to provide necessary medical or dental care on the basis of any patient's inability to pay or lack of third party coverage;

(2) Does not apply a sliding discount fee schedule to the portion of the entity's charges which are the patient's responsibility; or

(3) Does not contract with the department to provide care under the medical assistance program.

NEW SECTION. Sec. 6. The secretary shall develop and maintain a formula for the distribution of grant funds among eligible recipients in the state according to the following guidelines:

(1) Forty percent of the funds shall be distributed equally among all eligible community health center applicants according to the number of primary health care service delivery sites operated by the eligible applicants as of January 1, 1987;

(2) Forty percent of the funds shall be allocated to all eligible applicants according to the percentage of all users that each eligible applicant serves, using the unduplicated user count from the most recent calendar year;

(3) Fifteen percent of the funds shall be allocated for primary dental care services, with fifty percent of the funds allocated under this subsection distributed equally among all eligible applicants, and the remaining fifty percent distributed among eligible applicants that provide direct dental care services according to the percentage of all dental health service delivery staff, that each eligible applicant employs with each dentist counted as one full-time equivalent and each dental hygienist counted as one-half full-time;

(4) The remaining five percent of the funds shall be allocated to the division of health of the department of social and health services for the administration of the program established under this chapter.

NEW SECTION. Sec. 7. Beginning July 1, 1987, applications for assistance under this chapter shall be accepted by the department. The applications shall include the following information:

(1) A description of the geographic area or target population being served by the applicant, the existing resources available to provide primary health care services to the population, and the nature and extent of need for the services;

(2) A description of the role played by the applicant in meeting the need for uncompensated primary health care;

(3) A description of the changes in that role to be accomplished through a state grant under this chapter;

(4) A description of any agreements or operation arrangements the clinic has with physicians, hospitals, laboratories, pharmacies, and other providers in its service area that are used for referral of patients whose health care needs the applicant cannot meet with its own resources;

(5) Copies of the applicant's annual budget for the current and preceding fiscal year, including identification of current and prospective funding from federal, state, and local sources, private charitable contributions, and patient-generated income;

(6) Such further information as the secretary may reasonably require to determine whether and in what amount to provide a state grant under this chapter; and

(7) A copy of the applicant's most recent independent financial audit.

NEW SECTION. Sec. 8. For the purpose of auditing the expenditure of state funds and assuring the use of state funds for the purposes defined in this chapter, the department may have access to the books and records, other than individual patient medical records, of applicants receiving grants under this chapter.

NEW SECTION. Sec. 9. Sections 1 through 8 of this act shall constitute a new chapter in Title 74 RCW.

NEW SECTION. Sec. 10. There is appropriated for the biennium ending June 30, 1989, from the general fund to the department of social and health services: (1) The sum of two million one hundred thousand dollars, or so much thereof as may be necessary, for grants to community health centers, public health departments, or hospitals under this act but no more than one-half of such sum shall be spent in fiscal year 1988 and no more than one-half of such sum shall be spent in fiscal year 1989, and (2) the sum of fifty thousand dollars, or so much thereof as may be necessary, for the administration of the program established under this act.

NEW SECTION. Sec. 11. This act is necessary for the immediate preservation of the public peace, health, and safety, the support of the state government and its existing public institutions, and shall take effect July 1, 1987.