AN ACT Relating to regional health councils; adding a new chapter to Title 70 RCW; and making an appropriation.

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

NEW SECTION. Sec. 1. It is the intent of the legislature to ensure that all citizens and local communities of this state have an opportunity to participate in the formation of local and state health policy and allocation of health care resources. As a major purchaser of health care services, the state government has a responsibility to act on behalf of its citizens to accomplish this intent. Local citizen and community involvement is particularly important at a time of rapidly evolving changes in the financing and delivery of health care services, when little information is available regarding the impacts of these changes. Increasing health care competition requires that consumers and purchasers have access to usable data about the services available, and that certain impacts, such as those on the uninsured poor, be addressed. It is also necessary to monitor the effects of these changes at the local level, and develop programs which address specific local needs within this competitive environment.

Regional health councils provide a mechanism by which the legislature will ensure public accountability and local citizen involvement in shaping the future direction of the health care delivery system in Washington state. It is the intent of the legislature that regional health councils cover the entire state and that they represent a broad cross section of the population in their area. The regional health councils will monitor the effects of the changes in health care financing and delivery at the local level, and provide local demonstration sites for innovative approaches to solve local health care problems. The regional health councils will also provide a link between local communities and the state in pursuit of health care policies which will assure a better life for all state residents.

NEW SECTION. Sec. 2. As used in this chapter, the following terms have the meanings indicated unless the context clearly requires otherwise:

(1) "Department" means the department of social and health services;

(2) "Health service area" means a geographic region which includes a broad range of health services and a population of at least four hundred fifty thousand persons;

(3) "Regional health council" means a public regional health council or a private nonprofit corporation which is organized and operated in a manner that is consistent with the laws of the state and which is capable of performing each of the functions described in this chapter. A regional health council shall have a governing body for these purposes which is composed of a majority, but not more than sixty percent of the members, of persons who are residents of the health service area served by the entity and are consumers of health care, who are broadly representative of the social, economic, linguistic, and racial populations, and geographic areas of the health service area, and major purchasers of health care, and who are not, nor within the twelve months preceding appointment have been, providers of health care. The remainder of the members shall be residents of the health service area served by the agency who are providers of health care. The regional health council shall demonstrate capability to serve the entire designated health service area.

NEW SECTION. Sec. 3. (1) The department is designated as the agency of this state responsible for administering the funds to and monitoring contract compliance of the regional health councils. The department is also given responsibility to coordinate activities of the regional health councils and to provide technical assistance for improvement of program design and implementation. The department shall also provide technical data collection and analysis assistance to the regional health councils. The department shall, on an annual basis, approve the work plans and project activities of the regional health councils and implement contractual arrangements.

(2) The department may designate the state health coordinating council or a similar agency to perform these functions on its behalf.

NEW SECTION. Sec. 4. (1) The department shall establish no more than four health service areas in the state and designate a single regional health council organized, composed, and established in accordance with this chapter to serve each health service area, considering the resources available for such purpose.

(2) Each designated regional health council shall have as its primary responsibility the monitoring and assessment of the effects of health care competition on the residents of the health service area, and the development and implementation of projects which coordinate health care consumer and provider efforts to address local health care priority needs. Regional health councils shall be available to local and state elected officials to conduct special studies and research approved by the legislative body. Each designated regional health council shall prepare and transmit to the department or its designee an annual report documenting its assessment of the effects of health care competition and its local project activities, as defined below. To meet these primary responsibilities, a designated regional health council shall carry out the following functions:

(a) Collect and analyze local data regarding the health status of the population and the status of the health care delivery system for the purpose of assessing the impacts of health care competition, and prepare and transmit and annual report to the department for compilation into a state-wide report;

(b) Identify local problems and concerns regarding financial access to health care by the uninsured poor, develop and implement projects to address this issue, and prepare and transmit to the department an annual report documenting the extent of the access problem. Local projects to be developed and implemented will include, but not be limited to, the following:

(i) Assistance to local community organizations involved in implementation of the Washington basic health care program;

(ii) Study of methods for expanding private insurance coverage among employers, and work with employer groups such as chambers of commerce to expand coverage;

(iii) Work with local medical societies and others to establish and/or expand voluntary medical referral programs;

(iv) Provide technical and planning assistance for expanded and improved service delivery through local low-income community health clinics;

(c) Develop and implement, in collaboration with other local and state agencies, demonstration projects to address identified local priority health care needs, including but not limited to:

(i) Assurance of reasonable access to health care services in rural areas;

(ii) Promotion of long-term care strategies which will insure an adequate array of resources and efficient delivery and financing of care to a rapidly increasing number of elderly citizens;

(iii) Health promotion efforts designed to improve quality of life and productivity while decreasing the need for expensive health care treatment;

(iv) Use of managed health care systems and case management as a method to efficiently utilize health care resources;

(d) Assemble and disseminate cost data and other information regarding the performance of health care delivery system components to purchasers and consumers in the health service area for their use as prudent purchasers to compare, evaluate, and select health care services, and make such information available to the department for the development of state-wide information and regional comparisons;

(e) On an annual basis, and within the department's nursing home capital budget as determined by the legislature:

(i) Review and establish priorities within the health service area among nursing home applications for the purpose of capital and leasehold improvements;

(ii) Make recommendations to the department regarding application of the capital budget based on established regional priorities;

(f) On an annual basis, and with information provided by the budget review process of the Washington state hospital commission:

(i) Hold nonregulatory public hearings to review the hospital budgets and long-range capital plans of those institutions within the health service area;

(ii) Make available to the commission and other appropriate state agencies local public comment on the hospital budgets and long-range plans;

(iii) Assess the extent to which, in aggregate and in specific, the state's target revenues for hospitalization are being achieved in the health service area;

(iv) Publish information regarding hospital budgets and long-range capital plans in a form usable to health care purchasers and consumers and state agencies for their use in prudent purchasing of health care services, to include at least comparative data on costs or charges for frequent diagnosis and schedules of anticipated future capital spending;

(g) Contract with the department to conduct local and/or regional review and analysis of proposed certificates of need in accordance with department rules and regulations, and make recommendations to the department regarding those applications.

NEW SECTION. Sec. 5. State funds to regional health councils shall not exceed seventy-five percent of their operating costs, excluding fees earned. The remaining twenty-five percent of regional health council operating funds shall be derived from local or regional matching funds, special studies and grants, or other contributions. Regional health councils are authorized to charge fees for services whenever possible.

NEW SECTION. Sec. 6. Sections 1 through 5 of this act shall constitute a new chapter in Title 70 RCW.

NEW SECTION. Sec. 7. There is appropriated from the general fund to the department of social and health services for the biennium ending June 30, 1989, the sum of one million nine hundred thousand dollars, or so much thereof as may be necessary, to carry out the purposes of this act.