HOUSE BILL REPORT

2SSB 6418

BYSenate Committee on Ways & Means (originally sponsored by Senators Barr, Warnke, West, Wojahn, Patterson, Rinehart, Smitherman, Newhouse, Owen, Smith, Amondson, Bauer, DeJarnatt, Williams, Talmadge, Hansen, Conner, Madsen and Kreidler; by request of Governor)

Expanding rural health care opportunities.

House Committe on Health Care

Majority Report:  Do pass as amended.  (9)

      Signed by Representatives Braddock, Chair; Day, Vice Chair; Brooks, Ranking Republican Member; Cantwell, Morris, Prentice, D. Sommers, Vekich and Wolfe.

House Staff:Bill Hagens (786-7131)

Rereferred House Committee on Appropriations

Majority Report:  Do pass as amended by Committee on Health Care as such amendment is amended by Committee on Appropriations.  (24)

      Signed by Representatives Locke, Chair; Grant, Vice Chair; H. Sommers, Vice Chair; Silver, Ranking Republican Member; Youngsman, Assistant Ranking Republican Member; Belcher, Bowman, Brekke, Brough, Dorn, Ebersole, Ferguson, Hine, Inslee, May, McLean, Nealey, Rust, Sayan, Spanel, Sprenkle, Valle, Wang and Wineberry.

House Staff:      Michelle Hauth (786-7384)

AS PASSED HOUSE MARCH 1, 1990

BACKGROUND:

Washington is currently experiencing a physician, pharmacist, and maternity care provider shortage in some rural areas of the state.  Studies have demonstrated that health providers who originate from rural areas, or who have exposure to rural areas during their training are more strongly committed to maintain a practice in a rural community.  Attracting individuals into medicine, pharmacy, and midwifery through scholarship programs may help address the rural shortage of providers of maternity care and basic health care services.

In the smaller rural communities of the state, basic health care services are provided by a few health care providers.  Should a provider leave the community or need time away from practice to attend to personal matters or to fulfill continuing education requirements, the community could be left without basic health care services.  A corps of providers willing to travel to these communities and provide temporary medical care services could help maintain the availability of basic health care services.

The problems of limited health access in rural areas are exacerbated by the limited ability to recruit needed health care providers especially maternity care providers, to these communities on a temporary or permanent basis.

Many rural communities are unable to finance local health services or establish effective local health care organizations, thus these health services are often limited to these areas.  Because of the inability of these communities to organize and finance their health care system, much of a resident's health dollar is spent outside of the community.

SUMMARY:

The Department of Health is directed to establish the health professional temporary substitute resource pool.  A state registry will be compiled to identify physicians, physician assistants, pharmacists, and advanced registered nurse practitioners willing to provide medical care services on a short-term basis in rural communities.  The pool will provide medical care coverage to communities with health professional shortages or where the local health professionals need time away from practice to attend educational programs or for personal matters.

Participating health care professionals will receive reimbursement for travel and lodging costs, medical malpractice insurance coverage through a department purchased plan or through reimbursement for malpractice insurance premium costs, and back-up support from area physicians and hospitals.  Rural communities are responsible for any salary costs.  Health professionals may serve continuously in a community for a maximum of 90 days unless extended by the department.  The department may require participating communities to agree to participate in recruitment programs or other programs designed to reorganize health care services.

The rural physician, pharmacist, and midwife scholarship program is established within the Higher Education Coordinating Board.  The program provides scholarships of up to $15,000 per year for five years for medical students declaring an intent to serve as a primary care physician serving in rural areas.  Midwife scholarships are available for an amount of up to $4,000 per year for three years if the student declares an intent to serve as a certified or licensed midwife in a midwifery shortage area.

Participants in the scholarship program must serve in a rural area or midwifery shortage area for at least five years or face repayment of portions of the scholarship plus a penalty equal to twice the total amount paid for on their behalf.  The department may provide technical assistance to rural communities to recruit individuals to apply for the scholarship program.  The Dean of the School of Medicine is directed to establish a policy to grant preference for admission openings to prospective medical students eligible for the scholarship program.

The department is directed to develop a plan for increasing rural training opportunities for students in medicine and nursing.  It is also directed to develop a statewide plan to address access to midwifery services.  A review of the scholarship program is to be conducted by the department by September 1, 1995 for the purpose of recommending whether the program should be continued.

The department may develop a rural health plan and approve hospitals to be designated as essential access community hospitals so that they may access federal program dollars and increase their Medicare reimbursement.

The Insurance Commissioner (OIC) is required to establish a committee to recommend ways to improve the availability of affordable health care in rural communities.  The recommendations shall be submitted to the governor and the Legislature no later than November 1, 1990.  The committee shall terminate on January 1, 1991.

Existing rural health care service arrangements RHCSA, as defined in the amendment, are permitted to continue operation if they meet the following requirements:  1) Inform the OIC, within 10 days of the effective date of this act, of the intent to apply for approval to operate as a health care service contractor, e.g., medical bureau or merge with a contractor, health maintenance organization HMO, or disability insurer; 2)  Submit application by May 1, 1990; 3)  Deposit reserves of $100,000 with the OIC by July 1, 1990; 4)  Deposit reserves of $150,000 with the OIC by September 1, 1990; and 5)  Comply with all OIC requirements, except as stated herein.  OIC is given related enforcement powers. RHCSAs are required to comply with all the pertinent health insurance laws.  The reserve requirements cannot be increased until May 1, 1991.

Forty nine thousand dollars is appropriated from the insurance commissioner's regulatory account to the OIC for the study.

An emergency clause is added.

Appropriation:    (Health Care Committee) $49,000 is appropriated to the OIC for the study.

(Appropriations Committee) $49,000 is appropriated to the OIC from the insurance commissioner's regulatory account for the study.

Fiscal Note:      Available.

Effective Date:The bill contains an emergency clause and takes effect immediately.

House Committee ‑ Testified For:    (Health Care)  Senator Barr; Representative Kirby; Lars Hennum, Pharmacists of Washington; JoAnne Myers-Ciecko, Midwife Association; and Greg Vigdor, Washington State Hospital Association.

(Appropriations)  No one.

House Committee - Testified Against:      (Health Care)  No one.

(Appropriations)  No one.

House Committee - Testimony For:    (Health Care)  This bill is needed to maintain adequate health care services in rural and other areas with shortage in health care providers.

(Appropriations)  None.

House Committee - Testimony Against:      (Health Care)  None.

(Appropriations)  None.

VOTE ON FINAL PASSAGE:

      Yeas 97 - 3/1