SENATE BILL REPORT

SHB 1560

BYHouse Committee on Health Care (originally sponsored by Representative Braddock; by request of Department of Social and Health Services)

Making changes to medical care provisions.

House Committe on Health Care

Rereferred House Committee on Appropriations

Senate Committee on Health Care & Corrections

Senate Hearing Date(s):March 28, 1989; March 29, 1989

Majority Report:  Do pass as amended.

      Signed by Senators West, Chairman; Smith, Vice Chairman; Amondson, Johnson, Kreidler, Niemi, Wojahn.

Senate Staff:Scott Plack (786-7409)

                  March 29, 1989

Senate Committee on Ways & Means

Senate Hearing Date(s):April 13, 1989

Majority Report:  Do pass as amended.

      Signed by Senators McDonald, Chairman; Craswell, Vice Chairman; Amondson, Bailey, Bluechel, Cantu, Hayner, Lee, Matson, Newhouse, Niemi, Owen, Saling, Talmadge, Wojahn.

Senate Staff:Randy Hodgins (786-7715)

                  April 13, 1989

AS REPORTED BY COMMITTEE ON WAYS & MEANS, APRIL 13, 1989

BACKGROUND:

The state definition of "disproportionate share" hospitals is not compatible with the federal definition included in the Omnibus Budget Reconciliation Act of 1987 (OBRA). "Disproportionate share hospitals" are hospitals that receive funds based on the level of uncompensated care they provide relative to other hospitals.  To ensure the Medicaid state plan complies with federal requirements, it is necessary to revise the state definition.

OBRA authorizes increased coverage for pregnant women and children under age eight.  However, there is no state enabling legislation to allow this greater coverage.  Enabling legislation is needed to allow expenditures up to appropriated amounts.

Medical assistance payments for persons with AIDS are expected to grow substantially in the 1989-91 biennium.  This amount can be reduced by purchasing "continuation coverage" (i.e. the purchase of insurance through the plan of a previous employer for not more than 18 months, as provided in federal law), or group health insurance coverage. Authority is needed before coverage can be purchased.

Current law requires the Department of Social and Health Services (DSHS) to enroll a portion of all AFDC recipients in managed health care systems.  One requirement is for all AFDC recipients in a given geographic area to be enrolled in the same HMO.  This does not allow flexibility when there is more than one HMO operating in an area.  AFDC recipients will be better served if they can choose among two or more HMOs.  Requiring mandatory enrollment under a single system is not permitted under Medicaid regulations.

SUMMARY:

RCW 74.09.120 is amended to require the department to make payment adjustments to disproportionate share hospitals based on the requirements set forth in federal statute.

The department is given authority to enroll AFDC recipients in a variety of managed health care programs that meet departmental requirements.

RCW 74.09.510 is amended to authorize the department to provide Medicaid coverage, including case management services, to pregnant women and children to the level for which funds are provided in the appropriation consistent with OBRA.

The department is authorized to provide an "HIV insurance program" for the purchase of insurance for persons with AIDS who meet eligibility requirements established by the department.

An erroneous reference to the emergency medical services statute is removed and replaced with the proper reference.

Appropriation:    none

Revenue:    none

Fiscal Note:      available

SUMMARY OF PROPOSED HEALTH CARE & CORRECTIONS AMENDMENT:

Provisions are deleted authorizing Medicaid coverage for case management and services to pregnant women and children.  Provisions are also deleted which authorize the HIV insurance program.

SUMMARY OF PROPOSED WAYS & MEANS AMENDMENT:

The provision is restored which authorizes the department to provide an "HIV insurance program."

Senate Committee - Testified: HEALTH CARE & CORRECTIONS:  Andrea Castell, Jim Halstrom, Health Care Purchasers Association; Basil Badley, Health Insurance Association of America; Mel Sorenson, Washington Physicians Service; Linda Christopherson, Virginia Mason Medical Center; K. Collins Sprague, AWB; Ron W. Kero, DSHS/DMA; Ken Bertrand, Group Health; Beverly Jacobson, Seattle Area Hosp. Co.

Senate Committee - Testified: WAYS & MEANS:  Ron W. Kero, DSHS/DMA (pro); Bob Lolcama, DSHS (pro)