SENATE BILL REPORT
SB 6145
BYSenator Barr
Pertaining to rural health care.
Senate Committee on Health Care & Corrections
Senate Hearing Date(s):April 14, 1989
Majority Report: That Substitute Senate Bill No. 6145 be substituted therefor, and the substitute bill do pass.
Signed by Senators West, Chairman; Smith, Vice Chairman; Amondson, Johnson, Wojahn.
Senate Staff:Scott Plack (786-7409)
April 14, 1989
AS REPORTED BY COMMITTEE ON HEALTH CARE & CORRECTIONS, APRIL 14, 1989
BACKGROUND:
Changes in the demand for health care services, in the reimbursement policies of public and private payers, as well as changes in economic conditions, threaten access to affordable basic health care services to rural citizens. The Washington Rural Health Care Commission was authorized by the Legislature to identify current problems associated with assuring continued access to health care in rural areas and to make recommendations for changes in state policy.
The commission identified many factors that inhibit needed changes in the delivery of rural health care services. They include outdated or rural-inappropriate regulatory laws, aging and inefficient health care facilities, an absence or ineffective local planning and coordination of services, a shortage of health care professionals and a lack of state reorganizing the delivery of health care services.
SUMMARY:
Part I: Rural Health System Project
The rural health system delivery project is created in the new Department of Health. The project provides technical assistance and limited financial assistance to six rural participant communities and technical assistance to another six participant communities. Participants are required to evaluate local health care needs, determine appropriate health care objectives and design strategies to assure continued access to affordable basic health care services. Communities may contract with consultants to help with specialized needs such as recruitment of primary care physicians, conversion of the local hospital to an alternative health care facility, and improved coordination of service delivery among existing local health care providers.
The secretary is directed to appoint a project administrator who shall report directly to the secretary. The project administrator will assist communities in: identifying technical assistance resources; administering funding; identifying local health care outcome objectives; and serving as an advisor to the secretary on rural health care.
Part II: Rural Health Facility Licensure Model
The Department of Health in consultation with representatives from rural health care providers, purchasers, consumers and others is to develop rules for an alternative health care facility licensure model. Rules must allow for maximum local flexibility in providing services which permit cost-efficient delivery of services, better coordination of existing services and the optimal use of existing facilities. The alternative health care facility is not to be considered a hospital for determining building occupancy purposes.
The department is to negotiate with the federal government to seek Medicare approval for the facility so that government reimbursement for services provided can be authorized. Periodic reports on the progress of rule making and negotiations are to be made to the standing House and Senate committees on health care.
Part III: Health Professional Loan Repayment
The health professional loan repayment program is established and designed to meet federal guidelines for matching funds. The Higher Education Coordinating Board is directed to implement the program. Student loan repayment is available to physicians, physician assistants, nurses and dentists who serve in a federally designated health professional shortage area. The maximum amount available is up to $15,000 for five years and payments begin upon service in a shortage area.
Participants must serve at least three years in a shortage area or face repaying twice the amount paid on their behalf. Participants must agree not to discriminate against Medicaid or Medicare patients and must accept Medicaid assignment. Payments to participants cease after five years or when the participant terminates service in a shortage area.
Part IV: Rural Health Training Opportunities
The Higher Education Coordinating Board, in consultation with the State Board of Community Colleges, the Superintendent of Public Instruction and training programs in medicine and nursing, is directed to develop a plan for providing students in nursing and medical training programs with rural training opportunities.
The board shall inventory current rural-based clinical experience opportunities, identify areas where opportunities do not exist, identify public and private funding for sources and make recommendations on how to improve clinical experience opportunities. The board shall report to the standing Senate and House health care committees by December 1, 1989 with its recommendations.
Part V: Health Professional Cross-Credentialing
The Department of Licensing, in consultation with the State Board of Pharmacy, the State Health Coordinating Council (SHCC), the Higher Education Coordinating Board, representatives of rural health care providers and others, is directed to investigate the feasibility of the use of limited cross-credentialed health professionals in rural areas of the state.
The department will investigate the need, public safety implications and training and experience requirements of developing a program of cross-credentialing of individuals with multiple skills for practice in rural areas. A report of its findings and recommendations shall be submitted to the State Health Coordinating Council (SHCC) by June 1, 1990. The SHCC shall make recommendations on the need for changes in current state credentialing laws to the standing House and Senate health care committees by December 1, 1990.
Part VI: Standards for Nurse Training
The Higher Education Coordinating Board, in consultation with the State Board for Community College Education, the Superintendent of Public Instruction, the State Board of Nursing, the State Board of Practical Nursing and representatives from nurse training programs and others, is directed to develop a plan providing for geographic availability of training and education programs, curriculum standards, procedures to facilitate transfer or granting of credit and the use of evaluation processes to maximize opportunities for receiving credit for knowledge and clinical skills.
The plan is to be implemented in institutions of higher education by January 1, 1992. It is to be submitted to the standing Senate and House health care committees as required by December 1, 1990, with a progress report due by December 1, 1989.
Part VII: Exempting Rural Hospitals from State Hospital Commission Rate Setting
Rural hospitals are defined.
Rural hospitals are exempt from rate approval requirements under the State Hospital Commission statutes. Hospital data reporting requirements are maintained.
Part VIII: Exempting Rural Hospitals from Certain Certificate of Need Requirements
Rural hospitals are exempted from most Certificate of Need requirements. A Certificate of Need is still required for the establishment of skilled nursing and intermediate care beds, a new nursing home, tertiary services and of duplicating covered services in a health service area. The establishment of hospice, home health or kidney dialysis services by a rural hospital requires a Certificate of Need if the service would duplicate an existing service already provided in the service area.
EFFECT OF PROPOSED SUBSTITUTE:
The Secretary of the Department of Health (or DSHS if the new department is not created) is given latitude in appointing an administrator for the health system project by allowing the appointment of an existing department employee. The health system project and the loan forgiveness program are enacted subject to an appropriation. Rural hospitals are required to have a certificate of need in order to establish a home health or hospice agency.
Appropriation: none
Revenue: none
Fiscal Note: requested
Senate Committee - Testified: John Anderson, Rural Health Care Commission (pro); Dan Rubin, DSHS; Mary Selecky, Rural Health Commission (pro); Gail Toraason, Home Care Association of Washington (pro); Thomas Trompeter, Washington State Primary Care Association (pro); Roy Holmes, Providence Central Mem. Hosp. (pro)