FINAL BILL REPORT
SB 6152
PARTIAL VETO
C 9 L 89 E1
BYSenators Wojahn, Barr, Gaspard, West, Stratton, Johnson, Rasmussen, Bluechel, Vognild, von Reichbauer, Warnke, Smitherman, Bailey, Craswell, Thorsness, Bender, Bauer, Amondson, Lee, Metcalf, Cantu and Sutherland
Creating the department of health.
Senate Committee on Rules
House Committe on Rules
SYNOPSIS AS ENACTED
BACKGROUND:
A Department of Health was first created in Washington in 1921 by transferring the administrative responsibilities of the state Board of Health. The Department of Health continued until 1970 when it was merged into the Department of Social and Health Services (DSHS). The new umbrella agency was formed to integrate and decentralize services. Repeated efforts to realize the goals for DSHS met with only limited success. Many now claim that services are not adequately integrated, that programs are not adequately decentralized, and accountability is hampered by an unnecessarily complex organization. Advocates for the traditional purposes of public health (i.e. disease and illness prevention, control of epidemics, etc.) state that DSHS places a low priority on public health purposes within the umbrella agency.
In 1986, the Legislature considered a proposal by the Joint Select Committee on Public Health to create a separate state department of public health and environment, by removing traditional public health functions from DSHS and merging them with health related functions housed in the Department of Ecology. Enabling legislation passed the Senate, but has failed in the House for several years.
The Washington State Hospital Commission was established in 1973 and reauthorized in 1984 with a mandate to contain hospital costs. The commission is scheduled to terminate on June 30, 1989 under the provisions of the Washington Sunset Act.
The Legislative Budget Committee (LBC) sunset review found that between 1981 and 1986, the rate of growth of hospital costs in Washington exceeded average increases nationally and in five other regulated states.
The LBC recommended that hospital rate setting and the Hospital Commission be replaced by a health care commission or a department of health that would monitor hospital costs and conduct research and policy analysis on how best to control health care costs.
The certificate of need process (CON) regulates the construction or establishment of new health care facilities, substantial changes in health services, changes in bed capacity, acquisitions of major medical equipment, and capital expenditures of health care facilities in excess of $1,111,000. Types of facilities subject to CON include: hospitals; psychiatric hospitals; nursing homes; kidney disease treatment facilities; ambulatory surgical facilities; home health care; hospices; and certain rehabilitation facilities. Since its creation in 1974, the CON process has been criticized as burdensome, costly and ineffective at controlling costs.
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, ineffective local planning and coordination of services and a lack of state health policy objectives.
The commission recommended that a partnership be established between the state and rural communities where the state provides general health policy direction and rural communities take an active role in reorganizing the delivery of health care services.
SUMMARY:
A Department of Health is created to provide leadership in assuring the quality of health care, protect the general population's health, monitor the cost of personal health care services, and develop state health policies.
The Governor must appoint a secretary of health with the consent of the Senate. A state health officer must be appointed by the secretary with the consent of the Senate, and must serve as the deputy secretary. The state health officer must be a physician and have a masters degree in public health or equivalent training or experience in public health.
Organizational principles are established as a guide for the department in its efficient and effective operation. The secretary is directed to consider the principles as he or she establishes the department's structure.
He or she may appoint such deputy secretaries, assistant secretaries and other personnel as required to head the divisions, bureaus, offices and programs within the department and an additional five persons, all of whom shall be exempt from civil service protections.
The Legislature intends that the department promote, assess and assure quality in health care. The department is designated as the primary agency to collect data related to illness and injury prevention, health promotion, and the quality of health care. Safeguards against improper use of data are established. The department must develop a state research agenda as part of the biennial state health report. Research and other studies may be undertaken only in accordance with the research agenda and procedures established for study approval and funding. The secretary must use study results as appropriate to improve health quality.
A data evaluation program is established to analyze health care practices, outcomes, the need for changes in health care delivery, and bioethical issues, and to provide data to consumers, providers and purchasers of health care. The department may, within available resources, conduct several studies specified in the act by July 1, 1991, including studies on health care rationing, medical liability issues, cost containment and prudent purchasing strategies.
An Office of Health Consumer Assistance is created which must contain a hotline to receive complaints.
The secretary must enter into written operating agreements with each professional licensing and disciplinary board to provide a process for consultation on administrative matters.
The new department merges the Board of Pharmacy, the hospital data collection duties of the State Hospital Commission, the health professional licensure functions of the Department of Licensing, and the traditional public health functions, the mandated health benefit review, new health professional credentialing review, health planning and certificate of need functions of the Department of Social and Health Services.
Traditional public health functions transferred from DSHS include:
Environmental health protection programs including radiation, drinking water, toxic substances, on-site sewage, recreational water contact facilities, food service sanitation, and shellfish;
Personal health protection programs including immunizations, tuberculosis, sexually transmitted diseases, AIDS, diabetes control, primary health care, hypertension, kidney disease, regional genetic services, newborn metabolic screening, sentinel birth defects, communicable disease epidemiology, and chronic disease epidemiology;
On January 1, 1991, Parent and Child Health Services;
The public health laboratory;
Public health support services, including vital records, health data, and health education and information;
Selected health facilities licensure authority including hospitals, maternity homes, boarding homes, abortion facility approval, emergency medical services, transient accommodations, home health and hospice care, and private establishments.
The State Health Coordinating Council, regional health planning councils and related health planning duties as authorized under Chapter 70.38 RCW are abolished.
The Board of Health is transferred to the Department of Health, designated as the primary entity for state health policy development and required to produce a biennial state health report which sets forth the state's health priorities. Mechanisms for public involvement are authorized through local health departments and ad hoc advisory groups. Two staff in addition to an executive director and a secretary must be employed by the Board of Health.
The duty to designate nursing shortage areas under the nursing scholarship program is transferred from the State Health Coordinating Council (SHCC) to the Secretary of Health.
All administrative duties and the duty to enforce drug laws are transferred from the Board of Pharmacy to the new department.
Funeral directors and embalmers regulation is retained within the Department of Licensing (DOL), and DOL must recommend legislation by 1990 to eliminate any statutory barriers to this retention.
The department must establish a hospital data collection system to monitor costs and access to hospital services. The Health Care Access and Cost Control Council is established to advise on the data collection system, to advise on certain departmental health cost, and access studies, to suggest means of increasing the effectiveness and efficiency of health care and to suggest changes in health care services to the Governor and the Legislature. The council is composed of the Secretaries of Health, and Social and Health Services, the Director of Labor and Industries, the administrators of the Health Care Authority and the basic health plan, a representative of the Governor's office, and a consumer of health care.
The certificate of need (CON) program is transferred to the department of health. CON requirements are eliminated except on new hospitals and nursing homes or new beds, tertiary services, bed redistributions between broad categories of care, and increased kidney dialysis stations. The current CON requirement that nursing home capital expenditures in excess of established minimums remains.
Hospitals are prohibited from adopting admissions practices that reduce the proportion of their patients who can pay none or only a part of the cost of their care. In addition, hospitals are required to treat all emergency admissions, including women in active labor, unless the hospital does not have the needed skills or facilities. In these cases, hospitals must stabilize and transfer patients to appropriate alternative facilities.
Each hospital must adopt a sliding fee schedule that will include care without charge for persons with incomes less than 100 percent of the federal poverty level.
Hospitals that do not comply with these requirements may be found guilty of a misdemeanor and fined up to $1,000 a day for first violations. Following an initial conviction, additional violations may be punished in the following manner: (1) up to $3,000 a day for a violation following an initial conviction within five years; (2) denial of access to the Washington Health Care Facilities Authority's bonding privilege and any certificate of need for up to three years for a violation within five years of a second conviction; (3) for a violation following a third conviction within five years, denial of participation in the Medicaid program for up to one year.
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.
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. 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.
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 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 report to the standing Senate and House health care committees by December 1, 1989 with its recommendations.
The Department of Health, in consultation with the State Board of Pharmacy, 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. A report of its findings and recommendations shall be submitted to the standing House and Senate health care committees by December 1, 1990.
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.
Adult family homes are declared to be residential uses for purposes of local zoning.
The University of Washington and DSHS are required to monitor and evaluate drug and alcohol treatment programs under the Alcohol and Drug Abuse Treatment and Shelter Act (ADATSA).
Restitution payments, income or assets received under state and federal internment restitution acts are exempt for purposes of eligibility under the public assistance and medical assistance programs.
Appropriation: $650,000 is appropriated from the general fund-state for the health system project and loan forgiveness program. $45,493 is appropriated from the health professions account to the Department of Health for the cross-credentialing study.
VOTES ON FINAL PASSAGE:
Senate 39 5
House 94 1
EFFECTIVE:July 1, 1989
Partial Veto Summary: The Governor vetoed the following requirements: (1) a deputy secretary must serve as the state health officer; (2) two persons must staff the State Board of Health; (3) a plan be developed to enhance rural training opportunities for doctors and nurses; and (4) several studies be completed. (See VETO MESSAGE)