AN ACT Relating to children's health; amending RCW 74.09.010; amending section 9, chapter 10, Laws of 1989 1st ex. sess. (uncodified); adding new sections to chapter 74.09 RCW; providing an effective date; and declaring an emergency.

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

NEW SECTION. Sec. 1. The legislature finds that the health status of poor children in the state of Washington is suffering. Children living in poverty are less likely to have adequate health insurance coverage than nonpoor children. They are less likely than middle and upper income children to be in good health, more likely to have a chronic illness or condition that limits their activities, more likely to miss school days because of illness, less likely to have contact with health care providers and less likely to be fully immunized. Access to health care for children in poverty is diminishing in rural areas where health care providers may not be available and in other communities where health care providers will not accept poor children as patients.

The declining state of children's health has widespread and long-term ramifications for the state. An investment in preventive health care programs for children in poverty benefits all of the state's citizens and is a sound approach to health care cost containment.

It is the purpose of this act to provide, consistent with appropriated funds, access to health care services for children in poverty in Washington. To this end, a children's health program is established based on the following principles:

(1) The family is the fundamental unit in our society and should be supported through public policy.

(2) Access to preventive and other health care services should be made more readily available to children in poverty.

(3) Unnecessary barriers to health care for children in poverty should be removed.

(4) The program should be sensitive to cultural and ethnic differences among children in poverty.

(5) The status of children's health and their access to health care services should be evaluated at appropriate intervals to determine the program's effectiveness and the need for modification.

(6) Health care services should be delivered in a cost-effective manner.

NEW SECTION. Sec. 2. For the purposes of this act, "poverty" means at or below the federal poverty level as annually determined by the federal department of health and human services adjusted for family size.

NEW SECTION. Sec. 3. There is hereby established a program to be known as the children's health program.

To the extent of available funds:

(1) Health care services may be provided to persons under eighteen years of age with household incomes at or below the federal poverty level and not otherwise eligible for medical assistance or the limited casualty program for the medically needy.

(2) The determination of eligibility for health care services shall be the responsibility of the department. The application process shall be easy to understand, and the department shall make eligibility determinations within the timeframes for establishing eligibility for children on medical assistance, as defined by RCW 74.09.520.

(3) The amount, scope, and duration of health care services provided to eligible children under the children's health program shall be the same as that provided to children under medical assistance, as defined in RCW 74.09.520.

NEW SECTION. Sec. 4. Local communities are encouraged to take actions necessary to make health care more accessible to children in poverty in their communities, such as coordinating the development of alternative provider relationships. To support communities in their efforts, the department, in coordination with the department of health, and to the extent funds are available, shall:

(1) Provide technical assistance to counties and tribal governments to develop provider resources and coordinate delivery of health care services to children in poverty. The department shall focus on those counties and tribal jurisdictions identified as having a significant problem with access to health care services for children in poverty, as defined in section 5 of this act, and on those counties or tribal jurisdictions seeking to develop alternative delivery systems of care; and

(2) Provide financial incentives, such as disproportionate share payments and grants to counties, tribal governments, local public agencies, or health care providers requesting assistance pursuant to section 6 of this act.

NEW SECTION. Sec. 5. (1) The department, in coordination with the department of health, shall identify counties and tribal jurisdictions experiencing significant problems with access to health care for children in poverty based on indicators such as, but not limited to, the following:

(a) Number of primary care providers serving children in poverty;

(b) Percent of children in the county or tribal jurisdiction who are living in poverty;

(d) Early and periodic screening, diagnosis, and treatment (EPSDT) utilization;

(e) Teen birth rate to teens in poverty; and

(f) Low birth weight rate for children in poverty.

(2) The department shall notify a county or tribal authority of its identification as an area having a significant problem with access to health care services for children in poverty, as determined pursuant to this section. The county or tribal authority also shall be advised of the availability of technical and financial assistance from the state in support of local remedial action.

NEW SECTION. Sec. 6. (1) Any county or tribal government, local public agency or health care provider, including those not identified pursuant to section 5 of this act, seeking state assistance as provided in section 4 of this act shall submit a request to the department. The request shall include: (a) A description of the barriers to access to health care services experienced by children in poverty in their jurisdiction; (b) a description of their plan for addressing those barriers; and (c) how the state's technical or financial assistance will further their plan and increase access to health care services for children in poverty in their jurisdiction. The request for assistance shall be prepared in consultation with the department and its local community service offices, the local public health officer, community health clinics, health care providers, hospitals, the business community, labor representatives, and advocates for low-income persons in their area.

(2) The department, in coordination with the department of health, shall evaluate each plan and request for technical or financial assistance submitted pursuant to subsection (1) of this section to determine: (a) The likelihood that the plan will address the barriers to access to health care services experienced by children in poverty in the jurisdiction; (b) whether the plan evidences an ability to meet the particular needs of its jurisdiction, including its responsiveness to the needs of ethnic and racial minorities and proposed mechanisms to address language barriers to access; (c) the extent to which the jurisdiction can benefit from the state's technical or financial assistance; and (d) the extent to which the plan advances the state's overall goal of increasing access to health care services for children. In determining which counties or tribal governments should receive technical or financial assistance, priority shall be given to requests from those counties and tribal jurisdictions identified pursuant to section 5 of this act as experiencing significant problems with access to health care services for children in poverty.

NEW SECTION. Sec. 7. The department, in coordination with the department of health, shall reevaluate the state of access to health care services for children in poverty on at least a biennial basis and shall provide this information, along with information on the implementation of this act, to the board of health for inclusion in the biennial state health report.

Sec. 8. Section 74.09.010, chapter 26, Laws of 1959 as last amended by section 11, chapter 406, Laws of 1987 and RCW 74.09.010 are each amended to read as follows:

As used in this chapter:

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

(2) "Secretary" means the secretary of social and health services.

(3) "Internal management" means the administration of medical assistance, medical care services, the children's health program, and the limited casualty program.

(4) "Medical assistance" means the federal aid medical care program provided to categorically needy persons as defined under Title XIX of the federal social security act.

(5) "Medical care services" means the limited scope of care financed by state funds and provided to general assistance recipients, and recipients of alcohol and drug addiction services provided under chapter 74.50 RCW.

(6) "Limited casualty program" means the medical care program provided to medically needy persons as defined under Title XIX of the federal social security act, and to medically indigent persons who are without income or resources sufficient to secure necessary medical services.

(7) "Nursing home" means nursing home as defined in RCW 18.51.010.

(8) "Children's health program" means the health care services program provided to children under eighteen years of age in households with incomes at or below the federal poverty level as annually determined by the federal department of health and human services as adjusted for family size, and who are not otherwise eligible for medical assistance or the limited casualty program for the medically needy.

NEW SECTION. Sec. 9. Sections 1 through 7 of this act are each added to chapter 74.09 RCW.

Sec. 10. Section 9, chapter 10, Laws of 1989 1st ex. sess. (uncodified) is amended to read as follows:

The department shall contract with an independent ((~~nonprofit entity~~)) contractor to evaluate the effectiveness of the maternity care access program set forth in RCW 74.09.760 through 74.09.820 based on the principles set forth in RCW 74.09.770. The evaluation shall also address:

(1) Characteristics of women receiving services, including health risk factors;

(2) Services utilized by eligible women;

(3) Birth outcomes of women receiving services;

(4) Birth outcomes of women receiving services, by type of practitioner;

(5) Services utilized by eligible infants; and

(6) Referrals to other programs for services.

The department shall submit an evaluation report to the appropriate committees of the legislature by ((~~December 1, 1990~~)) November 1, 1991.

NEW SECTION. Sec. 11. Sections 1 through 9 of this act shall take effect July 1, 1990.

NEW SECTION. Sec. 12. Section 10 of this act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately.