AN ACT Relating to children's health; amending RCW 74.09.010; adding new sections to chapter 74.09 RCW; and providing an effective date.

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

NEW SECTION. Sec. 1. The legislature finds that the state of children's health in the state of Washington is suffering. More and more, children are living in poverty, putting them at risk for health and social problems. Access to health care is diminishing, especially in rural areas where health care providers may not be available. There are communities in Washington where health care providers do not accept low-income children as patients. Many children are uninsured or underinsured.

These factors, and others, are contributing to the declining state of children's health. The ramifications on the state are widespread and long term. The investment in preventive health care programs contributes to the benefit of all citizens and is a sound approach to health care cost containment.

It is the purpose of sections 3 and 4 of this act to provide, consistent with appropriated funds, health care access and services to the young citizens in this state. To this end, a children's health program is established based on the following principles:

(1) Access to preventive and other health care services should be made more readily available for eligible children.

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

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

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

NEW SECTION. Sec. 2. For the purposes of sections 3 through 6 of this act, (1) "poverty" means at or below the federal poverty level as annually defined by the federal department of health and human services and adjusted for family size, (2) within sections 4 through 6 of this act, "committee" means the executive steering committee operating on January 1, 1990, within the department which includes staff from the department of health and which is responsible for implementation of the maternity care access program under chapter 74.09 RCW, and (3) "county" means a board of county commissioners, county council, county executive, or tribal jurisdiction.

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

To the extent of available state funds:

(1) Medical care may be provided to persons who are 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 of recipients for medical care 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 74.09.510.

(3) The amount, scope, and duration of medical care 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, except as approved according to section 5 of this act.

NEW SECTION. Sec. 4. Local communities are encouraged to take actions necessary to make health care more accessible to children in their communities, such as coordinating the development of alternative health care delivery systems. To support communities in their efforts, the committee, in coordination with counties and to the extent funds are available, shall: (1) Provide technical assistance to counties to enable them to develop provider resources and expand coordinated provision of health care to children in poverty, and (2) recommend that financial incentives be provided within counties requesting assistance according to section 5 of this act.

NEW SECTION. Sec. 5. (1) The committee, in coordination with counties, shall identify counties experiencing significant problems with access to health care for children eligible for services under chapter 74.09 RCW, on the following indicators:

(a) Number of primary care providers for children eligible for services under chapter 74.09 RCW;

(b) Percent of children eligible for services under chapter 74.09 RCW;

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

(e) Teen birth rate for low-income children; and

(f) Low birth weight rate for low-income children.

(2) The department shall provide data to each county within the state regarding its performance on the indicators in subsection (1) of this section and notify those counties having a significant problem with access, as defined in this section. The county shall also be advised of the availability of technical and financial assistance from the state in support of local remedial action.

(3) Any county, including those not identified by the committee, wishing to pursue state assistance under this section may submit a request to the committee. The request should include a description of the access problems in their community, a plan for addressing those problems, and a description of how the state's technical or financial assistance will aid them in increasing access to pediatric care for children in poverty. The request for assistance shall be prepared in consultation with the department, local community service offices, the local public health officer, community health clinics, health care providers, hospitals, the business community, labor representatives, and low-income advocates in their area.

(4) Counties are encouraged to combine to fulfill their duties under this section. In doing so, they shall consider the organizational principles set forth in RCW 43.70.020. If after one hundred twenty days' notice by the committee that a significant problem with health care access to children exists within a county, the county has not submitted a preliminary request for assistance according to this section, the committee shall solicit or may receive requests for assistance from any health care provider within that county.

(5) The committee, in coordination with counties, shall evaluate all local requests for technical and financial assistance, and shall recommend funding of any or all parts of the requests, using criteria such as:

(a) The number of children proposed to receive expanded access to pediatric health care per dollar expended;

(b) Ability to meet the particular needs of the community as defined in the county request, including responsiveness to the needs of ethnic and racial minorities and addressing language barriers to access; and

(6) The department of social and health services shall provide grants to counties or disproportionate share payments to providers, from appropriations for the children's health program, as recommended in this section. The department of social and health services shall make such changes to the state medicaid plan or take such other action as may be needed to secure federal matching funds for grants under this section.

NEW SECTION. Sec. 6. The committee, in coordination with the department of health, shall reevaluate the state of access to care for children in poverty on at least a biennial basis and shall provide this information, along with information on the implementation of sections 1 through 5 of this act, to the board of health for their consideration for inclusion in the biennial state health report.

Sec. 7. 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 medical care program and other services under section 5 of this act financed by state funds and provided to children under eighteen years of age and in households with incomes at or below the federal poverty level as annually defined 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. 8. Sections 1 through 6 of this act are each added to chapter 74.09 RCW.

NEW SECTION. Sec. 9. This act shall take effect July 1, 1990.