AN ACT Relating to social and health services; amending RCW 74.09.510; adding new sections to chapter 74.09 RCW; creating a new sections; and making appropriations.

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

NEW SECTION. Sec. 1. LEGISLATIVE INTENT. (1) The legislature finds that Washington state and the nation as a whole have a high rate of infant illness and death compared with other industrialized nations. This is especially true for minority and low- income populations. Premature and low weight births have been directly linked to infant illness and death. The availability of adequate maternity care throughout the course of pregnancy has been identified as a major factor in reducing infant illness and death. Further, the investment in preventive health care programs, such as maternity care, contributes to the growth of a healthy and productive society, and is a sound approach to health care cost containment. The legislature further finds that access to maternity care for low-income women in the state of Washington has declined significantly in recent years and has reached a crisis level.

(2) It is the purpose of this chapter to provide, consistent with appropriated funds, maternity care necessary to ensure healthy birth outcomes for low-income families. To this end, a maternity care access system is established based on the following principles:

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

(b) Access to maternity care for eligible persons should be made readily available in an expeditious manner through a single service entry point.

(d) Access to preventive and other health care services should be available for low-income children.

(e) Each woman should be encouraged to and assisted in making her own informed decisions about her maternity care.

(f) Unnecessary barriers to the provision of maternity care by qualified health professionals should be removed.

(g) The system should be sensitive to cultural differences among eligible persons.

(h) To the extent possible, decisions about the scope, content, and delivery of services should be made at the local level involving a broad representation of community interests.

(i) The maternity care access system should be evaluated at appropriate intervals to determine effectiveness and need for modification.

(j) Maternity care services should be delivered in a cost-effective manner.

NEW SECTION. Sec. 2. DEFINITIONS. Unless the context clearly requires otherwise, the definitions in this section apply throughout sections 1 through 5, 7, and 8 of this act and RCW 74.09.510.

(1) "County authority" means the board of county commissioners, county council, or county executive having the authority to participate in the program created by this act or its designee. Two or more county authorities may enter into joint agreements to fulfill the requirements of this act.

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

(3) "Eligible person" means a woman in need of maternity care or a child, who is eligible for medical assistance pursuant to this chapter.

(4) "Health care provider" means physician, nurse practitioner, registered nurse, midwife, and nursing assistants-registered.

(5) "High-risk eligible person" means an eligible person determined by the department to need special assistance in applying for and obtaining maternity care, including in the following order of priority, pregnant women who are drug or alcohol addicted or affected, pregnant and parenting adolescents, pregnant minority women who live in poverty, pregnant homeless women, and other eligible persons who need special assistance in gaining access to the maternity care system.

(6) "Maternity care services" means inpatient and outpatient medical care, case management, and support services necessary during prenatal, delivery, and postpartum periods.

(7) "Support services" should include a nursing assessment and followup, health and childbirth education, psychological assessment and counseling, outreach services, nutritional assessment and counseling, needed vitamin and nonprescriptive drugs, transportation, and child care. Support services may include alcohol and substance abuse treatment for pregnant women who are addicted or at risk of being addicted to alcohol or drugs to the extent funds are made available for that purpose by Engrossed Second Substitute House Bill No. 1793, if enacted.

NEW SECTION. Sec. 3. HEALTH CARE PROVIDER AVAILABILITY AND LIABILITY INSURANCE. (1) The legislature finds that a major factor contributing to the decline in the number of health care providers providing maternity care to low-income women is the below cost reimbursement to those providers for services delivered. Consequently, it is the legislature's intent that the reimbursement levels to health care providers be increased to the extent allowed by the funds appropriated for that purpose.

(2) The sum of fourteen million three hundred ten thousand dollars, or as much thereof as may be necessary, of which seven million seven hundred ten thousand dollars shall be from federal funds, is appropriated from the state general fund for the biennium ending June 30, 1991, to the department of social and health services, medical assistance program, to increase reimbursement levels to health care providers for the delivery of maternity services.

(3) An additional barrier to the provision of maternity care to low-income women by health care providers is the lack of affordable liability insurance for health care providers. To help remedy this problem, the department may, within available funds, develop a program that addresses maternity care health care provider's liability insurance problems.

NEW SECTION. Sec. 4. MATERNITY CARE ACCESS PROGRAM. In an effort to provide for healthy births, the department shall, within funds appropriated for this purpose and subject to limitations placed on those funds, develop a maternity care access program as follows:

(1) Provide maternity care services to low-income pregnant women and health care services to children eligible solely pursuant to RCW 74.09.510(6) to the maximum extent allowable under the medical assistance program, Title XIX of the federal social security act.

The sum of forty-seven million five hundred thirty-one thousand dollars, or as much thereof as may be necessary, of which twenty-five million five hundred seventy thousand dollars shall be from federal funds, is appropriated from the state general fund for the biennium ending June 30, 1991, to the department of social and health services, medical assistance program, for medical assistance for categorically needy pregnant women and children under one year of age whose household income does not exceed one hundred eighty-five percent of the federal poverty level, whose resources do not exceed reasonable standards established by the department, and whose coverage qualifies for federal financial participation under Title XIX of the federal social security act.

The sum of nine million five hundred thirty thousand dollars, or as much thereof as may be necessary, of which five million one hundred ten thousand dollars shall be from federal funds, is appropriated from the state general fund for the biennium ending June 30, 1991, to the department of social and health services, medical assistance program, for medical assistance for children under eight years of age whose family income does not exceed one hundred percent of the federal poverty level, whose resources do not exceed reasonable standards established by the department, and whose coverage qualifies for federal financial participation under Title XIX of the federal social security act;

(2) Provide that if a woman enters the maternity care access program and later decides to terminate her pregnancy, then she shall qualify for further services through the family planning program at the bureau of parent and child health services in the department;

(3) Provide maternity care services to low-income women with household incomes at or below one hundred eighty-five percent of the federal poverty level as determined annually by the federal department of health and human services;

(4) By January 1, 1990, have the following procedures in place to improve access to maternity care services and eligibility determinations for pregnant women applying for maternity care services under the medical assistance program, Title XIX of the federal social security act:

(a) Use of a shortened and simplified application form;

(b) Outstationing department staff, at the department's discretion, to make eligibility determinations;

(d) Conducting an interview for the purpose of determining medical assistance eligibility within five working days of the date of an application by a pregnant woman and making an eligibility determination within fifteen working days of the date of application by a pregnant woman;

(5) Establish a maternity care case management system that shall assist only high-risk eligible persons with obtaining medical assistance benefits and receiving maternity care services, including transportation and child care services.

The sum of eight million eight hundred forty-one thousand dollars, or as much thereof as may be necessary, of which four million seven hundred forty-one thousand dollars shall be from federal funds, is appropriated from the state general fund for the biennium ending June 30, 1991, to the department of social and health services, medical assistance program, for the purpose of establishing a maternity care case management system as prescribed in this act.

The sum of ten million one hundred fifty-three thousand dollars, or as much thereof as may be necessary, of which five million three hundred thirty-six thousand dollars shall be from federal funds, is appropriated from the state general fund for the biennium ending June 30, 1991, to the department of social and health services, children and family services program, for the purpose of establishing a maternity care support service system as prescribed in this act;

(6) Implement a broad-based public education program, in cooperation with local health departments and other agencies providing maternity care, that stresses the importance of obtaining maternity care early during pregnancy. Special emphasis shall be directed toward high-risk eligible persons;

(7) Develop and maintain linkages with existing maternity care providers and assist in the recruitment of additional maternity care providers;

(8) Work with local communities to develop maternity care clinics in areas in need of access to prenatal or maternity care, or if such clinics already exist, work to enhance existing services; and

(9) Study the desirability and feasibility of implementing the presumptive eligibility provisions set forth in section 9407 of the federal omnibus budget reconciliation act of 1986 and report to the appropriate committees of the legislature by December 1, 1989.

NEW SECTION. Sec. 5. ALTERNATIVE MATERNITY CARE SERVICE DELIVERY SYSTEM. (1) Within funds appropriated for this purpose, the department shall establish an alternative maternity care service delivery system, if it determines that a county or group of counties is a maternity care distressed area. A maternity care distressed area shall be defined by the department, in rule, as a county or group of counties where eligible persons are unable to obtain adequate maternity care. The department shall include the following factors in its determination:

(a) Higher than average percentage of eligible persons in the distressed area who receive late or no prenatal care;

(b) Higher than average percentage of eligible persons in the distressed area who go out of the area to receive maternity care;

(c) Lower than average percentage of obstetrical care providers in the distressed area who provide care to eligible persons;

(d) Higher than average percentage of infants born to eligible persons per obstetrical care provider in the distressed area; and

(e) Higher than average percentage of infants that are of low birth weight, five and one-half pounds or two thousand five hundred grams, born to eligible persons in the distressed area.

(2) If the department determines that a maternity care distressed area exists, it shall notify the relevant county authority. The county authority shall, within one hundred twenty days, submit a brief report to the department recommending remedial action. The report shall be prepared in consultation with the department and its local community service offices, the local public health offices, community health clinics, health care providers, hospitals, the business community, labor representatives, and low-income advocates in the distressed area. A county authority may contract with a local nonprofit entity to develop the report. If the county authority is unwilling or unable to develop the report, it shall notify the department within thirty days, and the department shall develop the report for the distressed area.

(3) The department shall review the report and use it, to the extent possible, in developing strategies to improve maternity care access in the distressed area. The department may contract with or directly employ qualified maternity care health providers to provide maternity care services, if access to such providers in the distressed area is not possible by other means. In such cases, the department is authorized to pay that portion of the health care providers' malpractice liability insurance that represents the percentage of maternity care provided to eligible persons by that provider through increased medical assistance payments.

Sec. 6. Section 4, chapter 30, Laws of 1967 ex. sess. as last amended by section 2, chapter 87, Laws of 1989 and RCW 74.09.510 are each amended to read as follows:

Medical assistance may be provided in accordance with eligibility requirements established by the department of social and health services, as defined in the social security Title XIX state plan for mandatory categorically needy persons and: (1) Individuals who would be eligible for cash assistance except for their institutional status; (2) individuals who are under twenty-one years of age, who would be eligible for aid to families with dependent children, but do not qualify as dependent children and who are in (a) foster care, (b) subsidized adoption, (c) an intermediate care facility or an intermediate care facility for the mentally retarded, or (d) inpatient psychiatric facilities; (3) the aged, blind, and disabled who: (a) Receive only a state supplement, or (b) would not be eligible for cash assistance if they were not institutionalized; (4) individuals who would be eligible for but choose not to receive cash assistance; (5) ((pregnant women who would be eligible for aid to families with dependent children if the child had been born and was living with the mother during the month of the payment, and the pregnancy has been medically verified; (6))) individuals who are enrolled in managed health care systems, who have otherwise lost eligibility for medical assistance, but who have not completed a current six-month enrollment in a managed health care system, and who are eligible for federal financial participation under Title XIX of the social security act; (6) children and pregnant women allowed by federal statute for whom funding is appropriated; (7) other individuals eligible for medical services under RCW 74.09.035 and 74.09.700 for whom federal financial participation is available under Title XIX of the social security act.

The sum of one million eight hundred five thousand dollars, or as much thereof as may be necessary, of which nine hundred twenty-six thousand dollars shall be from federal funds, is appropriated from the state general fund for the biennium ending June 30, 1991, to the department of social and health services, community services administration program, for administration and claims processing activities associated with the medical assistance eligibility expansions prescribed in this act, and for prenatal case management and support services claims processing.

NEW SECTION. Sec. 7. EVALUATION. The department, within funds appropriated for this purpose, shall contract with an independent nonprofit entity to evaluate the effectiveness of the maternity care access program set forth in sections 1 through 5 of this act and RCW 74.09.510 based on the principles set forth in section 1 of this act.

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 existing programs for services.

The department shall submit an evaluation report to the appropriate committees of the legislature by December 1, 1990.

NEW SECTION. Sec. 8. PROHIBITION OF ENTITLEMENT. The legislature reserves the right to amend or repeal all or any part of this act at any time and there shall be no vested private right of any kind against such amendment or repeal. All rights, privileges, or immunities conferred by this act or any acts done pursuant thereto shall exist subject to the power of the legislature to amend or repeal this act at any time.

NEW SECTION. Sec. 9. Section headings as used in this act do not constitute any part of the law.

NEW SECTION. Sec. 10. Sections 1 through 5, 7, and 8 of this act are each added to chapter 74.09 RCW.