BP BHEAD INT H

AN ACT Relating to the department of corrections health care costs; creating new sections; and declaring an emergency.

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

NEW SECTION. Sec. 1. The legislature finds that Washington state government purchases approximately one-fourth of all the health care state-wide. In addition to this huge expenditure, the state also faces health care inflation rates, far exceeding the growth rate of the economy as a whole and the general inflationary rate. Together these factors are straining state resources beyond our capability to pay.

The legislature finds that the department of corrections is responsible for providing health care to a large and growing number of offenders. It is also facing rapidly escalating medical, dental, and mental health care expenditures. As a result of this, the department must review its entire inmate health care system and take steps to reduce health care expenditures.

The legislature further finds that efforts to achieve state-wide health care reform should also include the department of correction's health care facilities. In this light, the department must develop an appropriate plan that will correspond to the changing health care environment.

NEW SECTION. Sec. 2. (1) The department of corrections shall conduct a comprehensive review and analysis of their offender health care system including all its corresponding expenditures during the 1991-1993 biennium. The department shall provide data that includes but is not limited to:

(a) Mortality and morbidity rates by institution and state-wide, including monthly morbidity rates broken down by the type of morbidity, by age, sex, and ethnicity. The analysis shall include medical, dental, and mental health-related morbidity data.

(b) The frequency of offender medical, dental, pharmacy, mental health, and other ancillary services encounters for each department of corrections facility and system-wide. The data shall include both on-site and off-site encounters, and offender encounters that are the result of the offender being transferred to other facilities. Data shall include a breakdown of cost per encounter data for purchased services by type of consultant or contract professional and for services provided by department of corrections personnel. Analysis shall include a comprehensive analysis of all inpatient medical services in department of corrections facilities and community facilities, including, but not limited to, the number of admissions/transfers in, discharges/transfers out, inpatient days, and short stays.

(c) The average cost per encounter for medical, dental, and ancillary services provided in each facility and off-site, and an average cost per encounter system-wide. Total cost data for all encounters state-wide shall be included. Cost data shall be calculated three ways by using: Direct costs only; indirect costs only; and a combination of indirect and direct costs together. Indirect costs include, but are not limited to patient transportation costs.

(d) A complete inventory of both inpatient and outpatient medical, dental, and mental health facilities and equipment, including leased and rented facilities or equipment. The inventory shall include the itemized cost or value of all durable medical equipment in each facility and the age and expected, predicted, or recommended replacement date for equipment that has a replacement value above five hundred dollars. The inventory of department of corrections medical facilities shall include the square footage, design, and layout of the physical structure.

(e) An analysis of purchased medical, dental, and ancillary consultant or contract and noncontract services by institution and state-wide with a focus on the expenditures for these services in each corrections facility. The analysis shall include a comparison of expenditures for purchased on-site noncontracted costs per inmate, purchased on-site contracted costs per inmate, and the cost for nonpurchased on-site department of corrections provided health care services by institution and state-wide. A description of purchasing practices and the names of vendors.

(f) A comprehensive analysis of all pharmaceuticals prescribed for inmates, including the names of each pharmaceutical, average number of prescriptions per inmate per institution, total number of prescriptions used per facility and system-wide, the unit cost for each pharmaceutical, and total cost per corrections facility and system-wide.

(g) A description of the current capacity of each facility and the range of medical procedures that could be appropriately and professionally handled in the facility based on the equipment available and optimal staffing.

(h) A description and analysis of medical information systems capabilities for each facility and all facilities state-wide. The analysis shall include the type of patient data collected, how it is stored, how it is retrieved, how extensively electronic information systems are used, and their capabilities, including patient tracking and methods used to protect confidentiality.

(2) The analysis shall include, if and how, health care information is currently used proactively to address the need for staffing needs and the control of medically related costs.

(3) The department of corrections shall recommend actions that will safely and effectively control medical costs. Each cost control recommendation shall be accompanied by a realistic action plan. The plan shall include a time line, who will be effected, and expected fiscal savings. The recommendation shall also identify what aspects, if any, of the corrections health care system can be privatized as a cost savings to the department.

(4) The department shall gather appropriate data on all offenders and assess if the offenders medical care can be covered by third-party billing through their spouse or any other appropriate sources.

(5) The department of corrections shall identify all inmates that have a chronic health condition that requires twenty-four hour nursing level of care. The analysis shall also include for each offender: Description of health conditions, level of functional disability, expected prognosis, type and amount of health care provided, type of special housing needs or special accommodations required to maintain the offender, all health care costs per day, the crime the offender was incarcerated for, level of security risk, and the total costs for providing care for all of these offenders, including both direct and indirect costs. The department shall describe their protocol or procedures for handling such offenders and provide recommendations on consolidation, other care options, or administrative procedures that could reduce the cost of providing this level of care within correctional institutions.

(6) The department of corrections shall consult with the legislative budget committee on all aspects of the study design. The legislative budget committee shall also monitor and provide consultation on the implementation of the study and make comments on the final recommendations and actions plans made by the department of corrections. The department of corrections shall provide a final copy of their findings and recommendations, in addition to the comments and suggestions provided by the legislative budget committee, to appropriate committees of the legislature by December 12, 1993. The department of health shall review the final report and make recommendations on how the department of corrections health data system can be integrated with the department of health data system.

NEW SECTION. Sec. 3. The department of corrections shall consult with the state health care authority to identify how the department of corrections shall develop a working plan to correspond to the health care reform measures that require all departments to place all state purchased health services in a community-rated, single risk pool under the direct administrative authority of the state purchasing agent by July 1, 1997. The department of corrections shall report the findings to the chairs of the house of representatives health care committee and committee on corrections and the chairs of the senate committee on health and human services and the law and justice committee by December 12, 1993.

NEW SECTION. Sec. 4. 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.