AN ACT Relating to health care; amending RCW
70.47.010, 70.47.020, 70.47.030, 70.47.040, 70.47.060, 70.47.080, 41.05.011,
41.05.021, 41.05.050, 41.05.055, 41.05.065, 41.05.120, 41.05.140, 47.64.270,
74.09.055, 19.68.010, 70.05.010, 70.05.030, 70.05.040, 70.05.050, 70.05.070,
70.05.080, 70.05.120, 70.05.130, 70.05.150, 70.08.010, 70.12.030, 70.12.050,
70.46.020, 70.46.060, 70.46.080, 70.46.085, 70.46.090, 70.46.120, 82.44.110,
82.44.155, 43.20.030, 70.170.100, 70.170.110, 28B.125.010, 28B.115.080,
70.185.030, 43.70.460, 43.70.470, 48.30.300, 48.44.260, 48.46.380, 48.44.095,
48.14.080, 82.04.260, 82.04.4289, 82.24.020, 82.24.080, 82.26.020, 82.08.150,
66.24.290, 82.02.030, 43.70.320, 70.41.200, 70.41.230, 5.60.070, 4.22.070,
43.84.092, 42.17.2401, and 43.20.050; reenacting and amending RCW 28A.400.200,
28A.400.350, 48.21.200, and 48.46.080; adding a new section to chapter 70.47
RCW; adding new sections to chapter 41.05 RCW; adding a new section to Title 43
RCW; adding new sections to chapter 70.05 RCW; adding new sections to chapter
70.170 RCW; adding a new section to chapter 70.41 RCW; adding new sections to
chapter 18.68 RCW; adding a new section to chapter 18.51 RCW; adding new
sections to chapter 70.185 RCW; adding a new section to chapter 48.18 RCW;
adding a new section to chapter 48.20 RCW; adding a new section to chapter
48.21 RCW; adding new sections to chapter 48.44 RCW; adding new sections to
chapter 48.46 RCW; adding a new section to chapter 48.01 RCW; adding a new
section to chapter 48.14 RCW; adding a new section to chapter 82.04 RCW; adding
new sections to chapter 18.130 RCW; adding new sections to chapter 43.70 RCW;
adding a new section to chapter 48.22 RCW; adding a new section to chapter
48.05 RCW; adding new sections to chapter 7.70 RCW; adding a new chapter to
Title 43 RCW; adding new chapters to Title 48 RCW; creating new sections;
recodifying RCW 70.08.010; repealing RCW 70.05.005, 70.05.020, 70.05.132,
70.05.145, 70.12.005, 70.46.030, 70.46.040, 70.46.050, 48.46.160, 48.46.905,
48.44.410, and 82.04.4288; prescribing penalties; providing effective dates;
and declaring an emergency.
BE
IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
"TABLE
OF CONTENTS
PART I. FINDINGS, GOALS,
AND INTENT...................................................................................................................................
3
PART II. EARLY
IMPLEMENTATION MEASURES....................................................................................................................
5
A. BASIC HEALTH PLAN
EXPANSION..........................................................................................................................................
5
B. EXPANDED MANAGED CARE
FOR STATE EMPLOYEES.................................................................................................
19
C. CONSOLIDATED STATE
HEALTH CARE PURCHASING AGENT....................................................................................
32
D. HEALTH CARE PROVIDER
CONFLICT OF INTEREST STANDARDS............................................................................
37
E. PUBLIC HEALTH
FINANCING AND GOVERNANCE...........................................................................................................
38
F. DATA COLLECTION..........................................................................................................................................................................
51
G. DISCLOSURE OF
HOSPITAL, NURSING HOME, AND PHARMACY CHARGES..........................................................
57
H. HEALTH PROFESSIONAL
SHORTAGES.................................................................................................................................
60
I. SHORT-TERM HEALTH INSURANCE
REFORM.....................................................................................................................
72
PART III. TAXES....................................................................................................................................................................................
84
PART IV. HEALTH SYSTEM
REFORM..........................................................................................................................................
95
A. THE WASHINGTON HEALTH
SERVICES COMMISSION...................................................................................................
99
B. PRACTICE INDICATORS................................................................................................................................................................. 108
C. HEALTH CARE LIABILITY
REFORMS................................................................................................................................... 108
D. HEALTH INSURANCE
PURCHASING COOPERATIVES..................................................................................................... 122
E. CERTIFIED HEALTH PLANS..................................................................................................................................................... 125
F. MANAGED COMPETITION
AND LIMITED ANTI-TRUST IMMUNITY............................................................................ 144
G. THE UNIFORM BENEFITS
PACKAGE..................................................................................................................................... 148
H. STATE RESIDENT AND
EMPLOYER PARTICIPATION..................................................................................................... 160
I. PUBLIC HEALTH SERVICES
IMPROVEMENT PLAN......................................................................................................... 165
J. HEALTH ACCOUNTS....................................................................................................................................................................... 167
K. EXCLUSIONS AND STUDIES....................................................................................................................................................... 171
L. WORKERS' COMPENSATION....................................................................................................................................................... 177
M. MISCELLANEOUS........................................................................................................................................................................... 180
PART I. FINDINGS, GOALS, AND INTENT
NEW SECTION. Sec. 101.
FINDINGS. The legislature finds that
our health and financial security are jeopardized by our ever increasing demand
for health care and by current health insurance and health system practices.
Current health system practices encourage public demand for unneeded,
ineffective, and sometimes dangerous health treatments. These practices often
result in unaffordable cost increases that far exceed ordinary inflation for
essential care. Current total health care expenditure rates should be
sufficient to provide access to essential health care interventions to all
within a reformed, efficient system.
The legislature finds that too many of our
state's residents are without health insurance, that each year many individuals
and families are forced into poverty because of serious illness, and that many
must leave gainful employment to be eligible for publicly funded medical
services. Additionally, thousands of citizens are at risk of losing adequate
health insurance, have had insurance canceled recently, or cannot afford to
renew existing coverage.
The legislature finds that businesses find it
difficult to pay for health insurance and remain competitive in a global
economy, and that individuals, the poor, and small businesses bear an
inequitable health insurance burden.
The legislature finds that persons of color
have significantly higher rates of mortality and poor health outcomes, and
substantially lower numbers and percentages of persons covered by health
insurance than the general population. It is intended that chapter . . .,
Laws of 1993 (this act) make provisions to address the special health care
needs of these racial and ethnic populations in order to improve their health
status.
The legislature finds that uncontrolled demand
and expenditures for health care are eroding the ability of families,
businesses, communities, and governments to invest in other enterprises that
promote health, maintain independence, and ensure continued economic welfare.
Housing, nutrition, education, and the environment are all diminished as we
invest ever increasing shares of wealth in health care treatments.
The legislature finds that while immediate
steps must be taken, a long-term plan of reform is also needed.
NEW SECTION. Sec. 102.
LEGISLATIVE INTENT AND GOALS. (1) The legislature intends that state
government policy stabilize health services costs, assure access to essential
services for all residents, actively address the health care needs of persons
of color, improve the public's health, and reduce unwarranted health services
costs to preserve the viability of nonhealth care businesses.
(2) The legislature intends that:
(a) Total health services costs be stabilized
and kept within rates of increase similar to the rates of personal income
growth within a publicly regulated, private marketplace that preserves personal
choice;
(b) State residents be enrolled in the
certified health plan of their choice that meets state standards regarding
affordability, accessibility, cost-effectiveness, and clinical efficaciousness;
(c) State residents be able to choose health
services from the full range of health care providers, as defined in section
402(12) of this act, in a manner consistent with good health services
management, quality assurance, and cost effectiveness;
(d) Individuals and businesses have the option
to purchase any health services they may choose in addition to those included
in the uniform benefits package or supplemental benefits;
(e) All state residents, businesses, employees,
and government participate in payment for health services, with total costs to
individuals on a sliding scale based on income to encourage efficient and
appropriate utilization of services;
(f) These goals be accomplished within a
reformed system using private service providers and facilities in a way that
allows consumers to choose among competing plans operating within budget limits
and other regulations that promote the public good; and
(g) A policy of coordinating the delivery,
purchase, and provision of health services among the federal, state, local, and
tribal governments be encouraged and accomplished by chapter . . .,
Laws of 1993 (this act).
(3) Accordingly, the legislature intends that
chapter . . ., Laws of 1993 (this act) provide both early
implementation measures and a process for overall reform of the health services
system.
PART II. EARLY IMPLEMENTATION MEASURES
A. BASIC HEALTH PLAN EXPANSION
NEW SECTION. Sec. 201. A
new section is added to chapter 70.47 RCW to read as follows:
TRANSFER OF POWER AND DUTIES TO WASHINGTON
STATE HEALTH CARE AUTHORITY. The powers, duties, and functions of the
Washington basic health plan are hereby transferred to the Washington state
health care authority. All references to the administrator of the Washington
basic health plan in the Revised Code of Washington shall be construed to mean
the administrator of the Washington state health care authority.
NEW SECTION. Sec. 202.
TRANSFER OF RECORDS, EQUIPMENT, FUNDS. All reports, documents, surveys, books,
records, files, papers, or written material in the possession of the Washington
basic health plan shall be delivered to the custody of the Washington state
health care authority. All cabinets, furniture, office equipment, motor
vehicles, and other tangible property used by the Washington basic health plan
shall be made available to the Washington state health care authority. All
funds, credits, or other assets held by the Washington basic health plan shall
be assigned to the Washington state health care authority.
Any appropriations made to the Washington basic
health plan shall, on the effective date of this section, be transferred and
credited to the Washington state health care authority. At no time may those
funds in the basic health plan trust account, any funds appropriated for the
subsidy of any enrollees, or any premium payments or other sums made or
received on behalf of any enrollees in the basic health plan be commingled with
any appropriated funds designated or intended for the purposes of providing
health care coverage to any state or other public employees.
Whenever any question arises as to the transfer
of any personnel, funds, books, documents, records, papers, files, equipment,
or other tangible property used or held in the exercise of the powers and the
performance of the duties and functions transferred, the director of financial
management shall make a determination as to the proper allocation and certify
the same to the state agencies concerned.
NEW SECTION. Sec. 203.
TRANSFER OF EMPLOYEES. All employees of the Washington basic health plan are
transferred to the jurisdiction of the Washington state health care authority.
All employees classified under chapter 41.06 RCW, the state civil service law,
are assigned to the Washington state health care authority to perform their
usual duties upon the same terms as formerly, without any loss of rights,
subject to any action that may be appropriate thereafter in accordance with the
laws and rules governing state civil service.
NEW SECTION. Sec. 204.
RULES AND BUSINESS. All rules and all pending business before the Washington
basic health plan shall be continued and acted upon by the Washington state
health care authority. All existing contracts and obligations shall remain in
full force and shall be performed by the Washington state health care
authority.
NEW SECTION. Sec. 205.
VALIDITY OF PRIOR ACTS. The transfer of the powers, duties, functions, and
personnel of the Washington basic health plan shall not affect the validity of
any act performed prior to the effective date of this section.
NEW SECTION. Sec. 206.
APPORTIONMENT OF BUDGETED FUNDS. If apportionments of budgeted funds are
required because of the transfers directed by sections 201 through 205 of this
act, the director of financial management shall certify the apportionments to
the agencies affected, the state auditor, and the state treasurer. Each of
these shall make the appropriate transfer and adjustments in funds and
appropriation accounts and equipment records in accordance with the
certification.
NEW SECTION. Sec. 207.
COLLECTIVE BARGAINING. Nothing contained in sections 201 through 206 of this
act may be construed to alter any existing collective bargaining unit or the
provisions of any existing collective bargaining agreement until the agreement
has expired or until the bargaining unit has been modified by action of the
personnel board as provided by law.
Sec. 208.
RCW 70.47.010 and 1987 1st ex.s. c 5 s 3 are each amended to read as follows:
BASIC HEALTH PLAN‑-FINDINGS. (1) The
legislature finds that:
(a) A significant percentage of the population
of this state does not have reasonably available insurance or other coverage of
the costs of necessary basic health care services;
(b) This lack of basic health care coverage is
detrimental to the health of the individuals lacking coverage and to the public
welfare, and results in substantial expenditures for emergency and remedial
health care, often at the expense of health care providers, health care
facilities, and all purchasers of health care, including the state; and
(c) The use of managed health care systems has
significant potential to reduce the growth of health care costs incurred by the
people of this state generally, and by low-income pregnant women ((who are
an especially vulnerable population, along with their children)), and at-risk
children and adolescents who need greater access to managed health care.
(2) The purpose of this chapter is to provide or
make more readily available necessary basic health care services in an
appropriate setting to working persons and others who lack coverage, at a cost
to these persons that does not create barriers to the utilization of necessary
health care services. To that end, this chapter establishes a program to be
made available to those residents ((under sixty-five years of age)) not
((otherwise)) eligible for medicare ((with gross family income at or
below two hundred percent of the federal poverty guidelines)) who share in a
portion of the cost or who pay the full cost of receiving basic
health care services from a managed health care system.
(3) It is not the intent of this chapter to
provide health care services for those persons who are presently covered
through private employer-based health plans, nor to replace employer-based
health plans. However, the legislature recognizes that cost-effective and
affordable health plans may not always be available to small business
employers. Further, it is the intent of the legislature to expand,
wherever possible, the availability of private health care coverage and to
discourage the decline of employer-based coverage.
(4) ((The program authorized under this
chapter is strictly limited in respect to the total number of individuals who
may be allowed to participate and the specific areas within the state where it
may be established. All such restrictions or limitations shall remain in full
force and effect until quantifiable evidence based upon the actual operation of
the program, including detailed cost benefit analysis, has been presented to
the legislature and the legislature, by specific act at that time, may then
modify such limitations.))
(a) It is the purpose of this chapter to
acknowledge the initial success of this program that has (i) assisted thousands
of families in their search for affordable health care; (ii) demonstrated that
low-income, uninsured families are willing to pay for their own health care
coverage to the extent of their ability to pay; and (iii) proved that local
health care providers are willing to enter into a public-private partnership as
a managed care system.
(b) As a consequence, the legislature
intends to extend an option to enroll to certain citizens above two hundred
percent of the federal poverty guidelines within the state who reside in
communities where the plan is operational and who collectively or individually
wish to exercise the opportunity to purchase health care coverage through the
basic health plan if the purchase is done at no cost to the state. It is also
the intent of the legislature to allow employers and other financial sponsors
to financially assist such individuals to purchase health care through the
program so long as such purchase does not result in a lower standard of
coverage for employees.
(c) The legislature intends that, to the
extent of available funds, the program be available throughout Washington state
to subsidized and nonsubsidized enrollees. It is also the intent of the
legislature to enroll subsidized enrollees first, to the maximum extent
feasible.
(d) The legislature directs that the basic
health plan administrator identify enrollees who are likely to be eligible for
medical assistance and assist these individuals in applying for and receiving
medical assistance. The administrator and the department of social and health
services shall implement a seamless system to coordinate eligibility
determinations and benefit coverage for enrollees of the basic health plan and
medical assistance recipients.
Sec. 209.
RCW 70.47.020 and 1987 1st ex.s. c 5 s 4 are each amended to read as follows:
BASIC HEALTH PLAN‑-DEFINITIONS. As used
in this chapter:
(1) "Washington basic health plan" or
"plan" means the system of enrollment and payment on a prepaid
capitated basis for basic health care services, administered by the plan
administrator through participating managed health care systems, created by
this chapter.
(2) "Administrator" means the
Washington basic health plan administrator, who also holds the position of
administrator of the Washington state health care authority.
(3) "Managed health care system"
means any health care organization, including health care providers, insurers,
health care service contractors, health maintenance organizations, or any
combination thereof, that provides directly or by contract basic health care
services, as defined by the administrator and rendered by duly licensed
providers, on a prepaid capitated basis to a defined patient population
enrolled in the plan and in the managed health care system. On and after
July 1, 1995, "managed health care system" means a certified health
plan, as defined in section 402 of this act.
(4) "Subsidized enrollee"
means an individual, or an individual plus the individual's spouse ((and/or))
or dependent children, ((all under the age of sixty-five and))
not ((otherwise)) eligible for medicare, who resides in an area of the
state served by a managed health care system participating in the plan, whose
gross family income at the time of enrollment does not exceed twice the federal
poverty level as adjusted for family size and determined annually by the
federal department of health and human services, who the administrator
determines at the time of application does not have health insurance more
comprehensive than that offered by the plan, and who chooses to obtain
basic health care coverage from a particular managed health care system in
return for periodic payments to the plan.
(5) "Nonsubsidized enrollee" means
an individual, or an individual plus the individual's spouse or dependent
children, not eligible for medicare, who resides in an area of the state served
by a managed health care system participating in the plan, who the
administrator determines at the time of application does not have health
insurance more comprehensive than that offered by the plan, who chooses to
obtain basic health care coverage from a particular managed health care system,
and who pays or on whose behalf is paid the full costs for participation in the
plan, without any subsidy from the plan.
(6) "Subsidy" means the
difference between the amount of periodic payment the administrator makes((,
from funds appropriated from the basic health plan trust account,)) to a
managed health care system on behalf of ((an)) a subsidized
enrollee plus the administrative cost to the plan of providing the plan to
that subsidized enrollee, and the amount determined to be the subsidized
enrollee's responsibility under RCW 70.47.060(2).
(((6))) (7) "Premium"
means a periodic payment, based upon gross family income ((and determined
under RCW 70.47.060(2),)) which an ((enrollee)) individual, their
employer or another financial sponsor makes to the plan as consideration
for enrollment in the plan as a subsidized enrollee or a nonsubsidized
enrollee.
(((7))) (8) "Rate"
means the per capita amount, negotiated by the administrator with and paid to a
participating managed health care system, that is based upon the enrollment of subsidized
and nonsubsidized enrollees in the plan and in that system.
Sec. 210.
RCW 70.47.030 and 1992 c 232 s 907 are each amended to read as follows:
ACCOUNTS. (1) The basic health plan trust
account is hereby established in the state treasury. ((All)) Any
nongeneral fund-state funds collected for this program shall be deposited in
the basic health plan trust account and may be expended without further
appropriation. Moneys in the account shall be used exclusively for the
purposes of this chapter, including payments to participating managed health
care systems on behalf of enrollees in the plan and payment of costs of
administering the plan. ((After July 1, 1993, the administrator shall not
expend or encumber for an ensuing fiscal period amounts exceeding ninety-five
percent of the amount anticipated to be spent for purchased services during the
fiscal year.))
(2) The basic health plan subscription
account is created in the custody of the state treasurer. All receipts from
amounts due from or on behalf of nonsubsidized enrollees shall be deposited
into the account. Funds in the account shall be used exclusively for the
purposes of this chapter, including payments to participating managed health
care systems on behalf of nonsubsidized enrollees in the plan and payment of
costs of administering the plan. The account is subject to allotment
procedures under chapter 43.88 RCW, but no appropriation is required for
expenditures.
(3) The administrator shall take every
precaution to see that none of the funds in the separate accounts created in
this section or that any premiums paid either by subsidized or nonsubsidized
enrollees are commingled in any way, except that the administrator may combine
funds designated for administration of the plan into a single administrative
account.
Sec. 211.
RCW 70.47.040 and 1987 1st ex.s. c 5 s 6 are each amended to read as follows:
BASIC HEALTH PLAN--PROGRAM WITHIN STATE HEALTH
CARE AUTHORITY. (1) The Washington basic health plan is created as ((an
independent agency of the state)) a program within the Washington state
health care authority. The administrative head and appointing authority of
the plan shall be the administrator ((who shall be appointed by the
governor, with the consent of the senate, and shall serve at the pleasure of
the governor. The salary for this office shall be set by the governor pursuant
to RCW 43.03.040)) of the Washington state health care authority.
The administrator shall appoint a medical director. The ((administrator,))
medical director((,)) and up to five other employees of the plan
shall be exempt from the civil service law, chapter 41.06 RCW.
(2) The administrator shall employ such other
staff as are necessary to fulfill the responsibilities and duties of the
administrator, such staff to be subject to the civil service law, chapter 41.06
RCW. In addition, the administrator may contract with third parties for
services necessary to carry out its activities where this will promote economy,
avoid duplication of effort, and make best use of available expertise. Any
such contractor or consultant shall be prohibited from releasing, publishing,
or otherwise using any information made available to it under its contractual
responsibility without specific permission of the plan. The administrator may
call upon other agencies of the state to provide available information as
necessary to assist the administrator in meeting its responsibilities under
this chapter, which information shall be supplied as promptly as circumstances
permit.
(3) The administrator may appoint such
technical or advisory committees as he or she deems necessary. The
administrator shall appoint a standing technical advisory committee that is
representative of health care professionals, health care providers, and those
directly involved in the purchase, provision, or delivery of health care
services, as well as consumers and those knowledgeable of the ethical issues
involved with health care public policy. Individuals appointed to any
technical or other advisory committee shall serve without compensation for
their services as members, but may be reimbursed for their travel expenses pursuant
to RCW 43.03.050 and 43.03.060.
(4) The administrator may apply for, receive,
and accept grants, gifts, and other payments, including property and service,
from any governmental or other public or private entity or person, and may make
arrangements as to the use of these receipts, including the undertaking of
special studies and other projects relating to health care costs and access to
health care.
(5) ((In the design, organization, and
administration of the plan under this chapter, the administrator shall consider
the report of the Washington health care project commission established under
chapter 303, Laws of 1986. Nothing in this chapter requires the administrator
to follow any specific recommendation contained in that report except as it may
also be included in this chapter or other law)) Whenever feasible, the
administrator shall reduce the administrative cost of operating the program by
adopting joint policies or procedures applicable to both the basic health plan
and employee health plans.
Sec. 212.
RCW 70.47.060 and 1992 c 232 s 908 are each amended to read as follows:
ADMINISTRATOR'S POWERS AND DUTIES. The
administrator has the following powers and duties:
(1) To design and from time to time revise a
schedule of covered basic health care services, including physician services,
inpatient and outpatient hospital services, prescription drugs and
medications, and other services that may be necessary for basic health
care, which subsidized and nonsubsidized enrollees in any participating
managed health care system under the Washington basic health plan shall be
entitled to receive in return for premium payments to the plan. The schedule
of services shall emphasize proven preventive and primary health care and shall
include all services necessary for prenatal, postnatal, and well-child care.
However, ((for the period ending June 30, 1993,)) with respect to
coverage for groups of subsidized enrollees who are eligible to receive
prenatal and postnatal services through the medical assistance program under
chapter 74.09 RCW, the administrator shall not contract for ((prenatal
or postnatal)) such services ((that are provided under the
medical assistance program under chapter 74.09 RCW)) except to the extent
that such services are necessary over not more than a one-month period in order
to maintain continuity of care after diagnosis of pregnancy by the managed care
provider((, or except to provide any such services associated with
pregnancies diagnosed by the managed care provider before July 1, 1992)).
The schedule of services shall also include a separate schedule of basic health
care services for children, eighteen years of age and younger, for those subsidized
or nonsubsidized enrollees who choose to secure basic coverage through the
plan only for their dependent children. In designing and revising the schedule
of services, the administrator shall consider the guidelines for assessing
health services under the mandated benefits act of 1984, RCW 48.42.080, and
such other factors as the administrator deems appropriate. On and after
July 1, 1995, the uniform benefits package adopted and from time to time
revised by the Washington health services commission pursuant to section 449 of
this act shall be implemented by the administrator as the schedule of covered
basic health care services. However, with respect to coverage for subsidized
enrollees who are eligible to receive prenatal and postnatal services through
the medical assistance program under chapter 74.09 RCW, the administrator shall
not contract for such services except to the extent that the services are
necessary over not more than a one-month period in order to maintain continuity
of care after diagnosis of pregnancy by the managed care provider.
(2)(a) To design and implement a
structure of periodic premiums due the administrator from subsidized
enrollees that is based upon gross family income, giving appropriate
consideration to family size ((as well as)) and the ages of all
family members. The enrollment of children shall not require the enrollment of
their parent or parents who are eligible for the plan. The structure of
periodic premiums shall be applied to subsidized enrollees entering the plan as
individuals pursuant to subsection (9) of this section and to the share of the
cost of the plan due from subsidized enrollees entering the plan as employees
pursuant to subsection (10) of this section.
(b) To determine the periodic premiums due
the administrator from nonsubsidized enrollees. Premiums due from
nonsubsidized enrollees shall be in an amount equal to the cost charged by the
managed health care system provider to the state for the plan plus the
administrative cost of providing the plan to those enrollees and the
appropriate premium tax as provided by law.
(c) An employer or other financial sponsor
may, with the prior approval of the administrator, pay the premium, rate, or
any other amount on behalf of a subsidized or nonsubsidized enrollee, by
arrangement with the enrollee and through a mechanism acceptable to the
administrator, but in no case shall the payment made on behalf of the enrollee
exceed the total premiums due from the enrollee.
(3) To design and implement a structure of ((nominal))
copayments due a managed health care system from subsidized and
nonsubsidized enrollees. The structure shall discourage inappropriate
enrollee utilization of health care services, but shall not be so costly to
enrollees as to constitute a barrier to appropriate utilization of necessary
health care services. On and after July 1, 1995, the administrator shall
endeavor to make the copayments structure of the plan consistent with enrollee
point of service cost-sharing levels adopted by the Washington health services
commission, giving consideration to funding available to the plan.
(4) ((To design and implement, in concert
with a sufficient number of potential providers in a discrete area, an enrollee
financial participation structure, separate from that otherwise established
under this chapter, that has the following characteristics:
(a) Nominal premiums that are based upon
ability to pay, but not set at a level that would discourage enrollment;
(b) A modified fee-for-services payment
schedule for providers;
(c) Coinsurance rates that are established
based on specific service and procedure costs and the enrollee's ability to pay
for the care. However, coinsurance rates for families with incomes below one
hundred twenty percent of the federal poverty level shall be nominal. No
coinsurance shall be required for specific proven prevention programs, such as
prenatal care. The coinsurance rate levels shall not have a measurable
negative effect upon the enrollee's health status; and
(d) A case management system that fosters a
provider-enrollee relationship whereby, in an effort to control cost, maintain
or improve the health status of the enrollee, and maximize patient involvement
in her or his health care decision-making process, every effort is made by the
provider to inform the enrollee of the cost of the specific services and
procedures and related health benefits.
The potential financial liability of the plan
to any such providers shall not exceed in the aggregate an amount greater than
that which might otherwise have been incurred by the plan on the basis of the
number of enrollees multiplied by the average of the prepaid capitated rates
negotiated with participating managed health care systems under RCW 70.47.100
and reduced by any sums charged enrollees on the basis of the coinsurance rates
that are established under this subsection.
(5)))
To limit enrollment of persons who qualify for subsidies so as to prevent an
overexpenditure of appropriations for such purposes. Whenever the
administrator finds that there is danger of such an overexpenditure, the administrator
shall close enrollment until the administrator finds the danger no longer
exists.
(5) To limit the payment of subsidies to
subsidized enrollees, as defined in RCW 70.47.020.
(6) To adopt a schedule for the orderly
development of the delivery of services and availability of the plan to
residents of the state, subject to the limitations contained in RCW 70.47.080 or
any act appropriating funds for the plan.
((In the selection of any area of the state
for the initial operation of the plan, the administrator shall take into
account the levels and rates of unemployment in different areas of the state,
the need to provide basic health care coverage to a population reasonably
representative of the portion of the state's population that lacks such coverage,
and the need for geographic, demographic, and economic diversity.
Before July 1, 1988, the administrator shall
endeavor to secure participation contracts with managed health care systems in
discrete geographic areas within at least five congressional districts.))
(7) To solicit and accept applications from
managed health care systems, as defined in this chapter, for inclusion as
eligible basic health care providers under the plan. The administrator shall
endeavor to assure that covered basic health care services are available to any
enrollee of the plan from among a selection of two or more participating
managed health care systems. In adopting any rules or procedures applicable to
managed health care systems and in its dealings with such systems, the
administrator shall consider and make suitable allowance for the need for
health care services and the differences in local availability of health care
resources, along with other resources, within and among the several areas of
the state. Contracts with participating managed health care systems shall
ensure that basic health plan enrollees who become eligible for medical
assistance may, at their option, continue to receive services from their
existing providers within the managed health care system if such providers have
entered into provider agreements with the department of social and health
services.
(8) To receive periodic premiums from or on
behalf of subsidized and nonsubsidized enrollees, deposit them in the basic
health plan operating account, keep records of enrollee status, and authorize
periodic payments to managed health care systems on the basis of the number of
enrollees participating in the respective managed health care systems.
(9) To accept applications from individuals
residing in areas served by the plan, on behalf of themselves and their spouses
and dependent children, for enrollment in the Washington basic health plan as
subsidized or nonsubsidized enrollees, to establish appropriate
minimum-enrollment periods for enrollees as may be necessary, and to determine,
upon application and at least ((annually)) semiannually
thereafter, or at the request of any enrollee, eligibility due to current gross
family income for sliding scale premiums. ((An enrollee who remains current
in payment of the sliding-scale premium, as determined under subsection (2) of
this section, and whose gross family income has risen above twice the federal
poverty level, may continue enrollment unless and until the enrollee's gross
family income has remained above twice the poverty level for six consecutive
months, by making payment at the unsubsidized rate required for the managed
health care system in which he or she may be enrolled.)) No subsidy may be
paid with respect to any enrollee whose current gross family income exceeds
twice the federal poverty level or, subject to RCW 70.47.110, who is a
recipient of medical assistance or medical care services under chapter 74.09
RCW. If, as a result of an eligibility review, the administrator determines
that a subsidized enrollee's income exceeds twice the federal poverty level and
that the enrollee knowingly failed to inform the plan of such increase in
income, the administrator may bill the enrollee for the subsidy paid on the
enrollee's behalf during the period of time that the enrollee's income exceeded
twice the federal poverty level. If a number of enrollees drop their
enrollment for no apparent good cause, the administrator may establish
appropriate rules or requirements that are applicable to such individuals before
they will be allowed to re-enroll in the plan.
(10) To accept applications from business
owners on behalf of themselves and their employees, spouses, and dependent
children, as subsidized or nonsubsidized enrollees, who reside in an area
served by the plan. The administrator may require all or the substantial
majority of the eligible employees of such businesses to enroll in the plan and
establish those procedures necessary to facilitate the orderly enrollment of
groups in the plan and into a managed health care system. The administrator
shall require that a business owner pay at least fifty percent of the
nonsubsidized premium cost of the plan on behalf of each employee enrolled in
the plan. Enrollment is limited to those not eligible for medicare who wish to
enroll in the plan and choose to obtain the basic health care coverage and
services from a managed care system participating in the plan. The
administrator shall adjust the amount determined to be due on behalf of or from
all such enrollees whenever the amount negotiated by the administrator with the
participating managed health care system or systems is modified or the
administrative cost of providing the plan to such enrollees changes.
(11) To determine the rate to be paid to
each participating managed health care system in return for the provision of
covered basic health care services to enrollees in the system. Although the
schedule of covered basic health care services will be the same for similar
enrollees, the rates negotiated with participating managed health care systems
may vary among the systems. In negotiating rates with participating systems,
the administrator shall consider the characteristics of the populations served
by the respective systems, economic circumstances of the local area, the need
to conserve the resources of the basic health plan trust account, and other
factors the administrator finds relevant.
(((11))) (12) To monitor the
provision of covered services to enrollees by participating managed health
care systems in order to assure enrollee access to good quality basic health
care, to require periodic data reports concerning the utilization of health
care services rendered to enrollees in order to provide adequate information
for evaluation, and to inspect the books and records of participating managed
health care systems to assure compliance with the purposes of this chapter. In
requiring reports from participating managed health care systems, including
data on services rendered enrollees, the administrator shall endeavor to
minimize costs, both to the managed health care systems and to the ((administrator))
plan. The administrator shall coordinate any such reporting
requirements with other state agencies, such as the insurance commissioner and
the department of health, to minimize duplication of effort.
(((12) To monitor the access that state
residents have to adequate and necessary health care services, determine the
extent of any unmet needs for such services or lack of access that may exist
from time to time, and make such reports and recommendations to the legislature
as the administrator deems appropriate.))
(13) To evaluate the effects this chapter has
on private employer-based health care coverage and to take appropriate measures
consistent with state and federal statutes that will discourage the reduction
of such coverage in the state.
(14) To develop a program of proven preventive
health measures and to integrate it into the plan wherever possible and consistent
with this chapter.
(15) To provide, consistent with available ((resources,
technical)) funding, assistance for rural ((health activities
that endeavor to develop needed health care services in rural parts of the
state)) residents, underserved populations, and persons of color.
Sec. 213.
RCW 70.47.080 and 1987 1st ex.s. c 5 s 10 are each amended to read as follows:
ENROLLMENT. On and after July 1, 1988, the
administrator shall accept for enrollment applicants eligible to receive
covered basic health care services from the respective managed health care
systems which are then participating in the plan. ((The administrator shall
not allow the total enrollment of those eligible for subsidies to exceed thirty
thousand.))
Thereafter, total ((enrollment shall not
exceed the number established by the legislature in any act appropriating funds
to the plan.
Before July 1, 1988, the administrator shall
endeavor to secure participation contracts from managed health care systems in
discrete geographic areas within at least five congressional districts of the
state and in such manner as to allow residents of both urban and rural areas
access to enrollment in the plan. The administrator shall make a special
effort to secure agreements with health care providers in one such area that
meets the requirements set forth in RCW 70.47.060(4))) subsidized enrollment shall not result in
expenditures that exceed the total amount that has been made available by the
legislature in any act appropriating funds to the plan. To the extent that new
funding is appropriated for expansion, the administrator shall endeavor to
secure participation contracts from managed health care systems in geographic
areas of the state that are unserved by the plan at the time at which the new
funding is appropriated. In the selection of any such areas the administrator
shall take into account the levels and rates of unemployment in different areas
of the state, the need to provide basic health care coverage to a population
reasonably representative of the portion of the state's population that lacks
such coverage, and the need for geographic, demographic, and economic diversity.
The administrator shall at all times closely
monitor growth patterns of enrollment so as not to exceed that consistent with
the orderly development of the plan as a whole, in any area of the state or in
any participating managed health care system. The annual or biennial
enrollment limitations derived from operation of the plan under this section do
not apply to nonsubsidized enrollees as defined in RCW 70.47.020(5).
B. EXPANDED MANAGED CARE FOR STATE EMPLOYEES
Sec. 214.
RCW 41.05.011 and 1990 c 222 s 2 are each amended to read as follows:
DEFINITIONS. Unless the context clearly
requires otherwise, the definitions in this section shall apply throughout this
chapter.
(1) "Administrator" means the
administrator of the authority.
(2) "State purchased health care" or
"health care" means medical and health care, pharmaceuticals, and
medical equipment purchased with state and federal funds by the department of
social and health services, the department of health, the basic health plan,
the state health care authority, the department of labor and industries, the
department of corrections, the department of veterans affairs, and local school
districts.
(3) "Authority" means the Washington
state health care authority.
(4) "Insuring entity" means an ((insurance
carrier as defined in chapter 48.21 or 48.22)) insurer as defined in
chapter 48.01 RCW, a health care service contractor as defined in chapter
48.44 RCW, or a health maintenance organization as defined in chapter 48.46
RCW. On and after July 1, 1995, "insuring entity" means a
certified health plan, as defined in section 402 of this act.
(5) "Flexible benefit plan" means a
benefit plan that allows employees to choose the level of health care coverage
provided and the amount of employee contributions from among a range of choices
offered by the authority.
(6) "Employee" includes all full-time
and career seasonal employees of the state, whether or not covered by civil
service; elected and appointed officials of the executive branch of government,
including full-time members of boards, commissions, or committees; and includes
any or all part-time and temporary employees under the terms and conditions
established under this chapter by the authority; justices of the supreme court
and judges of the court of appeals and the superior courts; and members of the
state legislature or of the legislative authority of any county, city, or town
who are elected to office after February 20, 1970. "Employee" also
includes: (a) By October 1, 1995, all employees of school districts.
Between October 1, 1994, and September 30, 1995, "employee" includes
employees of those school districts for whom the authority has undertaken the
purchase of insurance benefits. The transition to insurance benefits
purchasing by the authority may not disrupt existing insurance contracts
between school district employees and insurers. However, except to the extent
provided in RCW 28A.400.200, any such contract that provides for health
insurance benefits coverage after October 1, 1995, shall be void as of that
date if the contract was entered into, renewed, or extended after July 1,
1993. Prior to October 1, 1994, "employee" includes employees of a
school district if the board of directors of the school district seeks and
receives the approval of the authority to provide any of its insurance programs
by contract with the authority; (b) employees of a county, municipality, or
other political subdivision of the state if the legislative authority of the
county, municipality, or other political subdivision of the state seeks and
receives the approval of the authority to provide any of its insurance programs
by contract with the authority, as provided in RCW 41.04.205((, and
employees of a school district if the board of directors of the school district
seeks and receives the approval of the authority to provide any of its
insurance programs by contract with the authority as provided in RCW
28A.400.350)); (c) employees of employee organizations representing
state civil service employees, at the option of each such employee
organization, and, effective October 1, 1995, employees of employee
organizations currently pooled with employees of school districts for the
purpose of purchasing insurance benefits, at the option of each such employee
organization.
(7) "Board" means the ((state))
public employees' benefits board established under RCW 41.05.055.
Sec. 215.
RCW 41.05.021 and 1990 c 222 s 3 are each amended to read as follows:
HEALTH CARE AUTHORITY DUTIES. (1) The
Washington state health care authority is created within the executive branch.
The authority shall have an administrator appointed by the governor, with the
consent of the senate. The administrator shall serve at the pleasure of the
governor. The administrator may employ up to seven staff members, who shall be
exempt from chapter 41.06 RCW, and any additional staff members as are
necessary to administer this chapter. The primary duties of the authority
shall be to administer state employees' insurance benefits ((and to)),
study state-purchased health care programs in order to maximize cost
containment in these programs while ensuring access to quality health care,
and implement state initiatives, joint purchasing strategies, and techniques
for efficient administration that have potential application to all
state-purchased health services. The authority's duties include, but are
not limited to, the following:
(((1))) (a) To administer a
health care benefit program for employees as specifically authorized in RCW
41.05.065 and in accordance with the methods described in RCW 41.05.075,
41.05.140, and other provisions of this chapter;
(((2))) (b) To analyze state-purchased
health care programs and to explore options for cost containment and delivery
alternatives for those programs that are consistent with the purposes of those
programs, including, but not limited to:
(((a))) (i) Creation of economic
incentives for the persons for whom the state purchases health care to
appropriately utilize and purchase health care services, including the
development of flexible benefit plans to offset increases in individual
financial responsibility;
(((b))) (ii) Utilization of provider
arrangements that encourage cost containment ((and ensure access to quality
care)), including but not limited to prepaid delivery systems, utilization
review, and prospective payment methods, and that ensure access to quality
care, including assuring reasonable access to local providers, especially for
employees residing in rural areas;
(((c))) (iii) Coordination of
state agency efforts to purchase drugs effectively as provided in RCW
70.14.050;
(((d))) (iv) Development of
recommendations and methods for purchasing medical equipment and supporting
services on a volume discount basis; and
(((e))) (v) Development of data
systems to obtain utilization data from state-purchased health care programs in
order to identify cost centers, utilization patterns, provider and hospital
practice patterns, and procedure costs, utilizing the information obtained
pursuant to RCW 41.05.031;
(((3))) (c) To analyze areas of
public and private health care interaction;
(((4))) (d) To provide
information and technical and administrative assistance to the board;
(((5))) (e) To review and approve
or deny applications from counties, municipalities, and other political
subdivisions of the state((, and school districts)) to provide state-sponsored
insurance or self-insurance programs to their employees in accordance with the
provisions of RCW 41.04.205 ((and 28A.400.350)), setting the premium
contribution for approved groups as outlined in RCW 41.05.050;
(((6))) (f) To appoint a health care
policy technical advisory committee as required by RCW 41.05.150; and
(((7))) (g) To promulgate and
adopt rules consistent with this chapter as described in RCW 41.05.160.
(2) The public employees' benefits board
shall implement strategies to promote managed competition among employee health
benefit plans by January 1, 1995, including but not limited to:
(a) Standardizing the benefit package;
(b) Soliciting competitive bids for the
benefit package;
(c) Limiting the state's contribution to a
percent of the lowest priced sealed bid of a qualified plan within a
geographical area. If the state's contribution is less than one hundred
percent of the lowest priced sealed bid, employee financial contributions shall
be structured on a sliding-scale basis related to household income;
(d) Monitoring the impact of the approach
under this subsection with regards to: Efficiencies in health service
delivery, cost shifts to subscribers, access to and choice of managed care
plans state-wide, and quality of health services. The health care authority
shall also advise on the value of administering a benchmark employer-managed
plan to promote competition among managed care plans. The health care
authority shall report its findings and recommendations to the legislature by
January 1, 1997.
Sec. 216.
RCW 41.05.050 and 1988 c 107 s 18 are each amended to read as follows:
FERRY EMPLOYEES. (1) Every department,
division, or separate agency of state government, and such county, municipal,
or other political subdivisions as are covered by this chapter, shall provide
contributions to insurance and health care plans for its employees and their
dependents, the content of such plans to be determined by the authority.
Contributions, paid by the county, the municipality, or other political
subdivision for their employees, shall include an amount determined by the
authority to pay such administrative expenses of the authority as are necessary
to administer the plans for employees of those groups. All such contributions
will be paid into the ((state)) public employees' health
insurance account.
(2) The contributions of any department,
division, or separate agency of the state government, and such county,
municipal, or other political subdivisions as are covered by this chapter,
shall be set by the authority, subject to the approval of the governor for
availability of funds as specifically appropriated by the legislature for that
purpose. ((However,)) Insurance and health care contributions
for ferry employees shall be governed by RCW 47.64.270 until December 31,
1996. On and after January 1, 1997, ferry employees shall enroll with
certified health plans under chapter . . ., Laws of 1993 (this act).
(3) The administrator with the assistance of
the ((state)) public employees' benefits board shall survey
private industry and public employers in the state of Washington to determine
the average employer contribution for group insurance programs under the
jurisdiction of the authority. Such survey shall be conducted during each
even-numbered year but may be conducted more frequently. The survey shall be
reported to the authority for its use in setting the amount of the recommended
employer contribution to the employee insurance benefit program covered by this
chapter. The authority shall transmit a recommendation for the amount of the
employer contribution to the governor and the director of financial management
for inclusion in the proposed budgets submitted to the legislature.
Sec. 217.
RCW 41.05.055 and 1989 c 324 s 1 are each amended to read as follows:
PUBLIC EMPLOYEES' BENEFITS BOARD‑-SCHOOL
DISTRICT EMPLOYEES. (1) The ((state)) public employees' benefits
board is created within the authority. The function of the board is to design
and approve insurance benefit plans for state employees and school district
employees.
(2) Effective January 1, 1995, the board
shall be composed of ((seven)) nine members appointed by the
governor as follows:
(a) ((Three)) Two representatives
of state employees, ((one of whom shall represent an employee association
certified as exclusive representative of at least one bargaining unit of
classified employees,)) one of whom shall represent an employee union
certified as exclusive representative of at least one bargaining unit of
classified employees, and one of whom is retired, is covered by a program under
the jurisdiction of the board, and represents an organized group of retired
public employees;
(b) Two representatives of school district
employees, one of whom shall represent an association of school employees and
one of whom is retired, and represents an organized group of retired school
employees;
((Three)) (c) Four members with
experience in health benefit management and cost containment; and
(((c))) (d) The administrator.
Prior to January 1, 1995, the composition of
the public employees benefits board shall reflect its composition on January 1,
1993.
(3) The governor shall appoint the initial
members of the board to staggered terms not to exceed four years. Members
appointed thereafter shall serve two-year terms. Members of the board shall be
compensated in accordance with RCW 43.03.250 and shall be reimbursed for their
travel expenses while on official business in accordance with RCW 43.03.050 and
43.03.060. The board shall prescribe rules for the conduct of its business.
The administrator shall serve as chair of the board. Meetings of the board
shall be at the call of the chair.
Sec. 218.
RCW 41.05.065 and 1988 c 107 s 8 are each amended to read as follows:
EMPLOYEE BENEFIT PLANS‑-STANDARDS. (1)
The board shall study all matters connected with the provision of health care
coverage, life insurance, liability insurance, accidental death and
dismemberment insurance, and disability income insurance or any of, or a
combination of, the enumerated types of insurance for employees and their
dependents on the best basis possible with relation both to the welfare of the
employees and to the state((: PROVIDED, That)), however
liability insurance shall not be made available to dependents.
(2) The ((state)) public
employees' benefits board shall develop employee benefit plans that include
comprehensive health care benefits for all employees. In developing these
plans, the board shall consider the following elements:
(a) Methods of maximizing cost containment
while ensuring access to quality health care;
(b) Development of provider arrangements that
encourage cost containment and ensure access to quality care, including but not
limited to prepaid delivery systems and prospective payment methods;
(c) Wellness incentives that focus on proven
strategies, such as smoking cessation, exercise, ((and)) automobile and
motorcycle safety, blood cholesterol reduction, and nutrition education;
(d) Utilization review procedures including,
but not limited to prior authorization of services, hospital inpatient length
of stay review, requirements for use of outpatient surgeries and second
opinions for surgeries, review of invoices or claims submitted by service
providers, and performance audit of providers; ((and))
(e) Effective coordination of benefits;
(f) Minimum standards for insuring entities;
and
(g) Minimum scope and content of standard
benefit plans to be offered to enrollees participating in the employee health
benefit plans. On and after July 1, 1995, the uniform benefits package shall
constitute the minimum level of health benefits offered to employees. To
maintain the comprehensive nature of employee health care benefits, employee
eligibility criteria related to the number of hours worked and the benefits
provided to employees shall be substantially equivalent to the state employees'
health benefits plan and eligibility criteria in effect on January 1, 1993.
(3) The board shall design benefits and
determine the terms and conditions of employee participation and coverage,
including establishment of eligibility criteria.
(4) The board shall attempt to achieve
enrollment of all employees and retirees in managed health care systems by July
1994.
The board may authorize premium contributions
for an employee and the employee's dependents in a manner that encourages
the use of cost-efficient managed health care systems. ((Such
authorization shall require a vote of five members of the board for approval.))
(5) Employees ((may)) shall
choose participation in ((only)) one of the health care benefit plans
developed by the board.
(6) The board shall review plans proposed by
insurance carriers that desire to offer property insurance and/or accident and
casualty insurance to state employees through payroll deduction. The board may
approve any such plan for payroll deduction by carriers holding a valid
certificate of authority in the state of Washington and which the board
determines to be in the best interests of employees and the state. The board
shall promulgate rules setting forth criteria by which it shall evaluate the
plans.
Sec. 219.
RCW 41.05.120 and 1991 sp.s. c 13 s 100 are each amended to read as follows:
PUBLIC EMPLOYEES' INSURANCE ACCOUNT. (1) The
((state)) public employees' insurance account is hereby
established in the custody of the state treasurer, to be used by the
administrator for the deposit of contributions, reserves, dividends, and
refunds, and for payment of premiums for employee insurance benefit contracts.
Moneys from the account shall be disbursed by the state treasurer by warrants
on vouchers duly authorized by the administrator.
(2) The state treasurer and the state
investment board may invest moneys in the ((state)) public
employees' insurance account. All such investments shall be in accordance with
RCW 43.84.080 or 43.84.150, whichever is applicable. The administrator shall
determine whether the state treasurer or the state investment board or both
shall invest moneys in the ((state)) public employees' insurance
account.
Sec. 220.
RCW 41.05.140 and 1988 c 107 s 12 are each amended to read as follows:
PUBLIC EMPLOYEES' INSURANCE RESERVE FUND. (1)
The authority may self-fund or self-insure for public employees' benefits
plans, but shall also enter into other methods of providing insurance coverage
for insurance programs under its jurisdiction except property and casualty
insurance. The authority shall contract for payment of claims or other
administrative services for programs under its jurisdiction. If a program does
not require the prepayment of reserves, the authority shall establish such
reserves within a reasonable period of time for the payment of claims as are
normally required for that type of insurance under an insured program.
Reserves established by the authority shall be held in a separate trust fund by
the state treasurer and shall be known as the ((state)) public
employees' insurance reserve fund. The state investment board shall act as the
investor for the funds and, except as provided in RCW 43.33A.160, one hundred
percent of all earnings from these investments shall accrue directly to the ((state))
public employees' insurance reserve fund.
(2) Any savings realized as a result of a
program created under this section shall not be used to increase benefits
unless such use is authorized by statute.
(3) Any program created under this section
shall be subject to the examination requirements of chapter 48.03 RCW as if the
program were a domestic insurer. In conducting an examination, the
commissioner shall determine the adequacy of the reserves established for the
program.
(4) The authority shall keep full and adequate
accounts and records of the assets, obligations, transactions, and affairs of
any program created under this section.
(5) The authority shall file a quarterly
statement of the financial condition, transactions, and affairs of any program
created under this section in a form and manner prescribed by the insurance
commissioner. The statement shall contain information as required by the
commissioner for the type of insurance being offered under the program. A copy
of the annual statement shall be filed with the speaker of the house of
representatives and the president of the senate.
NEW SECTION. Sec. 221. A
new section is added to chapter 41.05 RCW to read as follows:
MEDICARE SUPPLEMENTAL BENEFITS. The
administrator, in consultation with the public employees' benefits board, shall
design a self-insured medicare supplemental insurance plan for retired and
disabled employees eligible for medicare. For the purpose of determining the
appropriate scope of the self-funded medicare supplemental plan, the
administrator shall consider the differences in the scope of health services
available under the uniform benefits package and the medicare program. The
proposed plan shall be submitted to appropriate committees of the legislature
by December 1, 1993.
NEW SECTION. Sec. 222. A
new section is added to chapter 41.05 RCW to read as follows:
MEDICARE SUPPLEMENTAL BENEFITS.
Notwithstanding any other provisions of this title or rules or procedures
adopted by the authority, the authority shall make available to retired or
disabled employees who are eligible for medicare at least two medicare
supplemental insurance policies that conform to the requirements of chapter
48.66 RCW. One policy shall include coverage for prescription drugs. The
policies shall be chosen in consultation with the public employees' benefits
board. These policies shall be made available to retired or disabled
employees, or employees of county, municipal, or other political subdivisions
eligible for coverage available under the authority. All offerings shall be
made available not later than January 1, 1994.
NEW SECTION. Sec. 223. A
new section is added to chapter 41.05 RCW to read as follows:
MEDICARE SUPPLEMENTAL BENEFITS. If a waiver of
the medicare statute, Title XVIII of the federal social security act,
sufficient to meet the requirements of chapter . . ., Laws of 1993
(this act) is not granted on or before January 1, 1995, the medicare
supplemental insurance policies authorized under section 222 of this act shall
be made available to any resident of the state eligible for medicare benefits.
Except for those retired state or school district employees eligible to
purchase medicare supplemental benefits through the authority, persons
purchasing a medicare supplemental insurance policy under this section shall be
required to pay the full cost of any such policy.
Sec. 224.
RCW 47.64.270 and 1988 c 107 s 21 are each amended to read as follows:
FERRY EMPLOYEES‑-ENROLLMENT IN CERTIFIED
HEALTH PLANS. Until December 31, 1996, absent a collective bargaining
agreement to the contrary, the department of transportation shall provide
contributions to insurance and health care plans for ferry system employees and
dependents, as determined by the state health care authority, under chapter
41.05 RCW((.)); and the ferry system management and employee
organizations may collectively bargain for other insurance and health care
plans, and employer contributions may exceed that of other state agencies as
provided in RCW 41.05.050, subject to RCW 47.64.180. On January 1, 1997,
ferry employees shall enroll in certified health plans under the provisions of
chapter . . ., Laws of 1993 (this act). To the extent that ferry
employees by bargaining unit have absorbed the required offset of wage
increases by the amount that the employer's contribution for employees' and
dependents' insurance and health care plans exceeds that of other state general
government employees in the 1985-87 fiscal biennium, employees shall not be
required to absorb a further offset except to the extent the differential
between employer contributions for those employees and all other state general
government employees increases during any subsequent fiscal biennium. If such
differential increases in the 1987-89 fiscal biennium or the 1985-87 offset by
bargaining unit is insufficient to meet the required deduction, the amount
available for compensation shall be reduced by bargaining unit by the amount of
such increase or the 1985-87 shortage in the required offset. Compensation
shall include all wages and employee benefits.
Sec. 225.
RCW 28A.400.200 and 1990 1st ex.s. c 11 s 2 and 1990 c 33 s 381 are each
reenacted and amended to read as follows:
SCHOOL DISTRICT EMPLOYEES‑-EMPLOYER
CONTRIBUTIONS. (1) Every school district board of directors shall fix, alter,
allow, and order paid salaries and compensation for all district employees in
conformance with this section.
(2)(a) Salaries for certificated instructional
staff shall not be less than the salary provided in the appropriations act in
the state-wide salary allocation schedule for an employee with a baccalaureate
degree and zero years of service; and
(b) Salaries for certificated instructional
staff with a masters degree shall not be less than the salary provided in the
appropriations act in the state-wide salary allocation schedule for an employee
with a masters degree and zero years of service;
(3)(a) The actual average salary paid to basic
education certificated instructional staff shall not exceed the district's average
basic education certificated instructional staff salary used for the state
basic education allocations for that school year as determined pursuant to RCW
28A.150.410.
(b) Fringe benefit contributions for basic
education certificated instructional staff shall be included as salary under
(a) of this subsection only to the extent that the district's actual
average benefit contribution exceeds the ((greater of: (i) The formula
amount for insurance benefits)) amount of the insurance benefits
allocation provided per certificated instructional staff unit in the state
operating appropriations act in effect at the time the compensation is
payable((; or (ii) the actual average amount provided by the school district
in the 1986‑87 school year)). For purposes of this section, fringe
benefits shall not include payment for unused leave for illness or injury under
RCW 28A.400.210((, or)); employer contributions for old age
survivors insurance, workers' compensation, unemployment compensation, and
retirement benefits under the Washington state retirement system; or
employer contributions for health benefits in excess of the insurance benefits
allocation provided per certificated instructional staff unit in the state
operating appropriations act in effect at the time the compensation is
payable. A school district may not use state funds to provide employer
contributions for such excess health benefits.
(c) Salary and benefits for certificated
instructional staff in programs other than basic education shall be consistent
with the salary and benefits paid to certificated instructional staff in the
basic education program.
(4) Salaries and benefits for certificated
instructional staff may exceed the limitations in subsection (3) of this
section only by separate contract for additional time, additional
responsibilities, or incentives. Supplemental contracts shall not cause the
state to incur any present or future funding obligation. Supplemental
contracts shall be subject to the collective bargaining provisions of chapter
41.59 RCW and the provisions of RCW 28A.405.240, shall not exceed one year, and
if not renewed shall not constitute adverse change in accordance with RCW
28A.405.300 through 28A.405.380. No district may enter into a supplemental
contract under this subsection for the provision of services which are a part
of the basic education program required by Article IX, section 3 of the state
Constitution.
(5) Employee benefit plans offered by any
district shall comply with RCW 28A.400.350 and 28A.400.275 and 28A.400.280.
Sec. 226.
RCW 28A.400.350 and 1990 1st ex.s. c 11 s 3 and 1990 c 74 s 1 are each
reenacted and amended to read as follows:
SCHOOL DISTRICTS‑-HEALTH CARE COVERAGE
ONLY BY CONTRACTS WITH THE STATE HEALTH CARE AUTHORITY. (1) The board of
directors of any of the state's school districts may make available liability,
life, health, health care, accident, disability and salary protection or
insurance or any one of, or a combination of the enumerated types of insurance,
or any other type of insurance or protection, for the members of the boards of
directors, the students, and employees of the school district, and their
dependents. Such coverage may be provided by contracts with private carriers,
with the state health care authority after July 1, 1990, pursuant to the
approval of the authority administrator, or through self-insurance or
self-funding pursuant to chapter 48.62 RCW, or in any other manner authorized
by law. Except for health benefits purchased with nonstate funds as
provided in RCW 28A.400.200, effective on and after October 1, 1995, health
care coverage, life insurance, liability insurance, accidental death and
dismemberment insurance, and disability income insurance shall be provided only
by contracts with the state health care authority.
(2) Whenever funds are available for these
purposes the board of directors of the school district may contribute all or a
part of the cost of such protection or insurance for the employees of their
respective school districts and their dependents. The premiums on such
liability insurance shall be borne by the school district.
After October 1, 1990, school districts may not
contribute to any employee protection or insurance other than liability
insurance unless the district's employee benefit plan conforms to RCW
28A.400.275 and 28A.400.280.
(3) For school board members and students, the
premiums due on such protection or insurance shall be borne by the assenting
school board member or student((: PROVIDED, That)). The school
district may contribute all or part of the costs, including the premiums, of
life, health, health care, accident or disability insurance which shall be
offered to all students participating in interschool activities on the behalf
of or as representative of their school or school district. The school
district board of directors may require any student participating in
extracurricular interschool activities to, as a condition of participation,
document evidence of insurance or purchase insurance that will provide adequate
coverage, as determined by the school district board of directors, for medical
expenses incurred as a result of injury sustained while participating in the
extracurricular activity. In establishing such a requirement, the district
shall adopt regulations for waiving or reducing the premiums of such coverage
as may be offered through the school district to students participating in
extracurricular activities, for those students whose families, by reason of
their low income, would have difficulty paying the entire amount of such
insurance premiums. The district board shall adopt regulations for waiving or
reducing the insurance coverage requirements for low-income students in order
to assure such students are not prohibited from participating in
extracurricular interschool activities.
(4) All contracts for insurance or protection
written to take advantage of the provisions of this section shall provide that
the beneficiaries of such contracts may utilize on an equal participation basis
the services of those practitioners licensed pursuant to chapters 18.22, 18.25,
18.53, 18.57, and 18.71 RCW.
C. CONSOLIDATED STATE HEALTH CARE PURCHASING AGENT
NEW SECTION. Sec. 227. A
new section is added to Title 43 RCW to read as follows:
STATE HEALTH SERVICES AGENT. (1) The health
care authority is hereby designated as the single state agent for purchasing
health services.
(2) On and after July 1, 1995, at least the
following state-purchased health services programs shall be merged into a
single, community-rated risk pool: The basic health plan; health benefits for
employees of school districts; and health benefits for state employees. Until
that date, in purchasing health services, the health care authority shall
maintain separate risk pools for each of the programs in this subsection. The
administrator may develop mechanisms to ensure that the cost of comparable
benefits packages does not vary widely across the risk pools. At the earliest
opportunity the governor shall seek necessary federal waivers and state
legislation to place the medical and acute care components of the medical
assistance program, the limited casualty program, and the medical care services
program of the department of social and health services in this single risk
pool. Long-term care services that are provided under the medical assistance
program shall not be placed in the single risk pool until such services have
been added to the uniform benefits package. On or before January 1, 1997, the
governor shall submit necessary legislation to place the purchasing of health
benefits for persons incarcerated in institutions administered by the
department of corrections into the single community-rated risk pool effective
on and after July 1, 1997.
(3) At a minimum, and regardless of other
legislative enactments, the state health services purchasing agent shall:
(a) Require that a public agency that provides
subsidies for a substantial portion of services now covered under the basic
health plan or a uniform benefits package as adopted by the Washington health
services commission as provided in section 449 of this act, use uniform
eligibility processes, insofar as may be possible, and ensure that multiple
eligibility determinations are not required;
(b) Require that a health care provider or a
health care facility that receives funds from a public program provide care to
state residents receiving a state subsidy who may wish to receive care from
them consistent with the provisions of chapter ..., Laws of 1993 (this act),
and that a health maintenance organization, health care service contractor,
insurer, or certified health plan that receives funds from a public program
accept enrollment from state residents receiving a state subsidy who may wish
to enroll with them under the provisions of chapter ..., Laws of 1993 (this
act);
(c) Strive to integrate purchasing for all
publicly sponsored health services in order to maximize the cost control
potential and promote the most efficient methods of financing and coordinating
services;
(d) Annually suggest changes in state and
federal law and rules to bring all publicly funded health programs in
compliance with the goals and intent of chapter . . ., Laws of 1993
(this act);
(e) Consult regularly with the governor, the
legislature, and state agency directors whose operations are affected by the
implementation of this section.
NEW SECTION. Sec. 228. A
new section is added to chapter 41.05 RCW to read as follows:
WASHINGTON STATE GROUP PURCHASING ASSOCIATION.
(1) The Washington state group purchasing association is established for the
purpose of coordinating and enhancing the health care purchasing power of the groups
identified in subsection (2) of this section. The purchasing association shall
be administered by the administrator.
(2) The following organizations or entities may
seek the approval of the administrator for membership in the purchasing
association:
(a) Private nonprofit human services provider
organizations under contract with state agencies, on behalf of their employees
and their employees' spouses and dependent children;
(b) Individuals providing in-home long-term
care services to persons whose care is financed in whole or in part through the
medical assistance personal care or community options program entry system
program as provided in chapter 74.09 RCW, or the chore services program, as
provided in chapter 74.08 RCW, on behalf of themselves and their spouses and
dependent children;
(c) Owners and operators of child day care
centers and family child care homes licensed under chapter 74.15 RCW and of
preschool or other child care programs exempted from licensing under chapter
74.15 RCW on behalf of themselves and their employees and employees' spouses
and dependent children; and
(d) Foster parents contracting with the
department of social and health services under chapter 74.13 RCW and licensed
under chapter 74.15 RCW on behalf of themselves and their spouses and dependent
children.
(3) In administering the purchasing
association, the administrator shall:
(a) Negotiate and enter into contracts on
behalf of the purchasing association's members in conjunction with its
contracting and purchasing activities for employee benefits plans under RCW
41.05.075. In negotiating and contracting with insuring entities on behalf of
employees and purchasing association members, two distinct pools shall be
maintained.
(b) Review and approve or deny applications
from entities seeking membership in the purchasing association:
(i) The administrator may require all or the
substantial majority of the employees of the organizations or entities listed
in subsection (2) of this section to enroll in the purchasing association.
(ii) The administrator shall require, that as a
condition of membership in the purchasing association, an entity or
organization listed in subsection (2) of this section that employs individuals
pay at least fifty percent of the cost of the health insurance coverage for
each employee enrolled in the purchasing association.
(iii) In offering and administering the
purchasing association, the administrator may not discriminate against
individuals or groups based on age, gender, geographic area, industry, or
medical history.
(4) On and after July 1, 1995, the uniform
benefits package and schedule of premiums and point of service cost-sharing
adopted and from time to time revised by the health services commission
pursuant to chapter . . ., Laws of 1993 (this act) shall be
applicable to the association.
(5) The administrator shall adopt preexisting
condition coverage provisions for the association as provided in sections 283
through 286 of this act.
(6) Premiums charged to purchasing association
members shall include the authority's reasonable administrative and marketing
costs. Purchasing association members may not receive any subsidy from the
state for the purchase of health insurance coverage through the association.
(7)(a) The Washington state group purchasing
association account is established in the custody of the state treasurer, to be
used by the administrator for the deposit of premium payments from individuals
and entities described in subsection (2) of this section, and for payment of
premiums for benefit contracts entered into on behalf of the purchasing
association's participants and operating expenses incurred by the authority in
the administration of benefit contracts under this section. Moneys from the
account shall be disbursed by the state treasurer by warrants on vouchers duly
authorized by the administrator.
(b) Disbursements from the account are not
subject to appropriations, but shall be subject to the allotment procedure
provided under chapter 43.88 RCW.
NEW SECTION. Sec. 229. A
new section is added to chapter 41.05 RCW to read as follows:
MARKETING PLAN. The administrator shall
develop a marketing plan for the basic health plan and the Washington state
group purchasing association. The plan shall be targeted to individuals and
entities eligible to enroll in the two programs and provide clear and
understandable explanations of the programs and enrollment procedures. The
plan also shall incorporate special efforts to reach communities and people of
color.
NEW SECTION. Sec. 230.
WASHINGTON STATE GROUP PURCHASING ASSOCIATION‑-REPEAL. The following
acts or parts of acts, as now existing or hereafter amended, are each repealed,
effective June 30, 1998:
(1) RCW 41.05.___ and 1993 c ___ s 228 (section
228 of this act); and
(2) RCW 41.05.___ and 1993 c ___ s 229 (section
229 of this act).
Sec. 231.
RCW 74.09.055 and 1982 c 201 s 19 are each amended to read as follows:
The department is authorized to establish
copayment, deductible, or coinsurance requirements for recipients of any
medical programs defined in RCW 74.09.010 ((but shall not establish
copayment, deductible or coinsurance requirements for legend drugs as defined
in RCW 69.41.210, unless required by federal law)).
NEW SECTION. Sec. 232.
TRANSFER OF AUTHORITY TO PURCHASE SERVICES FROM COMMUNITY HEALTH CENTERS. (1)
State general funds appropriated to the department of health for the purposes
of funding community health centers to provide primary health and dental care
services, migrant health services, and maternity health care services shall be
transferred to the state health care authority. Any related administrative
funds expended by the department of health for this purpose shall also be
transferred to the health care authority. The health care authority shall
exclusively expend these funds through contracts with community health centers
to provide primary health and dental care services, migrant health services,
and maternity health care services. The administrator of the health care
authority shall establish requirements necessary to assure community health
centers provide quality health care services that are appropriate and effective
and are delivered in a cost-efficient manner. The administrator shall further
assure that community health centers have appropriate referral arrangements for
acute care and medical specialty services not provided by the community health
centers.
(2) To further the intent of chapter
. . ., Laws of 1993 (this act), the health care authority, in
consultation with the department of health, shall evaluate the organization and
operation of the federal and state-funded community health centers and other
not-for-profit health care organizations and propose recommendations to the
health services commission and the health policy committees of the legislature
by November 30, 1994, that identify changes to permit community health centers
and other not-for-profit health care organizations to form certified health
plans or other innovative health care delivery arrangements that help ensure
access to primary health care services consistent with the purposes of chapter
. . ., Laws of 1993 (this act).
(3) The authority, in consultation with the
department of health, shall work with community and migrant health clinics and
other providers of care to underserved populations, to ensure that the number
of people of color and underserved people receiving access to managed care is
expanded in proportion to need, based upon demographic data.
D. HEALTH CARE PROVIDER CONFLICT OF INTEREST STANDARDS
Sec. 233.
RCW 19.68.010 and 1973 1st ex.s. c 26 s 1 are each amended to read as follows:
FINANCIAL INTEREST IN HEALTH CARE FACILITIES‑-LIST
OF ALTERNATIVE FACILITIES TO BE PROVIDED. It shall be unlawful for any person,
firm, corporation or association, whether organized as a cooperative, or for
profit or nonprofit, to pay, or offer to pay or allow, directly or indirectly,
to any person licensed by the state of Washington to engage in the practice of
medicine and surgery, drugless treatment in any form, dentistry, or pharmacy
and it shall be unlawful for such person to request, receive or allow, directly
or indirectly, a rebate, refund, commission, unearned discount or profit by
means of a credit or other valuable consideration in connection with the
referral of patients to any person, firm, corporation or association, or in
connection with the furnishings of medical, surgical or dental care, diagnosis,
treatment or service, on the sale, rental, furnishing or supplying of clinical
laboratory supplies or services of any kind, drugs, medication, or medical
supplies, or any other goods, services or supplies prescribed for medical
diagnosis, care or treatment((: PROVIDED, That)). Ownership of
a financial interest in any firm, corporation or association which furnishes any
kind of clinical laboratory or other services prescribed for medical, surgical,
or dental diagnosis shall not be prohibited under this section where (1)
the referring practitioner affirmatively discloses to the patient in writing,
the fact that such practitioner has a financial interest in such firm,
corporation, or association; and (2) the referring practitioner provides the
patient with a list of effective alternative facilities, informs the patient
that he or she has the option to use one of the alternative facilities, and
assures the patient that he or she will not be treated differently by the
referring practitioner if the patient chooses one of the alternative facilities.
Any person violating the provisions of this
section is guilty of a misdemeanor.
E. PUBLIC HEALTH FINANCING AND GOVERNANCE
Sec. 234.
RCW 70.05.010 and 1967 ex.s. c 51 s 1 are each amended to read as follows:
DEFINITIONS‑-DEPARTMENT OF HEALTH. For
the purposes of chapters 70.05 and 70.46 RCW ((and RCW
70.46.020 through 70.46.090)) and unless the context thereof clearly
indicates to the contrary:
(1) "Local health departments" means
the ((city, town,)) county or district which provides public health
services to persons within the area;
(2) "Local health officer" means the
legally qualified physician who has been appointed as the health officer for
the ((city, town,)) county or district public health department;
(3) "Local board of health" means the
((city, town,)) county or district board of health.
(4) "Health district" means ((all
territory encompassed within a single county and all cities and towns therein
except cities with a population of over one hundred thousand, or)) all the
territory consisting of one or more counties ((and all the cities and towns
in all of the combined counties except cities of over one hundred thousand
population which have been combined and)) organized pursuant to the
provisions of chapters 70.05 and 70.46 RCW ((and RCW 70.46.020
through 70.46.090: PROVIDED, That cities with a population of over one hundred
thousand may be included in a health district as provided in RCW 70.46.040)).
(5) "Department" means the
department of health.
Sec. 235.
RCW 70.05.030 and 1967 ex.s. c 51 s 3 are each amended to read as follows:
LOCAL BOARD OF HEALTH‑-COUNTIES WITHOUT
HOME RULE CHARTER‑-JURISDICTION. In counties without a home rule
charter, the board of county commissioners ((of each and every county in
this state, except where such county is a part of a health district or is
purchasing services under a contract as authorized by chapter 70.05 RCW and RCW
70.46.020 through 70.46.090,)) shall constitute the local board of health
((for such county, and said local board of health's jurisdiction)),
unless the county is part of a health district pursuant to chapter 70.46 RCW.
The jurisdiction of the local board of health shall be coextensive with the
boundaries of said county((, except that nothing herein contained shall give
said board jurisdiction in cities of over one hundred thousand population or in
such other cities and towns as are providing health services which meet health
standards pursuant to RCW 70.46.090)).
Sec. 236.
RCW 70.05.040 and 1984 c 25 s 1 are each amended to read as follows:
LOCAL BOARD OF HEALTH‑-VACANCIES. The
local board of health shall elect a ((chairman)) chair and may
appoint an administrative officer. A local health officer shall be appointed
pursuant to RCW 70.05.050. Vacancies on the local board of health shall be
filled by appointment within thirty days and made in the same manner as was the
original appointment. At the first meeting of the local board of health, the
members shall elect a ((chairman)) chair to serve for a period of
one year. ((In home rule charter counties that have a local board of health
established under RCW 70.05.050, the administrative officer may be appointed by
the official designated under the county's charter.))
NEW SECTION. Sec. 237. A
new section is added to chapter 70.05 RCW to read as follows:
HOME RULE CHARTER‑-LOCAL BOARD OF
HEALTH. In counties with a home rule charter, the county legislative authority
shall establish a local board of health and may prescribe the membership and
selection process for the board. The jurisdiction of the local board of health
shall be coextensive with the boundaries of the county. The local health
officer, as described in RCW 70.05.050, shall be appointed by the official
designated under the provisions of the county charter. The same official
designated under the provisions of the county charter may appoint an
administrative officer, as described in RCW 70.05.045.
Sec. 238.
RCW 70.05.050 and 1984 c 25 s 5 are each amended to read as follows:
LOCAL HEALTH OFFICER. ((Each local board of
health, other than boards which are established under RCW 70.05.030 and which
are located in counties having home rule charters, shall appoint a local health
officer. In home rule charter counties which have a local board of health
established under RCW 70.05.030, the local health officer shall be appointed by
the official designated under the provisions of the county's charter.))
The local health officer shall be an
experienced physician licensed to practice medicine and surgery or osteopathy
and surgery in this state and who is qualified or provisionally qualified in
accordance with the standards prescribed in RCW 70.05.051 through 70.05.055 to
hold the office of local health officer. No term of office shall be
established for the local health officer but ((he)) the local health
officer shall not be removed until after notice is given ((him)),
and an opportunity for a hearing before the board or official responsible for
his or her appointment under this section as to the reason for his or
her removal. ((He)) The local health officer shall act as
executive secretary to, and administrative officer for the local board of
health and shall also be empowered to employ such technical and other personnel
as approved by the local board of health except where the local board of health
has appointed an administrative officer under RCW 70.05.040. The local health
officer shall be paid such salary and allowed such expenses as shall be
determined by the local board of health.
Sec. 239.
RCW 70.05.070 and 1991 c 3 s 309 are each amended to read as follows:
LOCAL HEALTH OFFICER DUTIES. The local health
officer, acting under the direction of the local board of health or under
direction of the administrative officer appointed under RCW 70.05.040 or
section 237 of this act, if any, shall:
(1) Enforce the public health statutes of the
state, rules of the state board of health and the secretary of health, and all
local health rules, regulations and ordinances within his or her jurisdiction
including imposition of penalties authorized under RCW 70.119A.030 and filing
of actions authorized by RCW 43.70.190;
(2) Take such action as is necessary to
maintain health and sanitation supervision over the territory within his or her
jurisdiction;
(3) Control and prevent the spread of any
dangerous, contagious or infectious diseases that may occur within his or her
jurisdiction;
(4) Inform the public as to the causes, nature,
and prevention of disease and disability and the preservation, promotion and
improvement of health within his or her jurisdiction;
(5) Prevent, control or abate nuisances which
are detrimental to the public health;
(6) Attend all conferences called by the
secretary of health or his or her authorized representative;
(7) Collect such fees as are established by the
state board of health or the local board of health for the issuance or renewal
of licenses or permits or such other fees as may be authorized by law or by the
rules of the state board of health;
(8) Inspect, as necessary, expansion or
modification of existing public water systems, and the construction of new
public water systems, to assure that the expansion, modification, or
construction conforms to system design and plans;
(9) Take such measures as he or she deems
necessary in order to promote the public health, to participate in the
establishment of health educational or training activities, and to authorize
the attendance of employees of the local health department or individuals
engaged in community health programs related to or part of the programs of the
local health department.
Sec. 240.
RCW 70.05.080 and 1991 c 3 s 310 are each amended to read as follows:
LOCAL HEALTH OFFICER‑-APPOINTMENT BY
SECRETARY OF HEALTH IF LOCAL BOARD FAILS TO ACT. If the local board of health
or other official responsible for appointing a local health officer under RCW
70.05.050 refuses or neglects to appoint a local health officer after a vacancy
exists, the secretary of health may appoint a local health officer and fix the
compensation. The local health officer so appointed shall have the same
duties, powers and authority as though appointed under RCW 70.05.050. Such
local health officer shall serve until a qualified individual is appointed
according to the procedures set forth in RCW 70.05.050. The board or official
responsible for appointing the local health officer under RCW 70.05.050 shall
also be authorized to appoint an acting health officer to serve whenever the
health officer is absent or incapacitated and unable to fulfill his or her
responsibilities under the provisions of chapters 70.05 and 70.46
RCW ((and RCW 70.46.020 through 70.46.090)).
Sec. 241.
RCW 70.05.120 and 1984 c 25 s 8 are each amended to read as follows:
REMOVAL OF LOCAL HEALTH OFFICER. Any local
health officer or administrative officer appointed under RCW 70.05.040, if any,
who shall refuse or neglect to obey or enforce the provisions of chapters
70.05 and 70.46 RCW ((and RCW 70.46.020 through 70.46.090)) or
the rules, regulations or orders of the state board of health or who shall
refuse or neglect to make prompt and accurate reports to the state board of
health, may be removed as local health officer or administrative officer by the
state board of health and shall not again be reappointed except with the
consent of the state board of health. Any person may complain to the state
board of health concerning the failure of the local health officer or
administrative officer to carry out the laws or the rules and regulations
concerning public health, and the state board of health shall, if a preliminary
investigation so warrants, call a hearing to determine whether the local health
officer or administrative officer is guilty of the alleged acts. Such hearings
shall be held pursuant to the provisions of chapter 34.05 RCW, and the rules
and regulations of the state board of health adopted thereunder.
Any member of a local board of health who shall
violate any of the provisions of chapters 70.05 and 70.46 RCW ((and
RCW 70.46.020 through 70.46.090)) or refuse or neglect to obey or enforce
any of the rules, regulations or orders of the state board of health made for
the prevention, suppression or control of any dangerous contagious or
infectious disease or for the protection of the health of the people of this
state, shall be guilty of a misdemeanor, and upon conviction shall be fined not
less than ten dollars nor more than two hundred dollars. Any physician who
shall refuse or neglect to report to the proper health officer or
administrative officer within twelve hours after first attending any case of
contagious or infectious disease or any diseases required by the state board of
health to be reported or any case suspicious of being one of such diseases,
shall be guilty of a misdemeanor, and upon conviction shall be fined not less
than ten dollars nor more than two hundred dollars for each case that is not
reported.
Any person violating any of the provisions of
chapters 70.05 and 70.46 RCW ((and RCW 70.46.020 through
70.46.090)) or violating or refusing or neglecting to obey any of the
rules, regulations or orders made for the prevention, suppression and control
of dangerous contagious and infectious diseases by the local board of health or
local health officer or administrative officer or state board of health, or who
shall leave any isolation hospital or quarantined house or place without the
consent of the proper health officer or who evades or breaks quarantine or
conceals a case of contagious or infectious disease or assists in evading or
breaking any quarantine or concealing any case of contagious or infectious
disease, shall be guilty of a misdemeanor, and upon conviction thereof shall be
subject to a fine of not less than twenty-five dollars nor more than one hundred
dollars or to imprisonment in the county jail not to exceed ninety days or to
both fine and imprisonment.
Sec. 242.
RCW 70.05.130 and 1991 c 3 s 313 are each amended to read as follows:
EXPENSES OF CARRYING OUT PUBLIC HEALTH LAW.
All expenses incurred by the state, health district, or county in carrying out
the provisions of chapters 70.05 and 70.46 RCW ((and RCW
70.46.020 through 70.46.090)) or any other public health law, or the rules
of the ((state)) department of health enacted under such laws, shall be
paid by the county ((or city by which or in behalf of which such expenses
shall have been incurred)) and such expenses shall constitute a claim
against the general fund as provided ((herein)) in this section.
Sec. 243.
RCW 70.05.150 and 1967 ex.s. c 51 s 22 are each amended to read as follows:
AUTHORITY TO CONTRACT. In addition to powers
already granted them, any ((city, town,)) county, district, or
local health department may contract for either the sale or purchase of any or
all health services from any local health department((: PROVIDED, That)).
Such contract shall require the approval of the state board of health.
Sec. 244.
RCW 70.08.010 and 1985 c 124 s 1 are each amended to read as follows:
APPOINTMENT OF LOCAL HEALTH OFFICER BY COMBINED
CITY AND COUNTY HEALTH DEPARTMENT. Any city with one hundred thousand or more
population and the county in which it is located, are authorized, as shall be
agreed upon between the respective governing bodies of such city and said
county, to establish and operate a combined city and county health department,
and to appoint ((the director of public health)) a local health
officer for the county served. Class AA counties may appoint a director of
public health as specified in this chapter.
Sec. 245.
RCW 70.12.030 and 1945 c 46 s 1 are each amended to read as follows:
MONEY MANAGEMENT. Any county, ((first class
city)) combined city-county health department, or health district is
hereby authorized and empowered to create a "public health pooling
fund", hereafter called the "fund", for the efficient management
and control of all moneys coming to such county, ((first class city)) combined
department, or district for public health purposes.
(("Health district" as used herein
may mean all territory consisting of one or more counties and all cities with a
population of one hundred thousand or less, and towns therein.))
Sec. 246.
RCW 70.12.050 and 1945 c 46 s 3 are each amended to read as follows:
EXPENDITURES. All expenditures in connection
with salaries, wages and operations incurred in carrying on the health
department of the county, ((first class city)) combined city-county
health department, or health district shall be paid out of such fund.
Sec. 247.
RCW 70.46.020 and 1967 ex.s. c 51 s 6 are each amended to read as follows:
MULTICOUNTY HEALTH DISTRICTS. Health districts
consisting of two or more counties may be created whenever two or more boards
of county commissioners shall by resolution establish a district for such
purpose. Such a district shall consist of all the area of the combined
counties ((including all cities and towns except cities of over one hundred
thousand population)). The district board of health of such a district
shall consist of not less than five members for districts of two counties
and seven members for districts of more than two counties, including
two representatives from each county who are members of the board of county
commissioners and who are appointed by the board of county commissioners of
each county within the district, and shall have a jurisdiction coextensive
with the combined boundaries. ((The remaining members shall be
representatives of the cities and towns in the district selected by mutual
agreement of the legislative bodies of the cities and towns concerned from
their membership, taking into consideration the financial contribution of such
cities and towns and representation from the several classifications of cities
and towns.))
At the first meeting of a district board of
health the members shall elect a ((chairman)) chair to serve for
a period of one year.
Sec. 248.
RCW 70.46.060 and 1967 ex.s. c 51 s 11 are each amended to read as follows:
DISTRICT BOARD OF HEALTH POWERS AND DUTIES.
The district board of health shall constitute the local board of health for all
the territory included in the health district, and shall supersede and exercise
all the powers and perform all the duties by law vested in the county ((or
city or town)) board of health of any county((, city or town))
included in the health district((, except as otherwise in chapter 70.05 RCW
and RCW 70.46.020 through 70.46.090 provided)).
Sec. 249.
RCW 70.46.080 and 1971 ex.s. c 85 s 10 are each amended to read as follows:
DISTRICT HEALTH FUND. Each health district
shall establish a fund to be designated as the "district health
fund", in which shall be placed all sums received by the district from any
source, and out of which shall be expended all sums disbursed by the district.
((The county treasurer of the county in the district embracing only one
county; or,)) In a district composed of more than one county the
county treasurer of the county having the largest population shall be the
custodian of the fund, and the county auditor of said county shall keep the
record of the receipts and disbursements, and shall draw and the county
treasurer shall honor and pay all warrants, which shall be approved before
issuance and payment as directed by the board((: PROVIDED, That in local
health departments wherein a city of over one hundred thousand population is a
part of said department, the local board of health may pool the funds available
for public health purposes in the office of the city treasurer in a special
pooling fund to be established and which shall be expended as set forth above)).
Each county((, city or town)) which is
included in the district shall contribute such sums towards the expense for
maintaining and operating the district as shall be agreed upon between it and
the local board of health in accordance with guidelines established by the
state board of health ((after consultation with the Washington state
association of counties and the association of Washington cities. In the event
that no agreement can be reached between the district board of health and the
county, city or town, the matter shall be resolved by a board of arbitrators to
consist of a representative of the district board of health, a representative
from the county, city or town involved, and a third representative to be
appointed by the two representatives, but if they are unable to agree, a
representative shall be appointed by a judge in the county in which the city or
town is located. The determination of the proportionate share to be paid by a
county, city or town shall be binding on all parties. Payments into the fund
of the district may be made by the county or city or town members during the
first year of membership in said district from any funds of the respective
county, city or town as would otherwise be available for expenditures for
health facilities and services, and thereafter the members shall include items
in their respective budgets for payments to finance the health district)).
Sec. 250.
RCW 70.46.085 and 1967 ex.s. c 51 s 20 are each amended to read as follows:
COUNTY TO BEAR EXPENSES. The expense of
providing public health services shall be borne by each county((, city or
town)) within the health district((, and the local health officer shall
certify the amount agreed upon or as determined pursuant to RCW 70.46.080, and
remaining unpaid by each county, city or town to the fiscal or warrant issuing
officer of such county, city or town.
If the expense as certified is not paid by any
county, city or town within thirty days after the end of the fiscal year, the
local health officer shall certify the amount due to the auditor of the county
in which the governmental unit is situated who shall promptly issue his warrant
on the county treasurer payable out of the current expense fund of the county,
which fund shall be reimbursed by the county auditor out of the money due said
governmental unit at the next monthly settlement or settlements of the
collection of taxes and shall be transferred to the current expense fund)).
Sec. 251.
RCW 70.46.090 and 1967 ex.s. c 51 s 21 are each amended to read as follows:
WITHDRAWAL FROM MEMBERSHIP. Any county ((or
any city or town)) may withdraw from membership in said health district any
time after it has been within the district for a period of two years, but no
withdrawal shall be effective except at the end of the calendar year in which
the county((, city or town)) gives at least six months' notice of its
intention to withdraw at the end of the calendar year. No withdrawal shall
entitle any member to a refund of any moneys paid to the district nor relieve
it of any obligations to pay to the district all sums for which it obligated
itself due and owing by it to the district for the year at the end of which the
withdrawal is to be effective((: PROVIDED, That)). Any county((,
city or town)) which withdraws from membership in said health district
shall immediately establish a health department or provide health services
which shall meet the standards for health services promulgated by the state
board of health((: PROVIDED FURTHER, That)). No local health
department ((shall)) may be deemed to provide adequate public
health services unless there is at least one full time professionally trained
and qualified physician as set forth in RCW 70.05.050.
Sec. 252.
RCW 70.46.120 and 1963 c 121 s 1 are each amended to read as follows:
FEES MAY BE CHARGED. In addition to all other
powers and duties, health districts shall have the power to charge fees in
connection with the issuance or renewal of a license or permit required by
law: PROVIDED, That the fees charged shall not exceed the actual cost involved
in issuing or renewing the license or permit((: PROVIDED FURTHER, That no
fees shall be charged pursuant to this section within the corporate limits of
any city or town which prior to the enactment of this section charged fees in
connection with the issuance or renewal of a license or permit pursuant to city
or town ordinance and where said city or town makes a direct contribution to
said health district, unless such city or town expressly consents thereto)).
Sec. 253.
RCW 82.44.110 and 1991 c 199 s 221 are each amended to read as follows:
DISPOSITION OF MOTOR VEHICLE EXCISE TAX REVENUE‑-PUBLIC
HEALTH. The county auditor shall regularly, when remitting license fee
receipts, pay over and account to the director of licensing for the excise
taxes collected under the provisions of this chapter. The director shall
forthwith transmit the excise taxes to the state treasurer.
(1) The state treasurer shall deposit the
excise taxes collected under RCW 82.44.020(1) as follows:
(a) 1.60 percent into the motor vehicle fund to
defray administrative and other expenses incurred by the department in the
collection of the excise tax.
(b) 8.15 percent into the Puget Sound capital
construction account in the motor vehicle fund.
(c) 4.07 percent into the Puget Sound ferry
operations account in the motor vehicle fund.
(d) ((8.83)) 5.88 percent into
the general fund to be distributed under RCW 82.44.155.
(e) 4.75 percent into the municipal sales and
use tax equalization account in the general fund created in RCW 82.14.210.
(f) 1.60 percent into the county sales and use
tax equalization account in the general fund created in RCW 82.14.200.
(g) 62.6440 percent into the general fund
through June 30, 1993, 57.6440 percent into the general fund beginning July 1,
1993, and 66 percent into the general fund beginning January 1, 1994.
(h) 5 percent into the transportation fund
created in RCW 82.44.180 beginning July 1, 1993.
(i) 5.9686 percent into the county criminal
justice assistance account created in RCW 82.14.310 through December 31, 1993.
(j) 1.1937 percent into the municipal criminal
justice assistance account for distribution under RCW 82.14.320 through
December 31, 1993.
(k) 1.1937 percent into the municipal criminal
justice assistance account for distribution under RCW 82.14.330 through
December 31, 1993.
(l) 2.95 percent into the general fund to be
distributed by the state treasurer to county health departments to be used
exclusively for public health. The state treasurer shall distribute these
funds proportionately among the counties based on population as determined by
the most recent United States census.
(2) The state treasurer shall deposit the
excise taxes collected under RCW 82.44.020(2) into the transportation fund.
(3) The state treasurer shall deposit the
excise tax imposed by RCW 82.44.020(3) into the air pollution control account
created by RCW 70.94.015.
Sec. 254.
RCW 82.44.155 and 1991 c 199 s 223 are each amended to read as follows:
MOTOR VEHICLE EXCISE TAX DISTRIBUTION TO CITIES
AND TOWNS. When distributions are made under RCW 82.44.150, the state
treasurer shall apportion and distribute the motor vehicle excise taxes
deposited into the general fund under RCW 82.44.110(((4)))(1)(d) to
the cities and towns ratably on the basis of population as last determined by
the office of financial management. When so apportioned, the amount payable to
each such city and town shall be transmitted to the city treasurer thereof, and
shall be used by the city or town for the purposes of police and fire
protection ((and the preservation of the public health)) in the city or
town, and not otherwise. If it is adjudged that revenue derived from the
excise taxes imposed by RCW 82.44.020 (1) and (2) cannot lawfully be
apportioned or distributed to cities or towns, all moneys directed by this
section to be apportioned and distributed to cities and towns shall be credited
and transferred to the state general fund.
Sec. 255.
RCW 43.20.030 and 1984 c 287 s 75 are each amended to read as follows:
COMPOSITION OF STATE BOARD OF HEALTH‑-CITY
MEMBER ELIMINATED. The state board of health shall be composed of ten
members. These shall be the secretary or the secretary's designee and nine
other persons to be appointed by the governor, including four persons
experienced in matters of health and sanitation, ((an elected city official
who is a member of a local health board, an)) two elected county
officials who ((is a)) are members of a local
health board, a local health officer, and two persons representing the
consumers of health care. ((Before appointing the city official, the
governor shall consider any recommendations submitted by the association of
Washington cities.)) Before appointing the county official, the governor
shall consider any recommendations submitted by the Washington state
association of counties. Before appointing the local health officer, the
governor shall consider any recommendations submitted by the Washington state
association of local public health officials. Before appointing one of the two
consumer representatives, the governor shall consider any recommendations
submitted by the state council on aging. The chairman shall be selected by the
governor from among the nine appointed members. The department ((of social
and health services)) shall provide necessary technical staff support to
the board. The board may employ an executive director and a confidential
secretary, each of whom shall be exempt from the provisions of the state civil
service law, chapter 41.06 RCW.
Members of the board shall be compensated in
accordance with RCW 43.03.240 and shall be reimbursed for their travel expenses
in accordance with RCW 43.03.050 and 43.03.060.
NEW SECTION. Sec. 256.
RECODIFICATION‑-CITY/COUNTY HEALTH DEPARTMENT. RCW 70.08.010, as amended
by this act, shall be recodified in chapter 70.05 RCW.
NEW SECTION. Sec. 257.
REPEALERS‑-CITIES AND TOWNS. The following acts or parts of acts are
each repealed:
(1) RCW
70.05.005 and 1989 1st ex.s. c 9 s 243;
(2) RCW
70.05.020 and 1967 ex.s. c 51 s 2;
(3) RCW
70.05.132 and 1984 c 25 s 9 & 1983 1st ex.s. c 39 s 6;
(4) RCW
70.05.145 and 1983 1st ex.s. c 39 s 5;
(5) RCW
70.12.005 and 1989 1st ex.s. c 9 s 245;
(6) RCW
70.46.030 and 1991 c 363 s 141, 1969 ex.s. c 70 s 1, 1967 ex.s. c 51 s 5, &
1945 c 183 s 3;
(7) RCW
70.46.040 and 1967 ex.s. c 51 s 7 & 1945 c 183 s 4; and
(8) RCW
70.46.050 and 1967 ex.s. c 51 s 8, 1957 c 100 s 1, & 1945 c 183 s 5.
NEW SECTION. Sec. 258.
STUDY LOCAL GOVERNMENT HEALTH SERVICE DELIVERY. It is hereby requested that
the governing authorities of the association of Washington cities, the
Washington state association of counties, and the Washington association of
county officials jointly initiate a study and develop consensus recommendations
regarding implementation of the provisions of sections 234 through 257 of this
act. The study and recommendations should at a minimum include consideration
of the fiscal impact of these sections on counties, the desirability of
maintaining a process whereby city officials can effectively communicate
concerns regarding the delivery of public health services to both the counties
and the state, the need for larger cities to be able to continue to provide
health care services when needed, and other matters as the three associations
agree are of substance in the implementation of sections 234 through 257 of
this act. This study shall be coordinated with the public health services
improvement planning process set forth in section 467 of this act. The agreed
upon recommendations shall be presented to the senate health and human services
and house of representatives health care committees prior to March 1, 1994.
F. DATA COLLECTION
Sec. 259.
RCW 70.170.100 and 1990 c 269 s 12 are each amended to read as follows:
STATE-WIDE DATA SYSTEM‑-HEALTH SERVICES
COMMISSION. (1) To promote the public interest consistent with the purposes
of chapter . . ., Laws of 1993 (this act), the department is
responsible for the development, implementation, and custody of a state-wide ((hospital))
health care data system, with policy direction and oversight to be
provided by the Washington health services commission. As part of the
design stage for development of the system, the department shall undertake a
needs assessment of the types of, and format for, ((hospital)) health
care data needed by consumers, purchasers, health care payers, ((hospitals))
providers, and state government as consistent with the intent of chapter
. . ., Laws of 1993 (this act) ((chapter)). The
department shall identify a set of ((hospital)) health care data
elements and report specifications which satisfy these needs. The ((council))
Washington health services commission, created by section 403 of this act,
shall review the design of the data system and may ((direct the department
to)) establish a technical advisory committee on health data and may, if
deemed cost-effective and efficient, recommend that the department contract
with a private vendor for assistance in the design of the data system or for
any part of the work to be performed under this section. The data
elements, specifications, and other ((design)) distinguishing
features of this data system shall be made available for public review and
comment and shall be published, with comments, as the department's first data
plan by ((January 1, 1990)) July 1, 1994.
(2) Subsequent to the initial development of
the data system as published as the department's first data plan, revisions to
the data system shall be considered ((through the department's development
of a biennial data plan, as proposed to,)) with the oversight and policy
guidance of the Washington health services commission or its technical advisory
committee and funded by((,)) the legislature through the biennial
appropriations process with funds appropriated to the health services account.
((Costs of data activities outside of these data plans except for special
studies shall be funded through legislative appropriations.
(3)))
In designing the state-wide ((hospital)) health care data system
and any data plans, the department shall identify ((hospital)) health
care data elements relating to ((both hospital finances)) health
care costs, the quality of health care services, the outcomes of health care
services, and ((the)) use of ((services by patients)) health
care by consumers. Data elements ((relating to hospital finances))
shall be reported ((by hospitals)) as the Washington health services
commission directs by reporters in conformance with a uniform ((system
of)) reporting ((as specified by the department and shall)) system
established by the department, which shall be adopted by reporters.
"Reporter" means an individual, hospital, or business entity,
required to be registered with the department of revenue for payment of taxes
imposed under chapter 82.04 RCW or Title 48 RCW, that is primarily engaged in
furnishing or insuring for medical, surgical, and other health services to
persons. In the case of hospitals this includes data elements
identifying each hospital's revenues, expenses, contractual allowances, charity
care, bad debt, other income, total units of inpatient and outpatient services,
and other financial information reasonably necessary to fulfill the purposes of
chapter . . ., Laws of 1993 (this ((chapter)) act),
for hospital activities as a whole and, as feasible and appropriate, for
specified classes of hospital purchasers and payers. Data elements relating to
use of hospital services by patients shall, at least initially, be the same as
those currently compiled by hospitals through inpatient discharge abstracts ((and
reported to the Washington state hospital commission)). The commission
and the department shall encourage and permit reporting by electronic
transmission or hard copy as is practical and economical to reporters.
(((4))) (3) The state-wide ((hospital))
health care data system shall be uniform in its identification of
reporting requirements for ((hospitals)) reporters across the
state to the extent that such uniformity is ((necessary)) useful
to fulfill the purposes of chapter . . ., Laws of 1993 (this
((chapter)) act). Data reporting requirements may reflect
differences ((in hospital size; urban or rural location; scope, type, and
method of providing service; financial structure; or other pertinent
distinguishing factors)) that involve pertinent distinguishing features
as determined by the Washington health services commission by rule. So far
as ((possible)) is practical, the data system shall be
coordinated with any requirements of the trauma care data registry as
authorized in RCW 70.168.090, the federal department of health and human
services in its administration of the medicare program, ((and)) the
state in its role of gathering public health statistics, or any other payer
program of consequence so as to minimize any unduly burdensome reporting
requirements imposed on ((hospitals)) reporters.
(((5))) (4) In identifying
financial reporting requirements under the state-wide ((hospital)) health
care data system, the department may require both annual reports and
condensed quarterly reports from reporters, so as to achieve both
accuracy and timeliness in reporting, but shall craft such requirements with
due regard of the data reporting burdens of reporters.
(((6) In designing the initial state-wide
hospital data system as published in the department's first data plan, the
department shall review all existing systems of hospital financial and
utilization reporting used in this state to determine their usefulness for the
purposes of this chapter, including their potential usefulness as revised or
simplified.
(7) Until such time as the state-wide hospital
data system and first data plan are developed and implemented and hospitals are
able to comply with reporting requirements, the department shall require
hospitals to continue to submit the hospital financial and patient discharge
information previously required to be submitted to the Washington state
hospital commission. Upon publication of the first data plan, hospitals shall
have a reasonable period of time to comply with any new reporting requirements
and, even in the event that new reporting requirements differ greatly from past
requirements, shall comply within two years of July 1, 1989.
(8))) (5)
The ((hospital)) health care data collected ((and)),
maintained, and studied by the department or the Washington health
services commission shall only be available for retrieval in
original or processed form to public and private requestors and shall be
available within a reasonable period of time after the date of request.
The cost of retrieving data for state officials and agencies shall be funded
through the state general appropriation. The cost of retrieving data for
individuals and organizations engaged in research or private use of data or studies
shall be funded by a fee schedule developed by the department which reflects
the direct cost of retrieving the data or study in the requested form.
(6) All persons subject to chapter
. . ., Laws of 1993 (this act) shall comply with departmental or
commission requirements established by rule in the acquisition of data.
Sec. 260.
RCW 70.170.110 and 1989 1st ex.s. c 9 s 511 are each amended to read as
follows:
HEALTH CARE DATA‑-STUDIES, ANALYSES, OR
REPORTS. The department shall provide, or may contract with a private entity
to provide, ((hospital)) analyses and reports or any studies it
chooses to conduct consistent with the purposes of chapter
. . ., Laws of 1993 (this ((chapter)) act), subject to
the availability of funds and any policy direction that may be given by the
Washington health services commission. ((Prior to release, the
department shall provide affected hospitals with an opportunity to review and
comment on reports which identify individual hospital data with respect to
accuracy and completeness, and otherwise shall focus on aggregate reports of
hospital performance.)) These studies, analyses, or reports shall
include:
(1) Consumer guides on purchasing ((hospital
care services and)) or consuming health care and publications
providing verifiable and useful aggregate comparative information to ((consumers
on hospitals and hospital services)) the public on health care services,
their cost, and the quality of health care providers who participate in
certified health plans;
(2) Reports for use by classes of purchasers, who
purchase from certified health plans, health care payers, and providers as
specified for content and format in the state-wide data system and data plan;
((and))
(3) Reports on relevant ((hospital)) health
care policy ((issues)) including the distribution of hospital
charity care obligations among hospitals; absolute and relative rankings of
Washington and other states, regions, and the nation with respect to expenses,
net revenues, and other key indicators; ((hospital)) provider
efficiencies; and the effect of medicare, medicaid, and other public health
care programs on rates paid by other purchasers of ((hospital)) health
care; and
(4) Any other reports the commission or
department deems useful to assist the public or purchasers of certified health
plans in understanding the prudent and cost-effective use of certified health
plan services.
NEW SECTION. Sec. 261. A
new section is added to chapter 70.170 RCW to read as follows:
CONFIDENTIALITY OF DATA. (1) Notwithstanding
the provisions of chapter 42.17 RCW, any material contained within the
state-wide health care data system or in the files of either the department or
the Washington health services commission shall be subject to the following
limitations: (a) Records obtained, reviewed by, or on file that contain
information concerning medical treatment of individuals shall be exempt from
public inspection and copying; and (b) any actuarial formulas, statistics, and
assumptions submitted by a certified health plan to the commission or
department upon request shall be exempt from public inspection and copying in
order to preserve trade secrets or prevent unfair competition.
(2) All persons and any public or private
agencies or entities whatsoever subject to this chapter shall comply with any
requirements established by rule relating to the acquisition or use of health
services data and maintain the confidentiality of any information that may, in
any manner, identify individual persons.
(3) Data collected pursuant to sections 262 and
263 of this act shall be used solely for the health care reform provisions of
chapter ..., Laws of 1993 (this act). The department shall ensure that the
enrollee identifier used will employ the highest available standards for
accuracy and uniqueness.
(4) Nothing in this section shall impede an
enrollee's access to her or his health care records as provided in chapter
70.02 RCW.
NEW SECTION. Sec. 262. A
new section is added to chapter 70.170 RCW to read as follows:
HEALTH SERVICES COMMISSION ACCESS TO DATA. The
Washington health services commission shall have access to all health data
available to the secretary of health. To the extent possible, the commission
shall use existing data systems and coordinate among existing agencies. The
department of health shall be the designated depository agency for all health
data collected pursuant to chapter . . ., Laws of 1993 (this act).
The following data sources shall be developed or made available:
(1) The commission shall coordinate with the
secretary of health to utilize data collected by the state center for health
statistics, including hospital charity care and related data, rural health
data, epidemiological data, ethnicity data, social and economic status data,
and other data relevant to the commission's responsibilities.
(2) The commission, in coordination with the
department of health and the health science programs of the state universities
shall develop procedures to analyze clinical and other health services outcome
data, and conduct other research necessary for the specific purpose of
assisting in the design of the uniform benefits package under chapter
. . ., Laws of 1993 (this act).
(3) The commission shall establish cost data
sources and shall require each certified health plan to provide the commission
and the department of health with enrollee care and cost information, to
include, but not be limited to: (a) Enrollee identifier, including date of
birth, sex, and ethnicity; (b) provider identifier; (c) diagnosis; (d) health
care services or procedures provided; (e) provider charges, if any; and (f)
amount paid. The department shall establish by rule confidentiality standards
to safeguard the information from inappropriate use or release.
(4) The commission shall coordinate with the
area Indian health service, reservation Indian health service units, tribal
clinics, and any urban Indian health service organizations the design, development,
implementation, and maintenance of an American Indian-specific health data,
statistics information system. The commission rules regarding the
confidentiality to safeguard the information from inappropriate use or release
shall apply.
NEW SECTION. Sec. 263. A
new section is added to chapter 70.170 RCW to read as follows:
PERSONAL HEALTH SERVICES DATA AND INFORMATION
SYSTEM. (1) The department is responsible for the implementation and custody
of a state-wide personal health services data and information system. The data
elements, specifications, and other design features of this data system shall
be consistent with criteria adopted by the Washington health services
commission. The department shall provide the commission with reasonable
assistance in the development of these criteria, and shall provide the
commission with periodic progress reports related to the implementation of the
system or systems related to those criteria.
(2) The department shall coordinate the development
and implementation of the personal health services data and information system
with related private activities and with the implementation activities of the
data sources identified by the commission. Data shall include: (a) Enrollee
identifier, including date of birth, sex, and ethnicity; (b) provider
identifier; (c) diagnosis; (d) health services or procedures provided; (e)
provider charges, if any; and (f) amount paid. The commission shall establish
by rule, confidentiality standards to safeguard the information from
inappropriate use or release. The department shall assist the commission in
establishing reasonable time frames for the completion of the system
development and system implementation.
NEW SECTION. Sec. 264.
HEALTH CARE ENTITY REPORTING REQUIREMENTS. The commission shall determine, by
January 1, 1995, the necessity, if any, of reporting requirements by the
following health care entities: Health care providers, health care facilities,
insuring entities, and certified health plans. The reporting requirements, if
any, shall be for the purposes of determining whether the health care system is
operating as efficiently as possible. Information reported pursuant to this
section shall be made available to interested parties upon request. The
commission shall report its findings to the legislature by January 1, 1995.
G. DISCLOSURE OF HOSPITAL, NURSING HOME, AND PHARMACY CHARGES
NEW SECTION. Sec. 265. A
new section is added to chapter 70.41 RCW to read as follows:
SPIRALING COSTS‑-HOSPITALS. (1) The
legislature finds that the spiraling costs of health care continue to surmount
efforts to contain them, increasing at approximately twice the inflationary
rate. The causes of this phenomenon are complex. By making physicians and other
health care providers with hospital admitting privileges more aware of the cost
consequences of health care services for consumers, these providers may be
inclined to exercise more restraint in providing only the most relevant and
cost-beneficial hospital services, with a potential for reducing the
utilization of those services. The requirement of the hospital to inform
physicians and other health care providers of the charges of the health care
services that they order may have a positive effect on containing health
costs. Further, the option of the physician or other health care provider to
inform the patient of these charges may strengthen the necessary dialogue in
the provider-patient relationship that tends to be diminished by intervening
third-party payers.
(2) The chief executive officer of a hospital
licensed under this chapter and the superintendent of a state hospital shall
establish and maintain a procedure for disclosing to physicians and other
health care providers with admitting privileges the charges of all health care
services ordered for their patients. Copies of hospital charges shall be made
available to any physician and/or other health care provider ordering care in
hospital inpatient/outpatient services. The physician and/or other health care
provider may inform the patient of these charges and may specifically review
them. Hospitals are also directed to study methods for making daily charges
available to prescribing physicians through the use of interactive software
and/or computerized information thereby allowing physicians and other health
care providers to review not only the costs of present and past services but
also future contemplated costs for additional diagnostic studies and
therapeutic medications.
NEW SECTION. Sec. 266. A
new section is added to chapter 18.68 RCW to read as follows:
SPIRALING COSTS‑-PRESCRIPTION
MEDICATIONS. The legislature finds that the spiraling costs of health care
continue to surmount efforts to contain them, increasing at approximately twice
the inflationary rate. One of the fastest growing segments of the health care
expenditure involves prescription medications. By making physicians and other
health care providers with prescriptive authority more aware of the cost
consequences of health care treatments for consumers, these providers may be
inclined to exercise more restraint in providing only the most relevant and
cost-beneficial drug and medication treatments. The requirement of the
pharmacy to inform physicians and other health care providers of the charges of
prescription drugs and medications that they order may have a positive effect
on containing health costs. Further, the option of the physician or other
health care provider to inform the patient of these charges may strengthen the
necessary dialogue in the provider-patient relationship that tends to be
diminished by intervening third-party payers.
NEW SECTION. Sec. 267. A
new section is added to chapter 18.68 RCW to read as follows:
COST OF PRESCRIPTIVE MEDICATIONS. The
registered or licensed pharmacist of this chapter shall establish and maintain
a procedure for disclosing to physicians and other health care providers with
prescriptive authority information detailed by prescriber, of the cost and
dispensation of all prescriptive medications prescribed by him or her for his
or her patients on request. These charges should be made available on at least
a quarterly basis for all requested patients and should include medication,
dosage, number dispensed, and the cost of the prescription. Pharmacies may
provide this information in a summary form for each prescribing physician for
all patients rather than as individually itemized reports. All efforts should
be made to utilize the existing computerized records and software to provide
this information in the least costly format.
NEW SECTION. Sec. 268. A
new section is added to chapter 18.51 RCW to read as follows:
SPIRALING COSTS‑-NURSING HOMES. (1) The
legislature finds that the spiraling costs of nursing home care continue to
surmount efforts to contain them, increasing at approximately twice the
inflationary rate. The causes of this phenomenon are complex. By making
nursing home facilities and care providers more aware of the cost consequences
of care services for consumers, these providers may be inclined to exercise
more restraint in providing only the most relevant and cost-beneficial services
and care, with a potential for reducing the utilization of those services. The
requirement of the nursing home to inform physicians, consumers, and other care
providers of the charges of the services that they order may have a positive
effect on containing health costs.
(2) All nursing home administrators in
facilities licensed under this chapter shall be required to develop and
maintain a written procedure for disclosing patient charges to attending
physicians with admitting privileges. The nursing home administrator shall
have the capability to provide an itemized list of the charges for all health
care services that may be ordered by a physician. The information shall be
made available on request of consumers, or the physicians or other appropriate
health care providers responsible for prescribing care.
H. HEALTH PROFESSIONAL SHORTAGES
NEW SECTION. Sec. 269.
LEGISLATIVE INTENT. The legislature finds that the successful implementation
of health care reform will depend on a sufficient supply of primary health care
providers throughout the state. Many rural and medically underserved urban
areas lack primary health care providers and because of this, basic health care
services are limited or unavailable to populations living in these areas. The
legislature has in recent years initiated new programs to address these
provider shortages but funding has been insufficient and additional specific
provider shortages remain.
Sec. 270.
RCW 28B.125.010 and 1991 c 332 s 5 are each amended to read as follows:
STATE-WIDE HEALTH PERSONNEL RESOURCE PLAN‑-PERSONS
OF COLOR‑-INDIAN HEALTH. (1) The higher education coordinating board,
the state board for community ((college education)) and technical
colleges, the superintendent of public instruction, the state department of
health, the Washington health services commission, and the state
department of social and health services, to be known for the purposes of this
section as the committee, shall establish a state-wide health personnel
resource plan. The governor shall appoint a lead agency from one of the
agencies on the committee.
In preparing the state-wide plan the committee
shall consult with the training and education institutions affected by this
chapter, health care providers, employers of health care providers, insurers,
consumers of health care, and other appropriate entities.
Should a successor agency or agencies be
authorized or created by the legislature with planning, coordination, or
administrative authority over vocational-technical schools, community colleges,
or four-year higher education institutions, the governor shall grant membership
on the committee to such agency or agencies and remove the member or members it
replaces.
The committee shall appoint subcommittees for
the purpose of assisting in the development of the institutional plans required
under this chapter. Such subcommittees shall at least include those committee
members that have statutory responsibility for planning, coordination, or
administration of the training and education institutions for which the
institutional plans are being developed. In preparing the institutional plans
for four-year institutes of higher education, the subcommittee shall be
composed of at least the higher education coordinating board and the state's
four-year higher education institutions. The appointment of subcommittees to
develop portions of the state-wide plan shall not relinquish the committee's
responsibility for assuring overall coordination, integration, and consistency
of the state-wide plan.
In establishing and implementing the state-wide
health personnel resource plan the committee shall, to the extent possible,
utilize existing data and information, personnel, equipment, and facilities and
shall minimize travel and take such other steps necessary to reduce the
administrative costs associated with the preparation and implementation of the
plan.
(2) The state-wide health resource plan shall
include at least the following:
(a)(i) Identification of the type, number, and
location of the health care professional work force necessary to meet health
care needs of the state.
(ii) A description and analysis of the
composition and numbers of the potential work force available for meeting
health care service needs of the population to be used for recruitment
purposes. This should include a description of the data, methodology, and process
used to make such determinations.
(b) A centralized inventory of the numbers of
student applications to higher education and vocational-technical training and
education programs, yearly enrollments, yearly degrees awarded, and numbers on
waiting lists for all the state's publicly funded health care training and
education programs. The committee shall request similar information for
incorporation into the inventory from private higher education and
vocational-technical training and education programs.
(c) A description of state-wide and local
specialized provider training needs to meet the health care needs of target
populations and a plan to meet such needs in a cost-effective and accessible
manner.
(d) A description of how innovative,
cost-effective technologies such as telecommunications can and will be used to
provide higher education, vocational-technical, continued competency, and skill
maintenance and enhancement education and training to placebound students who
need flexible programs and who are unable to attend institutions for training.
(e) A strategy for assuring higher education
and vocational-technical educational and training programming is sensitive to
the changing work force such as reentry workers, women, minorities, and the
disabled.
(f) Strategies to increase the number of
persons of color in the health professions. Such strategies shall incorporate,
to the extent possible, federal and state assistance programs for health career
development, including those for American Indians, economically disadvantaged
persons, physically challenged persons, and persons of color.
(g) A strategy and coordinated
state-wide policy developed by the subcommittees authorized in subsection (1)
of this section for increasing the number of graduates intending to serve in
shortage areas after graduation, including such strategies as the establishment
of preferential admissions and designated enrollment slots.
(((g))) (h) Guidelines and
policies developed by the subcommittees authorized in subsection (1) of this
section for allowing academic credit for on-the-job experience such as
internships, volunteer experience, apprenticeships, and community service
programs.
(((h))) (i) A strategy developed
by the subcommittees authorized in subsection (1) of this section for making
required internships and residency programs available that are geographically
accessible and sufficiently diverse to meet both general and specialized
training needs as identified in the plan when such programs are required.
(((i))) (j) A description of the
need for multiskilled health care professionals and an implementation plan to
restructure educational and training programming to meet these needs.
(((j))) (k) An analysis of the
types and estimated numbers of health care personnel that will need to be
recruited from out-of-state to meet the health professional needs not met by
in-state trained personnel.
(((k))) (l) An analysis of the
need for educational articulation within the various health care disciplines
and a plan for addressing the need.
(((l))) (m) An analysis of the
training needs of those members of the long-term care profession that are not
regulated and that have no formal training requirements. Programs to meet
these needs should be developed in a cost-effective and a state-wide accessible
manner that provide for the basic training needs of these individuals.
(((m))) (n) A designation of the
professions and geographic locations in which loan repayment and scholarships
should be available based upon objective data-based forecasts of health
professional shortages. A description of the criteria used to select
professions and geographic locations shall be included. Designations of
professions and geographic locations may be amended by the department of health
when circumstances warrant as provided for in RCW 28B.115.070.
(((n))) (o) A description of
needed changes in regulatory laws governing the credentialing of health
professionals.
(((o))) (p) A description of
linguistic and cultural training needs of foreign-trained health care
professionals to assure safe and effective practice of their health care
profession.
(((p))) (q) A plan to implement
the recommendations of the state-wide nursing plan authorized by RCW 74.39.040.
(((q))) (r) A description of
criteria and standards that institutional plans provided for in this section
must address in order to meet the requirements of the state-wide health
personnel resource plan, including funding requirements to implement the
plans. The committee shall also when practical identify specific outcome
measures to measure progress in meeting the requirements of this plan. The
criteria and standards shall be established in a manner as to provide
flexibility to the institutions in meeting state-wide plan requirements. The
committee shall establish required submission dates for the institutional plans
that permit inclusion of funding requests into the institutions budget requests
to the state.
(((r))) (s) A description of how
the higher education coordinating board, state board for community ((college
education)) and technical colleges, superintendent of public
instruction, department of health, and department of social and health services
coordinated in the creation and implementation of the state plan including the
areas of responsibility each agency shall assume. The plan should also include
a description of the steps taken to assure participation by the groups that are
to be consulted with.
(((s))) (t) A description of the
estimated fiscal requirements for implementation of the state-wide health
resource plan that include a description of cost saving activities that reduce
potential costs by avoiding administrative duplication, coordinating
programming activities, and other such actions to control costs.
(3) The committee may call upon other agencies
of the state to provide available information to assist the committee in
meeting the responsibilities under this chapter. This information shall be
supplied as promptly as circumstances permit.
(4) State agencies involved in the development
and implementation of the plan shall to the extent possible utilize existing
personnel and financial resources in the development and implementation of the
state-wide health personnel resource plan.
(5) The state-wide health personnel resource
plan shall be submitted to the governor by July 1, 1992, and updated by July 1
of each even-numbered year. The governor, no later than December 1 of that
year, shall approve, approve with modifications, or disapprove the state-wide
health resource plan.
(6) The approved state-wide health resource
plan shall be submitted to the senate and house of representatives committees
on health care, higher education, and ways and means or appropriations by
December 1 of each even-numbered year.
(7) Implementation of the state-wide plan shall
begin by July 1, 1993.
(8) Notwithstanding subsections (5) and (7) of
this section, the committee shall prepare and submit to the higher education
coordinating board by June 1, 1992, the analysis necessary for the initial
implementation of the health professional loan repayment and scholarship
program created in chapter 28B.115 RCW.
(9) Each publicly funded two-year and four-year
institute of higher education authorized under Title 28B RCW and
vocational-technical institution authorized under Title 28A RCW that offers
health training and education programs shall biennially prepare and submit an
institutional plan to the committee. The institutional plan shall identify
specific programming and activities of the institution that meet the
requirements of the state-wide health professional resource plan.
The committee shall review and assess whether
the institutional plans meet the requirements of the state-wide health
personnel resource plan and shall prepare a report with its determination. The
report shall become part of the institutional plan and shall be submitted to
the governor and the legislature.
The institutional plan shall be included with
the institution's biennial budget submission. The institution's budget shall
identify proposed spending to meet the requirements of the institutional plan.
Each vocational-technical institution, college, or university shall be
responsible for implementing its institutional plan.
Sec. 271.
RCW 28B.115.080 and 1991 c 332 s 21 are each amended to read as follows:
ANNUAL AWARD AMOUNT. After June 1, 1992, the
board, in consultation with the department and the department of social and
health services, shall:
(1) Establish the annual award amount for each
credentialed health care profession which shall be based upon an assessment of
reasonable annual eligible expenses involved in training and education for each
credentialed health care profession. The annual award amount may be
established at a level less than annual eligible expenses. The annual award
amount shall ((not be more than fifteen thousand dollars per year)) be
established by the board for each eligible health profession. The awards
shall not be paid for more than a maximum of five years per individual;
(2) Determine any scholarship awards for
prospective physicians in such a manner to require the recipients declare an
interest in serving in rural areas of the state of Washington. Preference for
scholarships shall be given to students who reside in a rural physician
shortage area or a nonshortage rural area of the state prior to admission to
the eligible education and training program in medicine. Highest preference
shall be given to students seeking admission who are recommended by sponsoring
communities and who declare the intent of serving as a physician in a rural
area. The board may require the sponsoring community located in a nonshortage
rural area to financially contribute to the eligible expenses of a medical
student if the student will serve in the nonshortage rural area;
(3) Establish the required service obligation
for each credentialed health care profession, which shall be no less than three
years or no more than five years. The required service obligation may be based
upon the amount of the scholarship or loan repayment award such that higher
awards involve longer service obligations on behalf of the participant;
(4) Determine eligible education and training
programs for purposes of the scholarship portion of the program;
(5) Honor loan repayment and scholarship
contract terms negotiated between the board and participants prior to May 21,
1991, concerning loan repayment and scholarship award amounts and service
obligations authorized under chapter ((18.150)) 28B.115, 28B.104,
or 70.180 RCW.
NEW SECTION. Sec. 272. A
new section is added to chapter 41.05 RCW to read as follows:
MULTICULTURAL HEALTH CARE TECHNICAL ASSISTANCE
PROGRAM. (1) Consistent with funds appropriated specifically for this purpose,
the authority shall provide matching grants to support community-based
multicultural health care technical assistance programs. The purpose of the
programs shall be to promote technical assistance through community and migrant
health clinics and other appropriate health care providers who serve
underserved populations and persons of color.
The technical assistance provided shall include,
but is not limited to: (a) Collaborative research and data analysis on health
care outcomes that disproportionately affect persons of color; (b) design and
development of model health education and promotion strategies aimed at
modifying unhealthy health behaviors or enhancing the use of the health care
delivery system by persons of color; (c) provision of technical information and
assistance on program planning and financial management; (d) administration,
public policy development, and analysis in health care issues affecting people
of color; and (e) enhancement and promotion of health care career opportunities
for persons of color.
(2) Consistent with appropriated funds, the
programs shall be available on a state-wide basis.
Sec. 273.
RCW 70.185.030 and 1991 c 332 s 9 are each amended to read as follows:
COMMUNITY-BASED RECRUITMENT AND RETENTION‑-UNDERSERVED
URBAN AREAS. (1) The department ((shall)) may, subject to funding,
establish ((up to three)) community-based recruitment and retention
project sites to provide financial and technical assistance to participating
communities. The goal of the project is to help assure the availability of
health care providers in rural and underserved urban areas of Washington
state.
(2) Administrative costs necessary to implement
this project shall be kept at a minimum to insure the maximum availability of
funds for participants.
(3) The secretary may contract with third
parties for services necessary to carry out activities to implement this
chapter where this will promote economy, avoid duplication of effort, and make
the best use of available expertise.
(4) The secretary may apply for, receive, and
accept gifts and other payments, including property and service, from any governmental
or other public or private entity or person, and may make arrangements as to
the use of these receipts, including the undertaking of special studies and
other projects related to the delivery of health care in rural areas.
(5) In designing and implementing the project
the secretary shall coordinate ((the project)) and avoid duplication
with similar federal programs and with the Washington rural health system
project as authorized under chapter 70.175 RCW to consolidate administrative
duties and reduce costs.
NEW SECTION. Sec. 274. A
new section is added to chapter 70.185 RCW to read as follows:
STUDENT POSITIONS. (1) The department may
develop a mechanism for underserved rural or urban communities to contract with
education and training programs for student positions above the full time
equivalent lids. The goal of this program is to provide additional capacity,
educating students who will practice in underserved communities.
(2) Eligible education and training programs
are those programs approved by the department that lead to eligibility for a
credential as a credentialed health care professional. Eligible professions
are those licensed under chapters 18.36A, 18.57, 18.57A, 18.71, and 18.71A RCW
and advanced registered nurse practitioners and certified nurse midwives
licensed under chapter 18.88 RCW, and may include other providers identified as
needed in the health personnel resource plan.
(3) Students participating in the community
contracted educational positions shall meet all applicable educational program
requirements and provide assurances, acceptable to the community, that they
will practice in the sponsoring community following completion of education and
necessary licensure.
(4) Participants in the program incur an
obligation to repay any contracted funds with interest set by state law, unless
they serve at least three years in the sponsoring community.
(5) The department may provide funds to
communities for use in contracting.
NEW SECTION. Sec. 275. A
new section is added to chapter 70.185 RCW to read as follows:
AREA HEALTH EDUCATION CENTERS. The secretary
may establish and contract with area health education centers in the eastern
and western parts of the state. Consistent with the recruitment and retention
objectives of this chapter, the centers shall provide or facilitate the
provision of health professional educational and continuing education programs
that strengthen the delivery of primary health care services in rural and
medically underserved urban areas of the state. The center shall assist in the
development and operation of health personnel recruitment and retention
programs that are consistent with activities authorized under this chapter.
The centers shall further provide technical expertise in the development of
well managed health care delivery systems in rural Washington consistent with
the goals and objectives of chapter . . ., Laws of 1993 (this act).
Sec. 276.
RCW 43.70.460 and 1992 c 113 s 2 are each amended to read as follows:
RETIRED PRIMARY CARE PROVIDERS‑-MALPRACTICE
INSURANCE. (1) The department may establish a program to purchase and maintain
liability malpractice insurance for retired ((physicians)) primary
care providers who provide primary health care services at community
clinics. The following conditions apply to the program:
(a) Primary health care services shall be
provided at community clinics that are public or private tax-exempt
corporations;
(b) Primary health care services provided at
the clinics shall be offered to low-income patients based on their ability to
pay;
(c) Retired ((physicians)) primary
care providers providing health care services shall not receive
compensation for their services; and
(d) The department shall contract only with a
liability insurer authorized to offer liability malpractice insurance in the
state.
(2) This section and RCW 43.70.470 shall not be
interpreted to require a liability insurer to provide coverage to a ((physician))
primary care provider should the insurer determine that coverage should
not be offered to a physician because of past claims experience or for other
appropriate reasons.
(3) The state and its employees who operate the
program shall be immune from any civil or criminal action involving claims
against clinics or physicians that provided health care services under this
section and RCW 43.70.470. This protection of immunity shall not extend to any
clinic or ((physician)) primary care provider participating in
the program.
(4) The department may monitor the claims
experience of retired physicians covered by liability insurers contracting with
the department.
(5) The department may provide liability
insurance under chapter 113, Laws of 1992 only to the extent funds are provided
for this purpose by the legislature.
Sec. 277.
RCW 43.70.470 and 1992 c 113 s 3 are each amended to read as follows:
RETIRED PRIMARY CARE PROVIDERS‑-CONDITIONS.
The department may establish by rule the conditions of participation in the
liability insurance program by retired ((physicians)) primary care
providers at clinics utilizing retired physicians for the purposes of this
section and RCW 43.70.460. These conditions shall include, but not be limited
to, the following:
(1) The participating ((physician)) primary
care provider associated with the clinic shall hold a valid license to
practice ((medicine and surgery in this state and otherwise)) as a
physician under chapter 18.71 or 18.57 RCW, a naturopath under chapter 18.36A
RCW, a physician assistant under chapter 18.71A or 18.57A RCW, an advanced
registered nurse practitioner under chapter 18.88 RCW, a dentist under chapter
18.32 RCW, or other health professionals as may be deemed in short supply in
the health personnel resource plan under chapter 28B.125 RCW. All primary care
providers must be in conformity with current requirements for licensure as
a retired ((physician)) primary care provider, including
continuing education requirements;
(2) The participating ((physician)) primary
care provider shall limit the scope of practice in the clinic to primary
care. Primary care shall be limited to noninvasive procedures and shall not
include obstetrical care, or any specialized care and treatment. Noninvasive
procedures include injections, suturing of minor lacerations, and incisions of boils
or superficial abscesses. Primary dental care shall be limited to
diagnosis, oral hygiene, restoration, and extractions and shall not include
orthodontia, or other specialized care and treatment;
(3) The provision of liability insurance
coverage shall not extend to acts outside the scope of rendering medical
services pursuant to this section and RCW 43.70.460;
(4) The participating ((physician)) primary
care provider shall limit the provision of health care services to primarily
low-income persons provided that clinics may, but are not required to, provide
means tests for eligibility as a condition for obtaining health care services;
(5) The participating ((physician)) primary
care provider shall not accept compensation for providing health care
services from patients served pursuant to this section and RCW 43.70.460, nor
from clinics serving these patients. "Compensation" shall mean any
remuneration of value to the participating ((physician)) primary care
provider for services provided by the ((physician)) primary care
provider, but shall not be construed to include any nominal copayments
charged by the clinic, nor reimbursement of related expenses of a participating
((physician)) primary care provider authorized by the clinic in
advance of being incurred; and
(6) The use of mediation or arbitration for
resolving questions of potential liability may be used, however any mediation
or arbitration agreement format shall be expressed in terms clear enough for a
person with a sixth grade level of education to understand, and on a form no
longer than one page in length.
NEW SECTION. Sec. 278.
MEDICAL SCHOOL GRADUATES SERVING IN RURAL AND MEDICALLY UNDERSERVED AREAS OF
THE STATE--LEGISLATIVE INTENT. The legislature finds that the shortage of
primary care physicians practicing in rural and medically underserved areas of
the state has created a severe public health and safety problem. If
unaddressed, this problem is expected to worsen with health care reform since
an increased demand for primary care services will only contribute further to
these shortages.
The legislature further finds that the medical
training program at the University of Washington is an important and well
respected resource to the people of this state in the training of primary care
physicians. Currently, only a small proportion of medical school graduates are
Washington residents who serve as primary care practitioners in certain parts
of this state.
NEW SECTION. Sec. 279.
MEDICAL SCHOOL PRIMARY CARE PHYSICIAN SHORTAGE PLAN DEVELOPMENT. (1) The
University of Washington shall prepare a primary care shortage plan that
accomplishes the following:
(a) Identifies specific activities that the
school of medicine shall pursue to increase the number of Washington residents
serving as primary care physicians in rural and medically underserved areas of
the state, including establishing a goal that assures that no less than fifty
percent of medical school graduates who are Washington state residents at the
time of matriculation will enter into primary care residencies, to the extent
possible, in Washington state by the year 2000;
(b) Assures that the school of medicine shall
establish among its highest training priorities the distribution of its primary
care physician graduates from the school and associated postgraduate residency
programs into rural and medically underserved areas;
(c) Establishes the goal of assuring that the
annual number of graduates from the family practice residency network entering
rural or medically underserved practice shall be increased by forty percent
over a baseline period from 1988 through 1990 by 1995;
(d) Establishes a further goal to make
operational at least two additional family practice residency programs within
Washington state in geographic areas identified by the plan as underserved in
family practice by 1997. The geographic areas identified by the plan as being
underserved by family practice physicians shall be consistent with any such
similar designations as may be made in the health personnel research plan as
authorized under chapter 28B.125 RCW;
(e) Establishes, with the cooperation of
existing community and migrant health clinics in rural or medically underserved
areas of the state, three family practice residency training tracks.
Furthermore, the primary care shortage plan shall provide that one of these training
tracks shall be a joint American osteopathic association and American medical
association approved training site coordinated with an accredited college of
osteopathic medicine with extensive experience in training primary care
physicians for the western United States. Such a proposed joint accredited
training track will have at least fifty percent of its residency positions in
osteopathic medicine; and
(f) Implements the plan, with the exception of
the expansion of the family practice residency network, within current biennial
appropriations for the University of Washington school of medicine.
(2) The plan shall be submitted to the
appropriate committees of the legislature no later than December 1, 1993.
I. SHORT-TERM HEALTH INSURANCE REFORM
NEW SECTION. Sec. 280.
INTENT‑-INCREASE ACCESS TO COVERAGE. The legislature intends that,
during the transition to a fully reformed health services system, certain
health insurance practices be modified to increase access to health insurance
coverage for some individuals and groups. The legislature recognizes that
health insurance reform will not remedy the significant lack of access to
coverage in Washington state without the implementation of strong cost control
measures. The authority granted to the commissioner in chapter
. . ., Laws of 1993 (this act) is in addition to any authority the
commissioner currently has under Title 48 RCW to regulate insurers, health care
service contractors, and health maintenance organizations.
NEW SECTION. Sec. 281. A
new section is added to chapter 48.18 RCW to read as follows:
CANCELLATIONS, DENIALS‑-WRITTEN
COMMUNICATION. Every insurer upon canceling, denying, or refusing to renew any
disability policy, shall, upon written request, directly notify in writing the
applicant or insured, as the case may be, of the reasons for the action by the
insurer and to any person covered under a group contract. Any benefits, terms,
rates, or conditions of such a contract that are restricted, excluded,
modified, increased, or reduced shall, upon written request, be set forth in
writing and supplied to the insured and to any person covered under a group
contract. The written communications required by this section shall be phrased
in simple language that is readily understandable to a person of average
intelligence, education, and reading ability.
Sec. 282.
RCW 48.21.200 and 1983 c 202 s 16 and 1983 c 106 s 24 are each reenacted and
amended to read as follows:
REDUCTIONS OR REFUSAL OF BENEFITS. (1) No individual
or group disability insurance policy, health care service contract, or
health maintenance agreement which provides benefits for hospital, medical,
or surgical expenses shall be delivered or issued for delivery in this state ((after
September 8, 1975)) which contains any provision whereby the insurer,
contractor, or health maintenance organization may reduce or refuse to pay
such benefits otherwise payable thereunder solely on account of the existence
of similar benefits provided under any ((individual)) disability
insurance policy, ((or under any individual)) health care service
contract, or health maintenance agreement.
(2) No individual or group disability
insurance policy, health care service contract, or health maintenance
agreement providing hospital, medical or surgical expense benefits and
which contains a provision for the reduction of benefits otherwise payable or
available thereunder on the basis of other existing coverages, shall
provide that such reduction will operate to reduce total benefits payable below
an amount equal to one hundred percent of total allowable expenses exclusive
of copayments, deductibles, and other similar cost-sharing arrangements.
(3) The commissioner shall by rule
establish guidelines for the application of this section, including:
(a) The procedures by which persons ((insured))
covered under such policies, contracts, and agreements are to be
made aware of the existence of such a provision;
(b) The benefits which may be subject to
such a provision;
(c) The effect of such a provision on
the benefits provided;
(d) Establishment of the order of
benefit determination; ((and))
(e) Exceptions necessary to preserve policy,
contract, or agreement requirements for use of particular health care
facilities or providers; and
(f) Reasonable claim administration
procedures to expedite claim payments and prevent duplication of payments or
benefits under such a provision((: PROVIDED, HOWEVER, That any group
disability insurance policy which is issued as part of an employee insurance
benefit program authorized by RCW 41.05.025(3) may exclude all or part of any
deductible amounts from the definition of total allowable expenses for purposes
of coordination of benefits within the plan and between such plan and other
applicable group coverages: AND PROVIDED FURTHER, That any group disability
insurance policy providing coverage for persons in this state may exclude all
or part of any deductible amounts required by a group disability insurance
policy from the definition of total allowable expenses for purposes of
coordination of benefits between such policy and a group disability insurance
policy issued as part of an employee insurance benefit program authorized by
RCW 41.05.025(3).
(3) The provisions of this section shall apply
to health care service contractor contracts and health maintenance organization
agreements)).
NEW SECTION. Sec. 283. A
new section is added to chapter 48.20 RCW to read as follows:
DISABILITY INSURER‑-PREEXISTING
CONDITIONS EXCLUSIONS AND LIMITATIONS. (1) After January 1, 1994, every
disability insurer issuing coverage against loss arising from medical,
surgical, hospital, or emergency care coverage shall waive any preexisting
condition exclusion or limitation for persons who had similar coverage under a
different policy, health care service contract, or health maintenance agreement
in the three-month period immediately preceding the effective date of coverage
under the new policy to the extent that such person has satisfied a waiting
period under such preceding policy, contract, or agreement; however, if the
person satisfied a twelve-month waiting period under such preceding policy,
contract, or agreement, the insurer shall waive any preexisting condition
exclusion or limitation. The insurer need not waive a preexisting condition
exclusion or limitation under the new policy for coverage not provided under
such preceding policy, contract, or agreement.
(2) The commissioner may adopt rules
establishing guidelines for determining when coverage is similar under new and
preceding policies, contracts, and agreements and for determining when a
preexisting condition waiting period has been satisfied.
(3) The commissioner in consultation with
insurers, health care service contractors, and health maintenance organizations
shall study the effect of preexisting condition exclusions and limitations on
the cost and availability of health care coverage and shall adopt rules
restricting the use of such conditions and limitations by January 1, 1994. No
insurer, health care service contractor, or health maintenance organization may
deny, exclude, or limit coverage for preexisting conditions for a period longer
than that provided for in such rules after July 1, 1994.
NEW SECTION. Sec. 284. A
new section is added to chapter 48.21 RCW to read as follows:
GROUP DISABILITY INSURERS‑-PREEXISTING
CONDITIONS EXCLUSIONS AND LIMITATIONS. (1) After January 1, 1994, every
disability insurer issuing coverage against loss arising from medical,
surgical, hospital, or emergency care coverage shall waive any preexisting
condition exclusion or limitation for persons who had similar coverage under a
different policy, health care service contract, or health maintenance agreement
in the three-month period immediately preceding the effective date of coverage
under the new policy to the extent that such person has satisfied a waiting
period under such preceding policy, contract, or agreement; however, if the
person satisfied a twelve-month waiting period under such preceding policy,
contract, or agreement, the insurer shall waive any preexisting condition
exclusion or limitation. The insurer need not waive a preexisting condition
exclusion or limitation under the new policy for coverage not provided under
such preceding policy, contract, or agreement.
(2) The commissioner may adopt rules
establishing guidelines for determining when coverage is similar under new and
preceding policies, contracts, and agreements and for determining when a
preexisting condition waiting period has been satisfied.
(3) The commissioner in consultation with
insurers, health care service contractors, and health maintenance organizations
shall study the effect of preexisting condition exclusions and limitations on
the cost and availability of health care coverage and shall adopt rules
restricting the use of such conditions and limitations by January 1, 1994. No
insurer, health care service contractor, or health maintenance organization may
deny, exclude, or limit coverage for preexisting conditions for a period longer
than that provided for in such rules after July 1, 1994.
NEW SECTION. Sec. 285. A
new section is added to chapter 48.44 RCW to read as follows:
HEALTH CARE SERVICE CONTRACTORS‑-PREEXISTING
CONDITIONS EXCLUSIONS AND LIMITATIONS. (1) After January 1, 1994, every health
care service contractor, except limited health care service contractors as
defined under RCW 48.44.035, shall waive any preexisting condition exclusion or
limitation for persons who had similar coverage under a different policy,
health care service contract, or health maintenance agreement in the
three-month period immediately preceding the effective date of coverage under
the new contract to the extent that such person has satisfied a waiting period
under such preceding policy, contract, or agreement; however, if the person
satisfied a twelve-month waiting period under such preceding policy, contract,
or agreement, the insurer shall waive any preexisting condition exclusion or
limitation. The insurer need not waive a preexisting condition exclusion or limitation
under the new policy for coverage not provided under such preceding policy,
contract, or agreement.
(2) The commissioner may adopt rules
establishing guidelines for determining when coverage is similar under new and
preceding policies, contracts, and agreements and for determining when a
preexisting condition waiting period has been satisfied.
(3) The commissioner in consultation with
insurers, health care service contractors, and health maintenance organizations
shall study the effect of preexisting condition exclusions and limitations on
the cost and availability of health care coverage and shall adopt rules
restricting the use of such conditions and limitations by January 1, 1994. No
insurer, health care service contractor, or health maintenance organization may
deny, exclude, or limit coverage for preexisting conditions for a period longer
than that provided for in such rules after July 1, 1994.
NEW SECTION. Sec. 286. A
new section is added to chapter 48.46 RCW to read as follows:
HEALTH MAINTENANCE ORGANIZATIONS‑-PREEXISTING
CONDITIONS EXCLUSIONS AND LIMITATIONS. (1) After January 1, 1994, every health
maintenance organization shall waive any preexisting condition exclusion or
limitation for persons who had similar coverage under a different policy,
health care service contract, or health maintenance agreement in the three-month
period immediately preceding the effective date of coverage under the new
agreement to the extent that such person has satisfied a waiting period under
such preceding policy, contract, or agreement; however, if the person satisfied
a twelve-month waiting period under such preceding policy, contract, or
agreement, the insurer shall waive any preexisting condition exclusion or
limitation. The insurer need not waive a preexisting condition exclusion or
limitation under the new policy for coverage not provided under such preceding
policy, contract, or agreement.
(2) The commissioner may adopt rules
establishing guidelines for determining when coverage is similar under new and
preceding policies, contracts, and agreements and for determining when a preexisting
condition waiting period has been satisfied.
(3) The commissioner in consultation with
insurers, health care service contractors, and health maintenance organizations
shall study the effect of preexisting condition exclusions and limitations on
the cost and availability of health care coverage and shall adopt rules
restricting the use of such conditions and limitations by January 1, 1994. No
insurer, health care service contractor, or health maintenance organization may
deny, exclude, or limit coverage for preexisting conditions for a period longer
than that provided for in such rules after July 1, 1994.
Sec. 287.
RCW 48.30.300 and 1975-'76 2nd ex.s. c 119 s 7 are each amended to read as
follows:
UNFAIR PRACTICES. Notwithstanding any
provision contained in Title 48 RCW to the contrary:
(1) No person or entity engaged in the
business of insurance in this state shall refuse to issue any contract of
insurance or cancel or decline to renew such contract because of the sex or
marital status, or the presence of any sensory, mental, or physical handicap of
the insured or prospective insured. The amount of benefits payable, or any
term, rate, condition, or type of coverage shall not be restricted, modified,
excluded, increased or reduced on the basis of the sex or marital status, or be
restricted, modified, excluded or reduced on the basis of the presence of any
sensory, mental, or physical handicap of the insured or prospective insured. Subject
to the provisions of subsection (2) of this section these provisions shall
not prohibit fair discrimination on the basis of sex, or marital status, or the
presence of any sensory, mental, or physical handicap when bona fide
statistical differences in risk or exposure have been substantiated.
(2) With respect to disability policies
issued or renewed on and after July 1, 1994, that provide coverage against loss
arising from medical, surgical, hospital, or emergency care services:
(a) Policies shall guarantee continuity of
coverage. Such provision, which shall be included in every policy, shall
provide that:
(i) The policy may be canceled or nonrenewed
without the prior written approval of the commissioner only for nonpayment of
premium or as permitted under RCW 48.18.090; and
(ii) The policy may be canceled or
nonrenewed because of a change in the physical or mental condition or health of
a covered person only with the prior written approval of the commissioner.
Such approval shall be granted only when the insurer has discharged its
obligation to continue coverage for such person by obtaining coverage with another
insurer, health care service contractor, or health maintenance organization,
which coverage is comparable in terms of premiums and benefits as defined by
rule of the commissioner.
(b) It is an unfair practice for a
disability insurer to modify the coverage provided or rates applying to an
in-force disability insurance policy and to fail to make such modification in
all such issued and outstanding policies.
(c) Subject to rules adopted by the
commissioner, it is an unfair practice for a disability insurer to:
(i) Cease the sale of a policy form unless
it has received prior written authorization from the commissioner and has
offered all policyholders covered under such discontinued policy the
opportunity to purchase comparable coverage without health screening; or
(ii) Engage in a practice that subjects
policyholders to rate increases on discontinued policy forms unless such
policyholders are offered the opportunity to purchase comparable coverage
without health screening.
The insurer may limit an offer of comparable
coverage without health screening to a period not less than thirty days from
the date the offer is first made.
NEW SECTION. Sec. 288. A
new section is added to chapter 48.44 RCW to read as follows:
HEALTH CARE SERVICE CONTRACTS‑-UNFAIR
PRACTICES. (1) With respect to all health care service contracts issued or
renewed on and after July 1, 1994, except limited health care service contracts
as defined in RCW 48.44.035:
(a) Contracts shall guarantee continuity of
coverage. Such provision, which shall be included in every contract, shall
provide that:
(i) The contract may be canceled or nonrenewed
without the prior written approval of the commissioner only for nonpayment of
premiums, for violation of published policies of the contractor that have been
approved by the commissioner, for persons who are entitled to become eligible
for medicare benefits and fail to subscribe to a medicare supplement plan
offered by the contractor, for failure of such subscriber to pay any deductible
or copayment amount owed to the contractor and not the provider of health care
services, for fraud, or for a material breach of the contract; and
(ii) The contract may be canceled or nonrenewed
because of a change in the physical or mental condition or health of a covered
person only with the prior written approval of the commissioner. Such approval
shall be granted only when the contractor has discharged its obligation to
continue coverage for such person by obtaining coverage with another insurer,
health care service contractor, or health maintenance organization, which
coverage is comparable in terms of premiums and benefits as defined by rule of
the commissioner.
(b) It is an unfair practice for a contractor
to modify the coverage provided or rates applying to an in-force contract and
to fail to make such modification in all such issued and outstanding contracts.
(c) Subject to rules adopted by the
commissioner, it is an unfair practice for a health care service contractor to:
(i) Cease the sale of a contract form unless it
has received prior written authorization from the commissioner and has offered
all subscribers covered under such discontinued contract the opportunity to
purchase comparable coverage without health screening; or
(ii) Engage in a practice that subjects
subscribers to rate increases on discontinued contract forms unless such
subscribers are offered the opportunity to purchase comparable coverage without
health screening.
(2) The health care service contractor may
limit an offer of comparable coverage without health screening to a period not
less than thirty days from the date the offer is first made.
NEW SECTION. Sec. 289. A
new section is added to chapter 48.46 RCW to read as follows:
HEALTH MAINTENANCE AGREEMENTS‑-UNFAIR
PRACTICES. (1) With respect to all health maintenance agreements issued or
renewed on and after July 1, 1994, and in addition to the restrictions and
limitations contained in RCW 48.46.060(4):
(a) Agreements shall guarantee continuity of
coverage. Such provision, which shall be included in every agreement, shall
provide that the agreement may be canceled or nonrenewed because of a change in
the physical or mental condition or health of a covered person only with the
prior written approval of the commissioner. Such approval shall be granted
only when the organization has discharged its obligation to continue coverage
for such person by obtaining coverage with another insurer, health care service
contractor, or health maintenance organization, which coverage is comparable in
terms of premiums and benefits as defined by rule of the commissioner.
(b) It is an unfair practice for an
organization to modify the coverage provided or rates applying to an in-force
agreement and to fail to make such modification in all such issued and
outstanding agreements.
(c) Subject to rules adopted by the
commissioner, it is an unfair practice for a health maintenance organization
to:
(i) Cease the sale of an agreement form unless
it has received prior written authorization from the commissioner and has
offered all enrollees covered under such discontinued agreement the opportunity
to purchase comparable coverage without health screening; or
(ii) Engage in a practice that subjects
enrollees to rate increases on discontinued agreement forms unless such
enrollees are offered the opportunity to purchase comparable coverage without
health screening.
(2) The health maintenance organization may
limit an offer of comparable coverage without health screening to a period not
less than thirty days from the date the offer is first made.
Sec. 290.
RCW 48.44.260 and 1979 c 133 s 3 are each amended to read as follows:
HEALTH CARE SERVICE CONTRACTOR‑-NOTICE OF
CANCELLATION. Every authorized health care service contractor, upon canceling,
denying, or refusing to renew any individual health care service contract,
shall, upon written request, directly notify in writing the applicant or ((insured))
subscriber, as the case may be, of the reasons for the action by the
health care service contractor. Any benefits, terms, rates, or conditions of
such a contract which are restricted, excluded, modified, increased, or reduced
((because of the presence of a sensory, mental, or physical handicap))
shall, upon written request, be set forth in writing and supplied to the ((insured))
subscriber. The written communications required by this section shall
be phrased in simple language which is readily understandable to a person of
average intelligence, education, and reading ability.
Sec. 291.
RCW 48.46.380 and 1983 c 106 s 16 are each amended to read as follows:
HEALTH MAINTENANCE ORGANIZATION‑-NOTICE
OF CANCELLATIONS. Every authorized health maintenance organization, upon
canceling, denying, or refusing to renew any individual health maintenance
agreement, shall, upon written request, directly notify in writing the
applicant or enrolled participant as appropriate, of the reasons for the action
by the health maintenance organization. Any benefits, terms, rates, or
conditions of such agreement which are restricted, excluded, modified, increased,
or reduced ((because of the presence of a sensory, mental, or physical
handicap)) shall, upon written request, be set forth in writing and
supplied to the individual. The written communications required by this
section shall be phrased in simple language which is readily understandable to
a person of average intelligence, education, and reading ability.
NEW SECTION. Sec. 292.
REPEALERS‑-REPORT; STUDIES. The following acts or parts of acts are each
repealed:
(1) RCW
48.46.160 and 1975 1st ex.s. c 290 s 17; and
(2) RCW
48.46.905 and 1975 1st ex.s. c 290 s 25.
NEW SECTION. Sec. 293.
REPEALER--NONTERMINATION FOR CHANGE IN HEALTH. RCW 48.44.410 and 1986 c 223 s
12 are each repealed, effective July 1, 1994.
NEW SECTION. Sec. 294. A
new section is added to chapter 48.01 RCW to read as follows:
CERTIFIED HEALTH PLAN PROVISIONS‑-APPLICATION.
Whenever the provisions of this title conflict with the provisions of chapter
. . ., Laws of 1993 (this act), chapter . . ., Laws of 1993
(this act) shall control.
Sec. 295.
RCW 48.44.095 and 1983 c 202 s 3 are each amended to read as follows:
ANNUAL STATEMENT. (1) Every health care
service contractor shall annually, ((within one hundred twenty days of the
closing date of its fiscal year)) before the first day of March,
file with the commissioner a statement verified by at least two of the
principal officers of the health care service contractor showing its financial
condition as of the ((closing date of its fiscal year)) last day of
the preceding calendar year. The statement shall be in such form as is
furnished or prescribed by the commissioner. The commissioner may for good
reason allow a reasonable extension of the time within which such annual
statement shall be filed.
(2) The commissioner may suspend or revoke the
certificate of registration of any health care service contractor failing to
file its annual statement when due or during any extension of time therefor
which the commissioner, for good cause, may grant.
Sec. 296.
RCW 48.46.080 and 1983 c 202 s 10 and 1983 c 106 s 6 are each reenacted and
amended to read as follows:
ANNUAL STATEMENT. (1) Every health maintenance
organization shall annually, ((within one hundred twenty days of the closing
date of its fiscal year)) before the first day of March, file with
the commissioner a statement verified by at least two of the principal officers
of the health maintenance organization showing its financial condition as of
the ((closing date of its fiscal year)) last day of the preceding calendar
year.
(2) Such annual report shall be in such form as
the commissioner shall prescribe and shall include:
(a) A financial statement of such organization,
including its balance sheet and receipts and disbursements for the preceding
year, which reflects at a minimum;
(i) all prepayments and other payments received
for health care services rendered pursuant to health maintenance agreements;
(ii) expenditures to all categories of health
care facilities, providers, insurance companies, or hospital or medical service
plan corporations with which such organization has contracted to fulfill
obligations to enrolled participants arising out of its health maintenance
agreements, together with all other direct expenses including depreciation,
enrollment, and commission; and
(iii) expenditures for capital improvements, or
additions thereto, including but not limited to construction, renovation, or
purchase of facilities and capital equipment;
(b) The number of participants enrolled and
terminated during the report period. Every employer offering health care
benefits to their employees through a group contract with a health maintenance
organization shall furnish said health maintenance organization with a list of
their employees enrolled under such plan;
(c) The number of doctors by type of practice
who, under contract with or as an employee of the health maintenance
organization, furnished health care services to consumers during the past year;
(d) A report of the names and addresses of all
officers, directors, or trustees of the health maintenance organization during
the preceding year, and the amount of wages, expense reimbursements, or other
payments to such individuals for services to such organization. For
partnership and professional service corporations, a report shall be made for
partners or shareholders as to any compensation or expense reimbursement
received by them for services, other than for services and expenses relating
directly for patient care;
(e) Such other information relating to the
performance of the health maintenance organization or the health care
facilities or providers with which it has contracted as reasonably necessary to
the proper and effective administration of this chapter, in accordance with
rules and regulations; and
(f) Disclosure of any financial interests held
by officers and directors in any providers associated with the health
maintenance organization or any provider of the health maintenance
organization.
(3) The commissioner may for good reason allow
a reasonable extension of the time within which such annual statement shall be
filed.
(4) The commissioner may suspend or revoke the
certificate of registration of any health maintenance organization failing to
file its annual statement when due or during any extension of time therefor
which the commissioner, for good cause, may grant.
(5) No person shall knowingly file with any
public official or knowingly make, publish, or disseminate any financial
statement of a health maintenance organization which does not accurately state
the health maintenance organization's financial condition.
PART III. TAXES
NEW SECTION. Sec. 301. A
new section is added to chapter 48.14 RCW to read as follows:
TAX ON PREMIUMS AND PREPAYMENTS. (1) As used
in this section, "taxpayer" means a health maintenance organization,
as defined in RCW 48.46.020, a health care service contractor, as defined in
RCW 48.44.010, or a certified health plan certified under section 434 of this
act.
(2) Each taxpayer shall pay a tax on or before
the first day of March of each year to the state treasurer through the
insurance commissioner's office. The tax shall be equal to the total amount of
all premiums and prepayments for health care services received by the taxpayer
during the preceding calendar year multiplied by the rate of two percent.
(3) Taxpayers shall prepay their tax
obligations under this section. The minimum amount of the prepayments shall be
percentages of the taxpayer's tax obligation for the preceding calendar year
recomputed using the rate in effect for the current year. For the prepayment
of taxes due during the first calendar year, the minimum amount of the
prepayments shall be percentages of the taxpayer's tax obligation that would
have been due had the tax been in effect during the previous calendar year.
The tax prepayments shall be paid to the state treasurer through the
commissioner's office by the due dates and in the following amounts:
(a) On or before June 15, forty-five percent;
(b) On or before September 15, twenty-five
percent;
(c) On or before December 15, twenty-five
percent.
(4) For good cause demonstrated in writing, the
commissioner may approve an amount smaller than the preceding calendar year's
tax obligation as recomputed for calculating the health maintenance
organization's prepayment obligations for the current tax year.
(5) Moneys collected under this section shall
be deposited in the health services account under section 469 of this act.
(6) The taxes imposed in this section do not
apply to:
(a) Amounts received by any taxpayer from the
United States or any instrumentality thereof as prepayments for health care
services provided under Title XVIII (medicare) of the federal social security
act. This exemption shall expire July 1, 1997.
(b) Amounts received by any health care service
contractor, as defined in RCW 48.44.010, as prepayments for health care
services included within the definition of practice of dentistry under RCW
18.32.020. This exemption does not apply to amounts received under a certified
health plan certified under section 434 of this act.
Sec. 302.
RCW 48.14.080 and 1949 c 190 s 21 are each amended to read as follows:
PREMIUM TAX IN LIEU OF OTHER FORMS. As to
insurers other than title insurers, the taxes imposed by this title shall be in
lieu of all other taxes, except taxes on real and tangible personal property ((and)),
excise taxes on the sale, purchase or use of such property, and the tax
imposed in RCW 82.04.260(15).
NEW SECTION. Sec. 303. A
new section is added to chapter 82.04 RCW to read as follows:
EXEMPTION FROM BUSINESS AND OCCUPATION TAX.
This chapter does not apply to any health maintenance organization, health care
service contractor, or certified health plan in respect to premiums or
prepayments that are taxable under section 301 of this act.
Sec. 304.
RCW 82.04.260 and 1991 c 272 s 15 are each amended to read as follows:
TAX ON HOSPITALS OPERATED AS NONPROFIT CORPORATIONS.
(1) Upon every person engaging within this state in the business of buying
wheat, oats, dry peas, dry beans, lentils, triticale, corn, rye and barley, but
not including any manufactured or processed products thereof, and selling the
same at wholesale; the tax imposed shall be equal to the gross proceeds derived
from such sales multiplied by the rate of one one-hundredth of one percent.
(2) Upon every person engaging within this
state in the business of manufacturing wheat into flour, barley into pearl
barley, soybeans into soybean oil, or sunflower seeds into sunflower oil; as to
such persons the amount of tax with respect to such business shall be equal to
the value of the flour, pearl barley, or oil manufactured, multiplied by the
rate of one-eighth of one percent.
(3) Upon every person engaging within this
state in the business of splitting or processing dried peas; as to such persons
the amount of tax with respect to such business shall be equal to the value of
the peas split or processed, multiplied by the rate of one-quarter of one
percent.
(4) Upon every person engaging within this
state in the business of manufacturing seafood products which remain in a raw,
raw frozen, or raw salted state at the completion of the manufacturing by that person;
as to such persons the amount of tax with respect to such business shall be
equal to the value of the products manufactured, multiplied by the rate of
one-eighth of one percent.
(5) Upon every person engaging within this
state in the business of manufacturing by canning, preserving, freezing or
dehydrating fresh fruits and vegetables; as to such persons the amount of tax
with respect to such business shall be equal to the value of the products
canned, preserved, frozen or dehydrated multiplied by the rate of three-tenths
of one percent.
(6) Upon every nonprofit corporation and
nonprofit association engaging within this state in research and development,
as to such corporations and associations, the amount of tax with respect to
such activities shall be equal to the gross income derived from such activities
multiplied by the rate of forty-four one-hundredths of one percent.
(7) Upon every person engaging within this
state in the business of slaughtering, breaking and/or processing perishable
meat products and/or selling the same at wholesale only and not at retail; as
to such persons the tax imposed shall be equal to the gross proceeds derived
from such sales multiplied by the rate of twenty-five one-hundredths of one
percent through June 30, 1986, and one-eighth of one percent thereafter.
(8) Upon every person engaging within this
state in the business of making sales, at retail or wholesale, of nuclear fuel
assemblies manufactured by that person, as to such persons the amount of tax
with respect to such business shall be equal to the gross proceeds of sales of
the assemblies multiplied by the rate of twenty-five one-hundredths of one
percent.
(9) Upon every person engaging within this
state in the business of manufacturing nuclear fuel assemblies, as to such
persons the amount of tax with respect to such business shall be equal to the
value of the products manufactured multiplied by the rate of twenty-five
one-hundredths of one percent.
(10) Upon every person engaging within this
state in the business of acting as a travel agent; as to such persons the
amount of the tax with respect to such activities shall be equal to the gross
income derived from such activities multiplied by the rate of twenty-five
one-hundredths of one percent.
(11) Upon every person engaging within this
state in business as an international steamship agent, international customs
house broker, international freight forwarder, vessel and/or cargo charter
broker in foreign commerce, and/or international air cargo agent; as to such
persons the amount of the tax with respect to only international activities
shall be equal to the gross income derived from such activities multiplied by
the rate of thirty-three one-hundredths of one percent.
(12) Upon every person engaging within this state
in the business of stevedoring and associated activities pertinent to the
movement of goods and commodities in waterborne interstate or foreign commerce;
as to such persons the amount of tax with respect to such business shall be
equal to the gross proceeds derived from such activities multiplied by the rate
of thirty-three one hundredths of one percent. Persons subject to taxation
under this subsection shall be exempt from payment of taxes imposed by chapter
82.16 RCW for that portion of their business subject to taxation under this
subsection. Stevedoring and associated activities pertinent to the conduct of
goods and commodities in waterborne interstate or foreign commerce are defined
as all activities of a labor, service or transportation nature whereby cargo
may be loaded or unloaded to or from vessels or barges, passing over, onto or
under a wharf, pier, or similar structure; cargo may be moved to a warehouse or
similar holding or storage yard or area to await further movement in import or
export or may move to a consolidation freight station and be stuffed,
unstuffed, containerized, separated or otherwise segregated or aggregated for
delivery or loaded on any mode of transportation for delivery to its
consignee. Specific activities included in this definition are: Wharfage,
handling, loading, unloading, moving of cargo to a convenient place of delivery
to the consignee or a convenient place for further movement to export mode;
documentation services in connection with the receipt, delivery, checking,
care, custody and control of cargo required in the transfer of cargo; imported
automobile handling prior to delivery to consignee; terminal stevedoring and
incidental vessel services, including but not limited to plugging and
unplugging refrigerator service to containers, trailers, and other refrigerated
cargo receptacles, and securing ship hatch covers.
(13) Upon every person engaging within this
state in the business of disposing of low-level waste, as defined in RCW
43.145.010; as to such persons the amount of the tax with respect to such
business shall be equal to the gross income of the business, excluding any fees
imposed under chapter 43.200 RCW, multiplied by the rate of fifteen percent.
(a) The rate specified in this subsection shall
be reduced to ten percent on May 20, 1991.
(b) The rate specified in this subsection shall
be further reduced to five percent on January 1, 1992.
(c) The rate specified in this subsection shall
be further reduced to three percent on July 1, 1993.
If the gross income of the taxpayer is
attributable to activities both within and without this state, the gross income
attributable to this state shall be determined in accordance with the methods
of apportionment required under RCW 82.04.460.
(14) Upon every person engaging within this
state as an insurance agent, insurance broker, or insurance solicitor licensed
under chapter 48.17 RCW; as to such persons, the amount of the tax with respect
to such licensed activities shall be equal to the gross income of such business
multiplied by the rate of one percent.
(15) Upon every person engaging within this
state in business as a hospital, as defined in chapter 70.41 RCW, that is
operated as a nonprofit corporation, as to such persons, the amount of tax with
respect to such activities shall be equal to the gross income of the business
multiplied by the rate of seventy-five one-hundredths of one percent through
June 30, 1995, and one and five-tenths percent thereafter. The moneys
collected under this subsection shall be deposited in the health services
account created under section 469 of this act.
Sec. 305.
RCW 82.04.4289 and 1981 c 178 s 2 are each amended to read as follows:
HOSPITAL EXEMPTION DELETED. ((In computing
tax there may be deducted from the measure of tax)) This chapter does
not apply to amounts derived as compensation for services rendered to
patients or from sales of prescription drugs as defined in RCW 82.08.0281
furnished as an integral part of services rendered to patients by ((a
hospital, as defined in chapter 70.41 RCW, which is operated as a nonprofit
corporation,)) a kidney dialysis facility operated as a nonprofit
corporation, ((whether or not operated in connection with a hospital,))
nursing homes, and homes for unwed mothers operated as religious or
charitable organizations, but only if no part of the net earnings received by
such an institution inures directly or indirectly, to any person other than the
institution entitled to deduction hereunder. ((In no event shall any such
deduction be allowed, unless the hospital building is entitled to exemption
from taxation under the property tax laws of this state.))
NEW SECTION. Sec. 306.
REPEALER‑-BUSINESS AND OCCUPATION TAX DEDUCTION FOR PUBLICLY OPERATED
HOSPITALS. RCW 82.04.4288 and 1980 c 37 s 9 are each repealed.
Sec. 307.
RCW 82.24.020 and 1989 c 271 s 504 are each amended to read as follows:
TAX ON CIGARETTES. (1) There is levied and
there shall be collected as ((hereinafter)) provided in this chapter,
a tax upon the sale, use, consumption, handling, possession or distribution of
all cigarettes, in an amount equal to the rate of eleven and one-half mills per
cigarette.
(2) Until July 1, 1995, an additional tax is
imposed upon the sale, use, consumption, handling, possession, or distribution
of all cigarettes, in an amount equal to the rate of one and one-half mills per
cigarette. All revenues collected during any month from this additional tax
shall be deposited in the drug enforcement and education account under RCW
69.50.520 by the twenty-fifth day of the following month.
(3) An additional tax is imposed upon the
sale, use, consumption, handling, possession, or distribution of all
cigarettes, in an amount equal to the rate of ten mills per cigarette through
June 30, 1994, eleven and one-fourth mills per cigarette for the period July 1,
1994, through June 30, 1995, twenty mills per cigarette for the period July 1,
1995, through June 30, 1996, and twenty and one-half mills per cigarette
thereafter. All revenues collected during any month from this additional tax
shall be deposited in the health services account created under section 469 of
this act by the twenty-fifth day of the following month.
(4) Wholesalers and retailers subject to
the payment of this tax may, if they wish, absorb one-half mill per cigarette
of the tax and not pass it on to purchasers without being in violation of this
section or any other act relating to the sale or taxation of cigarettes.
(((4))) (5) For purposes of this
chapter, "possession" shall mean both (a) physical possession by the
purchaser and, (b) when cigarettes are being transported to or held for the
purchaser or his or her designee by a person other than the purchaser,
constructive possession by the purchaser or his designee, which constructive
possession shall be deemed to occur at the location of the cigarettes being so
transported or held.
Sec. 308.
RCW 82.24.080 and 1972 ex.s. c 157 s 4 are each amended to read as follows:
TAX LIABILITY‑-CIGARETTE TAX. It is the
intent and purpose of this chapter to levy a tax on all of the articles taxed
((herein)) under this chapter, sold, used, consumed, handled,
possessed, or distributed within this state and to collect the tax from the
person who first sells, uses, consumes, handles, possesses (either physically
or constructively, in accordance with RCW 82.24.020) or distributes them in the
state. It is further the intent and purpose of this chapter that whenever any
of the articles ((herein)) taxed under this chapter is given away
for advertising or any other purpose, it shall be taxed in the same manner as
if it were sold, used, consumed, handled, possessed, or distributed in this
state.
It is also the intent and purpose of this
chapter that the tax shall be imposed at the time and place of the first
taxable event occurring within this state((: PROVIDED, HOWEVER, That)).
Failure to pay the tax with respect to a taxable event shall not prevent
tax liability from arising by reason of a subsequent taxable event.
In the event of an increase in the rate of
the tax imposed under this chapter, it is the intent of the legislature that
the first person who sells, uses, consumes, handles, possesses, or distributes
previously taxed articles after the effective date of the rate increase shall
be liable for the additional tax represented by the rate increase, but the
failure to pay the additional tax with respect to the first taxable event after
the effective date of a rate increase shall not prevent tax liability for the
additional tax from arising from a subsequent taxable event.
Sec. 309.
RCW 82.26.020 and 1983 2nd ex.s. c 3 s 16 are each amended to read as follows:
TAX ON TOBACCO PRODUCTS. (1) ((From and
after June 1, 1971,)) There is levied and there shall be collected a
tax upon the sale, use, consumption, handling, or distribution of all tobacco
products in this state at the rate of forty-five percent of the wholesale sales
price of such tobacco products. ((Such tax))
(2) Taxes under this section shall be
imposed at the time the distributor (a) brings, or causes to be brought, into
this state from without the state tobacco products for sale, (b) makes,
manufactures, or fabricates tobacco products in this state for sale in this
state, or (c) ships or transports tobacco products to retailers in this state,
to be sold by those retailers.
(((2))) (3) An additional tax is
imposed equal to ((the rate specified in RCW 82.02.030)) seven
percent multiplied by the tax payable under subsection (1) of this section.
(4) An additional tax is imposed equal to
ten percent of the wholesale sales price of tobacco products. The moneys
collected under this subsection shall be deposited in the health services
account created under section 469 of this act.
Sec. 310.
RCW 82.08.150 and 1989 c 271 s 503 are each amended to read as follows:
TAX ON SPIRITS. (1) There is levied and shall
be collected a tax upon each retail sale of spirits, or strong beer in the
original package at the rate of fifteen percent of the selling price. The tax
imposed in this subsection shall apply to all such sales including sales by the
Washington state liquor stores and agencies, but excluding sales to class H
licensees.
(2) There is levied and shall be collected a
tax upon each sale of spirits, or strong beer in the original package at the
rate of ten percent of the selling price on sales by Washington state liquor
stores and agencies to class H licensees.
(3) There is levied and shall be collected an
additional tax upon each retail sale of spirits in the original package at the
rate of one dollar and seventy-two cents per liter. The additional tax imposed
in this subsection shall apply to all such sales including sales by Washington
state liquor stores and agencies, and including sales to class H licensees.
(4) An additional tax is imposed equal to ((the
rate specified in RCW 82.02.030)) fourteen percent multiplied by the
taxes payable under subsections (1), (2), and (3) of this section.
(5) Until July 1, 1995, an additional tax is
imposed upon each retail sale of spirits in the original package at the rate of
seven cents per liter. The additional tax imposed in this subsection shall
apply to all such sales including sales by Washington state liquor stores and
agencies, and including sales to class H licensees. All revenues collected
during any month from this additional tax shall be deposited in the drug
enforcement and education account under RCW 69.50.520 by the twenty-fifth day
of the following month.
(6)(a) An additional tax is imposed upon
retail sale of spirits in the original package at the rate of one and
seven-tenths percent of the selling price through June 30, 1995, two and
six-tenths percent of the selling price for the period July 1, 1995, through June
30, 1997, and three and four-tenths of the selling price thereafter. This
additional tax applies to all such sales including sales by Washington state
liquor stores and agencies, but excluding sales to class H licensees.
(b) An additional tax is imposed upon retail
sale of spirits in the original package at the rate of one and one-tenth
percent of the selling price through June 30, 1995, one and seven-tenths
percent of the selling price for the period July 1, 1995, through June 30,
1997, and two and three-tenths of the selling price thereafter. This
additional tax applies to all such sales to class H licensees.
(c) An additional tax is imposed upon each
retail sale of spirits in the original package at the rate of twenty cents per
liter through June 30, 1995, thirty cents per liter for the period July 1,
1995, through June 30, 1997, and forty-one cents per liter thereafter. This
additional tax applies to all such sales including sales by Washington state
liquor stores and agencies, and including sales to class H licensees.
(d) All revenues collected during any month
from additional taxes under this subsection shall be deposited in the health
services account created under section 469 of this act by the twenty-fifth day
of the following month.
(7) The tax imposed in RCW 82.08.020((,
as now or hereafter amended,)) shall not apply to sales of spirits or
strong beer in the original package.
(((7))) (8) The taxes imposed in
this section shall be paid by the buyer to the seller, and each seller shall
collect from the buyer the full amount of the tax payable in respect to each
taxable sale under this section. The taxes required by this section to be
collected by the seller shall be stated separately from the selling price and
for purposes of determining the tax due from the buyer to the seller, it shall
be conclusively presumed that the selling price quoted in any price list does
not include the taxes imposed by this section.
(((8))) (9) As used in this
section, the terms, "spirits," "strong beer," and "package"
shall have the meaning ascribed to them in chapter 66.04 RCW.
Sec. 311.
RCW 66.24.290 and 1989 c 271 s 502 are each amended to read as follows:
TAX ON BEER‑-REDUCED RATE FOR CERTAIN
BREWERIES. (1) Any brewer or beer wholesaler licensed under this title may
sell and deliver beer to holders of authorized licenses direct, but to no other
person, other than the board; and every such brewer or beer wholesaler shall
report all sales to the board monthly, pursuant to the regulations, and shall
pay to the board as an added tax for the privilege of manufacturing and selling
the beer within the state a tax of two dollars and sixty cents per barrel of
thirty-one gallons on sales to licensees within the state and on sales to licensees
within the state of bottled and canned beer shall pay a tax computed in gallons
at the rate of two dollars and sixty cents per barrel of thirty-one gallons.
Any brewer or beer wholesaler whose applicable tax payment is not postmarked by
the twentieth day following the month of sale will be assessed a penalty at the
rate of two percent per month or fraction thereof. Each such brewer or
wholesaler shall procure from the board revenue stamps representing such tax in
form prescribed by the board and shall affix the same to the barrel or package
in such manner and in such denominations as required by the board, and shall
cancel the same prior to commencing delivery from his or her place of
business or warehouse of such barrels or packages. Beer shall be sold by
brewers and wholesalers in sealed barrels or packages. The revenue stamps ((herein))
provided ((for)) under this section need not be affixed and
canceled in the making of resales of barrels or packages already taxed by the
affixation and cancellation of stamps as provided in this section.
(2) An additional tax is imposed equal to ((the
rate specified in RCW 82.02.030)) seven percent multiplied by the
tax payable under subsection (1) of this section. All revenues collected
during any month from this additional tax shall be transferred to the state
general fund by the twenty-fifth day of the following month.
(3) Until July 1, 1995, an additional tax is
imposed on all beer subject to tax under subsection (1) of this section. The
additional tax is equal to two dollars per barrel of thirty-one gallons. All
revenues collected during any month from this additional tax shall be deposited
in the drug enforcement and education account under RCW 69.50.520 by the
twenty-fifth day of the following month.
(4)(a) An additional tax is imposed on all
beer subject to tax under subsection (1) of this section. The additional tax
is equal to ninety-six cents per barrel of thirty-one gallons through June 30,
1995, two dollars and thirty-nine cents per barrel of thirty-one gallons for
the period July 1, 1995, through June 30, 1997, and four dollars and
seventy-eight cents per barrel of thirty-one gallons thereafter.
(b) The additional tax imposed under this
subsection does not apply to the sale of the first sixty thousand barrels of
beer each year by breweries that are entitled to a reduced rate of tax under 26
U.S.C. Sec. 5051, as existing on the effective date of this section or such
subsequent date as may be provided by the board by rule consistent with the
purposes of this exemption.
(c) All revenues collected from the
additional tax imposed under this subsection (4) shall be deposited in the
health services account under section 469 of this act.
(5) The tax imposed under this section
shall not apply to "strong beer" as defined in this title.
Sec. 312.
RCW 82.02.030 and 1990 c 42 s 319 are each amended to read as follows:
ADDITIONAL TAX RATES. (((1))) The rate
of the additional taxes under RCW 54.28.020(2), 54.28.025(2), 66.24.210(2), ((66.24.290(2),))
82.04.2901, 82.16.020(2), ((82.26.020(2),)) 82.27.020(5), and
82.29A.030(2) shall be seven percent((; and
(2) The rate of the additional taxes under RCW
82.08.150(4) shall be fourteen percent)).
PART IV. HEALTH SYSTEM REFORM
NEW SECTION. Sec. 401.
INTENT. The legislature intends that chapter . . ., Laws of 1993
(this act) establish structures, processes, and specific financial limits to
stabilize the overall cost of health services within the economy, reduce the
demand for unneeded health services, provide access to essential health
services, improve public health, and ensure that health system costs do not
undermine the financial viability of nonhealth care businesses.
NEW SECTION. Sec. 402.
DEFINITIONS. In this chapter, unless the context otherwise requires:
(1) "Certified health plan" or
"plan" means a disability insurer regulated under chapter 48.20 or
48.21 RCW, a health care service contractor as defined in RCW 48.44.010, a
health maintenance organization as defined in RCW 48.46.020, or an entity
certified in accordance with sections 433 through 443 of this act.
(2) "Chair" means the presiding
officer of the Washington health services commission.
(3) "Commission" or "health
services commission" means the Washington health services commission.
(4) "Community rate" means the rating
method used to establish the premium for the uniform benefits package adjusted
to reflect actuarially demonstrated differences in utilization or cost
attributable to geographic region and family size as determined by the
commission.
(5) "Continuous quality improvement and
total quality management" means a continuous process to improve health
services while reducing costs.
(6) "Employee" means a resident who
is in the employment of an employer, as defined by chapter 50.04 RCW.
(7) "Enrollee" means any person who
is a Washington resident enrolled in a certified health plan.
(8) "Enrollee point of service
cost-sharing" means amounts paid to certified health plans directly
providing services, health care providers, or health care facilities by
enrollees for receipt of specific uniform benefits package services, and may
include copayments, coinsurance, or deductibles, that together must be
actuarially equivalent across plans and within overall limits established by
the commission.
(9) "Enrollee premium sharing" means
that portion of the premium that is paid by enrollees or their family members.
(10) "Federal poverty level" means
the federal poverty guidelines determined annually by the United States
department of health and human services or successor agency.
(11) "Health care facility" or
"facility" means hospices licensed under chapter 70.127 RCW,
hospitals licensed under chapter 70.41 RCW, rural health facilities as defined
in RCW 70.175.020, psychiatric hospitals licensed under chapter 71.12 RCW,
nursing homes licensed under chapter 18.51 RCW, community mental health centers
licensed under chapter 71.05 or 71.24 RCW, kidney disease treatment centers
licensed under chapter 70.41 RCW, ambulatory diagnostic, treatment or surgical
facilities licensed under chapter 70.41 RCW, drug and alcohol treatment
facilities licensed under chapter 70.96A RCW, and home health agencies licensed
under chapter 70.127 RCW, and includes such facilities if owned and operated by
a political subdivision or instrumentality of the state and such other
facilities as required by federal law and implementing regulations, but does
not include Christian Science sanatoriums operated, listed, or certified by the
First Church of Christ Scientist, Boston, Massachusetts.
(12) "Health care provider" or
"provider" means:
(a) A person regulated under Title 18 RCW and
chapter 70.127 RCW, to practice health or health-related services or otherwise
practicing health care services in this state consistent with state law; or
(b) An employee or agent of a person described
in (a) of this subsection, acting in the course and scope of his or her
employment.
(13) "Health insurance purchasing
cooperative" or "cooperative" means a member-owned and governed
nonprofit organization certified in accordance with sections 425 and 426 of
this act.
(14) "Long-term care" means
institutional, residential, outpatient, or community-based services that meet
the individual needs of persons of all ages who are limited in their functional
capacities or have disabilities and require assistance with performing two or
more activities of daily living for an extended or indefinite period of time.
These services include case management, protective supervision, in-home care,
nursing services, convalescent, custodial, chronic, and terminally ill care.
(15) "Major capital expenditure"
means any project or expenditure for capital construction, renovations, or
acquisition, including medical technological equipment, as defined by the
commission, costing more than one million dollars.
(16) "Managed care" means an
integrated system of insurance, financing, and health services delivery
functions that: (a) Assumes financial risk for delivery of health services and
uses a defined network of providers; or (b) assumes financial risk for delivery
of health services and promotes the efficient delivery of health services through
provider assumption of some financial risk including capitation, prospective
payment, resource-based relative value scales, fee schedules, or similar method
of limiting payments to health care providers.
(17) "Maximum enrollee financial
participation" means the income-related total annual payments that may be
required of an enrollee per family who chooses one of the three lowest priced
uniform benefits packages offered by plans in a geographic region including
both premium sharing and enrollee point of service cost-sharing.
(18) "Persons of color" means
Asians/Pacific Islanders, African, Hispanic, and Native Americans.
(19) "Premium" means all sums
charged, received, or deposited by a certified health plan as consideration for
a uniform benefits package or the continuance of a uniform benefits package.
Any assessment, or any "membership," "policy,"
"contract," "service," or similar fee or charge made by the
certified health plan in consideration for the uniform benefits package is
deemed part of the premium. "Premium" shall not include amounts paid
as enrollee point of service cost-sharing.
(20) "Qualified employee" means an
employee who is employed at least thirty hours during a week or one hundred
twenty hours during a calendar month.
(21) "Registered employer health
plan" means a health plan established by a private employer of more than
seven thousand active employees in this state solely for the benefit of such
employees and their dependents and that meets the requirements of section 430 of
this act. Nothing contained in this subsection shall be deemed to preclude the
plan from providing benefits to retirees of the employer.
(22) "Supplemental benefits" means
those appropriate and effective health services that are not included in the
uniform benefits package or that expand the type or level of health services
available under the uniform benefits package and that are offered to all
residents in accordance with the provisions of sections 452 and 453 of this
act.
(23) "Technology" means the drugs,
devices, equipment, and medical or surgical procedures used in the delivery of
health services, and the organizational or supportive systems within which such
services are provided. It also means sophisticated and complicated machinery
developed as a result of ongoing research in the basic biological and physical
sciences, clinical medicine, electronics, and computer sciences, as well as
specialized professionals, medical equipment, procedures, and chemical
formulations used for both diagnostic and therapeutic purposes.
(24) "Uniform benefits package" or
"package" means those appropriate and effective health services,
defined by the commission under section 449 of this act, that must be offered
to all Washington residents through certified health plans.
(25) "Washington resident" or
"resident" means a person who intends to reside in the state
permanently or indefinitely and who did not move to Washington for the primary
purpose of securing health services under sections 427 through 466 of this
act. "Washington resident" also includes people and their
accompanying family members who are residing in the state for the purpose of
engaging in employment for at least one month, who did not enter the state for
the primary purpose of obtaining health services. The confinement of a person
in a nursing home, hospital, or other medical institution in the state shall
not by itself be sufficient to qualify such person as a resident.
A. THE WASHINGTON HEALTH SERVICES COMMISSION
NEW SECTION. Sec. 403.
CREATION OF COMMISSION‑-MEMBERSHIP‑-TERMS OF OFFICE‑-VACANCIES‑-SALARIES.
(1) There is created an agency of state government to be known as the
Washington health services commission. The commission shall consist of five
members reflecting ethnic and racial diversity, appointed by the governor, with
the consent of the senate. One member shall be designated by the governor as
chair and shall serve at the pleasure of the governor. The insurance
commissioner shall serve as an additional nonvoting member. Of the initial
members, one shall be appointed to a term of three years, two shall be
appointed to a term of four years, and two shall be appointed to a term of five
years. Thereafter, members shall be appointed to five-year terms. Vacancies
shall be filled by appointment for the remainder of the unexpired term of the
position being vacated.
(2) Members of the commission shall have no
pecuniary interest in any business subject to regulation by the commission and
shall be subject to chapter 42.18 RCW, the executive branch conflict of
interest act.
(3) Members of the commission shall occupy their
positions on a full-time basis and are exempt from the provisions of chapter
41.06 RCW. Commission members and the professional commission staff are
subject to the public disclosure provisions of chapter 42.17 RCW. Members
shall be paid a salary to be fixed by the governor in accordance with RCW
43.03.040. A majority of the members of the commission constitutes a quorum
for the conduct of business.
NEW SECTION. Sec. 404.
ADVISORY COMMITTEES. (1)(a) The chair shall appoint an advisory committee with
balanced representation from consumers, business, government, labor, certified
health plans, practicing health care providers, health care facilities, and
health services researchers reflecting ethnic and racial diversity. In
addition, the chair may appoint special committees for specified periods of
time.
(b) The chair shall also appoint a five-member
health services effectiveness committee whose members possess a breadth of
experience and knowledge in the treatment, research, and public and private
funding of health care services. The committee shall meet at the call of the
chair. The health services effectiveness committee shall advise the commission
on: (i) Those health services that may be determined by the commission to be
appropriate and effective; (ii) use of technology and practice indicators;
(iii) the uniform benefits package; and (iv) rules that insurers and certified
health plans must use to determine whether a procedure, treatment, drug, or
other health service is no longer experimental or investigative.
(c) The commission shall also appoint a small
business advisory committee composed of seven owners of businesses with
twenty-five or fewer full-time equivalent employees' reflecting ethnic and
racial diversity, to assist the commission in development of the small business
economic impact statement and the small business assistance program, as
provided in sections 450 and 466 of this act.
(d) The commission shall also appoint an
organized labor advisory committee composed of seven representatives of
employee organizations representing employees of public or private employers.
The committee shall assist the commission in conducting the evaluation of
Taft-Hartley health care trusts and self-insured employee health benefits
plans, as provided in section 406(26) of this act, and shall advise the
commission on issues related to the impact of chapter . . ., Laws of
1993 (this act) on negotiated health benefits agreements and other employee
health benefits plans.
(2) Members of committees and panels shall
serve without compensation for their services but shall be reimbursed for their
expenses while attending meetings on behalf of the commission in accordance
with RCW 43.03.050 and 43.03.060.
NEW SECTION. Sec. 405.
POWERS AND DUTIES OF THE CHAIR. The chair shall be the chief administrative
officer and the appointing authority of the commission and has the following
powers and duties:
(1) Direct and supervise the commission's
administrative and technical activities in accordance with the provisions of
this chapter and rules and policies adopted by the commission;
(2) Employ personnel of the commission in
accordance with chapter 41.06 RCW, and prescribe their duties. With the
approval of a majority of the commission, the chair may appoint persons to
administer any entity established pursuant to subsection (8) of this section,
and up to seven additional employees all of whom shall be exempt from the
provisions of chapter 41.06 RCW;
(3) Enter into contracts on behalf of the
commission;
(4) Accept and expend gifts, donations, grants,
and other funds received by the commission;
(5) Delegate administrative functions of the
commission to employees of the commission as the chair deems necessary to
ensure efficient administration;
(6) Subject to approval of the commission,
appoint advisory committees and undertake studies, research, and analysis
necessary to support activities of the commission;
(7) Preside at meetings of the commission;
(8) Consistent with policies and rules
established by the commission, establish such administrative divisions,
offices, or programs as are necessary to carry out the purposes of chapter
. . ., Laws of 1993 (this act); and
(9) Perform such other administrative and
technical duties as are consistent with chapter . . ., Laws of 1993
(this act) and the rules and policies of the commission.
NEW SECTION. Sec. 406.
POWERS AND DUTIES OF THE COMMISSION. The commission has the following powers
and duties:
(1) Ensure that all residents of Washington
state are enrolled in a certified health plan to receive the uniform benefits
package, regardless of age, sex, family structure, ethnicity, race, health
condition, geographic location, employment, or economic status.
(2) Endeavor to ensure that all residents of
Washington state have access to appropriate, timely, confidential, and
effective health services, and monitor the degree of access to such services.
If the commission finds that individuals or populations lack access to
certified health plan services, the commission shall:
(a) Authorize appropriate state agencies, local
health departments, community or migrant health clinics, public hospital
districts, or other nonprofit health service entities to take actions necessary
to assure such access. This includes authority to contract for or directly
deliver services described within the uniform benefits package to special
populations; or
(b) Notify appropriate certified health plans
and the insurance commissioner of such findings. The commission shall adopt by
rule standards by which the insurance commissioner may, in such event, require
certified health plans in closest proximity to such individuals and populations
to extend their catchment areas to those individuals and populations and offer
them enrollment.
(3) Adopt necessary rules in accordance with
chapter 34.05 RCW to carry out the purposes of chapter . . ., Laws of
1993 (this act). An initial set of draft rules establishing at least the
commission's organization structure, the uniform benefits package, and
standards for certified health plan certification, must be submitted in draft
form to appropriate committees of the legislature by December 1, 1994.
(4) Establish and modify as necessary, in
consultation with the state board of health and the department of health, and
coordination with the planning process set forth in section 467 of this act a
uniform set of health services based on the recommendations of the health care
cost control and access commission established under House Concurrent
Resolution No. 4443 adopted by the legislature in 1990.
(5) Establish and modify as necessary the
uniform benefits package as provided in section 449 of this act, which shall be
offered to enrollees of a certified health plan. The benefit package shall be
provided at no more than the maximum premium specified in subsection (6) of
this section.
(6)(a) Establish for each year a
community-rated maximum premium for the uniform benefits package that shall
operate to control overall health care costs. The maximum premium cost of the
uniform benefits package in the base year 1995 shall be established upon an
actuarial determination of the costs of providing the uniform benefits package
and such other cost impacts as may be deemed relevant by the commission.
Beginning in 1996, the growth rate of the premium cost of the uniform benefits
package for each certified health plan shall be allowed to increase by a rate
no greater than the average growth rate in the cost of the package between 1990
and 1993 as actuarially determined, reduced by two percentage points per year
until the growth rate is no greater than the five-year rolling average of
growth in Washington per capita personal income, as determined by the office of
financial management.
(b) In establishing the community-rated maximum
premium under this subsection, the commission shall develop a composite rate
for employees that provides nominal, if any, variance between the rate for
individual employees and employees with dependents to minimize any economic
incentive to an employer to discriminate between prospective employees based
upon whether or not they have dependents for whom coverage would be required.
Nothing in this subsection (6)(b) shall preclude the commission from evaluating
other methodologies for establishing the community-rated maximum premium and
recommending an alternative methodology to the legislature.
(c) If the commission adds or deletes services
or benefits to the uniform benefits package in subsequent years, it may
increase or decrease the maximum premium to reflect the actual cost experience
of a broad sample of providers of that service in the state, considering the
factors enumerated in (a) of this subsection and adjusted actuarially. The
addition of services or benefits shall not result in a redetermination of the
entire cost of the uniform benefits package.
(d) The level of state expenditures for the
uniform benefits package shall be limited to the appropriation of funds
specifically for this purpose.
(7) Determine the need for medical risk
adjustment mechanisms to minimize financial incentives for certified health
plans to enroll individuals who present lower health risks and avoid enrolling
individuals who present higher health risks, and to minimize financial
incentives for employer hiring practices that discriminate against individuals
who present higher health risks. In the design of medical risk distribution
mechanisms under this subsection, the commission shall (a) balance the benefits
of price competition with the need to protect certified health plans from any
unsustainable negative effects of adverse selection; (b) consider the development
of a system that creates a risk profile of each certified health plan's
enrollee population that does not create disincentives for a plan to control
benefit utilization, that requires contributions from plans that enjoy a
low-risk enrollee population to plans that have a high-risk enrollee
population, and that does not permit an adjustment of the premium charged for
the uniform benefits package or supplemental coverage based upon either receipt
or contribution of assessments; and (c) consider whether registered employer
health plans should be included in any medical risk adjustment mechanism.
Proposed medical risk adjustment mechanisms shall be submitted to the
legislature as provided in section 454 of this act.
(8) Design a mechanism to assure minors have
access to confidential health care services as currently provided in RCW
70.24.110 and 71.34.030.
(9) Monitor the actual growth in total annual
health services costs.
(10) Monitor the increased application of
technology as required by chapter . . ., Laws of 1993 (this act) and
take necessary action to ensure that such application is made in a
cost-effective and efficient manner and consistent with existing laws that
protect individual privacy.
(11) Establish reporting requirements for
certified health plans that own or manage health care facilities, health care
facilities, and health care providers to periodically report to the commission
regarding major capital expenditures of the plans. The commission shall review
and monitor such reports and shall report to the legislature regarding major
capital expenditures on at least an annual basis. The Washington health care
facilities authority and the commission shall develop standards jointly for
evaluating and approving major capital expenditure financing through the
Washington health care facilities authority, as authorized pursuant to chapter
70.37 RCW. By December 1, 1994, the commission and the authority shall submit
jointly to the legislature such proposed standards. The commission and the
authority shall, after legislative review, but no later than June 1, 1995,
publish such standards. Upon publication, the authority may not approve
financing for major capital expenditures unless approved by the commission.
(12) Establish maximum enrollee financial
participation levels. The levels shall be related to enrollee household
income.
(13) For health services provided under the
uniform benefits package and supplemental benefits, adopt standards for
enrollment, and standardized billing and claims processing forms. The
standards shall ensure that these procedures minimize administrative burdens on
health care providers, health care facilities, certified health plans, and
consumers. Subject to federal approval or phase-in schedules whenever
necessary or appropriate, the standards also shall apply to state-purchased
health services, as defined in RCW 41.05.011.
(14) Propose that certified health plans adopt
certain practice indicators or risk management protocols for quality assurance,
utilization review, or provider payment. The commission may consider
indicators or protocols recommended according to section 410 of this act for
these purposes.
(15) Propose other guidelines to certified
health plans for utilization management, use of technology and methods of
payment, such as diagnosis‑related groups and a resource-based relative
value scale. Such guidelines shall be voluntary and shall be designed to
promote improved management of care, and provide incentives for improved
efficiency and effectiveness within the delivery system.
(16) Adopt standards and oversee and develop
policy for personal health data and information system as provided in chapter
70.170 RCW.
(17) Adopt standards that prevent conflict of
interest by health care providers as provided in section 408 of this act.
(18) At the appropriate juncture and in the
fullness of time, consider the extent to which medical research and health
professions training activities should be included within the health service
system set forth in this chapter . . ., Laws of 1993 (this act).
(19) Evaluate and monitor the extent to which
racial and ethnic minorities have access and to receive health services within
the state, and develop strategies to address barriers to access.
(20) Develop standards for the certification
process to certify health plans and employer health plans to provide the
uniform benefits package, according to the provisions for certified health
plans and registered employer health plans under chapter . . ., Laws
of 1993 (this act).
(21) Develop rules for implementation of
individual and employer participation under sections 463 and 464 of this act
specifically applicable to persons who work in this state but do not live in
the state or persons who live in this state but work outside of the state. The
rules shall be designed so that these persons receive coverage and financial
requirements that are comparable to that received by persons who both live and
work in the state.
(22) After receiving advice from the health
services effectiveness committee, adopt rules that must be used by certified
health plans, disability insurers, health care service contractors, and health
maintenance organizations to determine whether a procedure, treatment, drug, or
other health service is no longer experimental or investigative.
(23) Establish a process for purchase of
uniform benefits package services by enrollees when they are out-of-state.
(24) Develop recommendations to the legislature
as to whether state and school district employees, on whose behalf health
benefits are or will be purchased by the health care authority pursuant to
chapter 41.05 RCW, should have the option to purchase health benefits through
health insurance purchasing cooperatives on and after July 1, 1997. In
developing its recommendations, the commission shall consider:
(a) The impact of state or school district
employees purchasing through health insurance purchasing cooperatives on the
ability of the state to control its health care costs; and
(b) Whether state or school district employees
purchasing through health insurance purchasing cooperatives will result in
inequities in health benefits between or within groups of state and school
district employees.
(25) Establish guidelines for providers dealing
with terminal or static conditions, taking into consideration the ethics of
providers, patient and family wishes, costs, and survival possibilities.
(26) Evaluate the extent to which Taft-Hartley
health care trusts provide benefits to certain individuals in the state; review
the federal laws under which these trusts are organized; and make appropriate
recommendations to the governor and the legislature on or before December 1,
1994, as to whether these trusts should be brought under the provisions of
chapter . . ., Laws of 1993 (this act) when it is fully implemented,
and if the commission recommends inclusion of the trusts, how to implement such
inclusion.
(27) Evaluate whether Washington is
experiencing a higher percentage in in-migration of residents from other states
and territories than would be expected by normal trends as a result of the
availability of unsubsidized and subsidized health care benefits for all
residents and report to the governor and the legislature their findings.
(28) In developing the uniform benefits package
and other standards pursuant to this section, consider the likelihood of the
establishment of a national health services plan adopted by the federal
government and its implications.
(29) Evaluate the effect of reforms under
chapter . . ., Laws of 1993 (this act) on access to care and economic
development in rural areas.
To the extent that the exercise of any of the
powers and duties specified in this section may be inconsistent with the powers
and duties of other state agencies, offices, or commissions, the authority of
the commission shall supersede that of such other state agency, office, or
commission, except in matters of personal health data, where the commission
shall have primary data system policymaking authority and the department of
health shall have primary responsibility for the maintenance and routine
operation of personal health data systems.
NEW SECTION. Sec. 407.
MODIFICATION OF MAXIMUM PREMIUM. Upon the recommendation of the insurance
commissioner, and on the basis of evidence established by independent actuarial
analysis, if the commission finds that the economic viability of a significant
number of the state's certified health plans is seriously threatened, the
commission may increase the maximum premium to the extent mandated by the
Constitution, and must immediately thereafter submit to the legislature a
proposal for a new formula for adjusting the maximum premium, which must be
enacted into law by a sixty percent vote of each house of the legislature.
NEW SECTION. Sec. 408. A
new section is added to chapter 18.130 RCW to read as follows:
CONFLICT OF INTEREST STANDARDS. The Washington
health services commission established by section 403 of this act, in
consultation with the secretary of health, and the health care disciplinary
authorities under RCW 18.130.040(2)(b), shall establish standards and monetary
penalties in rule prohibiting provider investments and referrals that present a
conflict of interest resulting from inappropriate financial gain for the
provider or his or her immediate family. These standards are not intended to
inhibit the efficient operation of managed health care systems or certified
health plans. The commission shall report to the health policy committees of
the senate and house of representatives by December 1, 1994, on the development
of the standards and any recommended statutory changes necessary to implement
the standards.
NEW SECTION. Sec. 409.
CONTINUOUS QUALITY IMPROVEMENT AND TOTAL QUALITY MANAGEMENT. To ensure the
highest quality health services at the lowest total cost, the commission shall
establish a total quality management system of continuous quality improvement.
Such endeavor shall be based upon the recognized quality science for continuous
quality improvement. The commission shall impanel a committee composed of
persons from the private sector and related sciences who have broad knowledge
and successful experiences in continuous quality improvement and total quality
management applications. It shall be the responsibility of the committee to
develop standards for a Washington state health services supplier certification
process and recommend such standards to the commission for review and
adoption. Once adopted, the commission shall establish a schedule, with full
compliance no later than July 1, 1996, whereby all health service providers and
health service facilities shall be certified prior to providing uniform
benefits package services.
B. PRACTICE INDICATORS
NEW SECTION. Sec. 410. A
new section is added to chapter 43.70 RCW to read as follows:
PRACTICE INDICATORS. The department of health
shall consult with health care providers and facilities, purchasers, health
professional regulatory authorities under RCW 18.130.040, appropriate research
and clinical experts, and consumers of health care services to identify
specific practice areas where practice indicators and risk management protocols
have been developed, including those that have been demonstrated to be
effective among persons of color. Practice indicators shall be based upon
expert consensus and best available scientific evidence. The department shall:
(1) Develop a definition of expert consensus
and best available scientific evidence so that practice indicators can serve as
a standard for excellence in the provision of health care services.
(2) Establish a process to identify and
evaluate practice indicators and risk management protocols as they are
developed by the appropriate professional, scientific, and clinical
communities.
(3) Recommend the use of practice indicators
and risk management protocols in quality assurance, utilization review, or
provider payment to the health services commission.
C. HEALTH CARE LIABILITY REFORMS
Sec. 411.
RCW 43.70.320 and 1991 sp.s. c 13 s 18 are each amended to read as follows:
HEALTH PROFESSIONS ACCOUNT. (1) There
is created in the state treasury an account to be known as the health
professions account. All fees received by the department for health
professions licenses, registration, certifications, renewals, or examinations and
the civil penalties assessed and collected by the department under RCW
18.130.190 shall be forwarded to the state treasurer who shall credit such
moneys to the health professions account.
(2) All expenses incurred in carrying
out the health professions licensing activities of the department shall be paid
from the account as authorized by legislative appropriation. Any residue in
the account shall be accumulated and shall not revert to the general fund at
the end of the biennium.
(3) The secretary shall biennially
prepare a budget request based on the anticipated costs of administering the
health professions licensing activities of the department which shall include
the estimated income from health professions fees.
NEW SECTION. Sec. 412. A
new section is added to chapter 18.130 RCW to read as follows:
MALPRACTICE INSURANCE COVERAGE MANDATE. Except
to the extent that liability insurance is not available, every licensed health
care practitioner whose services are included in the uniform benefits package,
as determined by section 449 of this act, and whose scope of practice includes
independent practice, shall, as a condition of licensure and relicensure, be
required to provide evidence of a minimum level of malpractice insurance
coverage issued by a company authorized to do business in this state. On or before
January 1, 1994, the department shall designate by rule:
(1) Those health professions whose scope of
practice includes independent practice;
(2) For each health profession whose scope of
practice includes independent practice, whether malpractice insurance is
available; and
(3) If such insurance is available, the
appropriate minimum level of mandated coverage.
NEW SECTION. Sec. 413. A
new section is added to chapter 48.22 RCW to read as follows:
RISK MANAGEMENT TRAINING OF INDEPENDENT HEALTH
CARE PRACTITIONERS. Effective July 1, 1994, a casualty insurer's issuance of a
new medical malpractice policy or renewal of an existing medical malpractice
policy to a physician or other independent health care practitioner shall be
conditioned upon that practitioner's participation in, and completion of, an
insurer-designed health care liability risk management training program once
every three years. The risk management training shall provide information
related to avoiding adverse health outcomes resulting from substandard practice
and minimizing damages associated with the adverse health outcomes that do
occur. For purposes of this section, "independent health care
practitioners" means those health care practitioner licensing
classifications designated by the department of health in rule pursuant to
section 412 of this act.
NEW SECTION. Sec. 414. A
new section is added to chapter 48.05 RCW to read as follows:
RISK MANAGEMENT TRAINING OF INDEPENDENT HEALTH
CARE PRACTITIONERS. Effective July 1, 1994, each health care provider,
facility, or health maintenance organization that self-insures for liability
risks related to medical malpractice and employs physicians or other
independent health care practitioners in Washington state shall condition each
physician's and practitioner's liability coverage by that entity upon that
physician's or practitioner's participation in risk management training offered
by the provider, facility, or health maintenance organization to its
employees. The risk management training shall provide information related to
avoiding adverse health outcomes resulting from substandard practice and
minimizing damages associated with those adverse health outcomes that do
occur. For purposes of this section, "independent health care
practitioner" means those health care practitioner licensing
classifications designated by the department of health in rule pursuant to
section 412 of this act.
Sec. 415.
RCW 70.41.200 and 1991 c 3 s 336 are each amended to read as follows:
QUALITY IMPROVEMENT PROGRAM. (1) Every
hospital shall maintain a coordinated quality improvement program for
the improvement of the quality of health care services rendered to patients
and the identification and prevention of medical malpractice. The program
shall include at least the following:
(a) The establishment of a quality ((assurance))
improvement committee with the responsibility to review the services
rendered in the hospital, both retrospectively and prospectively, in
order to improve the quality of medical care of patients and to prevent medical
malpractice. The committee shall oversee and coordinate the quality
improvement and medical malpractice prevention program and shall insure
that information gathered pursuant to the program is used to review and to
revise hospital policies and procedures((. At least one member of the
committee shall be a member of the governing board of the hospital who is not
otherwise affiliated with the hospital in an employment or contractual capacity));
(b) A medical staff privileges sanction
procedure through which credentials, physical and mental capacity, and competence
in delivering health care services are periodically reviewed as part of an
evaluation of staff privileges;
(c) The periodic review of the credentials,
physical and mental capacity, and competence in delivering health care services
of all persons who are employed or associated with the hospital;
(d) A procedure for the prompt resolution of
grievances by patients or their representatives related to accidents, injuries,
treatment, and other events that may result in claims of medical malpractice;
(e) The maintenance and continuous collection
of information concerning the hospital's experience with negative health care
outcomes and incidents injurious to patients, patient grievances, professional
liability premiums, settlements, awards, costs incurred by the hospital for
patient injury prevention, and safety improvement activities;
(f) The maintenance of relevant and appropriate
information gathered pursuant to (a) through (e) of this subsection concerning
individual physicians within the physician's personnel or credential file
maintained by the hospital;
(g) Education programs dealing with quality
improvement, patient safety, injury prevention, staff responsibility to
report professional misconduct, the legal aspects of patient care, improved
communication with patients, and causes of malpractice claims for staff
personnel engaged in patient care activities; and
(h) Policies to ensure compliance with the
reporting requirements of this section.
(2) Any person who, in substantial good faith,
provides information to further the purposes of the quality improvement and
medical malpractice prevention program or who, in substantial good faith,
participates on the quality ((assurance)) improvement committee
shall not be subject to an action for civil damages or other relief as a result
of such activity.
(3) Information and documents, including
complaints and incident reports, created specifically for, and
collected, and maintained ((about health care providers arising out of the
matters that are under review or have been evaluated)) by a ((review))
quality improvement committee ((conducting quality assurance reviews))
are not subject to discovery or introduction into evidence in any civil action,
and no person who was in attendance at a meeting of such committee or ((board))
who participated in the creation, collection, or maintenance of information
or documents specifically for the committee shall be permitted or required
to testify in any civil action as to the content of such proceedings or the
documents and information prepared specifically for the committee. This
subsection does not preclude: (a) In any civil action, the discovery of the
identity of persons involved in the medical care that is the basis of the civil
action whose involvement was independent of any quality improvement activity;
(b) in any civil action, the testimony of any person concerning the facts
which form the basis for the institution of such proceedings of which the
person had personal knowledge acquired independently of such proceedings; (((b)))
(c) in any civil action by a health care provider regarding the
restriction or revocation of that individual's clinical or staff privileges,
introduction into evidence information collected and maintained by quality ((assurance))
improvement committees regarding such health care provider; (((c)))
(d) in any civil action, disclosure of the fact that staff privileges
were terminated or restricted, including the specific restrictions imposed, if
any and the reasons for the restrictions; or (((d))) (e)
in any civil action, discovery and introduction into evidence of the patient's
medical records required by regulation of the department of health to be made
regarding the care and treatment received.
(4) Each quality improvement committee
shall, on at least a semiannual basis, report to the governing board of the
hospital in which the committee is located. The report shall review the
quality improvement activities conducted by the committee, and any actions
taken as a result of those activities.
(5) The department of health shall adopt
such rules as are deemed appropriate to effectuate the purposes of this
section.
(((5))) (6) The medical
disciplinary board or the board of osteopathic medicine and surgery, as
appropriate, may review and audit the records of committee decisions in which a
physician's privileges are terminated or restricted. Each hospital shall
produce and make accessible to the board the appropriate records and otherwise
facilitate the review and audit. Information so gained shall not be subject to
the discovery process and confidentiality shall be respected as required by
subsection (3) of this section. Failure of a hospital to comply with this
subsection is punishable by a civil penalty not to exceed two hundred fifty
dollars.
(((6))) (7) Violation of this
section shall not be considered negligence per se.
Sec. 416.
RCW 70.41.230 and 1991 c 3 s 337 are each amended to read as follows:
REQUEST FOR STAFF PRIVILEGES. (1) Prior to
granting or renewing clinical privileges or association of any physician or
hiring a physician, a hospital or facility approved pursuant to this chapter
shall request from the physician and the physician shall provide the following
information:
(a) The name of any hospital or facility with
or at which the physician had or has any association, employment, privileges,
or practice;
(b) If such association, employment, privilege,
or practice was discontinued, the reasons for its discontinuation;
(c) Any pending professional medical misconduct
proceedings or any pending medical malpractice actions in this state or another
state, the substance of the allegations in the proceedings or actions, and any
additional information concerning the proceedings or actions as the physician
deems appropriate;
(d) The substance of the findings in the
actions or proceedings and any additional information concerning the actions or
proceedings as the physician deems appropriate;
(e) A waiver by the physician of any
confidentiality provisions concerning the information required to be provided
to hospitals pursuant to this subsection; and
(f) A verification by the physician that the
information provided by the physician is accurate and complete.
(2) Prior to granting privileges or association
to any physician or hiring a physician, a hospital or facility approved
pursuant to this chapter shall request from any hospital with or at which the
physician had or has privileges, was associated, or was employed, the following
information concerning the physician:
(a) Any pending professional medical misconduct
proceedings or any pending medical malpractice actions, in this state or
another state;
(b) Any judgment or settlement of a medical
malpractice action and any finding of professional misconduct in this state or
another state by a licensing or disciplinary board; and
(c) Any information required to be reported by
hospitals pursuant to RCW 18.72.265.
(3) The medical disciplinary board shall be
advised within thirty days of the name of any physician denied staff
privileges, association, or employment on the basis of adverse findings under
subsection (1) of this section.
(4) A hospital or facility that receives a
request for information from another hospital or facility pursuant to
subsections (1) and (2) of this section shall provide such information
concerning the physician in question to the extent such information is known to
the hospital or facility receiving such a request, including the reasons for
suspension, termination, or curtailment of employment or privileges at the
hospital or facility. A hospital, facility, or other person providing such
information in good faith is not liable in any civil action for the release of
such information.
(5) Information and documents, including
complaints and incident reports, created specifically for, and
collected, and maintained ((about health care providers arising out of the
matters that are under review or have been evaluated)) by a ((review))
quality improvement committee ((conducting quality assurance reviews))
are not subject to discovery or introduction into evidence in any civil action,
and no person who was in attendance at a meeting of such committee or ((board))
who participated in the creation, collection, or maintenance of information
or documents specifically for the committee shall be permitted or required
to testify in any civil action as to the content of such proceedings or the
documents and information prepared specifically for the committee. This
subsection does not preclude: (a) In any civil action, the discovery of the
identity of persons involved in the medical care that is the basis of the civil
action whose involvement was independent of any quality improvement activity;
(b) in any civil action, the testimony of any person concerning the facts
which form the basis for the institution of such proceedings of which the
person had personal knowledge acquired independently of such proceedings; (((b)))
(c) in any civil action by a health care provider regarding the
restriction or revocation of that individual's clinical or staff privileges,
introduction into evidence information collected and maintained by quality ((assurance))
improvement committees regarding such health care provider; (((c)))
(d) in any civil action, disclosure of the fact that staff privileges
were terminated or restricted, including the specific restrictions imposed, if
any and the reasons for the restrictions; or (((d))) (e)
in any civil action, discovery and introduction into evidence of the patient's
medical records required by regulation of the department of health to be made
regarding the care and treatment received.
(6) Hospitals shall be granted access to
information held by the medical disciplinary board and the board of osteopathic
medicine and surgery pertinent to decisions of the hospital regarding
credentialing and recredentialing of practitioners.
(7) Violation of this section shall not be
considered negligence per se.
NEW SECTION. Sec. 417. A
new section is added to chapter 43.70 RCW to read as follows:
COORDINATED QUALITY IMPROVEMENT PROGRAM.
(1)(a) Health care institutions and medical facilities, other than hospitals,
that are licensed by the department, professional societies or organizations,
and certified health plans approved pursuant to section 428 of this act may
maintain a coordinated quality improvement program for the improvement of the
quality of health care services rendered to patients and the identification and
prevention of medical malpractice as set forth in RCW 70.41.200.
(b) All such programs shall comply with the
requirements of RCW 70.41.200(1)(a), (c), (d), (e), (f), (g), and (h) as
modified to reflect the structural organization of the institution, facility,
professional societies or organizations, or certified health plan, unless an
alternative quality improvement program substantially equivalent to RCW
70.41.200(1)(a) is developed. All such programs, whether complying with the
requirement set forth in RCW 70.41.200(1)(a) or in the form of an alternative
program, must be approved by the department before the discovery limitations
provided in subsections (3) and (4) of this section shall apply. In reviewing
plans submitted by licensed entities that are associated with physicians'
offices, the department shall ensure that the discovery limitations of this
section are applied only to information and documents related specifically to
quality improvement activities undertaken by the licensed entity.
(2) Health care provider groups of ten or more
providers may maintain a coordinated quality improvement program for the
improvement of the quality of health care services rendered to patients and the
identification and prevention of medical malpractice as set forth in RCW
70.41.200. All such programs shall comply with the requirements of RCW
70.41.200(1)(a), (c), (d), (e), (f), (g), and (h) as modified to reflect the
structural organization of the health care provider group. All such programs must
be approved by the department before the discovery limitations provided in
subsections (3) and (4) of this section shall apply.
(3) Any person who, in substantial good faith,
provides information to further the purposes of the quality improvement and medical
malpractice prevention program or who, in substantial good faith, participates
on the quality improvement committee shall not be subject to an action for
civil damages or other relief as a result of such activity.
(4) Information and documents, including
complaints and incident reports, created specifically for, and collected, and
maintained by a quality improvement committee are not subject to discovery or
introduction into evidence in any civil action, and no person who was in
attendance at a meeting of such committee or who participated in the creation,
collection, or maintenance of information or documents specifically for the
committee shall be permitted or required to testify in any civil action as to
the content of such proceedings or the documents and information prepared
specifically for the committee. This subsection does not preclude: (a) In any
civil action, the discovery of the identity of persons involved in the medical
care that is the basis of the civil action whose involvement was independent of
any quality improvement activity; (b) in any civil action, the testimony of any
person concerning the facts that form the basis for the institution of such
proceedings of which the person had personal knowledge acquired independently
of such proceedings; (c) in any civil action by a health care provider
regarding the restriction or revocation of that individual's clinical or staff
privileges, introduction into evidence information collected and maintained by
quality improvement committees regarding such health care provider; (d) in any
civil action, disclosure of the fact that staff privileges were terminated or
restricted, including the specific restrictions imposed, if any and the reasons
for the restrictions; or (e) in any civil action, discovery and introduction
into evidence of the patient's medical records required by rule of the
department of health to be made regarding the care and treatment received.
(5) The department of health shall adopt rules
as are necessary to implement this section.
NEW SECTION. Sec. 418.
MEDICAL MALPRACTICE REVIEW. (1) The administrator for the courts shall
coordinate a collaborative effort to develop a voluntary system for review of
medical malpractice claims by health services experts prior to the filing of a
cause of action under chapter 7.70 RCW.
(2) The system shall have at least the
following components:
(a) Review would be initiated, by agreement of
the injured claimant and the health care provider, at the point at which a
medical malpractice claim is submitted to a malpractice insurer or a
self-insured health care provider.
(b) By agreement of the parties, an expert
would be chosen from a pool of health services experts who have agreed to
review claims on a voluntary basis.
(c) The mutually agreed upon expert would
conduct an impartial review of the claim and provide his or her opinion to the
parties.
(d) A pool of available experts would be
established and maintained for each category of health care practitioner by the
corresponding practitioner association, such as the Washington state medical
association and the Washington state nurses association.
(3) The administrator for the courts shall seek
to involve at least the following organizations in a collaborative effort to
develop the informal review system described in subsection (2) of this section:
(a) The Washington defense trial lawyers
association;
(b) The Washington state trial lawyers
association;
(c) The Washington state medical association;
(d) The Washington state nurses association and
other employee organizations representing nurses;
(e) The Washington state hospital association;
(f) The Washington state physicians insurance
exchange and association;
(g) The Washington casualty company;
(h) The doctor's agency;
(i) Group health cooperative of Puget Sound;
(j) The University of Washington;
(k) Washington osteopathic medical association;
(l) Washington state chiropractic association;
(m) Washington association of naturopathic
physicians; and
(n) The department of health.
(4) On or before January 1, 1994, the
administrator for the courts shall provide a report on the status of the
development of the system described in this section to the governor and the
appropriate committees of the senate and the house of representatives.
NEW SECTION. Sec. 419. A
new section is added to chapter 7.70 RCW to read as follows:
MANDATORY MEDIATION OF HEALTH CARE MALPRACTICE
CLAIMS. (1) All causes of action, whether based in tort, contract, or
otherwise, for damages arising from injury occurring as a result of health care
provided after the effective date of this section shall be subject to mandatory
mediation prior to trial.
(2) The supreme court shall by rule adopt
procedures to implement mandatory mediation of actions under this chapter. The
rules shall address, at a minimum:
(a) Procedures for the appointment of, and
qualifications of, mediators. A mediator shall have experience or expertise
related to actions arising from injury occurring as a result of health care,
and be a member of the state bar association who has been admitted to the bar
for a minimum of five years or who is a retired judge. The parties may
stipulate to a nonlawyer mediator. The court may prescribe additional
qualifications of mediators;
(b) Appropriate limits on the amount or manner
of compensation of mediators;
(c) The number of days following the filing of
a claim under this chapter within which a mediator must be selected;
(d) The method by which a mediator is
selected. The rule shall provide for designation of a mediator by the superior
court if the parties are unable to agree upon a mediator;
(e) The number of days following the selection
of a mediator within which a mediation conference must be held;
(f) A means by which mediation of an action
under this chapter may be waived by a mediator who has determined that the
claim is not appropriate for mediation; and
(g) Any other matters deemed necessary by the
court.
(3) Mediators shall not impose discovery
schedules upon the parties.
NEW SECTION. Sec. 420. A
new section is added to chapter 7.70 RCW to read as follows:
MANDATORY MEDIATION OF HEALTH CARE
MALPRACTICE. The making of a written, good faith request for mediation of a
dispute related to damages for injury occurring as a result of health care
provided prior to filing a cause of action under this chapter shall toll the
statute of limitations provided in RCW 4.16.350.
NEW SECTION. Sec. 421. A
new section is added to chapter 7.70 RCW to read as follows:
MANDATORY MEDIATION OF HEALTH CARE MALPRACTICE
CLAIMS. Section 419 of this act may not be construed to abridge the right to
trial by jury following an unsuccessful attempt at mediation.
Sec. 422.
RCW 5.60.070 and 1991 c 321 s 1 are each amended to read as follows:
MEDIATION‑-COMMUNICATIONS PRIVILEGED.
(1) If there is a court order to mediate ((or)), a written
agreement between the parties to mediate, or if mediation is mandated under
section 419 of this act, then any communication made or materials submitted
in, or in connection with, the mediation proceeding, whether made or submitted
to or by the mediator, a mediation organization, a party, or any person
present, are privileged and confidential and are not subject to disclosure in
any judicial or administrative proceeding except:
(a) When all parties to the mediation agree, in
writing, to disclosure;
(b) When the written materials or tangible
evidence are otherwise subject to discovery, and were not prepared specifically
for use in and actually used in the mediation proceeding;
(c) When a written agreement to mediate permits
disclosure;
(d) When disclosure is mandated by statute;
(e) When the written materials consist of a
written settlement agreement or other agreement signed by the parties resulting
from a mediation proceeding;
(f) When those communications or written
materials pertain solely to administrative matters incidental to the mediation
proceeding, including the agreement to mediate; or
(g) In a subsequent action between the mediator
and a party to the mediation arising out of the mediation.
(2) When there is a court order ((or)),
a written agreement to mediate, or when mediation is mandated under
section 419 of this act, as described in subsection (1) of this section,
the mediator or a representative of a mediation organization shall not testify
in any judicial or administrative proceeding unless:
(a) All parties to the mediation and the
mediator agree in writing; or
(b) In an action described in subsection (1)(g)
of this section.
NEW SECTION. Sec. 423. A
new section is added to chapter 7.70 RCW to read as follows:
MANDATORY MEDIATION OF HEALTH CARE MALPRACTICE
CLAIMS. A cause of action that has been mediated as provided in section 419 of
this act shall be exempt from any superior court civil rules mandating
arbitration of civil actions or participation in settlement conferences prior
to trial.
Sec. 424.
RCW 4.22.070 and 1986 c 305 s 401 are each amended to read as follows:
PERCENTAGE OF FAULT‑-JOINT AND SEVERAL
LIABILITY. (1) Except as provided in subsection (4) of this section, in
all actions involving fault of more than one entity, the trier of fact shall
determine the percentage of the total fault which is attributable to every
entity which caused the claimant's damages, including the claimant or person
suffering personal injury or incurring property damage, defendants, third-party
defendants, entities released by the claimant, entities immune from liability
to the claimant and entities with any other individual defense against the
claimant. Judgment shall be entered against each defendant except those who
have been released by the claimant or are immune from liability to the claimant
or have prevailed on any other individual defense against the claimant in an
amount which represents that party's proportionate share of the claimant's
total damages. The liability of each defendant shall be several only and shall
not be joint except:
(a) A party shall be responsible for the fault
of another person or for payment of the proportionate share of another party
where both were acting in concert or when a person was acting as an agent or
servant of the party.
(b) If the trier of fact determines that the
claimant or party suffering bodily injury or incurring property damages was not
at fault, the defendants against whom judgment is entered shall be jointly and
severally liable for the sum of their proportionate shares of the claimants
total damages.
(2) If a defendant is jointly and severally
liable under one of the exceptions listed in subsection((s)) (1)(a) or
(1)(b) or (4) (a) or (b) of this section, such defendant's rights to
contribution against another jointly and severally liable defendant, and the
effect of settlement by either such defendant, shall be determined under RCW
4.22.040, 4.22.050, and 4.22.060.
(3)(a) Nothing in this section affects any
cause of action relating to hazardous wastes or substances or solid waste
disposal sites.
(b) Nothing in this section shall affect a
cause of action arising from the tortious interference with contracts or
business relations.
(c) Nothing in this section shall affect any
cause of action arising from the manufacture or marketing of a fungible product
in a generic form which contains no clearly identifiable shape, color, or
marking.
(4) In all actions governed by chapter 7.70
RCW involving fault of more than one entity, the trier of fact shall determine
the percentage of the total fault that is attributable to every entity that caused
the claimant's damages, including the claimant or person suffering personal
injury or incurring property damage, defendants, third-party defendants,
entities released by the claimant, entities immune from liability to the
claimant, and entities with any other individual defense against the claimant.
Judgment shall be entered against each defendant except those who have been
released by the claimant or are immune from liability to the claimant or have
prevailed on any other individual defense against the claimant in an amount
that represents that party's proportionate share of the claimant's total
damages. The total damages shall first be reduced by any amount paid to the
claimant by a released entity. The liability of each defendant shall be several
only and shall not be joint except:
(a) A party shall be responsible for the
fault of another person or for payment of the proportionate share of another
party where both were acting in concert or when a person was acting as an agent
or servant of the party.
(b) If the trier of fact determines that the
claimant or party suffering bodily injury or incurring property damages was not
at fault, the defendants against whom judgment is entered shall be jointly and
severally liable for the sum of their proportionate shares of the claimant's
total damages.
(c) A defendant against whom judgment has
been entered shall be responsible to the claimant for any fault of an entity
released by the claimant. The total damages shall first be reduced by any
amount paid to the claimant by a released entity, and, then, where some fault
has been attributed to the claimant, by the claimant's proportionate share of
his or her total damages.
D. HEALTH INSURANCE PURCHASING COOPERATIVES
NEW SECTION. Sec. 425.
HEALTH INSURANCE PURCHASING COOPERATIVES--DESIGNATION OF REGIONS BY COMMISSION,
INFORMATION SYSTEMS, MINIMUM STANDARDS, AND RULES. (1) The commission shall
designate four geographic regions within the state in which health insurance
purchasing cooperatives may operate, based upon population, assuming that each
cooperative must serve no less than one hundred fifty thousand persons;
geographic factors; market conditions; and other factors deemed appropriate by
the commission. The commission shall designate one health insurance purchasing
cooperative per region.
(2) In coordination with the commission and
consistent with the provisions of chapter 70.170 RCW, the department of health
shall establish an information clearinghouse for the collection and dissemination
of information necessary for the efficient operation of cooperatives, including
the establishment of a risk profile information system related to certified
health plan enrollees that would permit the equitable distribution of losses
among plans in accordance with section 406(7) of this act.
(3) Every health insurance purchasing
cooperative shall:
(a) Admit all individuals, employers, or other
groups wishing to participate in the cooperative;
(b) Make available for purchase by cooperative
members every health care program offered by every certified health plan
operating within the cooperative's region;
(c) Be operated as a member-governed and owned,
nonprofit cooperative in which no certified health plan, health maintenance
organization, health care service contractor, independent practice association,
independent physician organization, or any individual with a pecuniary interest
in any such organization, shall have any pecuniary interest in or management
control of the cooperative;
(d) Provide for centralized enrollment and
premium collection and distribution among certified health plans; and
(e) Serve as an ombudsman for its members to
resolve inquiries, complaints, or other concerns with certified health plans.
(4) Every health insurance purchasing
cooperative shall assist members in selecting certified health plans and for
this purpose may devise a rating system or similar system to judge the quality
and cost- effectiveness of certified health plans consistent with guidelines
established by the commission. For this purpose, each cooperative and
directors, officers, and other employees of the cooperative are immune from
liability in any civil action or suit arising from the publication of any
report, brochure, or guide, or dissemination of information related to the
services, quality, price, or cost-effectiveness of certified plans unless
actual malice, fraud, or bad faith is shown. Such immunity is in addition to
any common law or statutory privilege or immunity enjoyed by such person, and
nothing in this section is intended to abrogate or modify in any way such
common law or statutory privilege or immunity.
(5) Every health insurance purchasing
cooperative shall bear the full cost of its operations, including the costs of
participating in the information clearinghouse, through assessments upon its
members. Such assessments shall be billed and accounted for separately from
premiums collected and distributed for the purchase of the uniform benefits
package or any other supplemental insurance or health services program.
(6) No health insurance purchasing cooperative
may bear any financial risk for the delivery of uniform benefits package
services, or for any other supplemental insurance or health services program.
(7) No health insurance purchasing cooperative
may directly broker, sell, contract for, or provide any insurance or health
services program. However, nothing contained in this section shall be deemed
to prohibit the use or employment of insurance agents or brokers by the
cooperative for other purposes or to prohibit the facilitation of the sale and
purchase by members of supplemental insurance or health services programs.
(8) The commission may adopt rules necessary
for the implementation of this section including rules governing charter and
bylaw provisions of cooperatives and may adopt rules prohibiting or permitting
other activities by cooperatives.
(9) The commission shall consider ways in which
cooperatives can develop, encourage, and provide incentives for employee
wellness programs.
NEW SECTION. Sec. 426.
LICENSING AND REGULATION OF HEALTH INSURANCE PURCHASING COOPERATIVES BY THE
INSURANCE COMMISSIONER. (1) No person may establish or operate a health
insurance purchasing cooperative without having first obtained a certificate of
authority from the insurance commissioner.
(2) Every proposed cooperative shall furnish
notice to the insurance commissioner that shall:
(a) Identify the principal name and address of
the cooperative;
(b) Furnish the names and addresses of the
initial officers of the cooperative;
(c) Include copies of letters of agreement for
participation in the cooperative including minimum term of participation;
(d) Furnish copies of its proposed articles and
bylaws; and
(e) Provide other information as prescribed by
the insurance commissioner in consultation with the health services commission
to verify that the cooperative is qualified and is managed by competent and
trustworthy individuals.
(3)(a) The commissioner shall approve
applications for certificates in accordance with the order received.
(b) The commissioner shall establish by rule a
fee to be paid by cooperatives in an amount necessary to review and approve
applications for a certificate of authority. Such fee shall accompany the
application and no certificate may be issued until such fee is paid. Fees
collected for such purpose shall be deposited in the insurance commissioner's
regulatory account in the state treasury.
(4) All funds representing premiums or return
premiums received by a cooperative in its fiduciary capacity shall be accounted
for and maintained in a separate account from all other funds. Each willful
violation of this section constitutes a misdemeanor.
(5) Every cooperative shall keep at its
principal address, a record of all transactions it has consummated on behalf of
its members with certified health plans. All such records shall be kept
available and open to the inspection of the insurance commissioner at any
business time during a five-year period immediately after the date of
completion of the transaction.
E. CERTIFIED HEALTH PLANS
NEW SECTION. Sec. 427.
CERTIFIED HEALTH PLANS--CERTIFICATION REQUIRED--PENALTY. (1) On and after July
1, 1995, no person or entity in this state shall provide the uniform benefits
package and supplemental benefits as defined in section 402 of this act without
being certified as a certified health plan by the insurance commissioner.
(2) On and after July 1, 1995, no certified
health plan may offer less than the uniform benefits package to residents of
this state and no registered employer health plan may provide less than the uniform
benefits package to its employees and their dependents.
NEW SECTION. Sec. 428.
HEALTH PLAN CERTIFICATION STANDARDS. A certified health plan shall:
(1) Provide the benefits included in the
uniform benefits package to enrolled Washington residents for a prepaid per
capita community-rated premium not to exceed the maximum premium established by
the commission and provide such benefits through managed care in accordance
with rules adopted by the commission;
(2) Offer supplemental benefits to enrolled
Washington residents for a prepaid per capita community-rated premium and
provide such benefits through managed care in accordance with rules adopted by
the commission;
(3) Accept for enrollment any state resident
within the plan's service area and provide or assure the provision of all
services within the uniform benefits package and offer supplemental benefits
regardless of age, sex, family structure, ethnicity, race, health condition,
geographic location, employment status, socioeconomic status, other condition
or situation, or the provisions of RCW 49.60.174(2). The insurance
commissioner may grant a temporary exemption from this subsection, if, upon
application by a certified health plan, the commissioner finds that the
clinical, financial, or administrative capacity to serve existing enrollees
will be impaired if a certified health plan is required to continue enrollment
of additional eligible individuals;
(4) If the plan provides benefits through
contracts with, ownership of, or management of health care facilities and
contracts with or employs health care providers, demonstrate to the
satisfaction of the insurance commissioner in consultation with the department
of health and the commission that its facilities and personnel are adequate to
provide the benefits prescribed in the uniform benefits package and offer
supplemental benefits to enrolled Washington residents, and that it is
financially capable of providing such residents with, or has made adequate
contractual arrangements with health care providers and facilities to provide
enrollees with such benefits;
(5) Comply with portability of benefits
requirements prescribed by the commission;
(6) Comply with administrative rules prescribed
by the commission, the insurance commissioner, and other state agencies
governing certified health plans;
(7) Provide all enrollees with instruction and
informational materials to increase individual and family awareness of injury
and illness prevention; encourage assumption of personal responsibility for
protecting personal health; and stimulate discussion about the use and limits
of medical care in improving the health of individuals and communities;
(8) Disclose to enrollees the charity care
requirements under chapter 70.170 RCW;
(9) Include in all of its contracts with health
care providers and health care facilities a provision prohibiting such
providers and facilities from billing enrollees for any amounts in excess of
applicable enrollee point of service cost-sharing obligations for services
included in the uniform benefits package and supplemental benefits;
(10) Include in all of its contracts issued for
uniform benefits package and supplemental benefits coverage a subrogation
provision that allows the certified health plan to recover the costs of uniform
benefits package and supplemental benefits services incurred to care for an
enrollee injured by a negligent third party. The costs recovered shall be
limited to:
(a) If the certified health plan has not
intervened in the action by an injured enrollee against a negligent third
party, then the amount of costs the certified health plan can recover shall be
limited to the excess remaining after the enrollee has been fully compensated
for his or her loss minus a proportionate share of the enrollee's costs and
fees in bringing the action. The proportionate share shall be determined by:
(i) The fees and costs approved by the court in
which the action was initiated; or
(ii) The written agreement between the attorney
and client that established fees and costs when fees and costs are not
addressed by the court.
When fees and costs have been approved by a
court, after notice to the certified health plan, the certified health plan
shall have the right to be heard on the matter of attorneys' fees and costs or
its proportionate share;
(b) If the certified health plan has intervened
in the action by an injured enrollee against a negligent third party, then the
amount of costs the certified health plan can recover shall be the excess
remaining after the enrollee has been fully compensated for his or her loss or
the amount of the plan's incurred costs, whichever is less;
(11) Establish and maintain a grievance
procedure approved by the commissioner, to provide a reasonable and effective
resolution of complaints initiated by enrollees concerning any matter relating
to the provision of benefits under the uniform benefits package and
supplemental benefits, access to health care services, and quality of
services. Each certified health plan shall respond to complaints filed with
the insurance commissioner within fifteen working days. The insurance
commissioner in consultation with the commission shall establish standards for
resolution of grievances;
(12) Comply with the provisions of chapter
48.30 RCW prohibiting unfair and deceptive acts and practices to the extent
such provisions are not specifically modified or superseded by the provisions
of chapter . . ., Laws of 1993 (this act) and be prohibited from
offering or supplying incentives that would have the effect of avoiding the
requirements of subsection (3) of this section;
(13) Have culturally sensitive health promotion
programs that include approaches that are specifically effective for persons of
color and accommodating to different cultural value systems, gender, and age;
(14) Permit every category of health care
provider to provide health services or care for conditions included in the
uniform benefits package to the extent that:
(a) The provision of such health services or
care is within the health care providers' permitted scope of practice; and
(b) The providers agree to abide by standards
related to:
(i) Provision, utilization review, and cost
containment of health services;
(ii) Management and administrative procedures;
and
(iii) Provision of cost-effective and
clinically efficacious health services;
(15) Establish the geographic boundaries in
which they will obligate themselves to deliver the services required under the
uniform benefits package and include such information in their application for
certification, but the commissioner shall review such boundaries and may
disapprove, in conformance with guidelines adopted by the commission, those
that have been clearly drawn to be exclusionary within a health care catchment
area;
(16) Annually report the names and addresses of
all officers, directors, or trustees of the certified health plan during the
preceding year, and the amount of wages, expense reimbursements, or other
payments to such individuals;
(17) Annually report the number of residents
enrolled and terminated during the previous year. Additional information
regarding the enrollment and termination pattern for a certified health plan
may be required by the commissioner to determine compliance with the open
enrollment and free access requirements of chapter..., Laws of 1993 (this act);
and
(18) Disclose any financial interests held by
officers and directors in any facilities associated with or operated by the
certified health plan.
NEW SECTION. Sec. 429.
LIMITED CERTIFIED HEALTH PLAN FOR DENTAL SERVICES. (1) For the purposes of
this section "limited certified dental plan" or "dental
plan" means a limited health service contractor governed by RCW 48.44.035
offering dental care services only and that complies with all certified health
plan requirements for managed care, community rating, portability, and
nondiscrimination as provided in section 428 of this act.
(2) A dental plan may provide coverage for
dental services directly to individuals or to employers for the benefit of
employees. If an individual or an employer purchases dental care services from
a dental plan, the certified health plan covering the individual or the
employees need not provide dental services required under the uniform benefits
package. A certified health plan may subcontract with a dental plan to provide
the dental benefits required under the uniform benefits package.
NEW SECTION. Sec. 430.
REGISTERED EMPLOYER HEALTH PLANS. Consistent with the provisions of section
464 of this act, a registered employer health plan shall:
(1) Register with the insurance commissioner by
filing its plan of management and operation including but not limited to
information required by the commissioner sufficient for a determination by the
commissioner that such plan meets the requirements of this section and any
rules adopted by the health services commission and the insurance commissioner
pertaining to such plans.
(2) Provide the benefits included in the
uniform benefits package to employees and their dependents for a prepaid,
community-rated premium not to exceed the maximum premium established by the
commission and provide such benefits through managed care in accordance with
rules adopted by the commission.
(3) Offer supplemental benefits to employees
and their dependents for a prepaid, community-rated premium and provide such
benefits through managed care in accordance with rules adopted by the
commission. Benefits offered by such plan need not comply with the provisions
of sections 452 and 453 of this act.
(4) Provide or assure the provision of all
services within the uniform benefits package and offer supplemental benefits
regardless of age, sex, family structure, ethnicity, race, health condition,
socioeconomic status, or other condition or situation, or the provisions of RCW
49.60.174(2).
(5) If the plan provides benefits through
contracts with, ownership of, or management of health care facilities and
contracts with or employs health care providers, demonstrate to the
satisfaction of the insurance commissioner in consultation with the department
of health and the commission that its facilities and personnel are adequate to
provide the uniform benefits package and any supplemental benefits or has made
adequate contractual arrangements with health care providers and facilities to
provide employees and their dependents with such benefits.
(6) Comply with portability of benefits
requirements prescribed by the commission for registered employer health plans.
(7) Comply with administrative rules prescribed
by the commission, the insurance commissioner, and other state agencies
governing registered employer health plans.
(8) Provide all employees and their dependents
enrolled in the plan with instruction and informational materials to increase
individual and family awareness of injury and illness prevention; encourage
assumption of personal responsibility for protecting personal health; and
stimulate discussion about the use and limits of medical care in improving the
health of individuals and communities.
(9) Include in all of its contracts with health
care providers and health care facilities a provision prohibiting such
providers and facilities from billing employees and their dependents enrolled
in the plan for any amounts in excess of applicable enrollee point of service,
cost-sharing obligations for services included in the uniform benefits package
and supplemental benefits.
(10) Include in all of its contracts issued for
uniform benefits package and supplemental benefits coverage a subrogation
provision that allows the plan to recover the costs of uniform benefits package
and supplemental benefit services incurred to care for a plan enrollee injured
by a negligent third party. The costs recovered shall be limited to:
(a) If the plan has not intervened in the
action by an injured plan enrollee against a negligent third party, then the
amount of costs the plan can recover shall be limited to the excess remaining
after the plan enrollee has been fully compensated for his or her loss minus a
proportionate share of the enrollee's costs and fees in bringing the action.
The proportionate share shall be determined by:
(i) The fees and costs approved by the court in
which the action was initiated; or
(ii) The written agreement between the attorney
and client that established fees and costs when fees and costs are not
addressed by the court.
When fees and costs have been approved by a
court, after notice to the plan, the plan shall have the right to be heard on
the matter of attorneys' fees and costs or its proportionate share;
(b) If the plan has intervened in the action by
an injured enrollee against a negligent third party, then the amount of costs
the plan can recover shall be the excess remaining after the enrollee has been
fully compensated for his or her loss or the amount of the plan's incurred
costs, whichever is less.
(11) Establish and maintain a grievance procedure
approved by the insurance commissioner, to provide a reasonable and effective
resolution of complaints initiated by plan enrollees concerning any matter
relating to the provision of benefits under the uniform benefits package and
supplemental benefits, access to health care services, and quality of
services. Each plan shall respond to complaints filed with the insurance
commissioner within fifteen working days. The insurance commissioner in
consultation with the commission shall establish standards for resolution of
grievances by enrollees of registered employer health plans.
(12) Have culturally sensitive health promotion
programs that include approaches that are specifically effective for persons of
color and accommodating to different cultural value systems, gender, and age. (13)
Permit every category of health care provider to provide health services or
care for conditions included in the uniform benefits package to the extent
that:
(a) The provision of such health services or
care is within the health care providers' permitted scope of practice; and
(b) The providers agree to abide by standards
related to:
(i) Provision, utilization review, and cost
containment of health services;
(ii) Management and administrative procedures;
and
(iii) Provision of cost-effective and
clinically efficacious health services.
(14) Pay to the state treasurer a tax
equivalent to the tax applied to taxpayers under section 301 of this act in
accordance with rules adopted by the department of revenue.
(15) File their uniform benefits package and
supplemental benefits with the insurance commissioner who may disapprove and
order a modification of such package or benefits if such package or benefits
fail to meet any standards or rules adopted by the commission pertaining to
maximum premiums, enrollee financial participation, point of service
cost-sharing, benefit design, or health service delivery.
(16) Comply with and shall be subject to
sections 431, 447, and 448 of this act.
(17) Pay an annual fee to the insurance commissioner's
office in an amount established by rule of the commissioner necessary for the
performance of the commissioner's responsibilities under this section
consistent with and subject to the collection, depositing, and spending
provisions applicable to fees collected pursuant to RCW 48.02.190.
(18) File an annual report with the
commissioner containing such information as the commissioner may require to
determine compliance with this section.
(19) In addition to any other penalties
prescribed by law, be subject to the penalties contained in section 432 of this
act for violations of this section.
NEW SECTION. Sec. 431.
CONTRACTS BETWEEN CERTIFIED HEALTH PLANS AND HEALTH CARE PROVIDERS. (1)
Balancing the need for health care reform and the need to protect health care
providers, as a class and as individual providers, from improper exclusion
presents a problem that can be satisfied with the creation of a process to
ensure fair consideration of the inclusion of health care providers in managed
care systems operated by certified health plans. It is therefore the intent of
the legislature that the health services commission in developing rules in
accordance with this section and the attorney general in monitoring the level of
competition in the various geographic markets, balance the need for
cost-effective and quality delivery of health services with the need for
inclusion of both individual health care providers and categories of health
care providers in managed care programs developed by certified health plans.
(2) All licensed health care providers licensed
by the state, irrespective of the type or kind of practice, should be afforded
the opportunity for inclusion in certified health plans consistent with the
goals of health care reform.
The health services commission shall adopt
rules requiring certified health plans to publish general criteria for the
plan's selection or termination of health care providers. Such rules shall not
require the disclosure of criteria deemed by the plan to be of a proprietary or
competitive nature that would hurt the plan's ability to compete or to manage
health services. Disclosure of criteria is proprietary or anticompetitive if
revealing the criteria would have the tendency to cause health care providers
to alter their practice pattern in a manner that would harm efforts to contain
health care costs and is proprietary if revealing the criteria would cause the
plan's competitors to obtain valuable business information.
If a certified health plan uses unpublished
criteria to judge the quality and cost-effectiveness of a health care
provider's practice under any specific program within the plan, the plan may
not reject or terminate the provider participating in that program based upon
such criteria until the provider has been informed of the criteria that his or her
practice fails to meet and is given a reasonable opportunity to conform to such
criteria.
(3)(a) Whenever a determination is made under
(b) of this subsection that a plan's share of the market reaches a point where
the plan's exclusion of health care providers from a program of the plan would
result in the substantial inability of providers to continue their practice
thereby unreasonably restricting consumer access to needed health services, the
certified health plan must allow all providers within the affected market to
participate in the programs of the certified health plan. All such providers
must meet the published criteria and requirements of the programs.
(b) The attorney general with the assistance of
the insurance commissioner shall periodically analyze the market power of
certified health plans to determine when the market share of any program of a
certified health plan reaches a point where the plan's exclusion of health
service providers from a program of the plan would result in the substantial
inability of providers to continue their practice thereby unreasonably
restricting consumer access to needed health services. In analyzing the market
power of a certified health plan, the attorney general shall consider:
(i) The ease with which providers may obtain
contracts with other plans;
(ii) The amount of the private pay and
government employer business that is controlled by the certified health plan
taking into account the selling of its provider network to self-insured
employer plans;
(iii) The difficulty in establishing new
competing plans in the relevant geographic market; and
(iv) The sufficiency of the number or type of
providers under contract with the plan available to meet the needs of plan
enrollees.
Notwithstanding the provisions of this
subsection, if the certified health plan demonstrates to the satisfaction of
the attorney general and the health services commission that health service
utilization data and similar information shows that the inclusion of additional
health service providers would substantially lessen the plan's ability to
control health care costs and that the plan's procedures for selection of
providers are not improperly exclusive of providers, the plan need not include
additional providers within the plan's program.
(4) The health services commission shall adopt
rules for the resolution of disputes between providers and certified health
plans including disputes regarding the decision of a plan not to include the
services of a provider.
(5) Nothing contained in this section shall be
construed to require a plan to allow or continue the participation of a
provider if the plan is a federally qualified health maintenance organization
and the participation of the provider or providers would prevent the health
maintenance organization from operating as a health maintenance organization in
accordance with 42 U.S.C. Sec. 300e.
NEW SECTION. Sec. 432.
CERTIFIED HEALTH PLANS‑-REGISTRATION REQUIRED‑-PENALTY. (1) No
person or entity in this state may, by mail or otherwise, act or hold himself
or herself out to be a certified health plan as defined by section 402 of this
act without being registered as a certified health plan with the insurance
commissioner.
(2) Anyone violating subsection (1) of this
section is liable for a fine not to exceed ten thousand dollars and
imprisonment not to exceed six months for each instance of such violation.
NEW SECTION. Sec. 433.
ELIGIBILITY REQUIREMENTS FOR CERTIFICATE OF REGISTRATION‑-APPLICATION
REQUIREMENTS. Any corporation, cooperative group, partnership, association, or
groups of health professionals licensed by the state of Washington, public
hospital district, or public institutions of higher education are entitled to a
certificate from the insurance commissioner as a certified health plan if it:
(1) Submits an application for certification as
a certified health plan, which shall be verified by an officer or authorized
representative of the applicant, being in a form as the insurance commissioner
prescribes in consultation with the health services commission;
(2) Meets the minimum net worth requirements
set forth in section 438 of this act and the funding reserve requirements set
forth in section 439 of this act;
(3) A certified health plan may establish the
geographic boundaries in which they will obligate themselves to deliver the
services required under the uniform benefits package and include such
information in their application for certification, but the commissioner shall
review such boundaries and may disapprove, in conformance to guidelines adopted
by the commission, those which have been clearly drawn to be exclusionary
within a health care catchment area.
NEW SECTION. Sec. 434.
ISSUANCE OF CERTIFICATE‑-GROUNDS FOR REFUSAL. The commissioner shall
issue a certificate as a certified health plan to an applicant within one
hundred twenty days of such filing unless the commissioner notifies the
applicant within such time that such application is not complete and the
reasons therefor; or that the commissioner is not satisfied that:
(1) The basic organization document of the
applicant permits the applicant to conduct business as a certified health plan;
(2) The applicant has demonstrated the intent
and ability to assure that the health services will be provided in a manner to
assure both their availability and accessibility;
(3) The organization is financially responsible
and may be reasonably expected to meet its obligations to its enrolled participants.
In making this determination, the commissioner shall consider among other
relevant factors:
(a) Any agreements with a casualty insurer, a
government agency, or any other organization paying or insuring payment for
health care services;
(b) Any agreements with providers for the
provision of health care services; and
(c) Any arrangements for liability and
malpractice insurance coverage.
(4) The procedures for offering health care
services are reasonable and equitable; and
(5) Procedures have been established to:
(a) Monitor the quality of care provided by the
certified health plan including standards and guidelines provided by the health
services commission and other appropriate state agencies;
(b) Operate internal peer review mechanisms;
and
(c) Resolve complaints and grievances in
accordance with section 443 of this act and rules established by the insurance
commissioner in consultation with the commission.
NEW SECTION. Sec. 435.
PREMIUMS AND ENROLLEE PAYMENT AMOUNTS‑-FILING OF PREMIUMS AND ENROLLEE
PAYMENT AMOUNTS‑-ADDITIONAL CHARGES PROHIBITED. (1) The insurance
commissioner shall verify that the certified health plan and its providers are
charging no more than the maximum premiums and enrollee financial participation
amounts during the course of financial and market conduct examinations or more
frequently if justified in the opinion of the insurance commissioner or upon
request by the health services commission.
(2) The certified health plans shall file the
premium schedules including employer contributions, enrollee premium sharing,
and enrollee point of service cost sharing amounts with the insurance
commissioner, within thirty days of establishment by the health services
commission.
(3) No certified health plan or its provider
may charge any fees, assessments, or charges in addition to the premium amount
or in excess of the maximum enrollee financial participation limits established
by the health services commission. The certified health plan that directly
provides health care services may charge and collect the enrollee point of
service cost sharing fees as established in the uniform benefits package or
other approved benefit plan.
NEW SECTION. Sec. 436.
ANNUAL STATEMENT FILING‑-CONTENTS‑-PENALTY FOR FAILURE TO FILE‑-ACCURACY
REQUIRED. (1) Every certified health plan shall annually not later than March
1 of the calendar year, file with the insurance commissioner a statement
verified by at least two of its principal officers showing its financial
condition as of December 31 of the preceding year.
(2) Such annual report shall be in such form as
the insurance commissioner shall prescribe and shall include:
(a) A financial statement of the certified
health plan, including its balance sheet and receipts and disbursements for the
preceding year, which reflects at a minimum;
(i) All prepayments and other payments received
for health care services rendered pursuant to certified health plan benefit
packages;
(ii) Expenditures to all categories of health
care facilities, providers, and organizations with which the plan has
contracted to fulfill obligations to enrolled residents arising out of the
uniform benefits package and other approved supplemental benefit agreements, together
with all other direct expenses including depreciation, enrollment, and
commission; and
(iii) Expenditures for capital improvements, or
additions thereto, including but not limited to construction, renovation, or
purchase of facilities and capital equipment;
(b) A report of the names and addresses of all
officers, directors, or trustees of the certified health plan during the
preceding year, and the amount of wages, expense reimbursements, or other
payments to such individuals;
(c) The number of residents enrolled and
terminated during the report period. Additional information regarding the
enrollment and termination pattern for a certified health plan may be required
by the commissioner to demonstrate compliance with the open enrollment and free
access requirements of chapter . . ., Laws of 1993 (this act). The
insurance commissioner shall specify additional information to be reported,
which may include but not be limited to age, sex, location, and health status
information;
(d) Such other information relating to the
performance of the certified health plan or the health care facilities or
providers with which it has contracted as reasonably necessary to the proper
and effective administration of this chapter in accordance with rules;
(e) Disclosure of any financial interests held
by officers and directors in any providers associated with the certified health
plan or provider of the certified health plan.
(3) The commissioner may require quarterly
reporting of financial information, such information to be furnished in a
format prescribed by the commissioner in consultation with the commission.
(4) The commissioner may for good reason allow
a reasonable extension of time within which such annual statement shall be
filed.
(5) The commissioner may suspend or revoke the
certificate of a certified health plan for failing to file its annual statement
when due or during any extension of time therefor that the commissioner, for
good cause, may grant.
(6) The commissioner shall provide to the
health services commission an annual summary report of at least the information
required in subsections (2) and (3) of this section.
(7) No person may knowingly file with any
public official or knowingly make, publish, or disseminate any financial
statement of a certified health plan that does not accurately state the
certified health plan's financial condition.
NEW SECTION. Sec. 437.
PROVIDER CONTRACTS‑-ENROLLED RESIDENT'S LIABILITY, COMMISSIONER'S
REVIEW. (1) Subject to subsection (2) of this section, every contract between
a certified health plan and its providers of health care services shall be in
writing and shall set forth that in the event the certified health plan fails
to pay for health care services as set forth in the uniform benefits package,
the enrollee is not liable to the provider for any sums owed by the certified
health plan. Every such contract shall provide that this requirement shall
survive termination of the contract.
(2) The provisions of subsection (1) of this
section shall not apply to emergency care from a provider who is not a
contracting provider with the certified health plan, or to emergent and
urgently needed out-of-area services.
(3) The certified health plan shall file the
contracts with the insurance commissioner for approval thirty days prior to
use.
NEW SECTION. Sec. 438.
MINIMUM NET WORTH‑-REQUIREMENTS TO MAINTAIN‑-DETERMINATION OF
AMOUNT. (1) Every certified health plan must maintain a minimum net worth
equal to the greater of:
(a) One million dollars; or
(b) Two percent of annual premium revenues as
reported on the most recent annual financial statement filed with the insurance
commissioner on the first one hundred fifty million dollars of premium and one
percent of annual premium on the premium in excess of one hundred fifty million
dollars; or
(c) An amount equal to the sum of three months'
uncovered expenditures as reported on the most recent financial statement filed
with the commissioner.
(2)(a) In determining net worth, no debt may be
considered fully subordinated unless the subordination clause is in a form
acceptable to the commissioner. An interest obligation relating to the
repayment of a subordinated debt must be similarly subordinated.
(b) The interest expenses relating to the
repayment of a fully subordinated debt may not be considered uncovered
expenditures.
(c) A subordinated debt incurred by a note
meeting the requirements of this section, and otherwise acceptable to the
insurance commissioner, may not be considered a liability and shall be recorded
as equity.
(3) Every certified health plan shall, in
determining liabilities, include an amount estimated in the aggregate to
provide for unearned premiums and for the payment of claims for health care
expenditures that have been incurred, whether reported or unreported, that are
unpaid and for which such organization is or may be liable and to provide for
the expense of adjustment or settlement of such claims.
The claims shall be computed in accordance with
rules adopted by the insurance commissioner in consultation with the health
services commission.
NEW SECTION. Sec. 439.
FUNDED RESERVE REQUIREMENTS. (1) Each certified health plan obtaining
certification from the insurance commissioner under sections 427 through 444 of
this act shall provide and maintain a funded reserve of one hundred fifty
thousand dollars. The funded reserve shall be deposited with the insurance
commissioner or with any organization acceptable to the commissioner in the
form of cash, securities eligible for investment under chapter 48.13 RCW,
approved surety bond, or any combination of these, and must be equal to or
exceed one hundred fifty thousand dollars. The funded reserve shall be
established as an assurance that the uncovered expenditures obligations of the
certified health plan to the enrolled Washington residents shall be performed.
(2) All income from reserves on deposit with
the commissioner shall belong to the depositing certified health plan and shall
be paid to it as it becomes available.
(3) Funded reserves required by this section
shall be considered an asset in determining the plan's net worth.
NEW SECTION. Sec. 440.
EXAMINATION OF CERTIFIED HEALTH PLANS, POWERS OF COMMISSIONER, DUTIES OF PLANS,
INDEPENDENT AUDIT REPORTS. (1) The insurance commissioner shall make an
examination of the operations of a certified health plan as often as the
commissioner deems it necessary in order to assure the financial security and
health and safety of the enrolled residents. The insurance commissioner shall
make an examination of a certified health plan not less than once every three
calendar years.
(2) Every certified health plan shall submit
its books and records relating to its operation for financial condition and
market conduct examinations and in every way facilitate them. The quality or
appropriateness of health services and systems shall be examined by the
department of health except that the insurance commissioner may review such
areas to the extent that such items impact the financial condition or the
market conduct of the certified health plan. For the purpose of the
examinations the insurance commissioner may issue subpoenas, administer oaths,
and examine the officers and principals of the certified health plans
concerning their business.
(3) The insurance commissioner may elect to
accept and rely on audit reports made by an independent certified public
accountant for the certified health plan in the course of that part of the
insurance commissioner's examination covering the same general subject matter
as the audit. The commissioner may incorporate the audit report in his or her
report of the examination.
(4) Certified health plans shall be equitably
assessed to cover the cost of financial condition and market conduct
examinations, the costs of adopting rules, and the costs of enforcing the
provisions of this chapter. The assessments shall be levied not less
frequently than once every twelve months and shall be in an amount expected to
fund the examinations, adoption of rules, and enforcement of the provisions of
this chapter including a reasonable margin for cost variations. The assessments
shall be established by rules adopted by the commissioner in consultation with
the health services commission but may not exceed five and one-half cents per
month per resident enrolled in the certified health plan. The minimum
assessment shall be one thousand dollars. Assessment receipts shall be
deposited in the insurance commissioner's regulatory account in the state
treasury and shall be used for the purpose of funding the examinations
authorized in subsection (1) of this section. Assessments received shall be
used to pay a pro rata share of the costs, including overhead of regulating
certified health plans. Amounts remaining in the separate account at the end
of a biennium shall be applied to reduce the assessments in succeeding biennia.
NEW SECTION. Sec. 441.
INSOLVENCY‑-COMMISSIONER'S DUTIES, CONTINUATION OF BENEFITS, ALLOCATION
OF COVERAGE. (1) In the event of insolvency of a certified health plan and
upon order of the commissioner, all other certified health plans shall offer
the enrolled Washington residents of the insolvent certified health plan the
opportunity to enroll in a solvent certified health plan. Enrollment shall be
without prejudice for any preexisting condition and shall be continuous
provided the resident enrolls in the new certified health plan within thirty
days of the date of insolvency and otherwise complies with the certified health
plan's managed care procedures within the thirty-day open enrollment period.
(2) The insurance commissioner, in consultation
with the health services commission, shall establish guidelines for the
equitable distribution of the insolvent certified health plan's enrollees to
the remaining certified health plans. The guidelines may include limitations
to enrollment based on financial conditions, provider delivery network,
administrative capabilities of the certified health plan, and other reasonable
measures of the certified health plan's ability to provide benefits to the
newly enrolled residents.
(3) Each certified health plan shall have a
plan for handling insolvency that allows for continuation of benefits for the
duration of the coverage period for which premiums have been paid and
continuation of benefits to enrolled Washington residents who are confined on the
date of insolvency in an inpatient facility until their discharge or transfer
to a new certified health plan as provided in subsection (1) of this section.
The plan shall be approved by the insurance commissioner at the time of
certification and shall be submitted for review and approval on an annual
basis. The commissioner shall approve such a plan if it includes:
(a) Insurance to cover the expenses to be paid
for continued benefits after insolvency;
(b) Provisions in provider contracts that
obligate the provider to provide services for the duration of the period after
the certified health plan's insolvency for which premium payment has been made
and until the enrolled participant is transferred to a new certified health
plan in accordance with subsection (1) of this section. Such extension of
coverage shall not obligate the provider of service beyond thirty days
following the date of insolvency;
(c) Use of the funded reserve requirements as
provided under section 439 of this act;
(d) Acceptable letters of credit or approved
surety bonds; or
(e) Other arrangements the insurance
commissioner and certified health plan mutually agree are appropriate to assure
that benefits are continued.
NEW SECTION. Sec. 442.
FINANCIAL FAILURE, SUPERVISION OF COMMISSIONER‑-PRIORITY OF DISTRIBUTION
OF ASSETS. (1) Any rehabilitation, liquidation, or conservation of a certified
health plan shall be deemed to be the rehabilitation, liquidation, or
conservation of an insurance company and shall be conducted under the
supervision of the insurance commissioner under the law governing the
rehabilitation, liquidation, or conservation of insurance companies. The
insurance commissioner may apply for an order directing the insurance
commissioner to rehabilitate, liquidate, or conserve a certified health plan
upon one or more of the grounds set forth in RCW 48.31.030, 48.31.050, and
48.31.080. Enrolled residents shall have the same priority in the event of
liquidation or rehabilitation as the law provides to policyholders of an
insurer.
(2) For purposes of determining the priority of
distribution of general assets, claims of enrolled residents and their
dependents shall have the same priority as established by RCW 48.31.280 for
policyholders and their dependents of insurance companies. If an enrolled
resident is liable to a provider for services under and covered by a certified
health plan, that liability shall have the status of an enrolled resident claim
for distribution of general assets.
(3) A provider who is obligated by statute or
agreement to hold enrolled residents harmless from liability for services
provided under and covered by a certified health plan shall have a priority of
distribution of the general assets immediately following that of enrolled
residents and enrolled residents' dependents as described in this section, and
immediately proceeding the priority of distribution described in RCW
48.31.280(2)(e).
NEW SECTION. Sec. 443.
GRIEVANCE PROCEDURE. A certified health plan shall establish and maintain a
grievance procedure approved by the commissioner, to provide a reasonable and
effective resolution of complaints initiated by enrolled Washington residents
concerning any matter relating to the provision of benefits under the uniform
benefits package, access to health care services, and quality of services.
Each certified health plan shall respond to complaints filed with the insurance
commissioner within twenty working days. The insurance commissioner in
consultation with the health services commission shall establish standards for
grievance procedures and resolution.
NEW SECTION. Sec. 444.
EXEMPTION. The provisions of sections 433 through 443 of this act do not apply
to any disability insurance company, health care service contractor, or health
maintenance organization authorized to do business in Washington.
NEW SECTION. Sec. 445.
ENFORCEMENT AUTHORITY OF COMMISSIONER. For the purposes of chapter
. . ., Laws of 1993 (this act), the insurance commissioner shall have
the same powers and duties of enforcement as are provided in Title 48 RCW.
NEW SECTION. Sec. 446.
ANNUAL REPORT BY THE INSURANCE COMMISSIONER TO THE HEALTH SERVICES COMMISSION.
Beginning January 1, 1997, the insurance commissioner shall report annually to
the health services commission on the compliance of certified health plans and
health insurance purchasing cooperatives with the provisions of chapter
. . ., Laws of 1993 (this act). The report shall include information
on (1) compliance with chapter . . ., Laws of 1993 (this act) open
enrollment and antidiscrimination provisions, (2) financial solvency
requirements, (3) the mix of enrollee characteristics within and among plans
and groups including age, sex, ethnicity, and any easily obtainable information
related to medical risk, (4) the geographic distribution of plans and groups,
and (5) other information that the commission may request consistent with the
goals of chapter . . ., Laws of 1993 (this act).
F. MANAGED COMPETITION AND LIMITED ANTI-TRUST IMMUNITY
NEW SECTION. Sec. 447.
MANAGED COMPETITION FINDINGS AND INTENT. (1) The legislature recognizes that
competition among health care providers, facilities, payers, and purchasers
will yield the best allocation of health care resources, the lowest prices for
health care, and the highest quality of health care when there exists a large
number of buyers and sellers, easily comparable health care plans and services,
minimal barriers to entry and exit into the health care market, and adequate
information for buyers and sellers to base purchasing and production
decisions. However, the legislature finds that purchasers of health care
services and health care coverage do not have adequate information upon which
to base purchasing decisions; that health care facilities and providers of health
care services face legal and market disincentives to develop economies of scale
or to provide the most cost-efficient and efficacious service; that health
insurers, contractors, and health maintenance organizations face market
disincentives in providing health care coverage to those Washington residents
with the most need for health care coverage; and that potential competitors in
the provision of health care coverage bear unequal burdens in entering the
market for health care coverage.
(2) The legislature therefore intends to exempt
from state anti-trust laws, and to provide immunity from federal anti-trust
laws through the state action doctrine for activities approved under this
chapter that might otherwise be constrained by such laws and intends to displace
competition in the health care market: To contain the aggregate cost of health
care services; to promote the development of comprehensive, integrated, and
cost-effective health care delivery systems through cooperative activities
among health care providers and facilities; to promote comparability of health
care coverage; to improve the cost-effectiveness in providing health care
coverage relative to health promotion, disease prevention, and the amelioration
or cure of illness; to assure universal access to a publicly determined,
uniform package of health care benefits; and to create reasonable equity in the
distribution of funds, treatment, and medical risk among purchasers of health
care coverage, payers of health care services, providers of health care
services, health care facilities, and Washington residents. To these ends, any
lawful action taken pursuant to chapter . . ., Laws of 1993 (this act) by
any person or entity created or regulated by chapter . . ., Laws of
1993 (this act) are declared to be taken pursuant to state statute and in
furtherance of the public purposes of the state of Washington.
(3) The legislature does not intend and unless
explicitly permitted in accordance with section 448 of this act or under rules
adopted pursuant to chapter . . ., Laws of 1993 (this act), does not
authorize any person or entity to engage in activities or to conspire to engage
in activities that would constitute per se violations of state and federal
anti-trust laws including but not limited to conspiracies or agreements:
(a) Among competing health care providers not
to grant discounts, not to provide services, or to fix the price of their
services;
(b) Among certified health plans as to the
price or level of reimbursement for health care services;
(c) Among certified health plans to boycott a
group or class of health care service providers;
(d) Among purchasers of certified health plan
coverage to boycott a particular plan or class of plans;
(e) Among certified health plans to divide the
market for health care coverage; or
(f) Among certified health plans and purchasers
to attract or discourage enrollment of any Washington resident or groups of
residents in a certified health plan based upon the perceived or actual risk of
loss in including such resident or group of residents in a certified health
plan or purchasing group.
NEW SECTION. Sec. 448.
COMPETITIVE OVERSIGHT AND ANTI-TRUST IMMUNITY. (1) A certified health plan,
health care facility, health care provider, or other person involved in the
development, delivery, or marketing of health care or certified health plans
may request, in writing, that the commission obtain an informal opinion from
the attorney general as to whether particular conduct is authorized by chapter
. . ., Laws of 1993 (this act). The attorney general shall issue such
opinion within thirty days of receipt of a written request for an opinion or
within thirty days of receipt of any additional information requested by the
attorney general necessary for rendering an opinion unless extended by the
attorney general for good cause shown. If the attorney general concludes that
such conduct is not authorized by chapter . . ., Laws of 1993 (this act),
the person or organization making the request may petition the commission for
review and approval of such conduct in accordance with subsection (3) of this
section.
(2) After obtaining the written opinion of the
attorney general and consistent with such opinion, the health services
commission:
(a) May authorize conduct by a certified health
plan, health care facility, health care provider, or any other person that
could tend to lessen competition in the relevant market upon a strong showing
that the conduct is likely to achieve the policy goals of chapter . . .,
Laws of 1993 (this act) and a more competitive alternative is impractical;
(b) Shall adopt rules governing conduct among
providers, health care facilities, and certified health plans including rules
governing provider and facility contracts with certified health plans, rules
governing the use of "most favored nation" clauses and exclusive
dealing clauses in such contracts, and rules providing that certified health
plans in rural areas contract with a sufficient number and type of health care
providers and facilities to ensure consumer access to local health care
services;
(c) Shall adopt rules permitting health care
providers within the service area of a plan to collectively negotiate the terms
and conditions of contracts with a certified health plan including the ability
of providers to meet and communicate for the purposes of these negotiations;
and
(d) Shall adopt rules governing cooperative
activities among health care facilities and providers.
(3) A certified health plan, health care
facility, health care provider, or any other person involved in the
development, delivery, and marketing of health services or certified health
plans may file a written petition with the commission requesting approval of
conduct that could tend to lessen competition in the relevant market. Such
petition shall be filed in a form and manner prescribed by rule of the
commission.
The commission shall issue a written decision
approving or denying a petition filed under this section within ninety days of
receipt of a properly completed written petition unless extended by the
commission for good cause shown. The decision shall set forth findings as to
benefits and disadvantages and conclusions as to whether the benefits outweigh
the disadvantages.
(4) In authorizing conduct and adopting rules
of conduct under this section, the commission with the advice of the attorney
general, shall consider the benefits of such conduct in furthering the goals of
health care reform including but not limited to:
(a) Enhancement of the quality of health
services to consumers;
(b) Gains in cost efficiency of health
services;
(c) Improvements in utilization of health
services and equipment;
(d) Avoidance of duplication of health services
resources; or
(e) And as to subsections (b) and (c) of this
subsection: (i) Facilitates the exchange of information relating to
performance expectations; (ii) simplifies the negotiation of delivery
arrangements and relationships; and (iii) reduces the transactions costs on the
part of certified health plans and providers in negotiating more cost effective
delivery arrangements.
These benefits must outweigh disadvantages
including and not limited to:
(i) Reduced competition among certified health
plans, health care providers, or health care facilities;
(ii) Adverse impact on quality, availability,
or price of health care services to consumers; or
(iii) The availability of arrangements less
restrictive to competition that achieve the same benefits.
(5) Conduct authorized by the commission shall
be deemed taken pursuant to state statute and in the furtherance of the public
purposes of the state of Washington.
(6) With the assistance of the attorney
general's office, the commission shall actively supervise any conduct
authorized under this section to determine whether such conduct or rules
permitting certain conduct should be continued and whether a more competitive
alternative is practical. The commission shall periodically review petitioned
conduct through, at least, annual progress reports from petitioners, annual or
more frequent reviews by the commission that evaluate whether the conduct is
consistent with the petition, and whether the benefits continue to outweigh any
disadvantages. If the commission determines that the likely benefits of any
conduct approved through rule, petition, or otherwise by the commission no
longer outweigh the disadvantages attributable to potential reduction in
competition, the commission shall order a modification or discontinuance of
such conduct. Conduct ordered discontinued by the commission shall no longer
be deemed to be taken pursuant to state statute and in the furtherance of the
public purposes of the state of Washington.
(7) Nothing contained in chapter
. . ., Laws of 1993 (this act) is intended to in any way limit the
ability of rural hospital districts to enter into cooperative agreements and
contracts pursuant to RCW 70.44.450 and chapter 39.34 RCW.
G. THE UNIFORM BENEFITS PACKAGE
NEW SECTION. Sec. 449.
UNIFORM BENEFITS PACKAGE DESIGN. (1) The commission shall define the uniform
benefits package, which shall include those health services that, consistent
with the goals and intent of chapter . . ., Laws of 1993 (this act),
are effective and necessary on a societal basis for the maintenance of the
health of citizens of the state, weighed against the need to control state
health services expenditures.
(2) The schedule of covered health services
shall emphasize proven preventive and primary health care and shall be composed
of the following essential health services: (a) Primary and specialty health
services; (b) inpatient and outpatient hospital services; (c) prescription
drugs and medications; (d) reproductive services; (e) services necessary for
maternity and well-child care, including preventive dental services for
children; and (f) case-managed chemical dependency, mental health, short-term
skilled nursing facility, home health, and hospice services, to the extent that
such services reduce inappropriate utilization of more intensive or less
efficacious medical services. The commission shall determine the specific
schedule of health services within the uniform benefits package, including
limitations on scope and duration of services. The schedule shall be the
benefit and actuarial equivalent of the schedule of benefits offered by the
basic health plan on January 1, 1993, including any additions that may result
from the inclusion of the services listed in (c) through (f) of this
subsection. The commission shall consider the recommendations of health
services effectiveness panels established pursuant to section 404 of this act
in defining the uniform benefits package.
(3) The uniform benefits package shall not
limit coverage for preexisting or prior conditions, except that the commission
shall establish exclusions for preexisting or prior conditions to the extent
necessary to prevent residents from waiting until health services are needed
before enrolling in a certified health plan.
(4) The commission shall establish enrollee
point of service cost-sharing for nonpreventive health services, related to
enrollee household income, such that financial considerations are not a barrier
to access for low-income persons, but that, for those of means, the uniform
benefits package provides for moderate point of service cost-sharing. All
point of service cost-sharing and cost control requirements shall apply
uniformly to all health care providers providing substantially similar uniform
benefits package services. The schedule shall provide for an alternate and
lower schedule of cost-sharing applicable to enrollees with household income
below the federal poverty level.
(5) The commission shall adopt rules related to
coordination of benefits and premium payments. The rules shall not have the
effect of eliminating enrollee financial participation. The commission shall
endeavor to assure an equitable distribution, among both employers and
employees, of the costs of coverage for those households composed of more than
one member in the work force.
(6) In determining the uniform benefits
package, the commission shall endeavor to seek the opinions of and information
from the public. The commission shall consider the results of official public
health assessment and policy development activities including recommendations
of the department of health in discharging its responsibilities under this
section.
(7) The commission shall submit the following
to the legislature by December 1, 1994, and by December 1 of the year preceding
any year in which the commission proposes to significantly modify the uniform
benefits package: (a) The uniform benefits package; and (b) an independent
actuarial analysis of the cost of the proposed package, giving consideration to
the factors considered under section 406(6) of this act. The commission shall
not modify the services included in the uniform benefits package before January
1, 1999.
NEW SECTION. Sec. 450.
SMALL BUSINESS ECONOMIC IMPACT STATEMENT. (1) In conjunction with submission
of the uniform benefits package as provided in section 449(7) of this act, the
commission also shall submit a small business economic impact statement,
prepared in consultation with the small business advisory committee. The
impact statement shall address the economic impact on businesses with
twenty-five or fewer full-time equivalent employees of participating in the
cost of the uniform benefits package for their employees and employees'
dependents. As an aid in preparing the small business economic impact
statement, the commission shall conduct a survey of a statistically valid
sample of small businesses.
(2) If the small business economic impact
statement indicates a need to address the economic consequences of mandating
employer participation in the cost of uniform benefits package coverage for
employees and their dependents, the commission shall submit proposed strategies
to address such consequences. Strategies may include: The level of employer
participation in uniform benefits package costs; coverage of dependents;
application of the uniform benefits package as the minimum benefits package
offered to employees or dependents; and any other strategies deemed appropriate
by the commission.
NEW SECTION. Sec. 451.
HOUSEHOLD INCOME ANALYSIS. In conjunction with submission of the uniform
benefits package as provided in section 449(7) of this act, the commission
shall submit an analysis of the impact of employee premium contributions on
individuals with household income of less than two hundred percent of the
federal poverty level. The analysis shall include estimates of the cost of
varying levels of premium subsidies for these individuals and their families.
NEW SECTION. Sec. 452.
CERTIFIED HEALTH PLAN BENEFIT PACKAGES‑-OFFERING, FILING, AND APPROVAL OF
FORMS. No uniform benefits package or supplemental benefits may be offered,
delivered, or issued for delivery to any person in this state unless it
otherwise complies with chapter . . ., Laws of 1993 (this act), and complies
with the following:
(1) All certified health plan forms for uniform
and supplemental benefits issued by the plan to enrollees and such other
marketing documents purporting to describe the plan's benefits shall comply
with the minimum standards the commissioner deems reasonable and necessary to
carry out the purposes and provisions of this chapter and consistent with
health services commission standards. The plan's forms and documents shall
fully inform enrollees of the health services to which they are entitled, and
shall fully disclose any limitations, exclusions, rights, responsibilities, and
duties required of either the enrollee or the certified health plan. No form
or document may be issued, delivered, or issued for delivery unless it has been
filed with and approved by the commissioner.
(2) Every form or document filing containing a
certification, in a manner approved by the commissioner, by either the chief
executive officer of the plan or by an actuary who is a member of the American
academy of actuaries, attesting that the filing complies with Title 48 RCW,
Title 284 WAC, and this chapter, may be used by such certified health plan
immediately after filing with the commissioner. The commissioner may order a
plan to cease using a certified form or document upon the grounds set forth in
subsection (6) of this section.
(3) Every filing that does not contain a
certification pursuant to subsection (2) of this section shall be made not less
than thirty days in advance of any such issuance, delivery, or use. At the
expiration of such thirty days the form or document filed shall be deemed
approved unless affirmatively approved or disapproved by the commissioner
within the thirty-day period. The commissioner may extend by not more than an
additional fifteen days the period within which the commissioner may review
such filing, by notifying the plan of the extension before expiration of the
initial thirty-day period. At the expiration of any extension period and in the
absence of prior affirmative approval or disapproval, any such form or document
shall be deemed approved. The commissioner may withdraw approval at any time
for cause. By approval of any filing for immediate use, the commissioner may
waive any unexpired portion of the initial thirty-day waiting period.
(4) Whenever the commissioner disapproves a
filing or withdraws a previous approval, the commissioner shall state the
grounds for disapproval.
(5) The commissioner may exempt from the
requirements of this section any plan document or form that, in the
commissioner's opinion, may not practicably be applied to, or the filing and
approval of which are, in the commissioner's opinion, not desirable or
necessary for the protection of the public.
(6) The commissioner shall disapprove any form
or document or shall withdraw any previous approval, only:
(a) If it is in any respect in violation of or
does not comply with Title 48 RCW, Title 284 WAC, and this chapter, or any
applicable order of the commissioner;
(b) If it does not comply with any controlling
filing previously made and approved;
(c) If it contains or incorporates by reference
any inconsistent, ambiguous, or misleading clauses, or exceptions and
conditions that unreasonably or deceptively affect the health services
purported to be offered or provided;
(d) If it has any title, heading, or other
indication of its provisions that is misleading;
(e) If purchase of health services under the
form or document is being solicited by deceptive advertising; or
(f) If the health service benefits provided in
the form or document are unreasonable in relation to the premium charged.
NEW SECTION. Sec. 453.
UNIFORM AND SUPPLEMENTAL BENEFITS‑-RATES‑-FILING AND APPROVAL. (1)
Premium rates for uniform benefits package and supplemental benefits shall not
be excessive or inadequate, and shall not discriminate in a manner prohibited
by section 428(3) of this act. Premium rates, enrollee point of service
cost-sharing, or maximum enrollee financial participation amounts for a uniform
benefits package may not exceed the limits established by the health services
commission in accordance with section 406 of this act. Premium rates for
uniform benefits package and supplemental benefits shall be developed on a
community-rated basis as determined by the health services commission.
(2) Prior to using, every certified health plan
shall file with the commissioner its enrollee point of service, cost-sharing
amounts, enrollee financial participation amounts, rates, its rating plan, and
any other information used to determine the specific premium to be charged any
enrollee and every modification of any of the foregoing.
(3) Every such filing shall indicate the type
and extent of the health services contemplated and must be accompanied by
sufficient information to permit the commissioner to determine whether it meets
the requirements of this chapter. A plan shall offer in support of any filing:
(a) Any historical data and actuarial
projections used to establish the rate filed;
(b) An exhibit detailing the major elements of
operating expense for the types of health services affected by the filing;
(c) An explanation of how investment income has
been taken into account in the proposed rates;
(d) Any other information that the plan deems
relevant; and
(e) Any other information that the commissioner
requires by rule.
(4) If a plan has insufficient loss experience
to support its proposed rates, it may submit loss experience for similar
exposures of other plans within the state.
(5) Every filing shall state its proposed
effective date.
(6) Actuarial formulas, statistics, and
assumptions submitted in support of a rate or form filing by a plan or
submitted to the commissioner at the commissioner's request shall be withheld
from public inspection in order to preserve trade secrets or prevent unfair
competition.
(7) No plan may make or issue a benefits
package except in accordance with its filing then in effect.
(8) The commissioner shall review a filing as
soon as reasonably possible after made, to determine whether it meets the
requirements of this section.
(9)(a) No filing may become effective within
thirty days after the date of filing with the commissioner, which period may be
extended by the commissioner for an additional period not to exceed fifteen
days if the commissioner gives notice within such waiting period to the plan
that the commissioner needs additional time to consider the filing.
(b) A filing shall be deemed to meet the
requirements of this section unless disapproved by the commissioner within the
waiting period or any extension period.
(c) If within the waiting or any extension
period, the commissioner finds that a filing does not meet the requirements of
this section, the commissioner shall disapprove the filing, shall notify the
plan of the grounds for disapproval, and shall prohibit the use of the
disapproved filing.
(10) If at any time after the applicable review
period provided in this section, the commissioner finds that a filing does not
meet the requirements of this section, the commissioner shall, after notice and
hearing, issue an order specifying in what respect the commissioner finds that
such filing fails to meet the requirements of this section, and stating when,
within a reasonable period thereafter, the filings shall be deemed no longer
effective.
The order shall not affect any benefits package
made or issued prior to the expiration of the period set forth in the order.
NEW SECTION. Sec. 454.
The legislature may disapprove of the uniform benefits package developed under
section 449 of this act and medical risk adjustment mechanisms developed under
section 406(7) of this act by an act of law at any time prior to the thirtieth
day of the following regular legislative session. If such disapproval action
is taken, the commission shall resubmit a modified package to the legislature
within fifteen days of the disapproval. If the legislature does not disapprove
or modify the package by an act of law by the end of that regular session, the
package is deemed approved.
NEW SECTION. Sec. 455.
SUPPLEMENTAL AND ADDITIONAL BENEFITS NEGOTIATION. (1) Nothing in chapter
. . ., Laws of 1993 (this act) shall preclude insurers, health care
service contractors, health maintenance organizations, or certified health
plans from insuring, providing, or contracting for benefits not included in the
uniform benefits package or in supplemental benefits.
(2) Nothing in chapter . . ., Laws of
1993 (this act) shall restrict the right of an employer to offer, an employee
representative to negotiate for, or an individual to purchase supplemental or
additional benefits not included in the uniform benefits package.
(3) Nothing in chapter . . ., Laws of
1993 (this act) shall restrict the right of an employer to offer or an employee
representative to negotiate for payment of up to one hundred percent of the
premium of the lowest priced uniform benefits package available in the
geographic area where the employer is located.
(4) Nothing in chapter . . ., Laws of
1993 (this act) shall be construed to affect the collective bargaining rights
of employee organizations to the extent that federal law specifically restricts
the ability of states to limit collective bargaining rights of employee
organizations.
(5) After July 1, 1999, no property or casualty
insurance policy issued in this state may provide first-party coverage for
health services to the extent that such services are provided under a uniform
benefits package covering the resident to whom such property or casualty
insurance policy is issued.
NEW SECTION. Sec. 456.
CONSCIENCE OR RELIGION. (1) No certified health plan or health care provider
may be required by law or contract in any circumstances to participate in the
provision of any uniform benefit if they object to so doing for reason of
conscience or religion. No person may be discriminated against in employment
or professional privileges because of such objection.
(2) The provisions of this section are not
intended to result in an enrollee being denied timely access to any service
included in the uniform benefits package. Each certified health plan shall:
(a) Provide written notice to certified health
plan enrollees, upon enrollment with the plan and upon enrollee request
thereafter, listing, by provider, services that any provider refuses to perform
for reason of conscience or religion;
(b) Develop written information describing how
an enrollee may directly access, in an expeditious manner, services that a
provider refuses to perform; and
(c) Ensure that enrollees refused services
under this section have prompt access to the information developed pursuant to
(b) of this subsection.
NEW SECTION. Sec. 457.
LONG-TERM CARE INTEGRATION PLAN. (1) To meet the health needs of the residents
of Washington state, it is critical to finance and provide long-term care and
support services through an integrated, comprehensive system that promotes
human dignity and recognizes the individuality of all functionally disabled
persons. This system shall be available, accessible, and responsive to all
residents based upon an assessment of their functional disabilities. The
governor and the legislature recognize that families, volunteers, and community
organizations are essential for the delivery of effective and efficient
long-term care and support services, and that this private and public service
infrastructure should be supported and strengthened. Further, it is important
to provide benefits without requiring family or program beneficiary
impoverishment for service eligibility.
(2) To realize the need for a strong long-term
care system and to carry out the November 30, 1992, final recommendations of
the Washington health care cost control and access commission, established
under House Concurrent Resolution No. 4443 adopted by the legislature in 1990,
related to long-term care, the commission shall:
(a) Engage in a planning process, in
conjunction with an advisory committee appointed for this purpose, for the
inclusion of long-term care services in the uniform benefits package
established under section 449 of this act by July 1999;
(b) Include in its planning process
consideration of the scope of services to be covered, the cost of and financing
of such coverage, the means through which existing long-term care programs and
delivery systems can be coordinated and integrated, and the means through which
family members can be supported in their role as informal caregivers for their
parents, spouses, or other relatives.
(3) The commission shall submit recommendations
concerning any necessary statutory changes or modifications of public policy to
the governor and the legislature by January 1, 1995.
(4) The departments of health, retirement
systems, revenue, social and health services, and veterans' affairs, the
offices of financial management, insurance commissioner, and state actuary,
along with the health care authority, shall participate in the review of the
long-term care needs enumerated in this section and provide necessary
supporting documentation and staff expertise as requested by the commission.
(5) The commission shall include in its
planning process, the development of two social health maintenance organization
long-term care pilot projects. The two pilot projects shall be referred to as
the Washington life care pilot projects. Each life care pilot program shall be
a single-entry system administered by an individual organization that is
responsible for bringing together a full range of medical and long-term care
services. The commission, in coordination with the appropriate agencies and
departments, shall establish a Washington life care benefits package that shall
include the uniform benefits package established in chapter . . ., Laws of 1993
(this act) and long-term care services. The Washington life care benefits
package shall include, but not be limited to, the following long-term care
services: Case management, intake and assessment, nursing home care, adult
family home care, home health and home health aide care, hospice, chore
services/homemaker/personal care, adult day care, respite care, and appropriate
social services. The pilot project shall develop assessment and case
management protocol that emphasize home and community-based care long-term care
options.
(a) In designing the pilot projects, the
commission shall address the following issues: Costs for the long-term care
benefits, a projected case-mix based upon disability, the required federal
waiver package, reimbursement, capitation methodology, marketing and
enrollment, management information systems, identification of the most
appropriate case management models, provider contracts, and the preferred
organizational design that will serve as a functioning model for efficiently
and effectively transitioning long-term care services into the uniform benefits
package established in chapter . . ., Laws of 1993 (this act). The
commission shall also be responsible for establishing the size of the two
membership pools.
(b) Each program shall enroll applicants based
on their level of functional disability and personal care needs. The
distribution of these functional level categories and ethnicity within the
enrolled program population shall be representative of their distribution
within the community, using the best available data to estimate the community
distributions.
(c) The two sites selected for the Washington
life care pilot program shall be drawn from the largest urban areas and include
one site in the eastern part of the state and one site in the western part of
the state. The two organizations selected to manage and coordinate the life
care services shall have the proven ability to provide ambulatory care,
personal care/chore services, dental care, case management and referral
services, must be accredited and licensed to provide long-term care for home
health services, and may be licensed to provide nursing home care.
(d) The report on the development and
establishment date of the two social health maintenance organizations shall be
submitted to the governor and appropriate committees of the legislature by
September 16, 1994. If the necessary federal waivers cannot be secured by
January 1, 1995, the commission may elect to not establish the two pilot
programs.
NEW SECTION. Sec. 458.
WASHINGTON LONG-TERM CARE PARTNERSHIP. The department of social and health
services shall from July 1, 1993, to July 1, 1998, coordinate a pilot program
entitled the Washington long-term care partnership, whereby private insurance
and medicaid funds shall be used to finance long-term care. This program must allow
for the exclusion of an individual's assets, as approved by the federal health
care financing administration, in a determination of the individual's
eligibility for medicaid; the amount of any medicaid payment; or any subsequent
recovery by the state for a payment for medicaid services to the extent such
assets are protected by a long-term care insurance policy or contract governed
by chapter 48.84 RCW and meeting the criteria prescribed in this chapter.
NEW SECTION. Sec. 459.
WASHINGTON LONG-TERM CARE PARTNERSHIP. The department of social and health
services shall seek approval and a waiver of appropriate federal medicaid
regulations to allow the protection of an individual's assets as provided in
this chapter. The department shall adopt all rules necessary to implement the
Washington long-term care partnership program, which rules shall permit the
exclusion of an individual's assets in a determination of medicaid eligibility
to the extent that private long-term care insurance provides payment or
benefits for services that medicaid would approve or cover for medicaid
recipients.
NEW SECTION. Sec. 460.
WASHINGTON LONG-TERM CARE PARTNERSHIP. (1) The insurance commissioner shall
adopt rules defining the criteria that long-term care insurance policies must
meet to satisfy the requirements of this chapter. The rules shall provide that
all long-term care insurance policies purchased for the purposes of this
chapter:
(a) Be guaranteed renewable;
(b) Provide coverage for home and
community-based services and nursing home care;
(c) Provide automatic inflation protection or
similar coverage to protect the policyholder from future increases in the cost
of long-term care;
(d) Not require prior hospitalization or
confinement in a nursing home as a prerequisite to receiving long-term care
benefits; and
(e) Contain at least a six-month grace period
that permits reinstatement of the policy or contract retroactive to the date of
termination if the policy or contract holder's nonpayment of premiums arose as
a result of a cognitive impairment suffered by the policy or contract holder as
certified by a physician.
(2) Insurers offering long-term care policies
for the purposes of this chapter shall demonstrate to the satisfaction of the
insurance commissioner that they:
(a) Have procedures to provide notice to each
purchaser of the long-term care consumer education program;
(b) Offer case management services;
(c) Have procedures that provide for the
keeping of individual policy records and procedures for the explanation of
coverage and benefits identifying those payments or services available under
the policy that meet the purposes of this chapter;
(d) Agree to provide the insurance commissioner,
on or before September 1 of each year, an annual report containing the
following information:
(i) The number of policies issued and of the
policies issued, that number sorted by issue age;
(ii) To the extent possible, the financial
circumstance of the individuals covered by such policies;
(iii) The total number of claims paid; and
(iv) Of the number of claims paid, the number
paid for nursing home care, for home care services, and community-based
services.
NEW SECTION. Sec. 461.
WASHINGTON LONG-TERM CARE PARTNERSHIP. The insurance commissioner, in
conjunction with the department of social and health services, shall develop a
consumer education program designed to educate consumers as to the need for
long-term care, methods for financing long-term care, the availability of
long-term care insurance, and the availability and eligibility requirements of
the asset protection program provided under this chapter.
NEW SECTION. Sec. 462.
WASHINGTON LONG-TERM CARE PARTNERSHIP. By January 1 of each year, the
insurance commissioner, in conjunction with the department of social and health
services, shall report to the legislature on the progress of the asset
protection program. The report shall include:
(1) The success of the agencies in implementing
the program;
(2) The number of insurers offering long-term
care policies meeting the criteria for asset protection;
(3) The number, age, and financial
circumstances of individuals purchasing long-term care policies meeting the
criteria for asset protection;
(4) The number of individuals seeking consumer
information services;
(5) The extent and type of benefits paid by
insurers offering policies meeting the criteria for asset protection;
(6) Estimates of the impact of the program on
present and future medicaid expenditures;
(7) The cost-effectiveness of the program; and
(8) A determination regarding the
appropriateness of continuing the program.
H. STATE RESIDENT AND EMPLOYER PARTICIPATION
NEW SECTION. Sec. 463.
INDIVIDUAL PARTICIPATION. (1) All residents of the state of Washington are
required to purchase a uniform benefits package from a certified health plan no
later than July 1, 1999. This participation requirement shall be waived if
imposition of the requirement would constitute a violation of the freedom of
religion provisions set forth in the First Amendment, United States
Constitution or Article I, section 11 of the state Constitution. Residents of
the state of Washington who work in another state for an out-of-state employer
shall be deemed to have satisfied the requirements of this section if they
receive health insurance coverage through such employer.
(2) The commission shall monitor the enrollment
of individuals into certified health plans and shall make public periodic
reports concerning the number of persons enrolled and not enrolled, the reasons
why individuals are not enrolled, recommendations to reduce the number of
persons not enrolled, and recommendations regarding enforcement of this
provision.
NEW SECTION. Sec. 464.
EMPLOYER PARTICIPATION. (1) The legislature recognizes that small businesses
play an essential and increasingly important role in the state's economy. The
legislature further recognizes that many of the state's small business owners
provide health insurance to their employees through small group policies at a
cost that directly affects their profitability. Other small business owners
are prevented from providing health benefits to their employees by the lack of
access to affordable health insurance coverage. The legislature intends that
the provisions of chapter . . ., Laws of 1993 (this act) make health
insurance more available and affordable to small businesses in Washington state
through strong cost control mechanisms and the option to purchase health
benefits through the basic health plan, the Washington state group purchasing
association, and health insurance purchasing cooperatives.
(2) On July 1, 1995, every employer employing
more than five hundred qualified employees shall:
(a) Offer a choice of the uniform benefits
package as provided by at least three available certified health plans, one of
which shall be the lowest cost available package within their geographic
region, and for employers who have established a registered employer health
plan, one of which may be its own registered employer health plan, to all
qualified employees. The employer shall be required to pay no less than fifty
percent of the premium cost of the lowest cost available package within their
geographic region. On July 1, 1996, all dependents of qualified employees of
these firms shall be offered a choice of packages as provided in this section
with the employer paying no less than fifty percent of the premium of the
lowest cost package within their geographic region.
(b) For employees who work fewer than thirty
hours during a week or one hundred twenty hours during a calendar month, three
hundred sixty hours during a calendar quarter or one thousand four hundred
forty hours during a calendar year, and their dependents, pay, for the period
of time adopted by the employer under this subsection, the amount resulting
from application of the following formula: The number of hours worked by the
employee in a month is multiplied by the amount of a qualified employee's
premium, and that amount is then divided by one hundred twenty.
(c) If an employee under (b) of this subsection
is the dependent of a qualified employee, and is therefore covered as a
dependent by the qualified employee's employer, then the employer of the
employee under (b) of this subsection shall not be required to participate in
the cost of the uniform benefits package for that employee.
(d) If an employee working on a seasonal basis
is a qualified employee of another employer, and therefore has uniform benefits
package coverage through that primary employer, then the seasonal employer of
the employee shall not be required to participate in the cost of the uniform
benefits package for that employee.
(3) By July 1, 1996, every employer employing
more than one hundred qualified employees shall:
(a) Offer a choice of the uniform benefits
package as provided by at least three available certified health plans, one of
which shall be the lowest cost available package within their geographic
region, to all qualified employees. The employer shall be required to pay no less
than fifty percent of the premium cost of the lowest cost available package
within their geographic region. On July 1, 1997, all dependents of qualified
employees in these firms shall be offered a choice of packages as provided in
this section with the employer paying no less than fifty percent of the premium
of the lowest cost package within their geographic region.
(b) For employees who work fewer than thirty
hours during a week or one hundred twenty hours during a calendar month, three
hundred sixty hours during a calendar quarter or one thousand four hundred
forty hours during a calendar year, and their dependents, pay, for the period
of time adopted by the employer under this subsection, the amount resulting
from application of the following formula: The number of hours worked by the
employee in a month is multiplied by the amount of a qualified employee's
premium, and that amount is then divided by one hundred twenty.
(c) If an employee under (b) of this subsection
is the dependent of a qualified employee, and is therefore covered as a
dependent by the qualified employee's employer, then the employer of the
employee under (b) of this subsection shall not be required to participate in
the cost of the uniform benefits package for that employee.
(d) If an employee working on a seasonal basis
is a qualified employee of another employer, and therefore has uniform benefits
package coverage through that primary employer, then the seasonal employer of
the employee shall not be required to participate in the cost of the uniform
benefits package for that employee.
(4) By July 1, 1997, every employer shall:
(a) Offer a choice of the uniform benefits
package as provided by at least three available certified health plans, one of
which shall be the lowest cost available package within their geographic
region, to all qualified employees. The employer shall be required to pay no
less than fifty percent of the premium cost of the lowest cost available
package within their geographic region. On July 1, 1999, all dependents of
qualified employees in all firms shall be offered a choice of packages as
provided in this section with the employer paying no less than fifty percent of
the premium of the lowest cost package within their geographic region.
(b) For employees who work fewer than thirty
hours during a week or one hundred twenty hours during a calendar month, three
hundred sixty hours during a calendar quarter or one thousand four hundred
forty hours during a calendar year, and their dependents, pay, for the period
of time adopted by the employer under this subsection, the amount resulting
from application of the following formula: The number of hours worked by the
employee in a month is multiplied by the amount of a qualified employee's
premium, and that amount is then divided by one hundred twenty.
(c) If an employee under (b) of this subsection
is the dependent of a qualified employee, and is therefore covered as a
dependent by the qualified employee's employer, then the employer of the
employee under (b) of this subsection shall not be required to participate in
the cost of the uniform benefits package for that employee.
(d) If an employee working on a seasonal basis
is a qualified employee of another employer, and therefore has uniform benefits
package coverage through that primary employer, then the seasonal employer of
the employee shall not be required to participate in the cost of the uniform
benefits package for that employee.
(5) This employer participation requirement
shall be waived if imposition of the requirement would constitute a violation
of the freedom of religion provisions of the First Amendment of the United
States Constitution or Article I, section 11, of the state Constitution. In
such case the employer shall, pursuant to commission rules, set aside an amount
equal to the applicable employer contribution level in a manner that would
permit his or her employee to fully comply with the requirements of this
chapter.
(6) In lieu of offering the uniform benefits
package to employees and their dependents through direct contracts with
certified health plans, an employer may combine the employer contribution with
that of the employee's contribution and enroll in the basic health plan as
provided in chapter 70.47 RCW or a health insurance purchasing cooperative
established under sections 425 and 426 of this act.
NEW SECTION. Sec. 465.
DEPOSITORY. (1) The health care authority shall establish a depository where
payments under section 464 of this act can be made and held in safekeeping for
the benefit of employees working less than the number of hours worked by a
qualified employee.
(2) The authority shall adopt appropriate rules
for operation of the depository, in consultation with representatives of
employees and employers, especially those that are seasonal or employ large
numbers of part-time workers. The rules shall address the means through which payments
will be properly deposited to the credit of employees and the means through
which employees can access payments made on their behalf. On and after July 1,
1995, payments deposited by employers on behalf of employees may be used by
employees only for purchase of the uniform benefits package. Prior to July 1,
1995, payments may be used for purchase of any health insurance coverage.
NEW SECTION. Sec. 466.
SMALL FIRM FINANCIAL ASSISTANCE. (1) Beginning July 1, 1997, firms with fewer
than twenty-five workers that face barriers to providing health insurance for
their employees may, upon application, be eligible to receive financial
assistance with funds set aside from the health services account. Firms with
the following characteristics shall be given preference in the distribution of
funds: (a) New firms, (b) employers with low average wages, (c) employers with
low profits, and (d) firms in economically distressed areas.
(2) All employers in existence on or before
July 1, 1997, who meet the criteria set forth in this section, and rules
adopted under this section, may apply to the health services commission for
assistance. Such employers may not receive premium assistance beyond July 1,
2001. New employers, who come into existence after July 1, 1997, may apply for
and receive premium assistance for a limited period of time, as determined by
the commission.
(3) The total funds available for small
business assistance shall not exceed one hundred fifty million dollars for the
biennium beginning July 1, 1997. Thereafter, the amount of total funds
available for premium assistance shall be determined by the office of financial
management, based on a forecast of inflation, employment, and the number of
eligible firms.
(4) By July 1, 1997, the health services
commission, with assistance from the small business advisory committee
established in section 404 of this act, shall develop specific definitions,
rules, and procedures governing all aspects of the small business assistance
program, including application procedures, thresholds regarding firm size,
wages, profits, and age of firm, and rules governing duration of assistance.
(5) Final determination of the amount of the
premium assistance to be dispensed to an employer shall be made by the
commission based on rules, definitions, and procedures developed under this
section. If total claims for assistance are above the amount of total funds
available for such purposes, the commission shall have the authority to prorate
employer claims so that the amount of available funds is not exceeded.
(6) The office of financial management, in
consultation with the commission, shall establish appropriate criteria for
monitoring and evaluating the economic and labor market impacts of the premium
assistance program and report its findings to the commission annually through
July 1, 2001.
I. PUBLIC HEALTH SERVICES IMPROVEMENT PLAN
NEW SECTION. Sec. 467. A
new section is added to chapter 43.70 RCW to read as follows:
PUBLIC HEALTH SERVICES IMPROVEMENT PLAN. (1)
The legislature finds that the public health functions of community assessment,
policy development, and assurance of service delivery are essential elements in
achieving the objectives of health reform in Washington state. The legislature
further finds that the population-based services provided by state and local
health departments are cost-effective and are a critical strategy for the
long-term containment of health care costs. The legislature further finds that
the public health system in the state lacks the capacity to fulfill these
functions consistent with the needs of a reformed health care system.
(2) The department of health shall develop, in
consultation with local health departments and districts, the state board of
health, the health services commission, area Indian health service, and other
state agencies, health services providers, and citizens concerned about public
health, a public health services improvement plan. The plan shall provide a
detailed accounting of deficits in the core functions of assessment, policy
development, assurance of the current public health system, how additional
public health funding would be used, and describe the benefits expected from
expanded expenditures.
(3) The plan shall include:
(a) Definition of minimum standards for public
health protection through assessment, policy development, and assurances;
(i) Enumeration of communities not meeting
those standards;
(ii) A budget and staffing plan for bringing
all communities up to minimum standards;
(iii) An analysis of the costs and benefits
expected from adopting minimum public health standards for assessment, policy
development, and assurances;
(b) Recommended strategies and a schedule for
improving public health programs throughout the state, including:
(i) Strategies for transferring personal health
care services from the public health system, into the uniform benefits package
where feasible; and
(ii) Timing of increased funding for public
health services linked to specific objectives for improving public health; and
(c) A recommended level of dedicated funding
for public health services to be expressed in terms of a percentage of total
health service expenditures in the state or a set per person amount; such
recommendation shall also include methods to ensure that such funding does not
supplant existing federal, state, and local funds received by local health
departments, and methods of distributing funds among local health departments.
(4) The department shall coordinate this
planning process with the study activities required in section 258 of this act.
(5) By March 1, 1994, the department shall provide
initial recommendations of the public health services improvement plan to the
legislature regarding minimum public health standards, and public health
programs needed to address urgent needs, such as those cited in subsection (7)
of this section.
(6) By December 1, 1994, the department shall
present the public health services improvement plan to the legislature, with
specific recommendations for each element of the plan to be implemented over
the period from 1995 through 1997.
(7) Thereafter, the department shall update the
public health services improvement plan for presentation to the legislature
prior to the beginning of a new biennium.
(8) Among the specific population-based public
health activities to be considered in the public health services improvement
plan are: Health data assessment and chronic and infectious disease
surveillance; rapid response to outbreaks of communicable disease; efforts to
prevent and control specific communicable diseases, such as tuberculosis and
acquired immune deficiency syndrome; health education to promote healthy
behaviors and to reduce the prevalence of chronic disease, such as those linked
to the use of tobacco; access to primary care in coordination with existing
community and migrant health clinics and other not for profit health care
organizations; programs to ensure children are born as healthy as possible and
they receive immunizations and adequate nutrition; efforts to prevent
intentional and unintentional injury; programs to ensure the safety of drinking
water and food supplies; poison control; trauma services; and other activities
that have the potential to improve the health of the population or special
populations and reduce the need for or cost of health services.
NEW SECTION. Sec. 468. A
new section is added to chapter 41.05 RCW to read as follows:
AMERICAN INDIAN HEALTH CARE DELIVERY PLAN.
Consistent with funds appropriated specifically for this purpose, the authority
shall establish in conjunction with the area Indian health services system and
providers an advisory group comprised of Indian and non-Indian health care
facilities and providers to formulate an American Indian health care delivery
plan. The plan shall include:
(1) Recommendations to providers and facilities
methods for coordinating and joint venturing with the Indian health services
for service delivery;
(2) Methods to improve American Indian-specific
health programming; and
(3) Creation of co-funding recommendations and
opportunities for the unmet health services programming needs of American
Indians.
J. HEALTH ACCOUNTS
NEW SECTION. Sec. 469.
HEALTH SERVICES ACCOUNT. The health services account is created in the state
treasury. Moneys in the account may be spent only after appropriation. Moneys
in the account may be expended only for maintaining and expanding health
services access for low-income residents, maintaining and expanding the public
health system, maintaining and improving the capacity of the health care
system, containing health care costs, and the regulation, planning, and
administering of the health care system.
NEW SECTION. Sec. 470.
PUBLIC HEALTH SERVICES ACCOUNT. The public health services account is created
in the state treasury. Moneys in the account may be spent only after
appropriation. Moneys in the account may be expended only for maintaining and
improving the health of Washington residents through the public health system.
For purposes of this section, the public health system shall consist of the
state board of health, the state department of health, and local health
departments and districts. Funds appropriated from this account to local
health departments and districts shall be distributed ratably based on county
population as last determined by the office of financial management.
NEW SECTION. Sec. 471.
HEALTH SYSTEM CAPACITY ACCOUNT. The health system capacity account is created
in the state treasury. Moneys in the account may be spent only after
appropriation. Moneys in the account may be expended for the following
purposes: Health data systems; health systems and public health research;
health system regulation; health system planning, development, and
administration; and improving the supply and geographic distribution of primary
health service providers.
NEW SECTION. Sec. 472.
PERSONAL HEALTH SERVICES ACCOUNT. The personal health services account is
created in the treasury. Moneys in the account may be spent only after
appropriation. Moneys in the account may be expended for the support of
subsidized personal health services for low-income Washington residents.
Sec. 473.
RCW 43.84.092 and 1993 c 4 s 9 are each amended to read as follows:
EARNINGS OF INVESTMENTS. (1) All earnings of
investments of surplus balances in the state treasury shall be deposited to the
treasury income account, which account is hereby established in the state
treasury.
(2) Monthly, the state treasurer shall
distribute the earnings credited to the treasury income account. The state
treasurer shall credit the general fund with all the earnings credited to the
treasury income account except:
(a) The following accounts and funds shall
receive their proportionate share of earnings based upon each account's and
fund's average daily balance for the period: The capitol building construction
account, the Cedar River channel construction and operation account, the
Central Washington University capital projects account, the charitable,
educational, penal and reformatory institutions account, the common school
construction fund, the county criminal justice assistance account, the county
sales and use tax equalization account, the data processing building
construction account, the deferred compensation administrative account, the
deferred compensation principal account, the department of retirement systems
expense account, the Eastern Washington University capital projects account,
the federal forest revolving account, the health services account, the
public health services account, the health system capacity account, the
personal health services account, the industrial insurance premium refund
account, the judges' retirement account, the judicial retirement administrative
account, the judicial retirement principal account, the local leasehold excise
tax account, the local sales and use tax account, the medical aid account, the
municipal criminal justice assistance account, the municipal sales and use tax
equalization account, the natural resources deposit account, the perpetual
surveillance and maintenance account, the public employees' retirement system
plan I account, the public employees' retirement system plan II account, the
Puyallup tribal settlement account, the resource management cost account, the
site closure account, the special wildlife account, the state employees'
insurance account, the state employees' insurance reserve account, the state
investment board expense account, the state investment board commingled trust
fund accounts, the supplemental pension account, the teachers' retirement
system plan I account, the teachers' retirement system plan II account, the
University of Washington bond retirement fund, the University of Washington
building account, the volunteer fire fighters' relief and pension principal
account, the volunteer fire fighters' relief and pension administrative
account, the Washington judicial retirement system account, the Washington law
enforcement officers' and fire fighters' system plan I retirement account, the
Washington law enforcement officers' and fire fighters' system plan II retirement
account, the Washington state patrol retirement account, the Washington State
University building account, the Washington State University bond retirement
fund, and the Western Washington University capital projects account. Earnings
derived from investing balances of the agricultural permanent fund, the normal
school permanent fund, the permanent common school fund, the scientific
permanent fund, and the state university permanent fund shall be allocated to
their respective beneficiary accounts. All earnings to be distributed under
this subsection (2)(a) shall first be reduced by the allocation to the state
treasurer's service fund pursuant to RCW 43.08.190.
(b) The following accounts and funds shall
receive eighty percent of their proportionate share of earnings based upon each
account's or fund's average daily balance for the period: The central Puget
Sound public transportation account, the city hardship assistance account, the
county arterial preservation account, the economic development account, the
essential rail assistance account, the essential rail banking account, the
ferry bond retirement fund, the grade crossing protective fund, the high
capacity transportation account, the highway bond retirement fund, the highway
construction stabilization account, the highway safety account, the marine
operating fund, the motor vehicle fund, the motorcycle safety education
account, the pilotage account, the public transportation systems account, the
Puget Sound capital construction account, the Puget Sound ferry operations
account, the recreational vehicle account, the rural arterial trust account,
the special category C account, the state patrol highway account, the transfer
relief account, the transportation capital facilities account, the transportation
equipment fund, the transportation fund, the transportation improvement
account, and the urban arterial trust account.
(3) In conformance with Article II, section 37
of the state Constitution, no treasury accounts or funds shall be allocated
earnings without the specific affirmative directive of this section.
K. EXCLUSIONS AND STUDIES
NEW SECTION. Sec. 474.
CODE REVISIONS AND WAIVERS. (1) The commission shall determine the state and
federal laws that would need to be repealed, amended, or waived to implement
chapter . . ., Laws of 1993 (this act), and report its
recommendations, with proposed revisions to the Revised Code of Washington, to
the governor, and appropriate committees of the legislature by July 1, 1994.
(2) The governor, in consultation with the
commission, shall take the following steps in an effort to receive waivers or
exemptions from federal statutes necessary to fully implement chapter
. . ., Laws of 1993 (this act) to include, but not be limited to:
(a) Negotiate with the United States congress
and the federal department of health and human services, health care financing
administration to obtain a statutory or regulatory waiver of provisions of the
medical assistance statute, Title XIX of the federal social security act that
currently constitute barriers to full implementation of provisions of chapter
. . ., Laws of 1993 (this act) related to access to health services
for low-income residents of Washington state. Such waivers shall include any
waiver needed to require that: (i) Medical assistance recipients enroll in
managed care systems, as defined in chapter ..., Laws of 1993 (this act); and
(ii) enrollee point of service, cost-sharing levels adopted pursuant to section
449 of this act be applied to medical assistance recipients. In negotiating
the waiver, consideration shall be given to the degree to which supplemental
benefits should be offered to medicaid recipients, if at all. Waived
provisions may include and are not limited to: Categorical eligibility
restrictions related to age, disability, blindness, or family structure; income
and resource limitations tied to financial eligibility requirements of the
federal aid to families with dependent children and supplemental security
income programs; administrative requirements regarding single state agencies,
choice of providers, and fee for service reimbursement; and other limitations
on health services provider payment methods.
(b) Negotiate with the United States congress
and the federal department of health and human services, health care financing
administration to obtain a statutory or regulatory waiver of provisions of the
medicare statute, Title XVIII of the federal social security act that currently
constitute barriers to full implementation of provisions of chapter
. . ., Laws of 1993 (this act) related to access to health services
for elderly and disabled residents of Washington state. Such waivers shall
include any waivers needed to implement managed care programs. Waived provisions
include and are not limited to: Beneficiary cost-sharing requirements;
restrictions on scope of services; and limitations on health services provider
payment methods.
(c) Negotiate with the United States congress
and the federal department of health and human services to obtain any statutory
or regulatory waivers of provisions of the United States public health services
act necessary to ensure integration of federally funded community and migrant
health clinics and other health services funded through the public health
services act into the health services system established pursuant to chapter
. . ., Laws of 1993 (this act). The commission shall request in the
waiver that funds from these sources continue to be allocated to federally
funded community and migrant health clinics to the extent that such clinics'
patients are not yet enrolled in certified health plans.
(d) Negotiate with the United States congress
to obtain a statutory exemption from provisions of the Employee Retirement
Income Security Act that limit the state's ability to ensure that all employees
and their dependents in the state comply with the requirement to enroll in
certified health plans, and have their employers participate in financing their
enrollment in such plans.
(e) Request that the United States congress
amend the Internal Revenue Code to treat employee premium contributions to
plans, such as the basic health plan or the uniform benefits package offered
through a certified health plan, as fully deductible from adjusted gross income.
(3) On or before December 1, 1995, the
commission shall report the following to the appropriate committees of the
legislature:
(a) The status of its efforts to obtain the
waivers provided in subsection (2) of this section;
(b) If all federal statutory or regulatory
waivers necessary to fully implement chapter ..., Laws of 1993 (this act) have
not been obtained:
(i) The extent to which chapter ..., Laws of
1993 (this act) can be implemented without receipt of all of such waivers; and
(ii) Changes in chapter ..., Laws of 1993 (this
act) necessary to implement a residency-based health services system using one
or a limited number of sponsors, or an alternative system that will ensure
access to care and control health services costs.
NEW SECTION. Sec. 475.
REPORTS OF HEALTH CARE COST CONTROL AND ACCESS COMMISSION. In carrying out its
powers and duties under chapter . . ., Laws of 1993 (this act), the
design of the uniform benefits package, and the development of guidelines and
standards, the commission shall consider the reports of the health care cost
control and access commission established under House Concurrent Resolution No.
4443 adopted by the legislature in 1990. Nothing in chapter . . .,
Laws of 1993 (this act) requires the commission to follow any specific
recommendation contained in those reports except as it may also be included in
chapter . . ., Laws of 1993 (this act) or other law.
NEW SECTION. Sec. 476.
EVALUATIONS, PLANS, AND STUDIES. (1) By July 1, 1997, the legislative budget
committee either directly or by contract shall conduct the following study:
A study to determine the desirability and
feasibility of consolidating the following programs, services, and funding
sources into the delivery and financing of uniform benefits package services
through certified health plans:
(a) State and federal veterans' health
services;
(b) Civilian health and medical program of the
uniformed services (CHAMPUS) of the federal department of defense and other
federal agencies; and
(c) Federal employee health benefits.
(2) The legislative budget committee shall
evaluate the implementation of the provisions of chapter . . ., Laws
of 1993 (this act). The study shall determine to what extent chapter
. . ., Laws of 1993 (this act) has been implemented consistent with
the principles and elements set forth in chapter . . ., Laws of 1993
(this act) and shall report its findings to the governor and appropriate
committees of the legislature by July 1, 2003.
NEW SECTION. Sec. 477.
FINANCIAL AND ACCOUNTING STRUCTURE OF STATE PURCHASED HEALTH CARE. The
commission, the office of financial management, and the legislative evaluation
and accountability program committee shall jointly review the financial and
accounting structure of all current state-purchased health care programs and
any new programs established in chapter . . ., Laws of 1993 (this
act). They shall report to the legislature on or before December 1, 1994, with
recommendations on how to structure a state-purchased health services budget
that: (1) Meets federal and state audit requirements; (2) exercises adequate
fiscal and programmatic control; (3) provides management and organizational
accountability and control; and (4) provides continuity with historical health
services expenditure data.
NEW SECTION. Sec. 478.
EVALUATION OF REFORM EFFORT. The office of financial management may undertake
or facilitate evaluations of health care reform, including analysis of fiscal
and economic impacts, the effectiveness of managed care and managed
competition, and effects of reform on access and quality of service.
NEW SECTION. Sec. 479.
COORDINATION OF CERTIFIED HEALTH PLANS AND OTHER INSURANCE. (1) On or before
December 1, 1994, the legislative budget committee, whether directly or by
contract, shall conduct a study related to coordination of certified health
plans and other property and casualty insurance products. The goal of the
study shall be to determine methods for containing costs of health services
paid for through coverage underwritten by property and casualty insurers.
(2) The study shall address methods to
integrate coverage sold by property and casualty insurance companies that
covers medical and hospital expenses with coverage provided through certified
health plans.
NEW SECTION. Sec. 480.
HOSPITAL REGULATION STUDY. The legislative budget committee, through a
competitive bidding process restricted to those with suitable expertise to
conduct such a study, shall contract for an examination of local, state, and
federal regulations that apply to hospitals and shall report to the health care
policy committees of the legislature by July 1, 1994, on the following:
(1) An inventory of health and safety
regulations that apply to hospitals;
(2) A description of the costs to local, state,
and federal agencies for operating the regulatory programs;
(3) An estimate of the costs to hospitals to
comply with the regulations;
(4) A description of whether regulatory
functions are duplicated among different regulatory programs;
(5) An analysis of the effectiveness of
regulatory programs in meeting their safety and health objectives;
(6) An analysis of hospital charity care
requirements under RCW 70.170.060 and their relevance under the health care
reforms created under chapter . . ., Laws of 1993 (this act);
(7) Recommendations on elimination or
consolidation of unnecessary or duplicative regulatory activities that would
not result in a reduction in the health and safety objectives.
NEW SECTION. Sec. 481.
NURSING HOME STUDY. The legislative budget committee, through a competitive
bidding process restricted to those with suitable expertise to conduct such a
study, shall contract for an examination of local, state, and federal
regulations that apply to nursing homes and shall report to the health care
policy committees of the legislature by July 1, 1994, on the following:
(1) An inventory of health and safety
regulations that apply to nursing homes;
(2) A description of the costs to local, state,
and federal agencies for operating the regulatory programs;
(3) An estimate of the costs to nursing homes
to comply with the regulations;
(4) A description of whether regulatory
functions are duplicated among different regulatory programs;
(5) An analysis of the effectiveness of regulatory
programs in meeting their safety and health objectives;
(6) Recommendations on elimination or
consolidation of unnecessary or duplicative regulatory activities that would
not result in a reduction in the health and safety objectives. The review
shall specifically address documentation or protocols that are redundant and
efficiencies that could be realized through the development of standardized
physicians' protocols for repetitive but nonlife-threatening conditions.
NEW SECTION. Sec. 482.
CERTIFIED HEALTH PLAN LICENSING STUDY. The insurance commissioner shall
undertake a study of the feasibility and benefits of developing a single
licensing category for certified health plans that would replace current
statues licensing disability insurers, health care service contractors, and
health maintenance organizations. The commissioner shall report his or her
findings and recommendations to the legislature by January 1, 1994, and final
findings and recommendations to the legislature by October 1, 1994. In
conducting such study, the commissioner shall:
(1) Consider standards for the regulation and
inclusion of preferred provider organizations, independent practice
associations, and independent physician organizations under such new certified
health plan statute;
(2) Review existing capital and reserve
statutes governing insurers, contractors, and health maintenance organizations
to determine the appropriate level of capital and reserve for licensing of
certified health plans to protect consumers while encouraging competition in
the certified health plan market from new entrants into the market;
(3) Review existing rate regulation of
disability insurance policies, health care service contracts, and health
maintenance agreements and propose a uniform approach for regulation of rates
that balances the need of certified health plans to freely compete and the need
to protect consumers from inadequate, excessive, or unfairly discriminatory
rates;
(4) Consider regulatory methods to ensure the
adequate provision of and contracting with health care facilities and providers
by certified health plans to meet the health care needs of enrollees of
certified health plans;
(5) Consider the need to modify existing
insurance statutes and regulations to govern the integration, development, and
marketing of health care coverage that would supplement the uniform benefits
package; and
(6) Consult with health care service
contractors, health maintenance organizations, disability insurance companies,
and other health care providers and facilities who would be affected by such
changes.
NEW SECTION. Sec. 483. CRIME
VICTIMS' COMPENSATION MEDICAL BENEFITS. (1) On or before January 1, 1995, the
department of labor and industries in coordination with the commission, shall
complete a study related to the medical services component of the crime
victims' compensation program of the department of labor and industries. The
goal of the study shall be to determine whether and how the medical services
component of the crime victims' compensation program can be modified to provide
appropriate medical services to crime victims in a more cost-effective manner.
In conducting the study, consideration shall be given to at least the following
factors: Required benefit design, necessary statutory changes, and the use of
managed care to provide services to crime victims. The study shall evaluate at
least the following options:
(a) Whether the medical services component of
the crime victims' compensation program should be maintained within the
department of labor and industries, and its purchasing and other practices
modified to control costs and increase efficacy of health services provided to
crime victims;
(b) Whether the medical services component of
the crime victims' compensation program should be administered by the health
care authority as the state health care purchasing agent;
(c) Whether the medical services component of
the crime victims' compensation program should be included in the services
offered by certified health plans.
(2) The department of labor and industries
shall present the recommendations to the governor and the appropriate
committees of the legislature by January 1, 1995.
NEW SECTION. Sec. 484.
MEDICAL CARE SAVINGS ACCOUNTS. The Washington health services commission shall
study and report to the legislature on the feasibility of offering
employer-funded medical care savings account arrangements and reduced cost
qualified higher deductible insurance policies as a choice to K-12 system,
state, and local government employees in meeting their health care obligations.
L. WORKERS' COMPENSATION
NEW SECTION. Sec. 485.
WORKERS' COMPENSATION MEDICAL BENEFITS. On or before January 1, 1995, the
health services commission, in coordination with the department of labor and
industries and the workers' compensation advisory committee, shall study and
make an interim report, and on or before January 1, 1996, a final report, to
the governor and appropriate committees of the legislature on the provision of
medical benefits for injured workers under a consolidated health care system.
The study shall include a review of options and recommendations for modifying
the industrial insurance system to provide medical services for injured workers
in a more cost-effective manner under a consolidated system, and may include
consideration of the purchase of industrial insurance medical benefits through
the health care authority or the inclusion of industrial insurance medical
benefits in the services offered by certified health plans or other appropriate
options. The commission should also give consideration to at least the
following issues: The use of managed care and the effect of managed care
options on the injured workers' choice of health services provider; the
potential cost savings or other impacts of various consolidation options; the
benefit structure required under industrial insurance; the potential for
consolidation to meet or exceed existing medical cost management of the medical
aid fund; the impact of separating the medical management of claims from the
disability management of claims; the relationship between return-to-work efforts,
medical services, and disability prevention; the relationship between medical
services and rehabilitation services; and the effects of the quasi-judicial
system that determines industrial insurance rights and obligations. In
addition, the final report shall include a proposed plan and timeline for
including the medical benefits of the industrial insurance system in the
services offered by certified health plans. The proposed plan shall assure
that:
(1) The plan shall not take effect until at
least ninety-seven percent of state residents have access to the uniform
benefits package as required in chapter ..., Laws of 1993 (this act);
(2) The uniform benefits package of the
certified health plan will provide benefits for injured workers that are at least
equivalent to the medical benefits provided to injured workers under Title 51
RCW as determined by the department of labor and industries as of the effective
date of the plan, including payments for services that are ancillary to
industrial insurance medical benefits, such as but not limited to medical
examinations for permanent disabilities;
(3) Other nonmedical benefits required to be
provided under Title 51 RCW, such as but not limited to total or partial
disability benefits or vocational rehabilitation benefits, are not affected;
(4) Employers who do not choose to become
certified health plans under chapter..., Laws of 1993 (this act), will continue
to be required to provide industrial insurance medical benefits under Title 51
RCW;
(5) Employees participating in the plan shall
not be required to pay deductibles, copayments, or other point of service
charges for services related to industrial insurance injuries or diseases, such
costs to be paid by the department of labor and industries or self-insured
employer, as applicable;
(6) The plan includes a mechanism to return to
workers and employers, in equal shares, any savings that are realized in the
costs of medical services for injured workers, as identified by the department
of labor and industries;
(7) The majority of the employer's employees
or, if the employees are represented for collective bargaining purposes, the
exclusive bargaining representative voluntarily agree to the employer's
participation in the plan.
NEW SECTION. Sec. 486.
MANAGED CARE PILOT PROJECTS. (1) The department of labor and industries, in
consultation with the workers' compensation advisory committee, may conduct
pilot projects to purchase medical services for injured workers through managed
care arrangements. The projects shall assess the effects of managed care on
the cost and quality of, and employer and employee satisfaction with, medical
services provided to injured workers.
(2) The pilot projects may be limited to
specific employers. The implementation of a pilot project shall be conditioned
upon a participating employer and a majority of its employees, or, if the
employees are represented for collective bargaining purposes, the exclusive
bargaining representative, voluntarily agreeing to the terms of the pilot.
Unless the project is terminated by the department, both the employer and
employees are bound by the project agreements for the duration of the project.
(3) Solely for the purpose and duration of a
pilot project, the specific requirements of Title 51 RCW that are identified by
the department as otherwise prohibiting implementation of the pilot project
shall not apply to the participating employers and employees to the extent
necessary for conducting the project. Managed care arrangements for the pilot
projects may include the designation of doctors responsible for the care
delivered to injured workers participating in the projects.
(4) The projects shall conclude no later than
January 1, 1996. The department shall present the results of the pilot
projects and any recommendations related to the projects to the governor and
appropriate committees of the legislature on or before October 1, 1996.
M. MISCELLANEOUS
NEW SECTION. Sec. 487.
SHORT TITLE. This act may be known and cited as the Washington health services
act of 1993.
Sec. 488.
RCW 42.17.2401 and 1991 c 200 s 404 are each amended to read as follows:
EXECUTIVE STATE OFFICERS. For the purposes of
RCW 42.17.240, the term "executive state officer" includes:
(1) The chief administrative law judge, the
director of agriculture, the administrator of the office of marine safety, the
administrator of the Washington basic health plan, the director of the
department of services for the blind, the director of the state system of
community and technical colleges, the director of community development,
the secretary of corrections, the director of ecology, the commissioner of
employment security, the chairman of the energy facility site evaluation
council, the director of the energy office, the secretary of the state finance
committee, the director of financial management, the director of fisheries, the
executive secretary of the forest practices appeals board, the director of the
gambling commission, the director of general administration, the secretary of
health, the administrator of the Washington state health care authority, the
executive secretary of the health care facilities authority, the executive
secretary of the higher education facilities authority, the director of the
higher education personnel board, the executive secretary of the horse racing
commission, the executive secretary of the human rights commission, the
executive secretary of the indeterminate sentence review board, the director of
the department of information services, the director of the interagency
committee for outdoor recreation, the executive director of the state
investment board, the director of labor and industries, the director of
licensing, the director of the lottery commission, the director of the office
of minority and women's business enterprises, the director of parks and
recreation, the director of personnel, the executive director of the public
disclosure commission, the director of retirement systems, the director of
revenue, the secretary of social and health services, the chief of the
Washington state patrol, the executive secretary of the board of tax appeals,
the director of trade and economic development, the secretary of
transportation, the secretary of the utilities and transportation commission,
the director of veterans affairs, the director of wildlife, the president of
each of the regional and state universities and the president of The Evergreen
State College, each district and each campus president of each state community
college;
(2) Each professional staff member of the
office of the governor;
(3) Each professional staff member of the
legislature; and
(4) Central Washington University board of
trustees, board of trustees of each community college, each member of the state
board for community and technical colleges ((education)),
state convention and trade center board of directors, committee for deferred
compensation, Eastern Washington University board of trustees, Washington
economic development finance authority, The Evergreen State College board of
trustees, forest practices appeals board, forest practices board, gambling
commission, Washington health care facilities authority, each member of the
Washington health services commission, higher education coordinating board,
higher education facilities authority, higher education personnel board, horse
racing commission, state housing finance commission, human rights commission,
indeterminate sentence review board, board of industrial insurance appeals,
information services board, interagency committee for outdoor recreation, state
investment board, liquor control board, lottery commission, marine oversight
board, oil and gas conservation committee, Pacific Northwest electric power and
conservation planning council, parks and recreation commission, personnel
appeals board, personnel board, board of pilotage (([commissioners])) commissioners,
pollution control hearings board, public disclosure commission, public pension
commission, shorelines hearing board, ((state)) public employees'
benefits board, board of tax appeals, transportation commission, University of
Washington board of regents, utilities and transportation commission,
Washington state maritime commission, Washington public power supply system
executive board, Washington State University board of regents, Western
Washington University board of trustees, and wildlife commission.
Sec. 489.
RCW 43.20.050 and 1992 c 34 s 4 are each amended to read as follows:
STATE BOARD OF HEALTH‑-PUBLIC HEALTH
POLICY. (1) The state board of health shall provide a forum for the
development of public health policy in Washington state. It is authorized
to recommend to the secretary means for obtaining appropriate citizen and
professional involvement in all public health policy formulation and
other matters related to the powers and duties of the department. It is
further empowered to hold hearings and explore ways to improve the health
status of the citizenry.
(a) At least every five years, the state board
shall convene regional forums to gather citizen input on public health
issues.
(b) Every two years, in coordination with the
development of the state biennial budget, the state board shall prepare the
state public health report that outlines the health priorities of the
ensuing biennium. The report shall:
(i) Consider the citizen input gathered at the
((health)) forums;
(ii) Be developed with the assistance of local
health departments;
(iii) Be based on the best available
information collected and reviewed according to RCW 43.70.050 and
recommendations from the council;
(iv) Be developed with the input of state
health care agencies. At least the following directors of state agencies shall
provide timely recommendations to the state board on suggested health
priorities for the ensuing biennium: The secretary of social and health services,
the health care authority administrator, the insurance commissioner, the
superintendent of public instruction, the director of labor and industries, the
director of ecology, and the director of agriculture;
(v) Be used by state health care agency
administrators in preparing proposed agency budgets and executive request
legislation;
(vi) Be submitted by the state board to the
governor by ((June)) January 1 of each even-numbered year for
adoption by the governor. The governor, no later than ((September)) March
1 of that year, shall approve, modify, or disapprove the state public
health report.
(c) In fulfilling its responsibilities under
this subsection, the state board ((shall)) may create ad hoc
committees or other such committees of limited duration as necessary. ((Membership
should include legislators, providers, consumers, bioethicists, medical
economics experts, legal experts, purchasers, and insurers, as necessary.))
(2) In order to protect public health, the
state board of health shall:
(a) Adopt rules necessary to assure safe and
reliable public drinking water and to protect the public health. Such rules
shall establish requirements regarding:
(i) The design and construction of public water
system facilities, including proper sizing of pipes and storage for the number
and type of customers;
(ii) Drinking water quality standards,
monitoring requirements, and laboratory certification requirements;
(iii) Public water system management and
reporting requirements;
(iv) Public water system planning and emergency
response requirements;
(v) Public water system operation and
maintenance requirements;
(vi) Water quality, reliability, and management
of existing but inadequate public water systems; and
(vii) Quality standards for the source or
supply, or both source and supply, of water for bottled water plants.
(b) Adopt rules and standards for prevention,
control, and abatement of health hazards and nuisances related to the disposal
of wastes, solid and liquid, including but not limited to sewage, garbage,
refuse, and other environmental contaminants; adopt standards and procedures
governing the design, construction, and operation of sewage, garbage, refuse
and other solid waste collection, treatment, and disposal facilities;
(c) Adopt rules controlling public health
related to environmental conditions including but not limited to heating,
lighting, ventilation, sanitary facilities, cleanliness and space in all types
of public facilities including but not limited to food service establishments,
schools, institutions, recreational facilities and transient accommodations and
in places of work;
(d) Adopt rules for the imposition and use of
isolation and quarantine;
(e) Adopt rules for the prevention and control
of infectious and noninfectious diseases, including food and vector borne
illness, and rules governing the receipt and conveyance of remains of deceased
persons, and such other sanitary matters as admit of and may best be controlled
by universal rule; and
(f) Adopt rules for accessing existing data
bases for the purposes of performing health related research.
(3) The state board may delegate any of its
rule-adopting authority to the secretary and rescind such delegated authority.
(4) All local boards of health, health
authorities and officials, officers of state institutions, police officers,
sheriffs, constables, and all other officers and employees of the state, or any
county, city, or township thereof, shall enforce all rules adopted by the state
board of health. In the event of failure or refusal on the part of any member
of such boards or any other official or person mentioned in this section to so
act, he shall be subject to a fine of not less than fifty dollars, upon first
conviction, and not less than one hundred dollars upon second conviction.
(5) The state board may advise the secretary on
health policy issues pertaining to the department of health and the state.
NEW SECTION. Sec. 490.
SEVERABILITY. If any provision of this act or its application to any person or
circumstance is held invalid, the remainder of the act or the application of
the provision to other persons or circumstances is not affected.
NEW SECTION. Sec. 491.
SAVINGS CLAUSE. The enactment of this act does not have the effect of
terminating, or in any way modifying, any obligation or any liability, civil or
criminal, which was already in existence on the effective date of this act.
NEW SECTION. Sec. 492.
CAPTIONS. Captions used in this act do not constitute any part of the law.
NEW SECTION. Sec. 493.
CODIFICATION. (1) Sections 401 through 407, 409, 425, 427 through 430, and 447
through 466 of this act shall constitute a new chapter in Title 43 RCW.
(2) Sections 426 and 431 through 446 of this
act shall constitute a new chapter in Title 48 RCW.
(3) Sections 458 through 462 of this act shall
constitute a new chapter in Title 48 RCW.
NEW SECTION. Sec. 494.
RESERVATION OF LEGISLATIVE AUTHORITY. 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 the
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. 495.
EFFECTIVE DATE CLAUSE. 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 July 1, 1993, except for:
(1) Sections 234 through 257 of this act, which
shall take effect July 1, 1995; and
(2) Sections 301 through 303 of this act, which
shall take effect January 1, 1996.
NEW SECTION. Sec. 496.
NULL AND VOID. If specific funding for section 418 of this act, referencing
section 418 of this act by bill and section number, is not provided by June 30,
1993, in the omnibus appropriations act, section 418 of this act shall be null
and void.
