5401 AMH HC H2553.1

5401 AMH HC H2553.1

SB 5401 - H COMM AMD FAILED 4/6/95

By Committee on Health Care

Strike everything after the enacting clause and insert the following:

"NEW SECTION. Sec. 1. A new section is added to chapter 51.04 RCW to read as follows:

On or before January 1, 1996, the department of labor and industries and the workers' compensation advisory committee, in coordination with the joint committee on health systems oversight, if created by law, shall study and make an interim report, and on or before January 1, 1997, 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 health carriers or other appropriate options. The committee should also give consideration to at least the following issues: The use of various health care coverage arrangements and the effect of various health care coverage arrangements 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 health carriers. 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 standard benefits package, if created in statute;

(2) The standard benefits package, if created in statute, will provide benefits for injured workers that are at least equivalent to the medical benefits provided to injured workers under this title 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 this title, 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 offer benefits under the plan will continue to be required to provide industrial insurance medical benefits under this title;

(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 the 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.

In addition, the study shall include review of an option for an employer to elect to provide medical aid benefits under this title through the employer-sponsored general health plan if the employer pays one hundred percent of the premium cost of the general employee health care benefit plan and the medical aid premium.

NEW SECTION. Sec. 2. A new section is added to chapter 51.04 RCW to read as follows:

(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 various health care coverage arrangements. The projects shall assess the effects of various health care coverage arrangements 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 this title 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. The various health care coverage 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, 1997. The department shall make an interim report on the projects to the governor and appropriate committees of the legislature on or before October 1, 1996. The department shall present the final results of the pilot projects and any final recommendations related to the projects to the governor and appropriate committees of the legislature on or before April 1, 1997.

NEW SECTION. Sec. 3. The following acts or parts of acts are each repealed:

(1) RCW 43.72.850 and 1993 c 492 s 485; and

(2) RCW 43.72.860 and 1993 c 492 s 486."

Correct the title accordingly.