BP BHEAD INT S [atlas:bill]

AN ACT Relating to primary health care providers; and creating new sections.

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

NEW SECTION. Sec. 1. The legislature declares that promoting and maintaining a financially viable health care system in all parts of the state is a paramount interest. The legislature finds that, especially in rural communities, demographics and economic conditions result in a large number of people relying on public programs to pay for their health care. In cases where providers serve a disproportionately large number of low-income clients, the reimbursement rates from public programs to primary health care providers may prove insufficient to maintain the financial viability of their medical practices. The legislature further finds that determining where these inequities are and developing strategies to correct them will help stabilize the current health care system, especially in rural areas.

NEW SECTION. Sec. 2. (1) The disproportionate share study is authorized.

(2) The medical assistance administration and the health care authority shall jointly conduct a state-wide study to determine payment sources for primary health care providers performing outpatient primary care services for the state's health options and basic health plan. The purpose of the study is to determine which providers serve a relatively high number low-income clients, and how that affects the financial viability of their medical practice. The agencies are directed to use this data to develop proposals that address any inequities that threaten the financial stability of these providers.

(3) The medical assistance administration and the health care authority shall develop a mechanism for gathering payment source information from individual primary care providers who perform outpatient primary care services. This includes primary care providers such as pediatricians, family practitioners, general practitioners, internists, physician assistants, or advanced registered nurse practitioners. The agencies will determine which regions of the state to seek this information from, based on factors they determine will provide the most representative data state-wide. The agencies will seek the following information:

(a) The rates paid to primary care providers for their healthy options and basic health plan contracts;

(b) How these rates compare with nonpublic pay clients for the same services; and

(c) For each participating provider, data on the payment sources for all of their clients. The agencies are authorized to attain this information from health plans or providers.

(4) The medical assistance administration and the health care authority shall determine what constitutes a relatively high percentage of low-income clients for individual providers who contract for healthy options and the basic health plan, and the point at which this proportionately high percentage threatens the economic viability of the primary care provider. The agencies will consider any relevant factors in making this determination, including regional labor costs and other economic factors that impact financial viability. The agencies will identify providers whose practices may be threatened due to factors determined in the study.

(5) The medical assistance administration and the health care authority will calculate a payment adjustment designed to help financially stabilize medical practices that are, according to the study's findings, financially threatened.

(6) The medical assistance administration and the health care authority shall report to the legislature by December 1, 2001, with the results of the disproportionate share study. The report will include recommendations on: (a) What constitutes a proportionately high number of low-income clients, and how that threatens the financial viability of primary care providers; (b) possible rate adjustment schedules for these providers; (c) ways to implement such a rate adjustment; and (d) what such an adjusted rate program will cost.