[atlas:bill]

AN ACT Relating to standards for health care system administration; adding new sections to chapter 48.43 RCW; adding a new section to chapter 41.05 RCW; adding a new section to chapter 70.47 RCW; adding a new section to chapter 74.09 RCW; creating new sections, and making an appropriation.

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

NEW SECTION. Sec. 1. FINDINGS. The legislature finds that current administrative requirements placed upon providers and facilities by health carriers and other payers, including state purchased health care programs, are burdensome. They have the unintended consequence of increasing health care costs and reducing time available for direct patient care. Greater scrutiny of the value added by imposing administrative requirements, and greater focus on consistency of requirements across carriers and payers can help decrease health system costs and increase time available for direct patient care.

NEW SECTION. Sec. 2. A new section is added to chapter 48.43 RCW to read as follows:

DEFINITIONS‑-STANDARDS COMMITTEE CREATION AND DUTIES. (1) For the purposes of this section:

(a) "Administrative requirement" or "requirement" means a requirement placed primarily upon a health care provider or health care facility by a carrier and other payer, including state purchased health care programs, as defined in RCW 41.05.011(2), for the purpose of contracting, billing, claims processing, eligibility determination, treatment authorization, credentialing, utilization management, data sharing, or other requirements conditioned on payment that do not involve direct patient care.

(b) "Committee" means the committee on health care system administrative standards created in subsection (2) of this section.

(2)(a) The committee on health care system administrative standards is created. No later than July 1, 2002, the commissioner shall convene the committee. The committee shall consist of representatives of health care purchasers, carriers, health care facilities, health care providers, and consumers. The committee also shall include the following ex officio members: The assistant secretary for the medical assistance administration in the department of social and health services, the assistant administrator of the basic health plan in the health care authority, and the assistant administrator of the public employees' benefits board plan in the health care authority.

(b) Committee members shall receive no compensation for their service, except that nonagency members may have travel expenses reimbursed consistent with available funds and under RCW 43.03.050 and 43.03.060.

(c) The commissioner shall provide administrative support for the committee and consistent with available funds may hire staff or contract for professional assistance.

(d) The committee shall comply with the public disclosure requirements set forth in chapter 42.17 RCW and the open public meetings provisions of chapter 42.30 RCW.

(e) The committee has the following duties:

(i) Review existing administrative requirements in a manner that groups those requirements related to specific goals, such as provider credentialing or prior authorization for services, and for each group of requirements, identifies:

(A) The source of the requirements;

(B) The basis for the requirements, such as federal statute or regulation, state statute or rule, or contract;

(C) The original purpose or intent of the requirements, as related to appropriateness of care, cost containment, or other goals;

(D) The degree to which the requirements, as currently implemented, have proven to add value in achieving their original intent or goal;

(E) The extent to which the requirements contribute to the efficiency and effectiveness of the health care system;

(F) The extent to which there is consistency of requirements within each grouping across carriers and purchasers;

(G) Whether the group of requirements will be standardized at all under regulations implementing the federal health insurance portability and accountability act;

(H) The extent to which the requirements detract from direct patient care; and

(I) Costs associated with the requirements for governmental programs, carriers, other payers, providers, facilities, and consumers;

(ii) Review similar efforts in the public and private sector to improve administrative efficiency and coordinate committee activities with related organizations, if appropriate;

(iii) Conduct necessary analyses, and prepare a health care system administrative improvement report that includes findings and recommendations addressing at least the following:

(A) A general description of appropriate purposes of administrative requirements and a set of principles to be used as guidance for requirement development, modification, consolidation, and elimination;

(B) Requirements that should be eliminated completely because they do not add value to the health care delivery system, or that should be modified or consolidated to bring greater consistency and value in administrative requirements across programs and payers;

(C) Methods to ensure that appropriate reductions in administrative requirements result in increased resources for direct patient care; and

(D) Statutory or regulatory modification necessary to implement the recommendations; and

(iv) Submit the initial health care system administrative improvement report to the commissioner, the governor, the house of representatives health care committee, and the senate health and long-term care committee by July 1, 2003.

(f) The commissioner may reconvene the committee, as necessary, and when doing so, may modify the timelines under this section.

NEW SECTION. Sec. 3. A new section is added to chapter 48.43 RCW to read as follows:

ADMINISTRATIVE STANDARDS‑-RULES AND ENFORCEMENT. (1) Upon review of the health care system administrative improvement report established under section 2 of this act, the commissioner shall adopt necessary rules implementing the report's recommendations to the extent permitted by law and under chapter 34.05 RCW.

(2) On a date set by the commissioner, but in no case earlier than July 1, 2004, the following entities must comply with the rules adopted under this section: Health carriers in providing health benefit plans; the state health care authority in providing public employee benefits, under chapter 41.05 RCW, and the basic health plan, under chapter 70.47 RCW; and the department of social and health services in providing medical assistance and other medical services programs, under chapter 74.09 RCW.

NEW SECTION. Sec. 4. A new section is added to chapter 41.05 RCW to read as follows:

ADMINISTRATIVE STANDARDS‑-HEALTH CARE AUTHORITY. Beginning July 1, 2004, or a subsequent date set by the insurance commissioner under section 2(f) of this act, the administrator shall comply with the health care system administrative standards adopted under sections 2 and 3 of this act.

NEW SECTION. Sec. 5. A new section is added to chapter 70.47 RCW to read as follows:

ADMINISTRATIVE STANDARDS‑-BASIC HEALTH PLAN. Beginning July 1, 2004, or a subsequent date set by the insurance commissioner under section 2(f) of this act, the administrator shall comply with the health care system administrative standards adopted under sections 2 and 3 of this act.

NEW SECTION. Sec. 6. A new section is added to chapter 74.09 RCW to read as follows:

ADMINISTRATIVE STANDARDS‑-MEDICAL ASSISTANCE. Beginning January 1, 2004, or a subsequent date set by the insurance commissioner under section 2(f) of this act, the secretary shall comply with the health care system administrative standards adopted under sections 2 and 3 of this act to the extent those standards are consistent with the requirements of title XIX of the federal social security act.

NEW SECTION. Sec. 7. CAPTIONS NOT LAW. Captions used in this act are not any part of the law.

NEW SECTION. Sec. 8. APPROPRIATION. The sum of one hundred thousand dollars, or as much thereof as may be necessary, is appropriated for the biennium ending June 30, 2003, from the insurance commissioner's regulatory account to the insurance commissioner for the purposes set forth in sections 2 and 3 of this act.