BILL REQ. #:  S-0778.2 

Read first time 01/22/2003.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to the Washington health care recovery act; adding a new section to chapter 70.47 RCW; adding a new section to chapter 48.43 RCW; adding a new section to chapter 41.05 RCW; adding a new section to chapter 48.47 RCW; and creating new sections.

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

NEW SECTION.  Sec. 1   FINDINGS. The legislature makes the following findings:
     (1) Despite numerous efforts to improve health care in the state, the crisis continues to worsen;
     (2) While this crisis is caused, to a great degree, by rising costs associated with changing demographics and the increasing availability of costly drugs and treatments, it is equally due to the lack of effective public policy governing the purpose of a health care system, its governance and financing, and related individual and/or organizational responsibilities;
     (3) Employer-based coverage has been on the decline for some time because the cost of providing adequate worker coverage can significantly affect the viability of a business, while minimal employer contributions can place an undue burden upon the worker; and
     (4) While consumer choice is important, the growing demand on existing resources requires that funding be focused on services identified to improve health status in the most economical manner.

NEW SECTION.  Sec. 2   INTENT. The legislature intends that health care improvement efforts include the following principles:
     (1) Residents are fundamentally responsible for their health to the extent it depends on the choices they make about the way they live;
     (2) To support its residents in improving their health, Washington state must establish a system that maintains and improves, where possible and necessary, the health status of residents in a clinically efficacious and cost-effective manner;
     (3) While effective rules are necessary, they should be limited to protecting the safety of consumers, ensuring necessary disclosure and privacy of health information, providing fairness, ensuring adequate and timely payment to providers, hospital, and other vendors, and collecting necessary data to support patient care and affect necessary public policy;
     (4) It should not be the expectation of Washington's health care system to maximize a resident's functioning or personal happiness, or provide medical treatment when nonmedical approaches are readily available. Thus, the system should be designed to minimize enrollee encounters, if possible;
     (5) An effective health care system is necessary for successful economic, educational, and community infrastructures;
     (6) Each resident should have access to a minimal set of health services necessary to maintain his or her health status at an acceptable level;
     (7) Residents should have a choice of types of providers and treatments, but such services should be limited to the provider's practice scope and treatment that have been deemed clinically efficacious through standard scientific methods and cost-effective; and
     (8) The funding and maintenance of an effective health care system is the joint responsibility of consumers, providers, health-related manufacturers, employers, and governments. These responsibilities should be clearly delineated and readily met.

NEW SECTION.  Sec. 3   A new section is added to chapter 70.47 RCW to read as follows:
     BENEFIT DESIGN. (1) The schedule of basic health care services designed by the administrator pursuant to RCW 70.47.060 shall include the following:
     (a) To the extent data is available, benefits designed using evidence-based methods with explicit health outcomes;
     (b) Catastrophic coverage, including inpatient and specialty care, pharmaceuticals, durable medical equipment, and therapies upon the satisfaction of a three thousand dollar deductible per person, not to exceed five thousand dollars per family. Catastrophic coverage shall be provided without copays or coinsurance, except for pharmaceuticals and durable medical equipment, which may be subject to copays and/or coinsurance;
     (c) Primary care, as defined by the health care authority, with a copayment of no more than fifteen dollars and/or coinsurance of no more than twenty percent; and
     (d) Preventive services, with no additional enrollee costs, based on care developed by the state board of health in consideration of nationally recognized standards.
     (2) The benefits included shall be reasonably expected to drive average total coverage costs in the basic health plan of no more than one hundred fifty dollars per enrollee per month.
     (3) Working with appropriate local organizations, the health care authority may develop alternative plans that, although meeting the requirements of subsections (1) and (2) of this section, are otherwise designed to address the specific population, health care system, or other unique circumstances presented by the local areas for which they are developed. The administrator may accept payment from an enrollee's employer in lieu of all or any portion of the state subsidy for an enrollee in an alternative plan. The unused state funds shall be used to subsidize additional enrollees in the local area.

NEW SECTION.  Sec. 4   A new section is added to chapter 48.43 RCW to read as follows:
     By January 1, 2005, a carrier offering any individual health benefit plan shall offer to all individuals a health benefit plan providing benefits identical to those included in the basic health plan under chapter 70.47 RCW. Such a plan is not required to include any benefits other than those in the basic health plan and is to be known as the Washington standard plan.

NEW SECTION.  Sec. 5   STUDIES. The governor, in consultation with the legislature, shall determine methods, means, and schedules for the following studies:
     (1) Methods of streamlining purchaser, carrier, and provider health care operations in areas of credentialing of providers, billings and claims, patient information, and enrollee access to health prevention information;
     (2) Review of existing mandated benefits to determine degrees of clinical efficacy and cost-effectiveness;
     (3) Review of all insurance and provider licensure regulations for the purpose of eliminating those that are unnecessary;
     (4) Analysis of consolidating and reorganizing existing state health agencies to increase efficiency;
     (5) Develop methods to modify payment and other compliance requirements to ensure an adequate percentage of provider's time for patient care;
     (6) Review of methods to recruit and retain necessary providers in underserved areas;
     (7) Review of current federal and state-funded benefit programs to ensure that benefits are based on evidence of improving health status; and
     (8) Review of methods to maximize the availability of federal funds to expand low-income access.

NEW SECTION.  Sec. 6   A new section is added to chapter 41.05 RCW to read as follows:
     QUALITY ASSURANCE. The administrator, in consultation with a committee of agency medical directors, shall:
     (1) Develop and implement a process to assure that any decision regarding the health care services and products for which the state pays is evidence-based, reflecting the conscientious, explicit, and judicious use of current best evidence with regard to patient care; and
     (2) Establish a scientifically based health care electronic communication program to educate consumers on improving their health status without medical intervention and to assist them in making appropriate choices when medical treatment is necessary.

NEW SECTION.  Sec. 7   A new section is added to chapter 48.47 RCW to read as follows:
     MANDATED BENEFIT MORATORIUM. After the effective date of this act, the authorization of mandated benefits is prohibited pending the completion of the related study required in section 5 of this act.

NEW SECTION.  Sec. 8   Captions used in this act are not any part of the law.

NEW SECTION.  Sec. 9   This act may be known and cited as the Washington health care recovery act.