BILL REQ. #:  Z-0435.1 

Read first time 01/09/2007.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to health care services for children; amending RCW 74.09.402; adding new sections to chapter 74.09 RCW; adding a new section to chapter 28A.210 RCW; and repealing RCW 74.09.405, 74.09.415, 74.09.425, 74.09.435, and 74.09.450.

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

Sec. 1   RCW 74.09.402 and 2005 c 279 s 1 are each amended to read as follows:
     (1) The legislature finds that:
     (a) Improving the health of children in Washington state is an investment in a productive and successful next generation. The health of ((the)) children ((of Washington state)) is critical to their success in school and throughout their lives((.));
     (b) Healthy children are ready to learn. In order to provide students with the opportunity to become responsible citizens, to contribute to their own economic well-being and to that of their families and communities, and to enjoy productive and satisfying lives, the state recognizes the importance that access to appropriate health services and improved health brings to the children of Washington state. In addition, fully immunized children are themselves protected, and in turn protect others, from contracting communicable diseases;
     (c) Children with health insurance coverage have better health outcomes than those who lack coverage. Children without health insurance coverage are more likely to be in poor health and more likely to delay receiving, or go without, needed health care services;
     (((b) Access to preventive and well-child health services for children is a cost-effective investment of both public and private dollars that improves the health of children and of our communities at large; and
     (c))) (d) Health care coverage for children in Washington state is the product of critical efforts in both the private and public sectors to help children succeed. Private health insurance coverage is complemented by public programs that meet needs of low-income children whose parents are not offered health insurance coverage through their employer or who cannot otherwise afford the costs of coverage. In ((2004)) 2006, thirty-five percent of children in Washington state had some form of public health coverage. Washington state is making progress in its efforts to increase the number of children with health care coverage. Yet, even with ((the)) these efforts of both ((the)) private and public sectors, ((too)) many children in Washington state continue to lack health insurance coverage. ((In 2004, almost one hundred)) In 2006, over seventy thousand children were uninsured. Almost two-thirds of these children are low income; and
     (e) Improved health outcomes for the children of Washington state are the expected result of improved access to health care coverage. Linking children with a medical home that provides preventive and well child health services, linking children with needed behavioral health and dental services, and more effectively managing childhood diseases are key to improving children's health. Care should be provided in appropriate settings by efficient providers, consistent with high quality care and at an appropriate stage, soon enough to avert to the need for overly expensive treatment.
     (2) It is therefore the intent of the legislature that:
     (a) All children in the state of Washington have health care coverage by 2010. This should be accomplished by building upon and strengthening the successes of private health insurance coverage and publicly supported children's health insurance programs in Washington state. Access to coverage should be streamlined and efficient, with reductions in unnecessary administrative costs and mechanisms to expeditiously link children with a medical home;
     (b) The state, in collaboration with parents, schools, communities, health plans, and providers, take steps to improve health outcomes for the children of Washington state by linking children with a medical home, identifying health improvement goals for children, and linking innovative purchasing strategies to those goals.

NEW SECTION.  Sec. 2   A new section is added to chapter 74.09 RCW to read as follows:
     (1) Consistent with the goals established in RCW 74.09.402, the department shall design and administer a program to provide affordable health care coverage to children under the age of nineteen who reside in Washington state and whose family income at the time of enrollment is not greater than two hundred fifty percent of the federal poverty level as adjusted for family size and determined annually by the federal department of health and human services. In administering the program, the department shall take such actions as may be necessary to ensure the receipt of federal financial participation under the medical assistance program, as codified at Title XIX of the federal social security act, the state children's health insurance program, as codified at Title XXI of the federal social security act, and any other federal funding sources that are now available or may become available in the future.
     (2) The department shall accept applications for enrollment for children's health care coverage; establish appropriate minimum-enrollment periods, as may be necessary; and determine eligibility due to current family income. The department shall make eligibility determinations within the time frames for establishing eligibility for children on medical assistance, as defined by RCW 74.09.510. No premium subsidy may be paid with respect to any child whose current family income is greater than two hundred fifty percent of the federal poverty level. The application and annual renewal processes shall be designed to minimize administrative barriers for applicants and enrolled clients, and to minimize gaps in eligibility for families who are eligible for coverage. If a change in family income results in a change in program eligibility, the department shall transfer the family to the appropriate program and notify the family with respect to any change in premium obligation, without a break in eligibility.
     (3) To ensure continuity of care and ease of understanding for families and health care providers, and to maximize the efficiency of the program, the amount, scope, and duration of health care services provided to children under this section shall be the same as that provided to children under medical assistance, as defined in RCW 74.09.520.
     (4) The primary mechanism for purchasing health care coverage under this section shall be through contracts with managed health care systems as defined in RCW 74.09.522. However, the department shall make every effort within available resources to purchase health care coverage for uninsured children whose families have access to dependent coverage through an employer-sponsored health plan or another source when it is cost-effective for the state to do so, and the purchase is consistent with requirements of Title XIX and Title XXI of the federal social security act. The department shall require families to enroll in available employer-sponsored coverage, as a condition of participating in the program established under this act, when it is cost-effective for the state to do so.
     (5)(a) To reflect appropriate parental responsibility, the department shall develop a schedule of premiums for children's health care coverage due to the department from families with income greater than two hundred percent of the federal poverty level. The amount of the premium shall be based upon family income and shall not exceed the premium limitations in Title XXI of the federal social security act. Premiums shall not be imposed on children in households at or below two hundred percent of the federal poverty level as articulated in RCW 74.09.055.
     (b) The department shall offer families whose income is greater than two hundred fifty percent of the federal poverty level the opportunity to purchase health care coverage for their children through the programs administered under this section without a premium subsidy from the state. The amount paid by the family shall be in an amount equal to the rate paid by the state to the managed health care system for coverage of the child, including any associated and administrative costs to the state of providing coverage for the child.
     (6) Enrollment for children, other than for those eligible for medical assistance, Title XIX of the federal social security act, administered under this section is not an entitlement. If it appears that continued enrollment will result in expenditures exceeding the appropriated level for a particular fiscal year, the department may freeze new enrollment in the applicable program for that year. As part of the department's biennial and supplemental operating budget, the department and caseload forecast council shall forecast the anticipated caseload and costs of the program established in this section and include those costs in the department's budget submission to the office of financial management.
     (7) The department shall undertake a proactive, targeted outreach and education effort with the goal of enrolling children in health coverage and improving the health literacy of youth and parents. The department shall collaborate with the department of health, local public health jurisdictions, the office of superintendent of public instruction, the department of early learning, health educators, health care providers, and parents in the design and development of this effort. The outreach and education effort shall include the following components:
     (a) Broad dissemination of information about the availability of coverage, including media campaigns;
     (b) Assistance with completing applications, and community-based outreach efforts to help people apply for coverage. Community-based outreach efforts should be targeted to the populations least likely to be covered;
     (c) Use of existing systems, such as enrollment information from the free and reduced price lunch program, the department of early learning child care subsidy program, and the early childhood education and assistance program, to identify children who may be eligible but not enrolled in coverage;
     (d) Development and dissemination of materials to engage and inform parents and families statewide on issues such as: The benefits of health insurance coverage; the appropriate use of health services, including primary care and emergency services; the value of a medical home, well-child services and immunization, and other preventive health services with linkages to department of health child profile efforts; identifying and managing chronic conditions such as asthma and diabetes; and the value of good nutrition and physical activity;
     (e) An evaluation of the outreach and education efforts, based upon clear outcome measures that are included in contracts with entities that undertake components of the outreach and education effort;
     (f) A feasibility study and implementation plan to develop online application capability that is integrated with the department's automated client eligibility system, and to develop data linkages with the office of superintendent of public instruction for free and reduced price lunch enrollment information and the department of early learning for child care subsidy program enrollment information. The department shall submit a feasibility study on the implementation of the requirements in this subsection to the governor and legislature by July 2008.

NEW SECTION.  Sec. 3   A new section is added to chapter 74.09 RCW to read as follows:
     (1) The legislature finds that parents have a responsibility to:
     (a) Enroll their children in affordable health coverage;
     (b) Ensure that their children receive appropriate well-child preventive care;
     (c) Link their child with a medical home; and
     (d) Understand and act upon the health benefits of good nutrition and physical activity.
     (2) The legislature intends that the programs and outreach and education efforts established in section 2(7) of this act, as well as partnerships with the public and private sectors, provide the support and information needed by parents to meet the responsibilities set forth in this section.

NEW SECTION.  Sec. 4   A new section is added to chapter 74.09 RCW to read as follows:
     (1) The department, in collaboration with the department of health, health plans, local public health jurisdictions, children's health care providers, parents, and other purchasers, shall identify explicit performance measures that indicate that a child has an established and effective medical home, such as:
     (a) Childhood immunization rates;
     (b) Well child care utilization rates, including the use of validated, structured developmental assessment tools that include behavioral and oral health screening;
     (c) Care management for children with chronic illnesses;
     (d) Emergency room utilization; and
     (e) Preventive oral health service utilization.
     Performance measures and targets for each performance measure must be completed by September 1, 2007.
     (2) Beginning in calendar year 2008 and 2009, on a phased-in basis, targeted provider rate increases shall be linked to quality improvement measures established under this section. The department, in conjunction with those groups identified in section 5(1) of this act, shall develop parameters for determining criteria for increased payment or other incentives for those practices and health plans that incorporate evidence-based practice and improve and achieve sustained improvement with respect to the measures in both fee for service and managed care.      (3) The department shall provide an annual report to the governor and the legislature related to provider performance on these measures, beginning in September 2009 and annually thereafter.

NEW SECTION.  Sec. 5   A new section is added to chapter 28A.210 RCW to read as follows:
     It is the goal of Washington state to ensure that:
     (1) By 2010, all K-12 districts have school health advisory committees that advise school administration and school board members on policies, environmental changes, and programs needed to support healthy food choice and physical activity and childhood fitness.
     (2) By 2010, only healthy food and beverages shall be available on school campuses. Minimal standards for available food items, except food served as part of a United States department of agriculture meal program, include:
     (a) Not more than thirty-five percent of its total calories from fat;
     (b) Not more than ten percent of its total calories from saturated fat; and
     (c) Not more than thirty-five percent of its total weight or fifteen grams sugar per food item composed of sugar, including naturally occurring and added sugar.
     (3) By 2010, all students in grades one through eight should have at least thirty minutes of quality physical education per school day.
     (4) By 2010, all student health and fitness instruction shall be conducted by appropriately certified instructors.
     (5) By 2010, any district waiver or exemption policy from physical education requirements for high school students shall be based upon meeting both health and fitness curricula concepts as well as relevant and adequate physical activity.

NEW SECTION.  Sec. 6   A new section is added to chapter 74.09 RCW to read as follows:
     When the department of social and health services has determined under section 2 of this act that it is cost-effective to enroll a child or his or her parent in dependent coverage through an employer-sponsored health plan or any other health plan offered by a health maintenance organization, the health maintenance organization shall permit the enrollment of the parent or child who is otherwise eligible for coverage in the health plan without regard to any open enrollment season restrictions.

NEW SECTION.  Sec. 7   The following acts or parts of acts are each repealed:
     (1) RCW 74.09.405 (Children's health program -- Purpose) and 1990 c 296 s 1;
     (2) RCW 74.09.415 (Children's health program established) and 2005 c 279 s 2, 2002 c 366 s 2, 1998 c 245 s 144, & 1990 c 296 s 2;
     (3) RCW 74.09.425 (Children's health care accessibility -- Community action) and 1990 c 296 s 4;
     (4) RCW 74.09.435 (Children's health program -- Biennial evaluation) and 1990 c 296 s 5; and
     (5) RCW 74.09.450 (Children's health insurance program -- Intent--Department duties) and 1999 c 370 s 1.