BILL REQ. #:  H-1501.1 

Read first time 02/01/2007.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to promoting chronic care management in medical assistance programs for full benefit dual eligible beneficiaries; adding a new section to chapter 74.09 RCW; creating a new section; and declaring an emergency.

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

NEW SECTION.  Sec. 1   (1) The legislature finds that the blue ribbon commission on health care costs and access has recommended that Washington state become a leader in prevention and management of chronic illness. Their consensus recommendation provides that state health purchasing agencies, including the medical assistance program, will integrate proven chronic care management into all state programs. The state further finds that full benefit dual eligible beneficiaries, who are eligible for both the federal medicare program and medical assistance benefits, are among the most chronically ill medical assistance clients.
     (2) The legislature intends to take an opportunity to realize the blue ribbon commission's recommendation by directing the department of social and health services to continue to support the enrollment of some full benefit dual eligible beneficiaries in the managed health care plan of their choice, in coordination with the federal medicare program.

NEW SECTION.  Sec. 2   A new section is added to chapter 74.09 RCW to read as follows:
     (1) The department shall pay the premiums associated with enrollment in a medicare advantage plan for those full benefit dual eligible beneficiaries who were enrolled on November 1, 2006, in a medicare advantage plan sponsored by an entity accredited by the national committee for quality assurance and for whom the department had been paying the medicare advantage plan premium as of that date.
     (2) The department shall undertake, directly or by contract, a study to determine the cost-effectiveness of paying premiums for enrollment of full benefit dual eligible beneficiaries in medicare advantage plans in lieu of paying full benefit dual eligible beneficiaries' medicare cost-sharing. The study shall compare the cost and health outcomes experience for three groups of full benefit dual eligible beneficiaries:
     (a) A group of full benefit dual eligible beneficiaries who have been continuously enrolled in a medicare advantage plan sponsored by an entity accredited by the national committee for quality assurance for at least the past three years;
     (b) A group of full benefit dual eligible beneficiaries who have been enrolled in a medicare special needs plan for a minimum of six months; and
     (c) A group of full benefit dual eligible beneficiaries who receive their medicare services through the medicare fee for service system.
     The department shall attempt to have consistency across the three groups with respect to the health status of the full benefit dual eligible beneficiaries being compared. The study shall compare the health status and utilization of health and long-term care services for the three groups, and the impact of access to a medical home and specialty care, over a period of two years to determine any differences in health status, health outcomes, and state expenditures that result.
     The department shall submit the results of the study to the governor and the legislature on or before December 1, 2009.
     (3) For purposes of this section, "full benefit dual eligible beneficiary" means an individual who, for any month: (a) Has coverage for the month under a medicare prescription drug plan or medicare advantage plan with part D coverage; and (b) is determined eligible by the state for full medicaid benefits for the month under any eligibility category in the state's medicaid plan or a section 1115 demonstration waiver that provides pharmacy benefits.

NEW SECTION.  Sec. 3   This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately.