5394-S AMH CODY BLAC 075

SSB 5394 - H AMD TO WAYS COMM AMD (H-2506.1/11) 569

By Representative Cody

ADOPTED 04/07/2011

    On page 12, after line 6 of the striking amendment, insert the following:

    "NEW SECTION. Sec. 6.  A new section is added to chapter 41.05 RCW to read as follows:

    (1) Effective January 1, 2013, the authority must contract with all of the public employees benefits board managed care plans and the self-insured plan or plans to include provider reimbursement methods that incentivize chronic care management within health homes resulting in reduced emergency department and inpatient use.

    (2) Health home services contracted for under this section may be prioritized to enrollees with complex, high cost, or multiple chronic conditions.

    (3) For the purposes of this section, "chronic care management," and "health home" have the same meaning as in RCW 74.09.010.

    (4) Contracts with fully insured plans and with any third party administrator for the self-funded plan that include the items in subsection (1) of this section must be funded within the resources provided by employer funding rates provided for employee health benefits in the omnibus appropriations act.

    (5) Nothing in this section shall require contracted third-party health plans administering the self-insured contract to expend resources to implement items in subsection (1) of this section beyond the resources provided by employer funding rates provided for employee health benefits in the omnibus appropriations act or from other sources in the absence of these provisions.

NEW SECTION. Sec. 7.  A new section is added to chapter 41.05 RCW to read as follows: 

    The authority shall coordinate a discussion with carriers to learn from successful chronic care management models and develop principles for effective reimbursement methods to align incentives in support of patient centered chronic care health homes.  The authority shall submit a report to the appropriate committees of the legislature by December 1, 2012 describing the principles developed from the discussion and any steps taken by the public employees benefits board or carriers in Washington State to implement the principles through their payment methodologies."

EFFECT:   Requires the Health Care Authority (HCA) to include health home services incentives in its managed care contracts and self-insured plans.  Allows the HCA to prioritize health home services to enrollees with complex, high cost, or multiple chronic conditions.

Directs the HCA to coordinate a discussion with carriers regarding successful chronic care management models and principles for effective reimbursement methods to incentivize chronic care health homes.  Requires the HCA to report to the Legislature regarding the principles and actions taken by to implement the principles in state employee health benefits by December 1, 2012.

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