READ FIRST TIME 02/07/14.   

     AN ACT Relating to transparency tools for consumer information on health care cost and quality; adding a new section to chapter 41.05 RCW; adding a new section to chapter 48.43 RCW; and creating a new section.

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

NEW SECTION.  Sec. 1   Consumers face a challenge finding reliable, consumer friendly information on health care pricing and quality. Greater transparency of health care prices and quality leads to engaged, activated consumers. Research indicates that engaged and educated consumers help control costs and improve quality with lower costs per patient, lower hospital readmission rates, and the use of higher quality providers. Washington is a leader in efforts to develop and publish provider quality information.
     Although data is available today, research indicates the existing information is not user friendly, consumers do not know which measures are most relevant, and quality ratings are inconsistent or nonstandardized. It is the intent of the legislature to ensure consumer tools are available to educate and engage patients in managing their care and understanding the costs and quality.

NEW SECTION.  Sec. 2   A new section is added to chapter 41.05 RCW to read as follows:
     (1) There is created a performance measures committee, the purpose of which is to identify and recommend standard statewide measures of health performance to inform public and private health care purchasers and to propose benchmarks to track costs and improvements in health outcomes.
     (2) Members of the committee must include representation from state agencies, small and large employers, the two largest health plans by enrollment, patient groups, federally recognized tribal members, consumers, academic experts on health care measurement, hospitals, physicians, and other providers. The governor shall appoint the members of the committee, except that a statewide association representing hospitals may appoint a member representing hospitals, a statewide association representing physicians may appoint a member representing physicians, and a statewide association representing nurses may appoint a member representing nurses. The governor shall ensure that members represent diverse geographic locations and both rural and urban communities. The committee must be chaired by the director of the authority.
     (3) The committee shall develop a transparent process for selecting performance measures, and the process must include opportunities for public comment.
     (4) By January 1, 2015, the committee shall submit the performance measures to the authority. The measures must include dimensions of:
     (a) Prevention and screening;
     (b) Effective management of chronic conditions;
     (c) Key health outcomes;
     (d) Care coordination and patient safety; and
     (e) Use of the lowest cost, highest quality care for preventive care and chronic and acute conditions.
     (5) The committee shall develop a measure set that:
     (a) Is of manageable size;
     (b) Gives preference to nationally reported measures and, where nationally reported measures may not be appropriate or available, measures used by state agencies that purchase health care or commercial health plans;
     (c) Focuses on the overall performance of the system, including outcomes and total cost;
     (d) Is aligned with the governor's performance management system measures and common measure requirements specific to medicaid delivery systems under RCW 70.320.020 and 43.20A.895;
     (e) Considers the needs of different stakeholders and the populations served; and
     (f) Is usable by multiple payers, providers, hospitals, purchasers, public health, and communities as part of health improvement, care improvement, provider payment systems, benefit design, and administrative simplification for providers and hospitals.
     (6) State agencies shall use the measure set developed under this section to inform and set benchmarks for their purchasing.
     (7) The committee shall establish a public process to periodically evaluate the measure set and make additions or changes to the measure set as needed.

NEW SECTION.  Sec. 3   A new section is added to chapter 48.43 RCW to read as follows:
     (1) Each carrier offering or renewing a health benefit plan on or after January 1, 2016, must offer member transparency tools with certain price and quality information to enable the member to make treatment decisions based on cost, quality, and patient experience. The transparency tools must aim for best practices and, at a minimum:
     (a) Must display cost data for common treatments within the following categories:
     (i) In-patient treatments;
     (ii) Outpatient treatments;
     (iii) Diagnostic tests; and
     (iv) Office visits;
     (b) Recognizing integrated health care delivery systems focus on total cost of care, carrier's operating integrated care delivery systems may meet the requirement of (a) of this subsection by providing meaningful consumer data based on the total cost of care. This subsection applies only to the portion of enrollment a carrier offers pursuant to chapter 48.46 RCW and as part of an integrated delivery system, and does not exempt from (a) of this subsection coverage offered pursuant to chapter 48.21, 48.44, or 48.46 RCW if not part of an integrated delivery system;
     (c) Are encouraged to display the cost for prescription medications on their member web site or through a link to a third party that manages the prescription benefits;
     (d) Must include a patient review option or method for members to provide a rating or feedback on their experience with the medical provider that allows other members to see the patient review, the feedback must be monitored for appropriateness and validity, and the site may include independently compiled quality of care ratings of providers and facilities;
     (e) Must allow members to access the estimated cost of the treatment, or the total cost of care, as set forth in (a) and (b) of this subsection on a portable electronic device;
     (f) Must display options based on the selected search criteria for members to compare;
     (g) Must display the estimated cost of the treatment, or total cost of the care episode, and the estimated out-of-pocket costs of the treatment for the member and display the application of personalized benefits such as deductibles and cost-sharing;
     (h) Must display quality information on providers when available; and
     (i) Are encouraged to display alternatives that are more cost-effective when there are alternatives available, such as the use of an ambulatory surgical center when one is available or medical versus surgical alternatives as appropriate.
     (2) In addition to the required features on cost and quality information, the member transparency tools must include information to allow a provider and hospital search of in-network providers and hospitals with provider information including specialists, distance from patient, the provider's contact information, the provider's education, board certification and other credentials, where to find information on malpractice history and disciplinary actions, affiliated hospitals and other providers in a clinic, and directions to provider offices and hospitals.
     (3) Each carrier offering or renewing a health benefit plan on or after January 1, 2016, must provide enrollees with the performance information required by section 2717 of the patient protection and affordable care act, P.L. 111-148 (2010), as amended by the health care and education reconciliation act, P.L. 111-152 (2010), and any federal regulations or guidance issued under that section of the affordable care act.
     (4) Each carrier offering or renewing a health benefit plan on or after January 1, 2016, must, within thirty days from the offer or renewal date, attest to the office of the insurance commissioner that the member transparency tools meet the requirements in this section and access to the tools is available on the home page within the health plan's secured member web site.