ByRepresentatives Stonier, Harris, Wylie, Ryu, Caldier, Dolan, Ortiz-Self, Thai, Doglio, Frame, Walen, and Stanford

AN ACT Relating to assuring access to health care services for medicaid beneficiaries by applying the medicare rate floor to health care services furnished under medicaid by health care providers; adding a new section to chapter 74.09 RCW; and creating a new section.

(1) Access to health care services is essential to assure quality of life and lower health care costs for Washingtonians.

(2) In particular, access for medicaid patients to primary care services is critical for coordinating care, including specialty care, assuring continuity of care, as well as providing necessary preventive care, which improves overall health and can reduce health care costs and emergency room admissions.

(3) The availability of primary care is particularly important for medicaid beneficiaries, in order to establish a regular source of care and to provide services to a group that is more prone to chronic health conditions that can be appropriately managed by primary care physicians.

(4) Beyond primary care, medicaid beneficiaries require services from a broad range of health care providers to meet their physical and behavioral health needs. The trend toward integrating health services demands that the medicaid program be able to incentivize participation by various categories of health care providers.

(5) In Washington, medicaid provides coverage for over one million eight hundred thousand people, including forty-five percent of Washington's children. Without medicaid coverage, many enrollees would be uninsured or lack coverage for services they need.

(6) Historically, inadequate provider reimbursement rates have proven to be a barrier to access to care for the medicaid population. In Washington, medicaid fee-for-service rates are twenty-nine percent less than medicare rates for the same health care services.

(7) A 2014 Washington state primary care medicaid survey found that more than three-quarters of primary care physicians in Washington that are not in large health care organizations would stop or limit their acceptance of new medicaid patients or stop or limit care for current medicaid patients if the medicaid rate increases authorized by the federal patient protection and affordable care act of 2010 were not maintained.

(8) According to a study published in 2015 in the New England Journal of Medicine, higher medicaid payment rates have significantly increased appointment availability for medicaid enrollees.

(9) It is critical that health care providers receive sufficient reimbursement to participate in medicaid. Applying medicare rates encourages greater provider participation by primary care physicians and other categories of health care providers in medicaid, thereby increasing access to health care services by medicaid beneficiaries, particularly in underserved areas.

NEW SECTION. Sec. 2. A new section is added to chapter 74.09 RCW to read as follows:

Medicaid payment for health care services furnished by a licensed health care provider, with either a provider contract with the authority on a fee-for-service basis or under a contract with a medicaid managed care organization, must be at a rate not less than one hundred percent of the payment rate that applies to those services and providers under medicare.