SENATE BILL REPORT
SB 5912
As of January 24, 2022
Title: An act relating to improving health outcomes for children on medicaid by ensuring early and periodic screening, diagnosis, and treatment.
Brief Description: Improving health outcomes for children on medicaid.
Sponsors: Senators Sefzik, Braun, Fortunato, Honeyford, Muzzall, Nguyen, Randall, Robinson and Short.
Brief History:
Committee Activity: Health & Long Term Care: 1/24/22.
Brief Summary of Bill
  • Requires the Health Care Authority to align Apple Health's schedule for providing early and periodic screening, diagnosis, and treatment benefits with the Bright Future Guidelines of the American Academy of Pediatrics.
SENATE COMMITTEE ON HEALTH & LONG TERM CARE
Staff: LeighBeth Merrick (786-7445)
Background:

The Health Care Authority (HCA) administers the Medicaid program, which is a state-federal program that pays for health care for low-income state residents who meet certain eligibility criteria.  Washington's Medicaid program, known as Apple Health, offers a complete medical benefits package, including prescription drug coverage, to eligible families, children under age 19, low-income adults, certain disabled individuals, and pregnant women.  The majority of Apple Health enrollees receive their coverage through managed care organizations (MCOs).  The remainder receive their care through fee-for-service (FFS).

 

Early Periodic Screening, Diagnosis, and Treatment (EPSDT), also known as well-child checkups, are regular, complete health exams for children and youth intended to help identify and treat health issues early.  EPSDT is a free health program for individuals, under the age of 21, enrolled in Apple Health coverage.  The American Academy of Pediatrics' Bright Future Guidelines recommended schedule provides a total of 31 EPSDT visits from birth through age 20, whereas Apple Health only covers 22 EPSDT visits for the FFS enrollees.  MCOs may exceed the FFS benefit and currently all five of the MCOs align their EPSDT benefit schedule with the Bright Future Guidelines.  
Summary of Bill:

The bill as referred to committee not considered.
Summary of Bill (Proposed Substitute):

Beginning January 1, 2023, HCA must ensure their schedule for covering Apple Health's EPSDT benefit aligns with the Bright Future Guidelines or a comparable standard.
Appropriation: None.
Fiscal Note: Requested on January 19, 2022.
Creates Committee/Commission/Task Force that includes Legislative members: No.
Effective Date: Ninety days after adjournment of session in which bill is passed.