HOUSE BILL REPORT

HB 2159

BYRepresentatives Braddock, Anderson, P. King, Morris, Brekke and Phillips

Creating the Washington state health commission.

House Committe on Health Care

Majority Report:  The substitute bill be substituted therefor and the substitute bill do pass.  (8)

      Signed by Representatives Braddock; Chair; Day, Vice Chair; Cantwell, Morris, Prentice, Sommers, Sprenkle and Vekich.

Minority Report:  Do not pass.  (3)

      Signed by Representatives Brooks, Ranking Republican Member; Chandler and Wolfe.

House Staff:Bill Hagens (786-7131)

AS REPORTED BY COMMITTEE ON HEALTH CARE MARCH 1, 1989

BACKGROUND:

The Hospital Commission was created in 1973.  During its first 11 years, the commission's primary responsibilities were to ensure that hospital rates were reasonably related to costs and that costs were reasonably related to services provided.  Cost containment, however, was principally the responsibility of the hospitals themselves.

Many of the statutory changes made when the commission was reauthorized in 1984, were designed to strengthen its cost containment orientation.  The amendments expanded the commission's composition, required the gathering of discharge data, required the setting of annual hospital revenue targets, and allowed payers to negotiate discounts from approved rates in recognition of the potential benefits of increased competition within the industry.

The current commission consists of nine members appointed by the Governor and composed of representatives of hospitals, insurers, purchasers, and consumers.  Its annual budget is approximately $1.7 million, and it is currently budgeted for 25 fulltime employees.  Its operations are funded, in part, by an annual assessment against hospitals in an amount not to exceed .04 percent of each hospital's gross operating costs.

In 1988, the Legislative Budget Committee (LBC) conducted a sunset review of the Hospital Commission.  It concluded that the current rate setting approach has not been effective in controlling costs.  It recommended that alternative ways to control hospital costs be developed.  Unless the legislature acts to re-authorize the commission in some form, it will terminate on June 30, 1989.

Presently, the certificate of need process (CON) regulates the construction or establishment of new health care facilities, substantial changes in health services, changes in bed capacity, acquisitions of major medical equipment, and capital expenditures of health care facilities in excess of $1,111,000.  Types of facilities subject to CON include: hospitals; psychiatric hospitals; nursing homes; kidney disease treatment facilities; ambulatory surgical facilities; home health care; hospices, and certain rehabilitation facilities.  Since its creation in 1974, the CON process has been generally criticized by certain segments of the health care industry as ineffective at controlling costs, burdensome, and costly.

SUMMARY:

SUBSTITUTE BILL:  The Washington State Health Commission is created to replace the Washington Hospital Commission. The nine member parttime commission is replaced with one of three fulltime members.  Members shall be appointed by the Governor, confirmed by the Senate, and shall serve at the pleasure of the Governor. No two members may belong to the same political party.

The main administrative office of the commission shall be located in Olympia, but administrative facilities may be established in other locations, if deemed necessary.

As a vehicle to control hospital costs, rate setting for individual hospitals is replaced with a "maximum allowable rate of increase" or "MARI."  MARI is the percentage of rate increase allowed over an established base.  Once computed, if a hospital's rates stay below the MARI level, no individual review will occur.

MARI is established through the following formula:

The Formula:

                        NHIPI

          MARI     = ------------------------------  + Cc

                    1 - [(Me x .25) + (Md x .5)]

Where:

NHIPI=  Change in the Medicare Market Basket Index

Me=     Portion of medicare reimbursement to total net revenue

Md=     Portion of Medicaid reimbursement to total net revenue

Cc=     Portion of charity care charges to total net revenue

Fiscal Year 1988 is established as the base year for the 1990 review.

Rural hospitals, as defined, are exempt from MARI.  However, these facilities will still have to comply with data collection requirements.

Hospitals are allowed to "bank" up to three percentage points for further use, such as, purchases of new equipment or construction of new facilities.

Increases above MARI are permitted upon review and approval by the commission.

Penalties shall be assessed against a hospital when non-approved rates exceed MARI as follows: for the first occurrence in five years; reduction of the budget for the following year up to 5 percent; any excess of 5 percent would be deposited in the Health Care Access Account, as created by HB 1378.  (If the account is not created, the amount would be deposited in the general fund.)  For the second occurrence in five years; a reduction up to 2 percent and the amount in excess of 2 percent would be deposited in the account.  For the third occurrence in five years the total excess would be deposited in the account and a moratorium on certificate of need for that hospital would be imposed.  If it is determined that the excess was willfully generated, revocation of the hospital license and a fine of up to $20,000 may be imposed.

Throughout the penalty phase the offending hospital is allowed a full modicum of due process rights.

Protection against discrimination is established by limiting the range of discounts permitted within any class of purchaser. Classes of purchasers are defined as: (1) purchasers of medical assistance hospital services; (2) purchasers of Medicaid hospital services; and (3) Purchasers of non-Medicare and non-medical assistance hospital services.  No hospital may charge one purchaser more than 110 percent of rate charged another purchaser in the same class for the same service.  The difference allowed is associated with an increased efficiency of operation. The commission may propose modifications in this difference, if deemed appropriate.

Requirements are established to prohibit hospitals from adopting an admissions practice that would deny persons without coverage access to hospital care.  A sliding fee schedule is established that would include care without charge for persons with a income less than 100 percent of the federal poverty level.  Hospitals that do not comply with these requirements may be denied access to the Washington Health Care Facilities Authority's bonding privilege, the certificate of need process, and participation in the Medicaid program.

The certificate of need program is transferred from DSHS to the commission.  The commission is required to study CON and propose changes to the Legislature by July 1, 1990.

The commission is also required to study: (1) professional liability problems associated with health care; and (2) Medicaid hospital rate development.

Penalties are prescribed for non-MARI violations to include possible criminal charges of a gross misdemeanor and civil fines of up to $1,000 per violation.

The Washington State Health Commission is scheduled for sunset review in 1993.

SUBSTITUTE BILL COMPARED TO ORIGINAL:  The definition of "charity care" is reverted to current language.  The proposed language was deemed too vague.

A definition of the "Health Care Access Fund" is added.

Authorization is given to the commission to evaluate health data for the possibility of determining the effectiveness of health care services.

An effective date of July 1, 1989 is added.

Language in the bill regarding discounting is consolidated into one section for ease of reading.

Fiscal Note:      Requested February 22, 1989.

Effective Date:The bill takes effect on July 1, 1989.

House Committee ‑ Testified For:    Dave Smith, Washington Hospital Commission; Fred Mills, AARP; Frank Morris, Washington State Council of Senior Citizens; E.G. Kroener, Washington State Council of Senior Citizens; Sean Bleck, Evergreen Legal Services and Bob Crittenden, Governor's Office.

House Committee - Testified Against:      Mel Sorenson, Monitored Marketplace Coalition.

House Committee - Testimony For:    This bill creates realistic provisions for monitoring and containing hospital costs.  By utilizing a "cap" method through the MARI provision, hospitals are better able to control and target funds.

House Committee - Testimony Against:      The provisions outlined in this bill are in direct contrast to the recommendations put forth by the Legislative Budget Committee.  Furthermore, this bill is too regulative and thus impedes competition among hospitals.