HOUSE BILL REPORT
ESB 6152
BYSenators Wojahn, Barr, Gaspard, West, Stratton, Johnson, Rasmussen, Bluechel, Vognild, von Reichbauer, Warnke, Smitherman, Bailey, Craswell, Thorsness, Bender, Bauer, Amondson, Lee, Metcalf, Cantu and Sutherland
Creating the department of health.
House Staff:Bill Hagens (786-7131)
AS PASSED SENATE
BACKGROUND:
Like many states at the time of creation, Washington placed its health administration responsibilities in a Board of Health. This body, with a part time membership of five physicians, was the only state agency officially responsible for the health of the citizens. The original purpose of the board was to respond to emergent short term problems, e.g., epidemics, with specific remedies. As the board evolved along with a greater need for public health oversight, new on-going responsibilities emerged, e.g., inspection of ships for communicable diseases; safety of milk; food sanitation; oyster bed inspections; and the collection of vital statistics. Along with this growth, came the need for local cooperation to enforce the state health regulations. To meet this need, the Legislature provided for the establishment of local boards of health, which eventually created local health departments.
The progressive expansion of the state's population and the public health sector required a more continuous supervision and management at the state level. Because of its part time nature, the Board of Health was no longer an effective means for administrating the increasingly complex public health system. To meet these new needs, a Department of Health was created in 1921. The board maintained certain rule making authority, while the new department assumed general administrative authority.
The Department of Health continued its independent existence until 1970, when it was enveloped, along with several other state departments, into the Department of Social and Health Services (DSHS)--the state's umbrella human services agency. DSHS was part of a national phenomenon meant to create a "comprehensive" and "integrated" human service system. Between 1969 and 1974, 26 states established umbrella agencies. However, since then, most of those state umbrella agencies, like Washington's, have been in an almost perpetual state of reorganization in the areas of: administration, service delivery, decentralization, scope of services, etc. Perennial complaints are that umbrella agencies are too big to be responsive to client needs, and that individual programs have lacked visibility and accountability because they are "buried" within the bureaucracy.
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.
Changes in the demand for health care services, in the reimbursement policies of public and private payers, as well as changes in economic conditions, threaten access to affordable basic health care services to rural citizens. The Washington Rural Health Care Commission was authorized by the Legislature to identify current problems associated with assuring continued access to health care in rural areas and to make recommendations for changes in state policy.
The commission identified many factors that inhibit needed changes in the delivery of rural health care services. They include outdated or rural-inappropriate regulatory laws, aging and inefficient health care facilities, an absence or ineffective local planning and coordination of services and a lack of state health policy objectives.
SUMMARY:
A Department of Health (DOH) is created to provide leadership in assuring the quality of health care, protect the general population's health and develop state health policies.
The Governor shall appoint a Secretary of Health with the consent of the Senate.
The Secretary of Health shall appoint a State Health Officer who shall have a masters degree in public health or equivalent training or experience.
The new department merges the health professional licensure functions of the Department of Licensing (DOL) and the traditional public health functions, the mandated health benefit review, the certificate of need program, new health professional credentialing review, and health planning functions of the Department of Social and Health Services.
Traditional public health functions transferred from DSHS include: Environmental health protection programs including radiation, drinking water, toxic substances, on-site sewage, recreational water contact facilities, food service sanitation, and shellfish;
Personal health protection programs including immunizations, tuberculosis, sexually transmitted diseases, AIDS, diabetes control, primary health care, hypertension, kidney disease, regional genetic services, newborn metabolic screening, sentinel birth defects, communicable disease epidemiology, and chronic disease epidemiology;
Certificate of Need; which is limited to tertiary health care, need facilities; and transfer of beds;
The public health laboratory;
Public health support services, including vital records, health data, and health education and information; Selected health facilities licensure authority including hospitals, maternity homes, boarding homes, abortion facility approval, emergency medical services, transient accommodations, home health and hospice care, and private establishments.
Parent and Child Health Services programs are transferred from DSHS to DOH effective January 1, 1991.
The Board of Health is transferred to the Department of Health, designated as the primary entity for state health policy development and required to produce a biennial state health report which sets forth the state's health priorities. Mechanisms for public involvement are authorized through local health departments and ad hoc advisory groups. Two staff in addition to an executive director and a secretary must be employed by the Board of Health.
The Board of Health is authorized to recommend means for obtaining citizen and professional involvement in all health policy formulation and other matters regarding the Department of Health's duties.
The department is designated as the primary agency to collect data related to illness and injury prevention, health promotion, and the quality of health care.
Safeguards against improper use of data are established. The department must develop a state research agenda as part of the biennial state health report. Research and other studies may be undertaken only in accordance with the research agenda and procedures established for study approval and funding. The secretary must use study results as appropriate to improve health quality.
An Office of Health Consumer Assistance is established and must include a hotline.
A study of present statutes and programs to assure quality in health care professional practices must be completed by the department.
The Secretary of Health and each professional licensure board may develop memorandum of understanding regarding their respective responsibilities which must be set in rule.
Funeral directors and embalmers regulation is retained within the Department of Licensing, and DOL must recommend legislation by 1990 to eliminate any statutory barriers to this retention.
Funds and employees for DSHS public health functions, DSHS health planning, DOL health professions licensure functions, and the Board of Pharmacy are transferred to the Department of Health.
The State Health Coordinating Council, regional health planning councils and related health planning duties as authorized under Chapter 70.38 RCW are abolished.
The Health Care Access and Cost Control Council is created to monitor the health care system and make recommendations regarding the health care system.
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 fined and denied access to the Washington Health Care Facilities Authority's bonding privilege, the certificate of need process, and participation in the Medicaid program.
The rural health system delivery project is created in the Department of Health. The project provides technical assistance and limited financial assistance to six rural participant communities and technical assistance to another six participant communities. Participants are required to evaluate local health care needs, determine appropriate health care objectives and design strategies to assure continued access to affordable basic health care services. Communities may contract with consultants to help with specialized needs such as recruitment of primary care physicians, conversion of the local hospital to an alternative health care facility, and improved coordination of service delivery among existing local health care providers.
Any funding for the program is dependent on the eventual passage of both this measure and the operating budget for the next biennium.
The department in consultation with representatives from rural health care providers, purchasers, consumers and others is to develop rules for an alternative health care facility licensure model. Rules must allow for maximum local flexibility in providing services which permit cost-efficient delivery of services, better coordination of existing services and the optimal use of existing facilities. The alternative health care facility is not to be considered a hospital for determining building occupancy purposes.
The department is to negotiate with the federal government to seek Medicare approval for the facility so that government reimbursement for services provided can be authorized. Periodic reports on the progress of rule making and negotiations are to be made to the standing House and Senate committees on health care.
The health professional loan repayment program is established and designed to meet federal guidelines for matching funds. The Higher Education Coordinating Board is directed to implement the program. Student loan repayment is available to physicians, physician assistants, nurses and dentists who serve in a federally designated health professional shortage areas. The maximum amount available is up to $15,000 for five years and payments begin upon service in a shortage area.
Participants must serve at least three years in a shortage area or face repaying twice the amount paid on their behalf. The board is granted authority to modify penalty provisions for participants who terminate before three years when extraordinary circumstances exist. Participants must agree not to discriminate against Medicaid or Medicare patients and must accept Medicaid assignment. Payments to participants cease after five years or when the participant terminates service in a shortage area. Any funding for the program is left to the eventual passage of both this measure and the operating budget for the next biennium.
The Higher Education Coordinating Board, in consultation with the State Board of Community Colleges, the Superintendent of Public Instruction and training programs in medicine and nursing, is directed to develop a plan for providing students in nursing and medical training programs with rural training opportunities.
The board shall inventory current rural-based clinical experience opportunities, identify areas where opportunities do not exist, identify public and private funding for sources and make recommendations on how to improve clinical experience opportunities. The board shall report to the standing Senate and House health care committees by December 1, 1989 with its recommendations.
The Department of Health, in consultation with the State Board of Pharmacy, the Higher Education Coordinating Board, and representatives of rural health care providers and others, is directed to investigate the feasibility of the use of limited cross-credentialed health professionals in rural areas of the state.
The department will investigate the need, public safety implications and training and experience requirements of developing a program of cross-credentialing of individuals with multiple skills for practice in rural areas. The Department shall make recommendations on the need for changes in current state credentialing laws to the standing House and Senate health care committees by December 1, 1990.
The Higher Education Coordinating Board, in consultation with the State Board for Community College Education, the Superintendent of Public Instruction, the State Board of Nursing, the State Board of Practical Nursing and representatives from nurse training programs and others, is directed to develop a plan providing for geographic availability of training and education programs, curriculum standards, procedures to facilitate transfer or granting of credit and the use of evaluation processes to maximize opportunities for receiving credit for knowledge and clinical skills. The plan is to be implemented in institutions of higher education by January 1, 1992. It is to be submitted to the standing Senate and House health care committees as required by December 1, 1990, with a progress report due by December 1, 1989.
Language is added to correct a drafting error regarding adult family home licensure.
Japanese and Aleut restitution payments are made exempt for public assistance purposes.
DSHS is directed to contract for a study of the effectiveness of alcohol and drug abuse treatment programs.
$650,000 general fund-state is appropriated for the rural health projects.