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An act relating to regional health care access demonstration projects; adding a new section to chapter 41.05 RCW and making an appropriation.
NEW SECTION. Sec. 1. A new section is added to chap. 41.05 to read as follows:
(1) The legislature finds that the state of Washington has made significant progress towards decreasing the number of persons in the state without health insurance coverage. However, despite these efforts, a substantial number of persons in Washington state remain uninsured. The legislature further finds that efforts are currently underway in local areas to identify and implement innovative approaches to increasing access to health coverage and health services for low income families and people with disabilities or chronic health conditions. Some of these innovative approaches require flexibility on the part of the state in its health care purchasing, administration of eligibility determination and enrollment processes, or regulatory activities. The legislature intends to further local efforts by giving the administrator the authority to grant applications for regional health care access demonstration projects.
(2) The administrator may grant applications for regional health care access demonstration projects under the terms and conditions set forth in this section. A panel shall be established for review and decisions upon each demonstration project application. The panel shall include representatives of the health care authority, the department of social and health services, the department of health, and the office of the insurance commissioner.
(3 ) The administrator may grant demonstration project applications in up to six sites around the state. The demonstration sites chosen shall be representative of urban and rural communities in eastern and western Washington. The demonstration projects may have a duration of up to five years.
(4) In granting demonstration project applications, the administrator may waive compliance with the requirements of RCW 70.47.060(7) and (11), RCW 70.47.100, and RCW 74.09.522 to the extent and for the periods necessary to enable the local initiative to carry out its demonstration project. The activities and operations of any demonstration project authorized under this section are exempt from the provisions and requirements of Title 48 RCW. The administrator is authorized, in granting an application for a demonstration project under this section, to include terms and conditions in the demonstration project adequate to ensure that consumers in regions served by the projects will be adequately protected in the event of financial failure or difficulties of any entity participating in the project.
(5) Any application for a demonstration project under this section must:
(a) Be designed to improve access to health care for uninsured low income families and people with disabilities or chronic illness who live in the region included in the project;
(b) Not make modifications in medical assistance programs or the basic health plan that would have the effect of disadvantaging low income families and people with disabilities or chronic illness who live in the region included in the project;
(c) Identify at least one goal of improved population-based health status that will result from the demonstration project’s efforts;
(d) Include proposed steps to reduce duplication and simplify administration of medical assistance programs and the basic health plan;
(e) Coordinate eligibility, enrollment and service delivery across medical assistance, the basic health plan and other programs serving low income families and people with disabilities or chronic illness who live in the region included in the project;
(f) Ensure the availability of an adequate number and type of health care providers in any provider network sponsored by or through the demonstration project; and
(d ) Include a rigorous evaluation component. The evaluation must be designed to measure:
(i) The per capita health care expenditures for the populations targeted for coverage under the project;
(ii) The impact of the project upon the targeted population, measured in terms of health insurance coverage, either public or private, access to health services and health status;
(iii) The impact of the project upon charity care expenses for hospitals in the region participating in the project;
(iv) The level of community and consumer input in the design and implementation of the project; and
(v) The adequacy of any health care provider network sponsored by or through the demonstration project.
(6) An entity submitting an application for a local initiative health care access demonstration project must:
(i) Demonstrate the capacity to undertake the project described in the application;
(ii) Identify monetary and in-kind resources that will be brought to bear in support of the project, and the source of those resources;
(iii) Demonstrate broad participation and support from the communities included in the region to be covered by the project. Such participation should include support from health care providers, social services providers, employers, carriers, local public health departments or districts, city or county councils or commissions, and consumers.
(iv) Identify the means through will the project will be accountable to the communities included in the region. Accountability can be achieved through, but would not be limited to: the lead agency of the project having a publicly elected board, such as a hospital district, or a board composed of elected officials, such as local public health district; establishment of a project steering committee that is broadly representative of the communities included in the region; and processes for obtaining public input as to the project’s design and implementation on a regular basis.
NEW SECTION. Sec. 2. The sum of ________________________ is appropriated to the health care authority for payments to demonstration projects approved under this act to cover the cost of such projects that would not be covered by payments under Chapters 74.09 RCW and 70.47 RCW.