Passed by the Senate April 20, 2009 YEAS 39   BRAD OWEN ________________________________________ President of the Senate Passed by the House April 8, 2009 YEAS 97   FRANK CHOPP ________________________________________ Speaker of the House of Representatives | I, Thomas Hoemann, Secretary of the Senate of the State of Washington, do hereby certify that the attached is SUBSTITUTE SENATE BILL 5891 as passed by the Senate and the House of Representatives on the dates hereon set forth. THOMAS HOEMANN ________________________________________ Secretary | |
Approved April 30, 2009, 11:25 a.m. CHRISTINE GREGOIRE ________________________________________ Governor of the State of Washington | May 1, 2009 Secretary of State State of Washington |
State of Washington | 61st Legislature | 2009 Regular Session |
READ FIRST TIME 02/25/09.
AN ACT Relating to establishing a forum for testing primary care medical home reimbursement pilot projects; adding new sections to chapter 70.54 RCW; creating a new section; and providing an expiration date.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 The legislature declares that collaboration
among public payors, private health carriers, third-party purchasers,
and providers to identify appropriate reimbursement methods to align
incentives in support of primary care medical homes is in the best
interest of the public. The legislature therefore intends to exempt
from state antitrust laws, and to provide immunity from federal
antitrust laws through the state action doctrine, for activities
undertaken pursuant to pilots designed and implemented under section 2
of this act that might otherwise be constrained by such laws. The
legislature does not intend and does not authorize any person or entity
to engage in activities or to conspire to engage in activities that
would constitute per se violations of state and federal antitrust laws
including, but not limited to, agreements among competing health care
providers or health carriers as to the price or specific level of
reimbursement for health care services.
NEW SECTION. Sec. 2 A new section is added to chapter 70.54 RCW
to read as follows:
The health care authority and the department of social and health
services shall design, oversee implementation, and evaluate one or more
primary care medical home reimbursement pilot projects in the state to
include as participants public payors, private health carriers, third-party purchasers, and health care providers. Based on input from
participants, the agencies shall:
(1) Determine the number and location of primary care medical home
reimbursement pilots;
(2) Determine criteria to select primary care clinics to serve as
pilot sites to facilitate testing of medical home reimbursement methods
in a variety of primary care settings;
(3) Select pilot sites from those primary care provider clinics
that currently employ a number of activities and functions typically
associated with medical homes, or from sites that have been selected by
the department of health to participate in a medical home collaborative
under section 2, chapter 295, Laws of 2008;
(4) Determine one or more reimbursement methods to be tested by the
pilots;
(5) Identify pilot performance measures for clinical quality,
chronic care management, cost, and patient experience through patient
self-reporting; and
(6) Appropriately coordinate during planning and operation of the
pilots with the department of health medical home collaboratives and
with other private and public efforts to promote adoption of medical
homes within the state.
NEW SECTION. Sec. 3 A new section is added to chapter 70.54 RCW
to read as follows:
The health care authority and the department of social and health
services may select a pilot site that currently employs the following
activities and functions associated with medical homes: Provision of
preventive care, wellness counseling, primary care, coordination of
primary care with specialty and hospital care, and urgent care
services;
availability of office appointments seven days per week and
e-mail and telephone consultation; availability of telephone access for
urgent care consultation on a seven-day per week, twenty-four hours per
day basis; and use of a primary care provider panel size that promotes
the ability of participating providers to appropriately provide the
scope of services described in this section. The reimbursement method
chosen for this pilot site must include a fixed monthly payment per
person participating in the pilot site for the services described in
this section. These services would be provided without the submission
of claims for payment from any health carrier by the medical home
provider. Agreements for payment made directly by a consumer or other
entity paying on the consumer's behalf must comply with the provisions
applicable to direct patient-provider primary care practices under
chapter 48.150 RCW. In addition, the agencies may determine that the
pilot should include a high deductible health plan or other health
benefit plan designed to wrap around the primary care services offered
under this section.
NEW SECTION. Sec. 4 This act expires July 1, 2013.