41.05.011  <<  41.05.013 >>   41.05.014

State purchased health care programsUniform policiesReport to the legislature.

(1) The authority shall coordinate state agency efforts to develop and implement uniform policies across state purchased health care programs that will ensure prudent, cost-effective health services purchasing, maximize efficiencies in administration of state purchased health care programs, improve the quality of care provided through state purchased health care programs, and reduce administrative burdens on health care providers participating in state purchased health care programs. The policies adopted should be based, to the extent possible, upon the best available scientific and medical evidence and shall endeavor to address:
(a) Methods of formal assessment, such as a health technology assessment under RCW 70.14.080 through 70.14.130. Consideration of the best available scientific evidence does not preclude consideration of experimental or investigational treatment or services under a clinical investigation approved by an institutional review board;
(b) Monitoring of health outcomes, adverse events, quality, and cost-effectiveness of health services;
(c) Development of a common definition of medical necessity; and
(d) Exploration of common strategies for disease management and demand management programs, including asthma, diabetes, heart disease, and similar common chronic diseases. Strategies to be explored include individual asthma management plans. On January 1, 2007, and January 1, 2009, the authority shall issue a status report to the legislature summarizing any results it attains in exploring and coordinating strategies for asthma, diabetes, heart disease, and other chronic diseases.
(2) The administrator may invite health care provider organizations, carriers, other health care purchasers, and consumers to participate in efforts undertaken under this section.
(3) For the purposes of this section "best available scientific and medical evidence" means the best available clinical evidence derived from systematic research.

NOTES:

Captions not lawConflict with federal requirements2006 c 307: See notes following RCW 70.14.080.
Findings2005 c 462: See note following RCW 28A.210.370.
Rule making2003 c 276: "Agencies administering state purchased health care programs shall cooperatively adopt rules necessary to implement this act." [ 2003 c 276 § 2.]
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