RCW 41.05.021
State health care
authority -- Administrator -- Cost control and delivery
strategies -- Health information technology -- Managed competition.
(Effective until January 1, 2009.)
(1) The Washington state
health care authority is created within the executive branch.
The authority shall have an administrator appointed by the
governor, with the consent of the senate. The administrator
shall serve at the pleasure of the governor. The administrator
may employ up to seven staff members, who shall be exempt from
chapter 41.06 RCW, and any additional staff members as are
necessary to administer this chapter. The administrator may
delegate any power or duty vested in him or her by this chapter,
including authority to make final decisions and enter final
orders in hearings conducted under chapter 34.05 RCW. The
primary duties of the authority shall be to: Administer state
employees' insurance benefits and retired or disabled school
employees' insurance benefits; administer the basic health plan
pursuant to chapter 70.47 RCW; study state-purchased health care
programs in order to maximize cost containment in these programs
while ensuring access to quality health care; implement state
initiatives, joint purchasing strategies, and techniques for
efficient administration that have potential application to all
state-purchased health services; and administer grants that
further the mission and goals of the authority. The authority's
duties include, but are not limited to, the following:
(a) To administer health care benefit programs for employees
and retired or disabled school employees as specifically
authorized in RCW 41.05.065 and in accordance with the methods
described in RCW 41.05.075, 41.05.140, and other provisions of
this chapter;
(b) To analyze state-purchased health care programs and to
explore options for cost containment and delivery alternatives
for those programs that are consistent with the purposes of those
programs, including, but not limited to:
(i) Creation of economic incentives for the persons for whom
the state purchases health care to appropriately utilize and
purchase health care services, including the development of
flexible benefit plans to offset increases in individual
financial responsibility;
(ii) Utilization of provider arrangements that encourage
cost containment, including but not limited to prepaid delivery
systems, utilization review, and prospective payment methods, and
that ensure access to quality care, including assuring reasonable
access to local providers, especially for employees residing in
rural areas;
(iii) Coordination of state agency efforts to purchase drugs
effectively as provided in RCW 70.14.050;
(iv) Development of recommendations and methods for
purchasing medical equipment and supporting services on a volume
discount basis;
(v) Development of data systems to obtain utilization data
from state-purchased health care programs in order to identify
cost centers, utilization patterns, provider and hospital
practice patterns, and procedure costs, utilizing the information
obtained pursuant to RCW 41.05.031; and
(vi) In collaboration with other state agencies that
administer state purchased health care programs, private health
care purchasers, health care facilities, providers, and carriers:
(A) Use evidence-based medicine principles to develop common
performance measures and implement financial incentives in
contracts with insuring entities, health care facilities, and
providers that:
(I) Reward improvements in health outcomes for individuals
with chronic diseases, increased utilization of appropriate
preventive health services, and reductions in medical errors; and
(II) Increase, through appropriate incentives to insuring
entities, health care facilities, and providers, the adoption and
use of information technology that contributes to improved health
outcomes, better coordination of care, and decreased medical
errors;
(B) Through state health purchasing, reimbursement, or pilot
strategies, promote and increase the adoption of health
information technology systems, including electronic medical
records, by hospitals as defined in RCW 70.41.020(4), integrated
delivery systems, and providers that:
(I) Facilitate diagnosis or treatment;
(II) Reduce unnecessary duplication of medical tests;
(III) Promote efficient electronic physician order entry;
(IV) Increase access to health information for consumers and
their providers; and
(V) Improve health outcomes;
(C) Coordinate a strategy for the adoption of health
information technology systems using the final health information
technology report and recommendations developed under chapter
261, Laws of 2005;
(c) To analyze areas of public and private health care
interaction;
(d) To provide information and technical and administrative
assistance to the board;
(e) To review and approve or deny applications from
counties, municipalities, and other political subdivisions of the
state to provide state-sponsored insurance or self-insurance
programs to their employees in accordance with the provisions of
RCW 41.04.205, setting the premium contribution for approved
groups as outlined in RCW 41.05.050;
(f) To establish billing procedures and collect funds from
school districts in a way that minimizes the administrative
burden on districts;
(g) To publish and distribute to nonparticipating school
districts and educational service districts by October 1st of
each year a description of health care benefit plans available
through the authority and the estimated cost if school districts
and educational service district employees were enrolled;
(h) To apply for, receive, and accept grants, gifts, and
other payments, including property and service, from any
governmental or other public or private entity or person, and
make arrangements as to the use of these receipts to implement
initiatives and strategies developed under this section;
(i) To issue, distribute, and administer grants that further
the mission and goals of the authority; and
(j) To adopt rules consistent with this chapter as described
in RCW 41.05.160.
(2) On and after January 1, 1996, the public employees'
benefits board may implement strategies to promote managed
competition among employee health benefit plans. Strategies may
include but are not limited to:
(a) Standardizing the benefit package;
(b) Soliciting competitive bids for the benefit package;
(c) Limiting the state's contribution to a percent of the
lowest priced qualified plan within a geographical area;
(d) Monitoring the impact of the approach under this
subsection with regards to: Efficiencies in health service
delivery, cost shifts to subscribers, access to and choice of
managed care plans statewide, and quality of health services.
The health care authority shall also advise on the value of
administering a benchmark employer-managed plan to promote
competition among managed care plans.
[2007 c 274 § 1; 2006 c 103 § 2; 2005 c 446 § 1; 2002 c 142 § 1; 1999 c 372 § 4; 1997 c 274 § 1; 1995 1st sp.s. c 6 § 7; 1994 c 309 § 1. Prior: 1993 c 492 § 215; 1993 c 386 § 6; 1990 c 222 § 3; 1988 c 107 § 4.]
NOTES:
Intent -- 2006 c 103: "(1) The legislature recognizes that
improvements in the quality of health care lead to better health
care outcomes for the residents of Washington state and contain
health care costs. The improvements are facilitated by the
adoption of electronic medical records and other health
information technologies.
(2) It is the intent of the legislature to encourage all
hospitals, integrated delivery systems, and providers in the
state of Washington to adopt health information technologies by
the year 2012." [2006 c 103 § 1.]
Effective date -- 1997 c 274: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 1997." [1997 c 274 § 10.]
Effective date -- 1995 1st sp.s. c 6: See note following RCW 28A.400.410.
Findings -- Intent--1993 c 492: See notes following RCW 43.20.050.
Short title--Severability -- Savings--Captions not law--Reservation of legislative power--Effective dates--1993 c 492: See RCW 43.72.910 through 43.72.915.
Intent -- 1993 c 386: See note following RCW 28A.400.391.
Effective date -- 1993 c 386 §§ 1, 2, 4-6, 8-10, and 12-16: See note following RCW 28A.400.391.
RCW 41.05.021
State health care
authority -- Administrator -- Cost control and delivery
strategies -- Health information technology -- Managed competition.
(Effective January 1, 2009.)
(1) The Washington state health
care authority is created within the executive branch. The
authority shall have an administrator appointed by the governor,
with the consent of the senate. The administrator shall serve at
the pleasure of the governor. The administrator may employ up to
seven staff members, who shall be exempt from chapter 41.06 RCW,
and any additional staff members as are necessary to administer
this chapter. The administrator may delegate any power or duty
vested in him or her by this chapter, including authority to make
final decisions and enter final orders in hearings conducted
under chapter 34.05 RCW. The primary duties of the authority
shall be to: Administer state employees' insurance benefits and
retired or disabled school employees' insurance benefits;
administer the basic health plan pursuant to chapter 70.47 RCW;
study state-purchased health care programs in order to maximize
cost containment in these programs while ensuring access to
quality health care; implement state initiatives, joint
purchasing strategies, and techniques for efficient
administration that have potential application to all
state-purchased health services; and administer grants that
further the mission and goals of the authority. The authority's
duties include, but are not limited to, the following:
(a) To administer health care benefit programs for employees
and retired or disabled school employees as specifically
authorized in RCW 41.05.065 and in accordance with the methods
described in RCW 41.05.075, 41.05.140, and other provisions of
this chapter;
(b) To analyze state-purchased health care programs and to
explore options for cost containment and delivery alternatives
for those programs that are consistent with the purposes of those
programs, including, but not limited to:
(i) Creation of economic incentives for the persons for whom
the state purchases health care to appropriately utilize and
purchase health care services, including the development of
flexible benefit plans to offset increases in individual
financial responsibility;
(ii) Utilization of provider arrangements that encourage
cost containment, including but not limited to prepaid delivery
systems, utilization review, and prospective payment methods, and
that ensure access to quality care, including assuring reasonable
access to local providers, especially for employees residing in
rural areas;
(iii) Coordination of state agency efforts to purchase drugs
effectively as provided in RCW 70.14.050;
(iv) Development of recommendations and methods for
purchasing medical equipment and supporting services on a volume
discount basis;
(v) Development of data systems to obtain utilization data
from state-purchased health care programs in order to identify
cost centers, utilization patterns, provider and hospital
practice patterns, and procedure costs, utilizing the information
obtained pursuant to RCW 41.05.031; and
(vi) In collaboration with other state agencies that
administer state purchased health care programs, private health
care purchasers, health care facilities, providers, and carriers:
(A) Use evidence-based medicine principles to develop common
performance measures and implement financial incentives in
contracts with insuring entities, health care facilities, and
providers that:
(I) Reward improvements in health outcomes for individuals
with chronic diseases, increased utilization of appropriate
preventive health services, and reductions in medical errors; and
(II) Increase, through appropriate incentives to insuring
entities, health care facilities, and providers, the adoption and
use of information technology that contributes to improved health
outcomes, better coordination of care, and decreased medical
errors;
(B) Through state health purchasing, reimbursement, or pilot
strategies, promote and increase the adoption of health
information technology systems, including electronic medical
records, by hospitals as defined in RCW 70.41.020(4), integrated
delivery systems, and providers that:
(I) Facilitate diagnosis or treatment;
(II) Reduce unnecessary duplication of medical tests;
(III) Promote efficient electronic physician order entry;
(IV) Increase access to health information for consumers and
their providers; and
(V) Improve health outcomes;
(C) Coordinate a strategy for the adoption of health
information technology systems using the final health information
technology report and recommendations developed under chapter
261, Laws of 2005;
(c) To analyze areas of public and private health care
interaction;
(d) To provide information and technical and administrative
assistance to the board;
(e) To review and approve or deny applications from
counties, municipalities, and other political subdivisions of the
state to provide state-sponsored insurance or self-insurance
programs to their employees in accordance with the provisions of
RCW 41.04.205 and (g) of this subsection, setting the premium
contribution for approved groups as outlined in RCW 41.05.050;
(f) To review and approve or deny the application when the
governing body of a tribal government applies to transfer their
employees to an insurance or self-insurance program administered
under this chapter. In the event of an employee transfer
pursuant to this subsection (1)(f), members of the governing body
are eligible to be included in such a transfer if the members are
authorized by the tribal government to participate in the
insurance program being transferred from and subject to payment
by the members of all costs of insurance for the members. The
authority shall: (i) Establish the conditions for participation;
(ii) have the sole right to reject the application; and (iii) set
the premium contribution for approved groups as outlined in RCW 41.05.050. Approval of the application by the authority
transfers the employees and dependents involved to the insurance,
self-insurance, or health care program approved by the authority;
(g) To ensure the continued status of the employee insurance
or self-insurance programs administered under this chapter as a
governmental plan under section 3(32) of the employee retirement
income security act of 1974, as amended, the authority shall
limit the participation of employees of a county, municipal,
school district, educational service district, or other political
subdivision, or a tribal government, including providing for the
participation of those employees whose services are substantially
all in the performance of essential governmental functions, but
not in the performance of commercial activities;
(h) To establish billing procedures and collect funds from
school districts in a way that minimizes the administrative
burden on districts;
(i) To publish and distribute to nonparticipating school
districts and educational service districts by October 1st of
each year a description of health care benefit plans available
through the authority and the estimated cost if school districts
and educational service district employees were enrolled;
(j) To apply for, receive, and accept grants, gifts, and
other payments, including property and service, from any
governmental or other public or private entity or person, and
make arrangements as to the use of these receipts to implement
initiatives and strategies developed under this section;
(k) To issue, distribute, and administer grants that further
the mission and goals of the authority; and
(l) To adopt rules consistent with this chapter as described
in RCW 41.05.160.
(2) On and after January 1, 1996, the public employees'
benefits board may implement strategies to promote managed
competition among employee health benefit plans. Strategies may
include but are not limited to:
(a) Standardizing the benefit package;
(b) Soliciting competitive bids for the benefit package;
(c) Limiting the state's contribution to a percent of the
lowest priced qualified plan within a geographical area;
(d) Monitoring the impact of the approach under this
subsection with regards to: Efficiencies in health service
delivery, cost shifts to subscribers, access to and choice of
managed care plans statewide, and quality of health services.
The health care authority shall also advise on the value of
administering a benchmark employer-managed plan to promote
competition among managed care plans.
[2007 c 274 § 1; 2007 c 114 § 3; 2006 c 103 § 2; 2005 c 446 § 1; 2002 c 142 § 1; 1999 c 372 § 4; 1997 c 274 § 1; 1995 1st sp.s. c 6 § 7; 1994 c 309 § 1. Prior: 1993 c 492 § 215; 1993 c 386 § 6; 1990 c 222 § 3; 1988 c 107 § 4.]
NOTES:
Reviser's note: This section was amended by 2007 c 114 § 3 and by 2007 c 274 § 1, each without reference to the other. Both amendments are incorporated in the publication of this section under RCW 1.12.025(2). For rule of construction, see RCW 1.12.025(1).
Intent -- Effective date -- 2007 c 114: See notes following RCW 41.05.011.
Intent -- 2006 c 103: "(1) The legislature recognizes that
improvements in the quality of health care lead to better health
care outcomes for the residents of Washington state and contain
health care costs. The improvements are facilitated by the
adoption of electronic medical records and other health
information technologies.
(2) It is the intent of the legislature to encourage all
hospitals, integrated delivery systems, and providers in the
state of Washington to adopt health information technologies by
the year 2012." [2006 c 103 § 1.]
Effective date -- 1997 c 274: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 1997." [1997 c 274 § 10.]
Effective date -- 1995 1st sp.s. c 6: See note following RCW 28A.400.410.
Findings -- Intent--1993 c 492: See notes following RCW 43.20.050.
Short title--Severability -- Savings--Captions not law--Reservation of legislative power--Effective dates--1993 c 492: See RCW 43.72.910 through 43.72.915.
Intent -- 1993 c 386: See note following RCW 28A.400.391.
Effective date -- 1993 c 386 §§ 1, 2, 4-6, 8-10, and 12-16: See note following RCW 28A.400.391.