WA: Key Medicaid Bill Introduced in Olympia

The legislation needed to implement the State Health Care Innovation Plan developed by the state Health Care Authority (HCA) was introduced yesterday in Olympia.

House Bill 2572 is, as one senior Republican senator said privately, is “a big bill with lots in it.”

One of the central and newest elements is the creation of “accountable collaboratives of health,” discussed colloquially by the acronym ACH. The bill defines the ACH as:

“A regional organization responsible for aligning community actions and initiatives within the region for the purpose of achieving healthy communities and populations, improving health care quality, and lowering costs.”

“Entities seeking certification may be nonprofit or quasi-governmental in orientation and must incorporate membership from across the health care delivery system, public health, social supports and services, and consumers with no single entity or organizational cohort serving in majority capacity.”

The funding for the ACH has been a somewhat controversial element due to the initial scope and funding. The original proposal called for funding to be drawn from the funds Medicaid premium plans use to pay providers.

The bill now funds the ACH through a grant process. The statutory language for the Community Health Care Collaborative Grant Program is re-purposed to fund the ACHs, with the grant awards prioritized for those applicants with matching funds from local entities, like counties.

The ACH will have a couple of roles, according to the bill.

First, the ACH will serve to “provide shared leadership and involvement in developing medicaid procurement criteria and local oversight of performance.”

This has been a central element of some controversy: what role should the community have in providing feedback to the state on the performance of the Medicaid health plans and medical providers with which it contracts to deliver care?

It’s a principle with appeal, but some stakeholders have said it would be difficult to implement. What kind of feedback on procurement should the community have on questions of provider network adequacy, provider reimbursement, or provider performance when the expertise to judge that performance is not widespread?

A second key task of the ACH will be to serve as the “health regional extension program.” This program will provide:

“training and technical assistance to primary care, behavioral health and other providers… The program must emphasize comprehensive, evidence-based, high-quality preventive chronic disease and behavioral health care.”

It’s also unclear whether the ACH will have the kind of expertise and provider experience that would have a positive impact and be well received by a provider community not used to being “trained” by non-medical entities.

Sections 8, 9 and 11 of the bill implement an “all payer claims database,” a topic of much discussion at the Washington Health Alliance (formerly the Puget Sound Health Alliance) over the summer. Plans like Regence and Premera have both voiced concerns with the concept generally.

Advocates argue that for any empowerment of consumers or employers to make sound market choices, it must start with transparency – and transparency on costs of care is step one. They argue that an all payer claims database is a key step in that direction.

The bill also outlines some details around a future integrated procurement in Medicaid between mental health, chemical dependency and medical care. The current fractured payment system has led to hardened silos in the delivery system with very little significant cross-silo collaboration, particularly between the mental health system’s RSNs with the MCOs of the medical care system.

It is noteworthy that the section on procurement – the final section of the bill – identifies nine “principles” that the HCA must use in its next procurement.

Of those nine principles, five of them include behavioral health. Primary care is not mentioned.