Summary of the HCA Budget Provisos Passed This Week

With another special session beginning at midnight last night, lawmakers in Olympia worked into the morning until a budget was finally passed, around 6 a.m. For the State Health Care Authority, this means they now know in terms of dollars and cents what they have to work with for the remainder of fiscal year 2012 and for fiscal year 2013. The total amount of appropriations for the HCA equates to $9,972,334,000.

The following is a selected summary from the 54 sub-sections in Sec. 213 (“For The State HCA”) of the recently passed budget.  What follows are some items of possible interest, identified by the subsection number first.

(27)  The HCA will use funds from sec. 213 to provide spoken-language interpreter services to assist health care providers. Nothing in this subsection prevents health care providers from providing those services through employed staff or other means when not reimbursed by the department.

(33)  Using the amounts appropriated from sec. 213, the HCA will continue to provide dental services to pregnant women, including preventive, routine, and emergent dental care.

(40)  The HCA, in collaboration with many other organizations across the state, will design a system of rural health system access and quality incentive payments.

(43)  To achieve a 12% reduction in emergency room expenditures in the fiscal year 2013, appropriations provided in subsection 43 will be used by the HCA, in consultation with selected organizations, to designate best practices and performance measures “to reduce medically unnecessary emergency room visits of Medicaid clients.  Best practices and performance measures will consist of the following items:

Adoption of a system to exchange patient information among 16 emergency room departments on a regional or statewide basis

A process to assist the HCA’s patient review and coordination program clients with their care plans

Implementation of narcotic guidelines that incorporate the WA chapter of the American College of Emergency Physician Guidelines

Physician enrollment in the state’s prescription monitoring programs, as long as the program is funded

Designation of a hospital emergency department physician responsible for reviewing the state’s Medicaid utilization management feedback reports

Active spreading of patient educational materials that “instruct patients on appropriate facilities for nonemergent health care needs

Designation of hospital and ER personnel to receive and disseminate “information on clients participating in the Medicaid patient review and coordination program and review monthly utilization reports on those clients

(43 Cont)

Requirements for best practices for critical access hospital should not include a system to exchange patient info if doing so would cause a financial burden. Executive level leadership with Hospitals participating in this program must submit a declaration of intent and compliance to previously listed items.

If hospitals representing at least 75% of emergency room visits in fiscal year 2010 do not submit declarations to the HCA by July 1, 2012, the HCA “may implement a policy of nonpayment of medically unnecessary emergency room payments.

By July 15, 2012, the HCA will perform preliminary fiscal analysis of trends in implementing the best practices listed in this subsection. By July 15, 2013, the HCA will report to the legislature whether forecasted data is on target with findings.

If necessary the HCA “may employ emergency rulemaking to achieve the reductions assumed in the appropriations under this section.”

(45) “Prior to entering into a contract for medicaid managed care services for the period commencing July 1, 2012, the director of the health care authority shall certify to the governor and to the health care committees of the legislature that the contractor has established a network of acute, primary, and specialty care providers that is sufficient to meet the needs of the contractor’s anticipated enrollee population. If no plan is able to certify an adequate provider network in a county, the health care authority shall request re-bids from all plans which originally submitted bids for the county during the regular procurement process until award is successful. No county, that is currently served by Medicaid managed care services shall revert to fee-for-service as a result of the procurement process.”

(46) “The department shall seek a Medicaid state plan amendment to create a graduate medical education supplemental payment for services delivered to managed care recipients by University of Washington medicine and other public professional providers.”

(47) “The authority shall exclude antiretroviral drugs used to treat HIV/AIDS, anticancer medication that is used to kill or slow the growth of cancerous cells, antihemophilic drugs, insulin and other drugs to lower blood glucose, and immunosuppressive drugs from any formulary limitations implemented to operate within the appropriations provided in this section.”

(54) Development of a new payment managed care enhancement reconciliation methodology for rural health clinics and in consultation with the Rural Health Clinic Association to increase administrative simplicity for the rural health clinics; increase transparency, efficiency, and predictability for the clinics; and shorten the time elapsing between initial payment and final reconciliation.


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