wa-law.org > bill > 2023-24 > HB 1079 > Original Bill
"Medical assistance," notwithstanding any other provision of law, shall not include routine foot care, or dental services delivered by any health care provider, that are not mandated by Title XIX of the social security act unless there is a specific appropriation for these services.
The department shall adopt, amend, or rescind such administrative rules as are necessary to ensure that Title XIX personal care services are provided to eligible persons in conformance with federal regulations.
These administrative rules shall include financial eligibility indexed according to the requirements of the social security act providing for medicaid eligibility.
The rules shall require clients be assessed as having a medical condition requiring assistance with personal care tasks. Plans of care for clients requiring health-related consultation for assessment and service planning may be reviewed by a nurse.
The department shall determine by rule which clients have a health-related assessment or service planning need requiring registered nurse consultation or review. This definition may include clients that meet indicators or protocols for review, consultation, or visit.
The department shall design and implement a means to assess the level of functional disability of persons eligible for personal care services under this section. The personal care services benefit shall be provided to the extent funding is available according to the assessed level of functional disability. Any reductions in services made necessary for funding reasons should be accomplished in a manner that assures that priority for maintaining services is given to persons with the greatest need as determined by the assessment of functional disability.
Effective July 1, 1989, the authority shall offer hospice services in accordance with available funds.
For Title XIX personal care services administered by the department, the department shall contract with area agencies on aging or may contract with a federally recognized Indian tribe under RCW 74.39A.090(3):
To provide case management services to individuals receiving Title XIX personal care services in their own home; and
To reassess and reauthorize Title XIX personal care services or other home and community services as defined in RCW 74.39A.009 in home or in other settings for individuals consistent with the intent of this section:
Who have been initially authorized by the department to receive Title XIX personal care services or other home and community services as defined in RCW 74.39A.009; and
Who, at the time of reassessment and reauthorization, are receiving such services in their own home.
In the event that an area agency on aging or federally recognized Indian tribe is unwilling to enter into or satisfactorily fulfill a contract or an individual consumer's need for case management services will be met through an alternative delivery system, the department is authorized to:
Obtain the services through competitive bid; and
Provide the services directly until a qualified contractor can be found.
Subject to the availability of amounts appropriated for this specific purpose, the authority may offer medicare part D prescription drug copayment coverage to full benefit dual eligible beneficiaries.
Effective January 1, 2016, the authority shall require universal screening and provider payment for autism and developmental delays as recommended by the bright futures guidelines of the American academy of pediatrics, as they existed on August 27, 2015. This requirement is subject to the availability of funds.
Subject to the availability of amounts appropriated for this specific purpose, effective January 1, 2018, the authority shall require provider payment for annual depression screening for youth ages twelve through eighteen as recommended by the bright futures guidelines of the American academy of pediatrics, as they existed on January 1, 2017. Providers may include, but are not limited to, primary care providers, public health nurses, and other providers in a clinical setting. This requirement is subject to the availability of funds appropriated for this specific purpose.
Subject to the availability of amounts appropriated for this specific purpose, effective January 1, 2018, the authority shall require provider payment for maternal depression screening for mothers of children ages birth to six months. This requirement is subject to the availability of funds appropriated for this specific purpose.
Subject to the availability of amounts appropriated for this specific purpose, the authority shall:
Allow otherwise eligible reimbursement for the following related to mental health assessment and diagnosis of children from birth through five years of age:
Up to five sessions for purposes of intake and assessment, if necessary;
Assessments in home or community settings, including reimbursement for provider travel; and
Require providers to use the current version of the DC:0-5 diagnostic classification system for mental health assessment and diagnosis of children from birth through five years of age.
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Effective January 1, 2024, the authority shall require provider payment for rapid whole genome sequencing for enrollees age 21 and younger in accordance with medical necessity criteria adopted, and revised as necessary to account for clinical developments, by the authority following consideration of standards developed by the American college of medical genetics and genomics as well as hospitals in Washington that predominantly serve children.
For the purposes of this subsection (12), "rapid whole genome sequencing" means the unbiased sequencing of all deoxyribonucleic acid bases in the genome of a patient and, if for the sole benefit of the patient, a biological parent of such individual for the purpose of determining whether one or more potentially disease-causing genetic variants are present in the genome of the patient or the patient's biological parent. The term includes any analysis, interpretation, and data report derived from such sequencing.
By January 1, 2024, the Washington state health care authority shall submit to the committees of the legislature with jurisdiction over health policy matters a brief summary of the process used to adopt the medical necessity criteria for rapid whole genome sequencing under RCW 74.09.520(12) and the final medical necessity criteria.
This section expires January 1, 2024.
The collaborative for the advancement of telemedicine is created to enhance the understanding and use of health services provided through telemedicine and other similar models in Washington state. The collaborative shall be hosted by the University of Washington telehealth services and shall be comprised of one member from each of the two largest caucuses of the senate and the house of representatives, and representatives from the academic community, hospitals, clinics, and health care providers in primary care and specialty practices, carriers, and other interested parties.
By July 1, 2016, the collaborative shall be convened. The collaborative shall develop recommendations on improving reimbursement and access to services, including originating site restrictions, provider to provider consultative models, and technologies and models of care not currently reimbursed; identify the existence of telemedicine best practices, guidelines, billing requirements, and fraud prevention developed by recognized medical and telemedicine organizations; and explore other priorities identified by members of the collaborative. After review of existing resources, the collaborative shall explore and make recommendations on whether to create a technical assistance center to support providers in implementing or expanding services delivered through telemedicine technologies.
The collaborative must submit an initial progress report by December 1, 2016, with follow-up policy reports including recommendations by December 1, 2017, December 1, 2018, and December 1, 2021. The reports shall be shared with the relevant professional associations, governing boards or commissions, and the health care committees of the legislature.
The collaborative shall study store and forward technology, with a focus on:
Utilization;
Whether store and forward technology should be paid for at parity with in-person services;
The potential for store and forward technology to improve rural health outcomes in Washington state; and
Ocular services.
The meetings of the board shall be open public meetings, with meeting summaries available on a web page.
The collaborative must study the need for an established patient/provider relationship before providing audio-only telemedicine, including considering what types of services may be provided without an established relationship. By December 1, 2021, the collaborative must submit a report to the legislature on its recommendations regarding the need for an established relationship for audio-only telemedicine.
The collaborative shall consider strategies to promote and expand the use of telemedicine to provide genetic counseling services, especially in rural parts of Washington. The collaborative shall provide a report to the governor and the relevant committees of the legislature by December 1, 2023, with a description of the obstacles to providing genetic counseling services through telemedicine and recommendations for promoting and expanding the use of telemedicine to provide genetic counseling services, especially in rural areas.
The future of the collaborative shall be reviewed by the legislature with consideration of ongoing technical assistance needs and opportunities. The collaborative terminates December 31, 2023.