Thursday night marked the close of the 2014 legislative session. And despite a divided leadership — the Majority Coalition Caucus (Republican-powered) in the Senate while Democrats rule the House — some significant, as well as less important, health-care legislation made it to the finish.
Here’s what passed and moves to Gov. Jay Inslee, who will likely approve most, if not all, of the measures:
Boosting transparency, cutting costs, coordinating mental health care
Engrossed Second Substitute House Bill 2572 got most of its attention over a provision to create a publicly-accessible database containing medical cost and quality information. But the legislation, requested by Inslee and sponsored by Rep. Eileen Cody, D-Seattle, does much more.
The bill includes strategies for improving mental-health care for low-income residents, has a plan for creating a system of measuring the quality of doctors, clinics and hospitals, and takes action on the Washington State Health Care Innovation Plan, a wide-reaching document that aims to cut medical costs.
And it creates an All-Payer Claims Database to help patients, doctors and businesses providing insurance for their employees shop around when choosing where to get medical care. But it’s not the database supporters hoped for.
Currently, if a patient needs their tonsils removed, for example, they likely don’t know that one clinic can cost two or three times more than another, but still offer the same quality service. And even if they wanted to compare prices and performance, they’d likely have a hard time finding the information.
To build a comprehensive transparency database, you need information on what the insurance companies are paying for the medical tests and procedures. That’s because while a doctor might charge $100 for an office visit, your insurance company has negotiated that price down to maybe $60 or $80. The insurers consider that information proprietary and don’t want to share it, even though the database wouldn’t say specifically who’s paying what.
In the end, the lawmakers decided to settle for less and dropped a requirement that insurance companies share their price information. Instead they’re creating a database that at least initially will only include costs from insurance covering state employees and Medicaid.
(See more on the transparency legislation in this blog post.)
Transparency, Part II
Engrossed Substitute Senate Bill 6228 provides more personalized medical care cost and quality information. The bill requires insurance companies by January 2016 to put a tool on their homepage, accessible only to their customers, that will allow people to look up medical tests and procedures, find out what they cost at different locations, and the quality of the facility. The measure, which was sponsored by Sen. Mark Mullet, D-Issaquah, also instructs companies to provide comparison apps for mobile devices.
Insurance companies generally like this solution to the transparency challenge, arguing that these comparison tools are more useful than the public database. These tools also include details about deductibles and out-of-pocket costs that specifically apply to the person searching for information.
Curbing paperwork for docs
Engrossed Substitute Senate Bill 6511 takes another crack at reducing the paperwork doctors do to get insurance-company approval before they can perform certain treatments and tests or prescribe some medications.
Last year, a legislative work group was supposed to come up with a strategy for streamlining “prior authorization” but they failed to come up with a plan in time. So the new bill restarts that process in the hope that a new group can devise prior authorization requirements to satisfy everyone’s needs.
Acting on the ACA
Engrossed Senate Bill 6458 helps define some of the communications between the state insurance commissioner and the health-insurance exchange, which runs the new health-insurance marketplace. It requires the commissioner to inform the exchange when making rule changes related to health insurance. As a spokesman for the insurance commissioner explained, the new law encourages the exchange “to be a more active participant” in the job of making the Affordable Care Act work in Washington.
The bill was sponsored by Sen. Randi Becker, the Republican chair of the Senate’s Health Care Committee. The original version of the legislation would have eliminated the Office of the Insurance Commissioner — an elected position created in 1907 — and replaced it with a state insurance board.
Reporting unpaid premiums
Engrossed Substitute Senate Bill 6016 addresses what happens when people stop paying their insurance premiums.
The Affordable Care Act includes a 90-day grace period for people with government-subsidized coverage purchased through the exchange. An insurance company must cover the costs for medical bills in the first month someone misses a premium payment, but the hospital or doctor pays for the bills in the second and third months. At the end of the grace period, the patient must pay for all three months or lose coverage.
The bill spells out when and how insurance companies tell hospitals and doctors that someone has fallen behind on insurance bills. The measures says that if a hospital or doctor asks for coverage information, the insurance company must say if someone is in the grace period.
The original version of the bill went much further, seeking to make the insurance company cover the medical bills for the entire grace period.
Bills that flat-lined
One of the more noteworthy bills to die this session was a measure requiring insurance companies to pay doctors for “telemedicine” or medical care that’s delivered remotely to patients by electronic communications. House Bill 1448 required payment for medical services that otherwise would be covered if the care was in person and if the service was medically necessary. The bill was first introduced in 2013 and came close to clearing the finish line this year, but time ran out.
Another provision that failed was a request to boost reimbursement rates Medicaid patients. The Affordable Care Act raised reimbursement rates for 2013 and 2014 in an effort to increase the number of doctors treating Medicaid patients. During those two years, primary care providers treating Medicaid patients are paid nearly the same rates they receive for Medicare recipients. Medical groups lobbied unsuccessfully to extend those higher reimbursements.
Other measures that failed included Senate Bill 6464, which would have allowed insurance companies to temporarily revive policies canceled at the end of 2013 and permit out-of-state insurers to sell plans here. House Bill 2148, also called the Reproductive Parity Act, would have required insurance plans to cover abortion costs. House Bill 2340 would have turned Washington’s health-insurance exchange, which runs the Healthplanfinder insurance marketplace, from a public-private partnership to a state agency.