The bill as amended by the Senate Ways and Means Committee does the following:
Modifies the intent section.
Requires that the Health Care Authority (HCA) have a neutral actuarial firm review the estimated savings in the innovation plan prior to application.
Before the HCA applies for a federal innovation grant, the application and actuarial review must be presented to the Joint Select Committee on Health Care Oversight for review and approval.
All required federal reporting related to the grant award must be shared with the Joint Committee at the same time it is submitted to the federal government.
The Joint Select Committee on Health Care Oversight is established in statute, and continued to December 31, 2022 (from December 31, 2017, established in Engrossed Substitute Senate Concurrent Resolution No.8401, in 2013).
Changes the "accountable collaborative for health" to "community of health", removes the establishment of regional boundaries, modifies the community of health grant criteria, and reduces it to two pilot programs.
The elements the Health Extension Program are modified the references to contract limitations are removed, the information on the Bree Collaborative and Health Technology Assessment program are restored, and information on evidence-based models to effectively treat depression and other conditions such as the AIMS program is inserted.
The amendment restores and modifies the Performance Measures Committee to recommend statewide measures and benchmarks; and adds a representative of the federally recognized tribes.
Medicaid purchasing is modified; the integration of behavioral health is changed from shall to may, and the guiding principles are modified and made permissive.
The amendment adds reference to HCA purchasing with value based contracting, alternative quality contracting, and other incentives, as well as chronic disease management techniques that reduce hospital admissions, that are assumed in the budget savings.
The reference to integration by January 1, 2019 is removed, and a link to the assumptions in 2SSB 6312 and recommendations of the Behavioral Health Task Force is added. The amendment also restores the references to the all-payer claims database and related data protections, but modifies the reporting to include the state funded claims in the Medicaid programs and Public Employees' Benefits Board program.
Lastly, the amendment ensures the third-party administrator for the UMP participates in the governance structure and advisory committees for the all-payer health care claims database; and provides that only organizations that provide data to the database can be represented on the governance or advisory committees.
Additionally, the bill was amended on the Senate floor as follows: (Becker) States that HCA may adopt rules for the community grants program, but the rules may not exceed the authority provided in this section. It also states that agencies must use the measure set developed by the performance measure committee to inform and set benchmarks for purchasing decisions rather than inform purchasing decisions and set benchmarks. The amendment limits the definition of claims data to those items specifically listed and allows flexibility with regard to the fees for the database (which are not to exceed $5,000) "unless otherwise negotiated.” The amendment adds clarification that claims data can be voluntarily provided by carriers and self-funded employers (consistent with another section that allows voluntary participation in the database). Finally, it removes the limitation for the third-party administrator to provide data "at no additional cost" if an entity chooses to participate in the database and prevents the publication of a report that compares performance that includes any provider in a practice with fewer than five providers.