Capitol Dispatch

Editor’s note: Capitol Dispatch appears every Sunday during the legislative session.

Three health care-related bills from Centralia Republican Sen. John Braun appear to be progressing through the Senate.

His bills to create and support community-based behavioral health facilities and prevent adults with developmental disabilities from being stuck in hospitals have both made it to the Senate floor and were awaiting a vote as of late last week.

A third bill, which is intended to improve managed care organization performance, made it to the Rules Committee and is still waiting to get to the floor.

Here is what these bills would do:

Community-based behavioral health facilities

Braun’s legislation would sell $500 million in bonds to create a mental health training hospital in Seattle as part of the University of Washington and establish grants for community-based behavioral health facilities.

About $200 million would pay for the new 150-bed training hospital and the other $300 million would be allocated to the Department of Commerce for the grants. The grants could fund projects such as evaluation and treatment centers, crisis triage and stabilization centers, detoxification centers, transitional and long-term housing, and residential treatment centers.

The idea is that smaller, closer facilities would keep patients near their families and communities. These facilities would be more effective and cheaper, Braun said Wednesday, because health care professionals could care for people earlier and get them back into regular life instead of sending them to a state hospital where they may stay for a long time.

“There’s a lot of support on both sides of the aisle for us to move away from treating mental health patients in state hospitals and move them back closer to their communities,” Braun told The Daily News. “The challenge is there’s not the facilities to do this. And it takes a long time to build these facilities.”

To speed up the process, his legislation would sell bonds beyond the state’s debt limit. The state currently has a cap of $4.65 billion in remaining debt capacity, according to the state Treasurer’s Office.

If passed, the measure would go to a public referendum for approval. The $500 million then would not count toward the remaining debt capacity.

The Legislature has previously approved bonds outside the debt limit for investment in higher education facilities, Braun said, but it should only be done on rare and necessary occasions.

“I take going outside the debt limit very seriously, but I think people broadly recognize we need to do better job and it’s going to take an initial investment,” he said.

He said the Legislature has been working on this problem for the last three biennia.

“We have been working hard but we continue to underestimate how long and hard this transition is and we need to find ways to go faster.”

Improving services for people with developmental disabilities.

Braun has also introduced a bill to address a “systemic” problem of adults with developmental disabilities getting stranded in hospitals because there is nowhere else for them to go.

The bill follows recommendations from the office of the Developmental Disabilities Ombuds to have the state Department of Social and Health Services track the problem, Braun said. The department would record the number of clients with developmental disabilities taken to the hospital without medical need, the locations where these patients were discharged, the number of clients that were unable to be discharged once the need was met and the reason and length of stay for nonmedical purposes.

In addition, DSHS would be required to either help transition patients to an appropriate provider or reimburse the hospital for providing the services.

Braun said he hopes the bill will go to vote on the Senate floor in the coming days.

Improving managed care performance for medicaid clients

Thirdly, Braun’s bill to improve accountability for state-purchased health care is still in the Rules Committee.

The Washington State Health Care Authority, which purchases health care for Medicaid clients, performed poorly on a recent audit, scoring below the national 50th percentile in almost every category, Braun said. At the same time, the agency has asked for an almost 9 percent rate increase, he said.

“Frankly, we’re not getting what we paid for,” he said.

The legislation would require the agency to contract with an external quality improvement organization for an annual audit of services. This analysis would compare Washington’s performance to other states in four categories: access to care, preventative care, chronic care management and medical care utilization.

The Legislature would withhold 4 percent of the total funding for each managed care organization. The organization can earn back 1 percent of its funds for each of the four categories that the organization performs above the national average.

“They can earn that back if they show they delivered care,” Braun said. “It forces people to deliver more effective and more accessible care around the state to get that last 4 percent of payment. Ideally, that results in better performance.”

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