Revised Code of Washington
Chapter 41.05 - State Health Care Authority.
41.05.690 - Performance measures committee—Membership—Selection of performance measures—Benchmarks for purchasing decisions—Public process for evaluation of measures.

RCW 41.05.690
Performance measures committee—Membership—Selection of performance measures—Benchmarks for purchasing decisions—Public process for evaluation of measures.

(1) There is created a performance measures committee, the purpose of which is to identify and recommend standard statewide measures of health performance to inform public and private health care purchasers and to propose benchmarks to track costs and improvements in health outcomes.
(2) Members of the committee must include representation from state agencies, small and large employers, health plans, patient groups, federally recognized tribes, consumers, academic experts on health care measurement, hospitals, physicians, and other providers. The governor shall appoint the members of the committee, except that a statewide association representing hospitals may appoint a member representing hospitals, and a statewide association representing physicians may appoint a member representing physicians. The governor shall ensure that members represent diverse geographic locations and both rural and urban communities. The chief executive officer of the lead organization must also serve on the committee. The committee must be chaired by the director of the authority.
(3) The committee shall develop a transparent process for selecting performance measures, and the process must include opportunities for public comment.
(4) By January 1, 2015, the committee shall submit the performance measures to the authority. The measures must include dimensions of:
(a) Prevention and screening;
(b) Effective management of chronic conditions;
(c) Key health outcomes;
(d) Care coordination and patient safety; and
(e) Use of the lowest cost, highest quality care for preventive care and acute and chronic conditions.
(5) The committee shall develop a measure set that:
(a) Is of manageable size;
(b) Is based on readily available claims and clinical data;
(c) Gives preference to nationally reported measures and, where nationally reported measures may not be appropriate, measures used by state agencies that purchase health care or commercial health plans;
(d) Focuses on the overall performance of the system, including outcomes and total cost;
(e) Is aligned with the governor's performance management system measures and common measure requirements specific to medicaid delivery systems under RCW 70.320.020 and 71.24.435;
(f) Considers the needs of different stakeholders and the populations served; and
(g) Is usable by multiple payers, providers, hospitals, purchasers, public health, and communities as part of health improvement, care improvement, provider payment systems, benefit design, and administrative simplification for providers and hospitals.
(6) State agencies shall use the measure set developed under this section to inform and set benchmarks for purchasing decisions.
(7) The committee shall establish a public process to periodically evaluate the measure set and make additions or changes to the measure set as needed.

[ 2019 c 325 § 5009; 2014 c 223 § 6.]
NOTES:

Effective date—2019 c 325: See note following RCW 71.24.011.


Finding—2014 c 223: "(1) The legislature finds that the state of Washington has an opportunity to transform its health care delivery system.
(2) The state health care innovation plan establishes the following primary drivers of health transformation, each with individual key actions that are necessary to achieve the objective:
(a) Improve health overall by stressing prevention and early detection of disease and integration of behavioral health;
(b) Developing linkages between the health care delivery system and community; and
(c) Supporting regional collaboratives for communities and populations, improve health care quality, and lower costs." [ 2014 c 223 § 1.]

Structure Revised Code of Washington

Revised Code of Washington

Title 41 - Public Employment, Civil Service, and Pensions

Chapter 41.05 - State Health Care Authority.

41.05.004 - Intent—Use of word "board."

41.05.006 - Purpose.

41.05.008 - Duties of employing agencies.

41.05.009 - Determination of employee or school employee eligibility for benefits.

41.05.0091 - Eligibility exists prior to January 1, 2010.

41.05.011 - Definitions.

41.05.013 - State purchased health care programs—Uniform policies—Report to the legislature.

41.05.014 - Applications, enrollment forms, and eligibility certification documents—Signatures.

41.05.015 - Medical director—Appointment of personnel.

41.05.017 - Provisions applicable to health plans offered under this chapter.

41.05.018 - Transfer of certain behavioral health-related powers, duties, and functions from the department of social and health services.

41.05.021 - State health care authority—Director—Cost control and delivery strategies—Health information technology—Managed competition—Rules.

41.05.022 - State agent for purchasing health services—Single community-rated risk pool.

41.05.023 - Chronic care management program—Uniform medical plan—Definitions.

41.05.026 - Contracts—Proprietary data, trade secrets, actuarial formulas, statistics, cost and utilization data—Exemption from public inspection—Executive sessions.

41.05.031 - Agencies to establish health care information systems.

41.05.033 - Shared decision-making demonstration project—Preference-sensitive care.

41.05.035 - Exchange of health information—Pilot—Advisory board, discretionary—Administrator's authority.

41.05.036 - Health information—Definitions.

41.05.037 - Nurse hotline, when funded.

41.05.039 - Health information—Secure access—Lead organization—Administrator's duties.

41.05.042 - Health information—Processes, guidelines, and standards.

41.05.046 - Health information—Conflict with federal requirements.

41.05.050 - Contributions for employees and dependents—Definitions.

41.05.055 - Public employees' benefits board—Members.

41.05.065 - Public employees' benefits board—Duties—Eligibility—Definitions—Penalties.

41.05.066 - Domestic partner benefits.

41.05.068 - Federal employer incentive program—Authority to participate.

41.05.074 - Public employees—Prior authorization standards and criteria—Health plan requirements—Definitions.

41.05.075 - Employee benefit plans—Contracts with insuring entities—Performance measures—Financial incentives—Health information technology.

41.05.080 - Participation in insurance plans and contracts—Retired, disabled, or separated employees—Certain surviving spouses, state registered domestic partners, and dependent children.

41.05.085 - Retired state employee and retired or disabled school employee health insurance subsidy.

41.05.090 - Continuation of coverage of employee, spouse, or covered dependent ineligible under state plan—Exceptions.

41.05.095 - Coverage for dependents under the age of twenty-six.

41.05.100 - Chapter not applicable to certain employees of Cooperative Extension Service.

41.05.110 - Chapter not applicable to officers and employees of state convention and trade center.

41.05.120 - Public employees' and retirees' insurance account—School employees' insurance account.

41.05.123 - Flexible spending administrative account—Salary reduction account—School employees' benefits board flexible spending and dependent care administrative account—School employees' benefits board salary reduction account.

41.05.130 - State health care authority administrative account—School employees' insurance administrative account.

41.05.140 - Payment of claims—Self-insurance—Insurance reserve fund created.

41.05.143 - Uniform medical plan benefits administration account—Uniform dental plan benefits administration account—School employees' benefits board medical benefits administrative account—School employees' benefits board dental benefits administrat...

41.05.160 - Rules.

41.05.165 - Rules—Insurance benefit reimbursement.

41.05.170 - Neurodevelopmental therapies—Employer-sponsored group contracts.

41.05.175 - Prescribed, self-administered anticancer medication.

41.05.177 - Prostate cancer screening—Required coverage.

41.05.180 - Mammograms—Insurance coverage.

41.05.183 - General anesthesia services for dental procedures—Public employee benefit plans.

41.05.185 - Diabetes benefits—State purchased health care.

41.05.188 - Eosinophilic gastrointestinal associated disorder—Elemental formula.

41.05.195 - Medicare supplemental insurance policies.

41.05.197 - Medicare supplemental insurance policies.

41.05.205 - Tricare supplemental insurance policy—Authority to offer—Rules.

41.05.220 - Community and migrant health centers—Maternity health care centers—People of color—Underserved populations.

41.05.225 - Blind licensees in the business enterprises program—Plan of health insurance.

41.05.240 - American Indian health care delivery plan.

41.05.280 - Department of corrections—Inmate health care.

41.05.295 - Dependent care assistance program—Health care authority—Powers, duties, and functions.

41.05.300 - Salary reduction agreements—Authorized.

41.05.310 - Salary reduction plan—Policies and procedures—Plan document.

41.05.320 - Salary reduction plan—Eligibility—Participation, withdrawal.

41.05.330 - Salary reduction plan—Accounts and records.

41.05.340 - Salary reduction plan—Termination—Amendment.

41.05.350 - Salary reduction plan—Rules.

41.05.360 - Salary reduction plan—Construction.

41.05.400 - Plan of health care coverage—Available funds—Components—Eligibility—Administrator's duties.

41.05.405 - Public option plans—Availability—Hospital contracts—Recommendations.

41.05.410 - Qualified health plans—Contract for—Requirements—Cost and quality data.

41.05.413 - Qualified health plans—Reimbursement limit—Waiver.

41.05.420 - Plan of health care coverage—Prescription insulin drug cost limits—Cost sharing.

41.05.430 - Plan of health care coverage—Immediate postpartum contraception devices.

41.05.520 - Pharmacy connection program—Notice.

41.05.525 - Treatment of opioid use disorder—Prior authorization.

41.05.526 - Withdrawal management services—Substance use disorder treatment services—Prior authorization—Utilization review—Medical necessity review.

41.05.527 - Opioid overdose reversal medication bulk purchasing and distribution program.

41.05.528 - Standard set of criteria—Medical necessity for substance use disorder treatment—Substance use disorder levels of care—Rules.

41.05.530 - Prescription drug assistance, education—Rules.

41.05.533 - Medication synchronization policy required for health benefit plans covering prescription drugs—Requirements—Definitions.

41.05.540 - State employee health program—Requirements—Report.

41.05.550 - Prescription drug assistance foundation—Nonprofit and tax-exempt corporation—Definitions—Liability.

41.05.600 - Mental health services—Definition—Coverage required, when.

41.05.601 - Mental health services—Rules.

41.05.630 - Annual report of customer service complaints and appeals.

41.05.650 - Community health care collaborative grant program—Grants—Administrative support—Eligibility.

41.05.651 - Rules—2009 c 299.

41.05.660 - Community health care collaborative grant program—Award and disbursement of grants.

41.05.670 - Chronic care management incentives—Provider reimbursement methods.

41.05.680 - Report—Chronic care management.

41.05.690 - Performance measures committee—Membership—Selection of performance measures—Benchmarks for purchasing decisions—Public process for evaluation of measures.

41.05.700 - Reimbursement of health care services provided through telemedicine or store and forward technology—Audio-only telemedicine.

41.05.730 - Ground emergency medical transportation services—Medicaid reimbursement—Calculation—Federal approval—Department's duties.

41.05.735 - Ground emergency medical transportation services—Medicaid reimbursement—Intergovernmental transfer program—Federal approval—Authority's duties.

41.05.740 - School employees' benefits board.

41.05.742 - Single enrollment requirement.

41.05.744 - School employee eligibility during COVID-19 state of emergency.

41.05.745 - School employees' benefits board—Employee-paid, voluntary benefits—Optional benefits.

41.05.750 - Problem and pathological gambling treatment program.

41.05.751 - Problem gambling account.

41.05.760 - Recovery residences—Registry.

41.05.761 - Recovery residences—Technical assistance for residences seeking certification.

41.05.762 - Recovery residences—Revolving fund.

41.05.765 - Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements.

41.05.820 - Qualified requirement for health carrier in insurance holding company to offer silver and gold health plans.

41.05.830 - Coverage for hearing instruments—Definitions.

41.05.840 - Universal health care commission.

41.05.890 - Certain health care and financial related data provided to authority—Exempt from disclosure.

41.05.900 - Short title.

41.05.901 - Implementation—Effective dates—1988 c 107.