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Care Coordination/Care Management in Washington

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        Washington law allows patients to manage their own care and participate in health care decisions.  The law requires hospitals in Washington to have policies that protect patients’ rights to be informed of their care, including possible outcomes, and to be involved in their health care decisions.1  The state allows a legal guardian, power of attorney, spouse, adult children, parents, or adult siblings to provide informed consent for an adult who cannot provide his or her own informed consent.2  The law also regulates the specific elements that must be contained in an informed consent to medical treatment.3  A person may also properly consent to treatment via a “validly executed mental health advance directive.”4  In addition, individuals who are both voluntarily or involuntarily committed to an institution have the right to discuss treatment plans and medical decisions with their providers.5  In an effort to allow patients to make better health care decisions, Washington also requires health care providers to provide patients with an estimate of fees related to a specific visit, treatment or stay, if requested by the patient.6

        Washington has promoted the use of primary care health homes in order to lower costs and improve health outcomes.7  The primary care health homes allow for primary care physicians of patients with multiple chronic conditions to provide higher quality, more coordinated care by collaborating with other providers outside of the medical insurance model.8  The state also promotes greater care coordination efforts by authorizing certain demonstration projects and pilots to further that end.  The Washington Health Authority has developed a shared decision making demonstration project, which must train practitioners on using decision supports, and evaluate the outcomes based on using the decision supports.9  The state must also take steps to develop an information exchange that grants patient access to their own records and facilitates the secure exchange of health information to improve care quality, continuity, efficiency, and patient safety.10  Hospitals are required to provide discharged patients with coordinated and effective transitions to long term care, which include a discharge plan coordination with the Department of Health, and coordination with family and other social service programs.11  Similarly, the Department of Health and Senior Services must contract with local agencies to provide case management services to individuals receiving home and community based care.12  The Health Care Authority, Department of social and health services, the Office of Insurance Commissioner, and Department of Labor and Industries must join with the Department of Health to form an interagency group that will coordinate and consult on the final recommendations for the uniform quality assurance program study.13  Similarly, all health care institutions, facilities, professional organizations, health service contractors, health maintenance organizations, and health carriers may, with the exception of hospitals, establish a “coordinated quality improvement program.”14  The state also encourages better coordination of care in the provision of mental health services for children by requiring the adoption of evidence based practices and communication between a child’s primary care physician and mental health provider.15

 

Footnotes

  • 1. Wash. Admin. Code §246-320-141
  • 2. Wash. Rev. Code § 7.70.065; Wash. Rev. Code § 11.92.043; Wash. Rev. Code § 11.94.010
  • 3. Wash. Rev. Code § 7.70.060
  • 4. Wash. Rev. Code § 7.70.068; Wash. Rev. Code § 11.94.010
  • 5. Wash. Rev. Code § 71.05.360; Wash. Rev. Code § 71.05.380
  • 6. Wash. Rev. Code §70.01.30
  • 7. Wash. Rev. Code § 74.09.5229
  • 8. Wash. Rev. Code § 74.09.5229; Wash. Rev. Code § 43.70.533
  • 9. Wash. Rev. Code § 41.05.033
  • 10. Wash. Rev. Code § 41.05.039
  • 11. Wash. Rev. Code § 70.41.310; Wash. Rev. Code § 70.41.320
  • 12. Wash. Rev. Code § 74.39A.090; Wash. Rev. Code § 74.39A.095; Wash. Rev. Code § 74.42.455
  • 13. Wash. Rev. Code §43.70.068
  • 14. Wash. Rev. Code §43.70.510
  • 15. Wash. Rev. Code § 74.09.490

 

Care Coordination/Care Management in Washington

Subtopic Statute/Regulation Description
Care Coordination/Care Management Wash. Admin. Code § 246-320-141 Patient Rights and Organizational Ethics In order to improve patient care and outcomes, to respect every patient, and to maintain ethical...
Wash. Rev. Code § 11.92.043 Additional duties Guardians have the duty to “provide timely, informed consent for health care of the incapacitated person.” Limited...
Wash. Rev. Code § 11.94.010 Designation — Authority — Effect of acts done — Appointment of guardian, effect — Accounting — Reliance on instrument A...
Wash. Rev. Code § 69.41.085 Medication assistance — Community-based care setting Washington permits individuals living in community-based care settings to receive...
Wash. Rev. Code § 69.51A.030 Acts not constituting crimes or unprofessional conduct — Health care professionals not subject to penalties or liabilities Providers may...
Wash. Rev. Code § 7.70.060 Consent form — Contents — Prima facie evidence — Shared decision making — Patient decision aid — Failure to use Courts...
Wash. Rev. Code § 7.70.065 Informed consent — Persons authorized to provide for patients who are not competent — Priority Washington has established the following...
Wash. Rev. Code § 7.70.068 Informed consent — May be contained in mental health advance directive A person may properly consent to treatment via a “validly executed...
Wash. Rev. Code § 70.01.30 Estimate of Health Care Fees and Charges Upon a request by a patient, a provider must give the patient an estimate of fees and charges related to a...
Wash. Rev. Code § 70.24.325 Counseling and testing — Insurance requirements Insurance issuers that request current or prospective enrollees to provide the results of an...
Wash. Rev. Code § 70.245.070 Informed decision An individual must make an informed decision to take life-ending medication in order to obtain such medication. A physician...
Wash. Rev. Code § 71.05.215 Right to refuse antipsychotic medicine — Rules Individuals that are disabled or present a likelihood of serious harm as a result of a mental...
Wash. Rev. Code § 71.05.360 Rights of involuntarily detained persons Every person involuntarily detained is entitled to rights, which shall be posted in the facility. No person...
Wash. Rev. Code § 71.05.380 Rights of voluntarily committed persons Persons that voluntarily commit themselves to an institution for mental illness evaluation and treatment must...
Wash. Rev. Code § 74.42.040 Resident's rights regarding medical condition, care, and treatment Nursing homes must make sure that residents and their guardians: (1) receive...
Disease management Wash. Rev. Code § 41.05.033 Shared decision-making demonstration project — Preference-sensitive care The Washington State Health Care Authority (“authority”)...
Information sharing across providers (including communication with other providers, across state lines, patient transfer) Wash. Rev. Code § 41.05.039 Health information — Secure access — Lead organization — Administrator's duties The Administrator must have, by August 1, 2009,...
Wash. Rev. Code § 70.225.060 Violations — Penalties — Disclosure exemption for health care providers Dispensers that fail to report or knowingly report incorrect...
Licensure laws requiring or recommending care coordination or care management activities (Cross reference with private insurance/Medicaid/Medicare data requirements) Wash. Rev. Code § 43.70.068 Quality assurance--Interagency cooperation The health care authority, department of social and health services, the office of insurance commissioner...
Wash. Rev. Code § 43.70.510 Health care quality-Findings and intent- Requirements for conducting study under 43.70.066 All health care institutions, facilities, professional...
Wash. Rev. Code § 70.41.310 Long-term care — Program information to be provided to hospitals — Information on options to be provided to patients The Department of...
Wash. Rev. Code § 70.41.320 Long term care -- patient discharge requirements for hospitals and acute care facilities -- pilot projects.    Hospitals and acute care...
Wash. Rev. Code § 71.24.061 Children's mental health providers — Children's mental health evidence-based practice institute — Pilot program Contracts between...
Wash. Rev. Code § 74.09.480 Performance measures — Provider rate increases — Report The Washington State Health Care Authority (“authority”) must...
Wash. Rev. Code § 74.09.490 Children's mental health — Improving medication management and care coordination The Washington state health care authority must consult with...
Wash. Rev. Code § 74.09.5229 Primary care health homes — Chronic care management — Findings — Intent The Washington legislature finds that primary care health...
Wash. Rev. Code § 74.39A.090 Discharge planning — Contracts for case management services and reassessment and reauthorization — Assessment of case management roles...
Wash. Rev. Code § 74.39A.095 Case management services — Agency on aging oversight — Plan of care — Termination of contract — Rejection of individual...
New coordinated systems of care (ACOs, Patient Centered Medical Homes/Health homes) (Cross reference with Quality Measurement) Wash. Rev. Code § 70.230.080 Coordinated quality improvement — Rules All ambulatory surgical facilities must implement a “coordinated quality improvement program...
Wash. Rev. Code § 74.09.5229 Primary care health homes — Chronic care management — Findings — Intent The Washington legislature finds that primary care health...
Wash. Rev. Code § 74.42.455 Transitional care management Nursing facilities may provide transitional care management services to individuals for a maximum of thirty days...
Click on the individual state law in the table above to see our summary of the individual law.


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