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Health Care System Development Commission Recommendations Emergency Declaration Resolution of 2000
PR 13-910

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Chairman Linda Cropp At the request of the Mayor


To approve, on an emergency basis, the recommendations of the Health Care System Development Commission.

RESOLVED, BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this resolution may be cited as the "Health Care System Development Commission Recommendations Emergency Approval Resolution of 2000".

Sec. 2. Pursuant to section 1306 of the Service Improvement and Fiscal Year 2000 Budget Support Act of 1999, DC Law 13-38, effective October 20, 1999, to be codified at D.C. Code Section 6-155, the Mayor transmitted to the Council for approval the following recommendations of the Health Care System Development Commission to develop the District's health care system.


(1) Improve the health care delivery system and services for vulnerable populations by:

(A) Establishing a certification program that designates local health centers (and planned centers) as DC Qualified Health Centers (DCQHC). This program will be guided by the state health plan, the certificate of need (CON) program, and community input. The certification would include practice standards and reporting requirements and would ensure that the centers are part of an integrated, comprehensive system of health care providers that includes hospitals, laboratories, pharmacies, and other health services and their patients would have increased access to needed secondary and tertiary care. The certification process will include community input.

(B) Using new Disproportionate Share Hospital (DSH) dollars, consistent with federal standards, to increase the accessibility of local medical homes that provide preventative and primary care to all District residents. Hospitals receiving DSH will be held responsible for increasing the availability of outpatient and primary care services, for formalizing relationships with local health centers (including hospital health centers) that lead to greater patient access to secondary and tertiary care, and for reporting to DOH the number of patients serviced and services provided with the hospitals' DSH dollars.

(C) Activating provisions of existing laws that enable the District to contract with the Public Benefits Corporation to provide hospital-based and clinic-based health services for the uninsured. This contract would use cost-effective reimbursement methodologies for in-patient services as well as comparable methodologies for outpatient and clinical services. Service quality and outcome measures will be incorporated in the contract. A comprehensive assessment, overseen jointly by the District and the PBC, will be conducted. The results of that assessment will provide the basis for refining/reviewing the PBC's structure and function within the District's health care safety net.

(D) Establishing a public/private capital fund that will help build the capacity of the District's community-based delivery system. Because the District has a public trust, District funds would be available initially to public clinics and public/private partnerships. Every effort would be made to establish finding to meet the needs of public and private health centers and hospital clinics that are DCQHCs or have DOH-approved plans for becoming DCQHCs. The health centers receiving capital funds will be approved under the CON process based on DOH's determination that their improvement or construction helps meet state plan-identified needs. These centers will also receive technical assistance. The capital fund will be developed using District capital fluids that will be matched by the private sector.

(E) Providing a higher Medicaid reimbursement rate for community health centers certified as DCQHCs or with DOH-approved plans to become DCQHCs. This will allow the District to provide additional funding to those centers that serve large percentages of uninsured individuals and centers that provide care in areas of the District where too few primary care providers operate.

(F) Developing a pharmaceutical program that continues the existing program for the uninsured when it expires in 2002. The program will work through participating pharmacies to provide free or discounted prescription drugs to uninsured residents.

(2) Expand Health Insurance Coverage by:

(A) Expanding DC Healthy Families coverage to adults without dependent children in phases once enrollment increases have been achieved and experiences assessed from the current implementation. Phase I will cover adults with incomes up to 50% of the federal poverty level (FPL); Phase II will cover adults with incomes up to 100% FPL.

(B) Providing tax credits to businesses offering health coverage to District residents, subject to actuarial estimates.

(C) Establishing a "brand" insurance coverage program which could include Medicaid beneficiaries and D.C. government employees and could be open to small businesses. A "Brand" insurance card will be issued to all participating individuals and will include a code to distinguish among benefit plans. The ultimate goal is to create a `seamless system care'.

(D) Proposing a change in the Federal Employee Health Benefit Program (FEHBP) to permit the inclusion of District of Columbia small businesses and District government employees. .This would require Congressional legislation.

(3) Build the Capacity of the Department of Health to ensure the public's health and better manage the health system by:

(A) Increasing enrollment in DC Healthy Families (DCHF) through,

(1) implementation of an electronic (web-based) enrollment system, improved training, and outreach efforts to register Medicaid eligible and uninsured patients at hospitals and DCQHCs and to provide a greater level of accountability

(2) maximization of TANF and CHIP funds earmarked for enrollment

(3) implementation of presumptive eligibility for all children

(4) implementation of a 1-year continuous enrollment program for all, including parents of DCHF and fixture DCHF expansion populations, including adults without dependent children

(B) Developing the Department of Health's monitoring and management capacity through,

(1) development of a state-of-the-art, outcomes measures-based, MIS system that links DOH to health care providers throughout the District and the provision needed staff development/training to implement this system

(2) rewriting the District's State Health Plan and Medicaid State Plan

(3) restructuring the Certificate of Need process and the reassessment, and rewriting if appropriate, of regulatory and reporting requirements

Sec. 3. Goals to be accomplished include to:

(A) Improve the health care system and services for vulnerable populations.

(B) Increase insurance coverage and decrease the number of uninsured District residents.

(C) Improve the capacity of the Department of Health to monitor and assess the quality and effectiveness of the health system.

Sec. 4. Fiscal impact statement. Health Care System Development Commission recommendations are subject to enabling legislation, regulation, and appropriations. Therefore, there is no fiscal impact.

Sec. 5. The Secretary of the Council shall transmit a copy of this resolution to Mayor upon its adoption.

Sec. 6. This resolution shall take effect immediately.

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