Resolutions submitted within two months of the House of Delegates are considered late, and the House must vote whether to even consider late resolutions. Late resolutions must be of an urgent nature, with action that cannot wait until the next House meeting, and could not have been known prior to the resolution deadline. When voting whether to accept late resolutions, delegates should consider these factors, not the merit of the resolution.

Late Resolution 1: Create a Care Gap Committee

Brought by: Pierce County Chapter

WHEREAS, Medicaid patients are being denied referrals to certain specialties in Pierce County, and likely in other counties in Washington State1, and

WHEREAS, some referrals are processed but with limited spots saved for Medicaid patients, they are waiting inappropriate or excessive times for specialty care1, and

WHEREAS, the Washington State Office of the Insurance Commissioner has a clear process for filing complaints against private insurance coverage, accessible through the insurance.wa.gov website with a team dedicated to investigating claims and responding to individuals who file the complaints2, and

WHEREAS, there is no equivalent body for submitting complaints against state insurance coverage or looking into claims about coverage, and,

WHEREAS, patients are currently being affected by this issue with increasing numbers being unable to see specialists within a reasonable time period or reasonable distance from there home, and no new solutions noted by insurance groups, therefore be it

RESOLVED, that the WAFP, advocate for the development of an investigative workgroup designed to identify gaps in care throughout Washington State for individuals covered by Medicaid and Medicare, and be it further

RESOLVED, that the WAFP, advocate for an online system for submitting complaints from providers and patients against Medicaid and Medicare coverage including a team dedicated to investigating and responding to such complaints, and be it further

RESOLVED, that the WAFP, assist with the administration of this workgroup given the requirement by many Medicaid and Medicare insurers that referrals for specialty care be created and sent by Primary Care Providers.

References

  1. These statements are based on personal experiences and the experiences of other providers in the Pierce County area. My group has personally kept a list of patients denied access to specialty care throughout Washington State
  2. (February 29, 2024) File a complaint or check your complaint status. Office of the Insurance Commissioner. https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status