The 2015 Legislative Session
What Does it Mean for Physicians, Hospitals
and Health Care?
Presenters
• Denny Maher, MD, JD
Washington State Medical Association
• Taya Briley, RN, MN, JD
Washington State Hospital Association
Objectives
• Describe major policy and budget issues from 2015
legislative session
• Identify key legislation affecting physicians, hospitals,
and health systems
• Consider how legislation will impact current practice
• Understand issues not resolved by the legislature that
may be the subject of ongoing policy debate
State Legislative Environment
Ideas into Laws
Last Biennium
Introduced
3390
Passed
604
Vetoed
6
Enacted
598
Percentage
18%
Policy Priorities
WSHA
Proactive Policy Priorities
Successes:
• Mental Health
• Telemedicine
• Pharmacy
• Suspect and Inmate Care
• All-Payer Claims Database
Unfinished Business:
• Work Force Flexibility
• Crisis Standards of Care
www.wsha.org/policyadvocacy.cfm
WSMA
Proactive Policy Priorities
Successes:
• All-Payer Claims Database
• Telemedicine
• Mental Health
• Scope of Practice
Unfinished Business:
• Grace Period Fix
• Non-disciplinary Remedial Actions
• GME Funding
• Health Professionals Loan Repayment
• Medicaid Reimbursement
• B&O Tax
Mental Health
•
In Re Detention of D.W.
•
Patient plaintiffs won, with WSHA and WSMA support
•
Short-term solutions
•
Long-term solutions
•
What would it take to get more psych beds and keep
people out of inpatient treatment?
Support Mental Health System Improvements
• SB 5649 passed:
 Mandates data collection on ER cases when no bed
available
 Requires regional support networks to administer an
adequate network of evaluation and treatment services to
ensure access to treatment
 Exempts time prior to medical clearance from ITA timelines
• HB 1450 passed:
 Establishes mandatory outpatient treatment
Ruling that bans ‘psychiatric boarding’ has health
officials scrambling
Medical Practice Bills:
• Scope of practice bills defeated
• SB 5621 - Definition of dentistry
• SB 5815 - Naturopath controlled substance prescribing
• Mandatory reporting of breast density
• SB 5040 defeated
• Patient medication coordination
• SB 5441 passed
• Surgical technologists requirements
• SB 5049 defeated
Telemedicine Payments:
SB 5175 Passed
• Ensures payment for services
provided using telemedicine
technology
• Includes “essential health
benefits” requirement
• Signed by Governor
• Effective January 2017
Pharmacy Access:
SB 5460 Passed
• Jointly supported by WSHA,
WSMA and DOH
• Allows hospitals to dispense
“pre-pack” medications when
pharmacies are not open
• Changes burdensome licensing
requirements for clinic
pharmacies
Radiology Benefit Managers:
HB 1183 Passed
• Requires radiology benefit
managers to register with the state
• RBMs and PBMs not otherwise
regulated
• Hopefully will lead to regulation
and use of accepted decisionmaking tools
Suspect and Inmate Care:
SB 5593 Passed
• Jointly proposed by WSHA and law enforcement
• Requires that all law enforcement agencies guard
hospital patients in law enforcement custody for violent
or sexual crimes
• Unless otherwise negotiated, payment for hospital
services will be Labor & Industries (L&I) rates
All-Payer Claims Database:
SB 5084 Passed
• Broad coalition
• Mandates that insurers
contribute data
• WSHA and hospitals can
access quality data
• Limited access to payment
data
Non-Disciplinary Remedial Measures:
HB 1135 Defeated
• DOH request legislation
• Would have allowed
licensing boards to suggest
education-based plans
• Designed to improve
patient safety
• WSMA opposed after
unfavorable amendments
added
Grace Period Fix:
HB 1626/ SB 5430 Defeated
• Designed to fix
reimbursement gap during
“grace period”
• Physician practices losing
thousands of dollars
• Hoping for interim work
sessions to prepare for
2016 session
Issues WSHA Successfully Opposed
• Levying a new 6% tax on hospitals
• Prohibiting hospital partnerships
• Mandating staffing regulations
• Creating Extended Stay Centers with
no hospital regulations
• Cutting Medicaid hospital clinic payments
• Banning non-compete clauses for MDs
• Returning to psychiatric boarding
• Dozens of others opposed or amended
Issues WSMA Successfully Opposed
• Changing definition of dentistry
• Naturopath controlled substance rx
• Mandatory report of breast density
• New requirements for surgical techs
• Repeal of the PMP
• Expanding beneficiaries in wrongful birth
and wrongful life lawsuits
• Dozens of others opposed or amended
New Medical School:
HB 1559 Passed
• WSHA and WSMA were aggressively neutral
• Amends a century-old state statute that gave exclusive
rights to provide medical education to UW
• Focus on rural and community-based training
• Funding for accreditation process and startup?
• Funding for residency slots?
Budget: Where Are We Now?
Special Session
Budget Chasm
Structural issues
• Education funding
• Class size initiative funding
• State employee salaries and
raises
• Lean savings
• Transportation budget
Health care issues
•
•
•
•
•
Hospital Safety Net Assessment
Mental health capital
Mental health operating
Health Benefit Exchange budget
Residencies
To Tax or Not To Tax?
WSHA’s Position
• Reasonable reforms and cuts
• Responsible revenues to fund essential services
• More equitable tax system
Budget Priorities
WSHA Outstanding Issue:
SB 6045 - Hospital Safety Net Assessment Program
•
Extends program through SFY 2019 without ratcheting
down
•
Maximizes federal match rate
•
Renews hospital contract
•
Senate version: Disproportionately benefits the state
•
House version: Shares increase in benefits between state
and hospitals
•
How to fund residencies?
WSMA Outstanding Issues:
• Enhanced Medicaid reimbursement
• Not likely
• Support for graduate medical education (GME)
• Looks favorable
• Repayment of health professional loans
• Looks favorable
• Avoid B&O tax increase
• Uncertain
Outstanding Issue for All: Mental Health Funding
Goals:
• Sufficient funding to reduce or end
psychiatric boarding for adults,
adolescents and children
• Resources need to be:
• Statewide
• Inclusive of inpatient and outpatient
services
• Include appropriate community
support services
How You Can Help and Stay Informed
Resources
WSHA
www.wsha.org/policyadvocacy.cfm
WSMA
Legislative Action Center
What Can You Do?
• Respond to requests for action
• Come to Olympia to testify or meet with your
legislators
• Schedule an in-district meeting; consider
including your neighbors
• Highlight your care improvements
What You Should Be Doing Now
• Understand new opportunities
Example: Pharmacy pre-pack and licensing
Example: Telemedicine
• Make sure partners are following new laws
Example: Designated Mental Health Professional reporting
• Reach out to your local partners
Example: Law enforcement on guarding and payment
• Join WSMA and WSHA educational events
Webcasts, Chelan, Annual Meeting
Possible Non-Legislative Solutions
• Charity care application
and notification
• Community benefit
• Non-compete clauses
• Observation status
Taya Briley, RN, MN, JD
General Counsel
WSHA
TayaB@wsha.org
206/216-2554
Denny Maher, MD, JD
Director of Legal Affairs
WSMA
denny@WSMA.org
206/956-3640
Feel free to contact us if you have questions or
would like additional information.