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 Introduced3390 Passed604 Vetoed6 Enacted598 Percentage18% Last Biennium

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

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 Definition of dentistry SB 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 decision- making 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 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 WSMA Legislative Action Center 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

Feel free to contact us if you have questions or would like additional information. Taya Briley, RN, MN, JD General Counsel WSHA 206/ Denny Maher, MD, JD Director of Legal Affairs WSMA 206/