1. 2016 Legislative Session Update WSMA Legislative and Regulatory Affairs

2. 2 2016 Legislative session context Two-year “biennial” legislative cycle o Supplemental budget year Election year Short session o 60 day regular session Special session o 14 days in o Special sessions six out of last seven years

3. 3 2016 Legislative session context Bills introduced 1392 Bills in Health Care Committees 200 Bills passed by Legislature Total: 297 Questions remain Bills “Necessary to implement the budget” Governor vetoes o 27 bills vetoed o SB 6569 – Patient out of pocket costs o SB 5145 – Health technology clinical committee

4. 4 Budget State budget outlook o 2015 -- $38.2B two year state spending plan o $1.3B new K-12 spending o College tuition decreases o $98M to address mental health, psych boarding o McCleary decision What’s different in 2016? o McCleary funding – up to $4.5B more by 2017-2019 o Revenue forecasts  November caseload forecast - $400M in increased caseload costs  $190M from increased Medicaid enrollee costs  February revenue forecast down $78M GF 2015-17

5. 5 2016 Budget WSMA 2016 asks Protect WSMA priority investments from 2015 o Student loan repayment- $9.6M o GME - $24M primary care; $8M psych residencies No taxes directed at physicians Pediatric Medicaid funding, $7M Mental health student loan repayment, $3M Vaccine portal/module, $511,000 (DOH) Maternal mortality review panel $230,000 (DOH)

6. 6 Budget breakdown – Senate vs. House Senate budget proposal Pediatric primary care reimbursement - $0 Vaccine module - $511K Health professional student loan repayment for mental health - $0 (avoided $1M cut) Health professions account – $500K sweep (no physician fee increase) Tax increases on physicians – none House budget proposal Pediatric primary care reimbursement - $0 Vaccine module - $511K Health professional student loan repayment for mental health - $1M Health professions account – no sweep Tax increases on physicians – none

7. 7 Top 5 takeaways from session 1.Credentialing 2.Telemedicine 2.0 3.MA medication retrieval 4.Maternal mortality review panel 5.Bad bills defeated

8. 8 Bad Bills Defeated

9. 9 Bad bills defeated Balance billing prohibition in emergency settings, HB 2447 (Cody) o Highly technical and political o WSMA opposed o Dead “ Associate physicians,” HB 2343 (Cody) o Alternative pathway for med school grads who do not match a residency o Dead Naturopath opioid prescribing (Schedule II-V), SB 2304 (DeBolt) o Inappropriate scope expansion o Dead Mandatory reporting of breast density to patients, SB 6416 (Rolfes) o Cost and use driver o Dead

10. 10 Healthy Doctors, Health Patients (HDHP)

11. 11 2016 HDHP Credentialing, HB 2335 (Cody) o Standardize turn-around time and process to credential providers o Passed House 97-0; Senate 48-0 Medical Assistant medication retrieval, HB 2350 (Cody) o PQAC overreach o Allowing MAs to retrieve medication while under appropriate supervision o Passed House 95-2; Senate 42-6 Benefit managers, HB 2445 (Robinson) – OIC legislation o Grant regulatory authority over BM/third party administrators o Dead Pharmacy Benefit Managers, 5ESSB 5857 (Parlette) o Registration and regulation of PBMs o Substitute includes requirement that OIC look at IRO process to settle disputes between pharmacies and insurance carriers o Passed Senate 49-0; House 94-3

12. 12 Workforce & Practice of Medicine

13. 13 2016 Workforce & Practice of Medicine Interstate licensure compact, HB 2452 (Riccelli) MQAC/DOH o Securing and stabilizing workforce o Advancing practice and payment of telemed (2015) o Dead Telemedicine 2.0, SB 6519 (Becker) o “In-home” reimbursement o Telehealth collaborative (TBD) o Passed Senate 49-0; House 91-6 Prescription Monitoring Program access, HB 2730 (Peterson) o “Bulk” access to the PMP for hospitals, groups of prescribers o Passed House 80-16; Senate 47-1

14. 14 Liability & Business Practice

15. 15 2016 Liability & Business Practice Medicaid fraud Qui Tam, SB 6156 (Rivers) o Support pushing out the sunset on Qui Tam provisions to 2023. o Act would expire in 2016 and allows private parties to pursue private causes of actions against medical providers. o Passed Senate 48-0; House 96-1 Blinded provider compensation agreements, HB 2332 (Kirby) o Keeps compensation arrangements filed with the OIC exempt from public disclosure o Passed House 97-0; Senate 47-0 Prohibiting /restricting non-competition (solicitation) clauses o WSMA monitored these bills, but does not have policy on non-compete clauses o HB 2406 (Manweller) – restricts non-competes for low-wage workers o HB 2931 (Stanford) – voids non-competes that are “unreasonable” o DEAD

16. 16 Public & Community Health

17. 17 2016 Public & Community Health MMR committee, SB 6534 (O’Ban) o Creates panel to conduct reviews of maternal death factors in WA o Passed Senate 47-0; House 95-0 Age of individuals which sale of tobacco and vapor products may be made, HB 2313 (Orwall) o Raises the legal age to purchase tobacco and vapor products from 18 to 21 o NTIB Concerning vapor products – Two bills o SB 6328 (Dammeier) o HB 1645 (Pollet) o NTIB

18. 18 2016 Public & Community Health Pharmacist ‘prescribing’, HB 2681 (Stambaugh) o Amended down “awareness” bill promoting pharmacists' ability to dispense contraception under CDTA. o Passed House 92-4; Senate 46-3 Reducing distracted driving incidents, HB 2574 (Farrell) o Focuses on wireless communication device-related activities, such as holding the device in-hand or reading or manually entering data o NTIB Increase oil transportation safety, HB 2575 (Farrell) o Updating a 2006 report to state emergency response commission regarding a statewide response to chemical, biological, radiological, nuclear and explosive materials. o NTIB

19. 19 2016 Election – WAMPAC, State Races 2016 campaigns o Impact on 2015 session o Campaigns o Presidential o Congressional o Statewide elected o State Senate o State House of Representatives o Judicial o Vote tracker / Diamond club o Candidate interviews / fundraisers

20. Thank You Kathryn Kolan, J.D. kak@wsma.org Sean Graham sean@wsma.org