1. The 2015 Legislative Session What Does it Mean for Hospitals and Health Care?

2. Presenters Cassie SauerClaudia SandersChelene Whiteaker

3. Objectives Understand the policy successes and what you should be doing Understand the status of budget negotiations and key health care issues in the budget Begin preparations for next session

4. State Legislative Environment

5. House Split Senate Split

6. Ideas into Laws Introduced3390 Passed604 Vetoed6 Enacted598 Percentage18% Last Biennium

7. WSHA Policy Priorities

8. Key Partners

9. 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

10. In Re Detention of D.W. Patient plaintiffs won, with WSHA’s support Short-term solutions Long-term solutions What would it take to get more psych beds and keep people out of inpatient treatment? Mental Health

11. 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

12. Other Mental Health Issues SB 5269: Family input into detention process More people will be detained Passed HB 1713: Chemical dependency crisis services Parallel to ITA Costly House is refusing to concur with Senate amendments (Senate made it a study)

13. Telemedicine Payments: SB 5175 Passed Ensures payment for services provided using telemedicine technology Includes “essential health benefits” requirement Signed by Governor Effective January 2017

14. Pharmacy Access: SB 5460 Passed Jointly supported by WSHA and DOH Allows hospitals to dispense “pre- pack” medications when pharmacies are not open Changes burdensome licensing requirements for clinic pharmacies

15. 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

16. 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

17. Governor Action Signed SB 5175, telemedicine Vetoed problematic section of SB 5052, cannabis patients WSHA has made requests on many other bills

18. Next Year: Rethinking HB 1340 and HB 1944 Work force flexibility: Are there important scope of practice legal issues preventing a new work force? Crisis standards of care: Can we counter plaintiffs’ attorneys?

19. 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 WSHA educational events Webcasts, Chelan, Annual Meeting

20. 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 We Successfully Opposed

21. New Medical School: HB 1559 Passed WSHA was 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?

22. Budget: Where Are We Now?

23. Special Session

24. 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

25. To Tax or Not To Tax?

26. WSHA’s Position Reasonable reforms and cuts Responsible revenues to fund essential services More equitable tax system

27. WSHA Budget Priorities

28. 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?

29. Outstanding Issue: 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

30. Mental Health in the Two Budgets

31. Outstanding Bill Tied to Capital Budget: CN for Mental Health Beds – Support HB 2212 Psychiatric beds needed quickly Certificate of Need is a time and money barrier to opening new beds Capital budget grant application and evaluation duplicates CN process HB 2212: Narrow, short-term exemption tied to grant award Not yet passed

32. How You Can Help and Stay Informed

33. Resources www.wsha.org/policyadvocacy.cfm www.wsha.org/policyadvocacy.cfm Stay informed Inside Olympia, Weekly Report Bulletins and Calls to Action Policy and Advocacy Website –Priorities –Issue Briefs Stay connected Feel free to contact Cassie, Claudia, or policy directors

34. 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 Can You Do?

35. Possible Non-Legislative Solutions Charity care application and notification Community benefit Non-compete clauses Observation status

37. Thank You! Your advocacy with your legislators, your testimony, your connections with local leaders and media, and your contributions to the PAC are essential to our success. Please keep up the good work!

38. More Information to Come! Questions?

39. Cassie Sauer Senior Vice President Advocacy and Government Affairs cassies@wsha.org  206/216-2538