1. 2015 Legislative Agenda and Update Sean Graham Associate Director of Policy & Political Affairs

2. Outreach and Advocacy Outreach and Advocacy Program Our Mission  Make the WSMA Legislative and Regulatory Affairs department the “go to” resource for information and advocacy for state and federal legislative and regulatory activities. Our Goal  Offer tiered legislative advocacy services to specialty and county societies and large physician groups. 2

3. Overview 2015 Legislative Session  Long Session 105 days Primary duty – operating budget (also capital, transpo)  April 24, 2015: Last day of regular session (April 26 th )  Three Special Sessions  Sine die on July 10 after 176 days of session 3

4. Overview 4 2015 Session by the Numbers  176 days of session  2497 bills introduced  290 bills in health care committees  363 bills passed by Legislature  10 bills partially or completely vetoed  14.5% of bills introduced passed into law

5. Overview 2015 Legislative Session Theme song?  Hotel California?...  Send in the Clowns?...  What a long, strange trip it’s been Legislative Priorities  Budget  Policy Why does this matter?  Advocacy is crucial  Legislation? It’s the long game that matters 5

6. Overview Policy – Top 5 takeaways from session Telemedicine, SB 5175 (Becker)  Reimbursement for services delivered via telemedicine  Narrow definition  Long-term goal to expand coverage All-payer claims database, SB 5084, (Becker)  Claims data from commercial, Medicaid, PEBB  Many concepts left up to rule-making 6

7. Overview Policy – Top 5 takeaways - Bad bills defeated Surgical techs, SB 5049 (Angel)  Restricted surg-tech from performing functions unless registered with state Naturopath prescribing power, SB 5185 (Becker)  Allow naturopaths to prescribe Schedule II-V drugs  Unsuccessful sunrise review in 2014 Dentistry scope of practice, SB 5621 (King)  “Adjacent and association structures…”  Concerns with botox 7

8. Overview Policy – Top 5 takeaways – Historic bills WSU medical school established, HB 1559 (Riccelli)  Washington State University to establish its own medical school.  WSMA was neutral on this bill  Broader issue of graduate medical education (i.e. medical residencies) Medical marijuana reformed, SB 5052 (Rivers)  Multi-year w/ admin simplification focus  Registry, standard of care, HP Account 8

9. State Budget Budget – the sticking points  McCleary ~$2.2 billion more (~$1 billion in 2013-2015)  Revenue House Democrats propose $1.5B – Includes B&O tax increase from 1.5% to 1.8%  Psychiatric Boarding ~$30 million – 145 psych beds  Class size initiative? ~$1.4 billion in additional spending in the next two-year budget cycle 9

10. Revenue Final budget  $38.2B two-year state spending plan $1.3B new K-12 spending College tuition decreases $98M to address mental health, psych boarding  Revenue $452M in tax exemptions repealed/modified 10

11. Legislative Priorities - Budget WSMA Budget Priorities – 2015-2017 Fair reimbursement for Medicaid primary care  WSMA ask – $100M  Final budget – $0 Residencies/Graduate medical education – Washington Family Medicine Residency Network  WSMA ask – $16M  Budget as passed – $24.4M 11

12. Legislative Priorities - Budget Loan repayment assistance for medical professionals  WSMA ask – $8M  Budget as passed – $9.6M Opportunity Scholarship for STEM, health care professionals  Final budget – $41M Public Health  Fully funded 12

13. Legislative Priorities - Policy Community/Public Health  Mandatory reporting of breast density information to patients. SB 5040 (O’Ban) WSMA Opposed, Defeated  Increasing legal age for smoking and use of vapor products, HB 1458 (Orwall): WSMA Supported, Defeated 13

14. Legislative Priorities - Policy Community/Public Health  Establishing marketing and product standards for vapor products, SB 5477 (Dammeier) WSMA Supported, Defeated  Increasing access to opioid antagonists to prevent opioid-related overdose deaths, HB 1671 (Walkinshaw) WSMA Support, Passed 14

15. Legislative Priorities - Policy Community/Public Health  Good Samaritans free testing, SB 5494/HB 1353 WSMA Supported, Defeated  Reducing distracted driving, SB 5656 (Rivers) WSMA Support, Defeated  Removing personal and philosophical exemptions for vaccine use, HB 2009 (Robinson) WSMA Support, Defeated Likely to be revisited by legislature Interim planning already underway 15

16. Legislative Priorities - Policy Mental/Behavioral Health  Primary care psychiatric consultation services – SB 5947 (Becker) UW Psych Program (Budget $4M in each of next two biennia – Safety Net Assessment)  Transport of patients to facilities other than hospitals, HB 1721 (Robinson) Workgroup to establish standards WSMA Supported, Passed 16

17. Legislative Priorities - Policy Administrative Simplification  Substitution of biosimilar drugs, SB 5935 (Parlette) WSMA Supported, Passed  Radiology benefit managers, HB 1183 (Harris) WSMA Supported, Passed OIC continued work to address benefit managers  Repealing the Prescription Monitoring Program, HB 2192 (Taylor) WSMA Opposed, Defeated 17

18. Legislative Priorities - Policy Payment Reform/Coverage  Network adequacy and Medicaid non- participating providers, HB 1652 (Cody) “Good faith” negotiations WSMA Support, Passed  Independent Review Organizations, HB 1956 (Moeller) WSMA Support, Defeated  Prescription Drug Assistance Foundation, HB 2021 (Riccelli) WSMA Supported, Passed 18

19. Legislative Priorities - Policy Payment Reform/Coverage  Grace Period, SB 5430/HB 1626 (Becker, Schmick) Two different approaches attempted WSMA Supported, Defeated Commitment from Sen. Becker to address in interim  Medicaid “look-back” and Exchange grace periods, SB 6089 (Hill) Exchange transparency, oversight Medicaid look-back – Exchange enrollee behind on premiums? Determine eligibility for Medicaid – Reimburse through Medicaid retroactively for claims WSMA Supported, Passed 19

20. Legislative Priorities - Policy DOH/MQAC/HCA/State Agencies  Demographic information collection, SB 5772 (Conway) WSMA Supported, Defeated (amended into HB 1485, as passed)  Education-based remediation plans for physicians (and other providers), HB 1135 (Cody) WSMA Supported (opposed after amendment), Defeated  Regarding requirements of allopathic physician licensure/”Foreign trained” licensure, HB 1874 (Tharinger) WSMA Supported, Defeated 20

21. Legislative Priorities - Policy DOH/MQAC/HCA/State Agencies  Bree Collaborative subject to the Open Public Meetings Act, SB 5144, (Dammeier) WSMA Supported, Passed 21

22. Legislative priorities - Policy Liability Reform  Reauthorizing the Medicaid fraud false claims act (Qui Tam) – SB 5287/HB 1067 WSMA Opposed, Defeated  Expanding beneficiaries for wrongful birth and wrongful life suits, SB 5747 (Padden) WSMA Opposed, Defeated  Crisis standards of Care during emergency Liability protection during emergency Anticipated but not addressed this year Likely to be revisited by legislature 22

23. Legislative Priorities - Policy Practice of Medicine  Patient medication coordination, SB 5441 (Rivers) WSMA Support, Passed  Refill eye drop prescriptions, SB 5268 (Parlette) WSMA Support, Passed 23

24. Legislative Priorities - Policy Practice of Medicine  Non-compete agreements - HB 1173, 1926, 1577 Prohibitions on non-competes for physicians, HB 1173 Others with focus on low-income individuals, broader non-compete issue WSMA HOD took no stance Will be revisited by legislature 24

25. Questions? Other issues of interest? 25

26. For more information Legislative Affairs Sean Graham Assoc. Director of Policy and Political Affairs sean@wsma.org 360-259-4184 Thank you! www.WSMA.org 26