1. The 2015 Legislative Session Session Kick-Off Webcast January 13, 2015

2. Presenters Cassie Sauer SVP, Advocacy & Government Affairs Claudia Sanders SVP, Policy Development

3. Webcast Outline Introduction State Health Care Environment State Legislative Environment WSHA Agenda: Improving Quality, Increasing Access Policy Budget Going Forward

4. State Health Care Environment: Improving Quality, Increasing Access Quality Innovative patient safety work: voluntary, collaborative, successful, national leadership Access Medicaid expansion is working: enrollment is up, charity care is down Some hospitals are in severe economic crisis New Vistas Promises and challenges of population health State’s innovation grant

5. State Legislative Environment

6. House Split

7. Senate Split

8. Governor Inslee’s Budget Multi-billion dollar budget gap Governor proposes $1.4 billion in new revenues Significant investments in education, transportation Mixed bag for hospitals and health care

9. WSHA Policy Priorities

10. Mental Health Telemedicine Mergers and Affiliations Hospital Services Nurse Staffing Pharmaceutical Dispensing Workforce Flexibility Suspect and Inmate Care All-Payer Claims Database Crisis Standards of Care Community Benefits www.wsha.org/policyadvocacy.cfm

11. Support Mental Health System Improvements Better integration of mental health and primary care Provide data and evaluation tools to improve system Reduce barriers to hospitals providing inpatient treatment Increase supply of psychiatric professionals Ruling that bans ‘psychiatric boarding’ has health officials scrambling

12. Support Telemedicine Payments Ensure payment for services provided using telemedicine technology Does not expand services beyond patient’s existing policy Recognizes “store and forward” Insurers are supportive or neutral on the bill

13. Ensure Flexibility for Strategic Partnerships and Hospital Services Some hospitals need partnerships to maintain basic services and access to care in the community Partnership decisions should be made at the local level Elective services should be determined locally, where quality and sustainability can be taken into account

14. Oppose Staffing Mandates Ratios: Not shown to increase safety Uninterrupted meal, rest breaks: Takes away nurse choice on best time to break Overtime/on-call restrictions: Lead to necessary treatments being delayed

15. Hospital Leadership on Nurse Staffing Hospital leaders are encouraged to ask themselves tough questions, including: How is your nurse staffing committee functioning? Do you use overtime or mandatory call? How much? What are the longest shifts people work? Are your staff getting their breaks?

16. Pharmaceutical Dispensing “Pre-pack” medications allow hospitals to provide necessary treatment when pharmacies are not open Protect ability to dispense pre-pack medication as needed

17. Work Force Flexibility Challenge: Geographic and practice areas where there are not enough providers to meet the need Opportunity: Establish structured process to safely pilot delivery alternatives, including expanded roles for already licensed health care professionals

18. Support Suspect and Inmate Care Increasing incidences of violent or sexual suspects or inmates injuring staff and patients Require that all law enforcement agencies provide guarding to patients in law enforcement hands for violent or sexual crimes Unless otherwise negotiated, payment would be Labor & Industries (L&I) rates

19. All-Payer Claims Database We can’t fix what we can’t measure APCD created last year, needs strengthening New bill makes needed fixes

20. Support: Crisis Standards of Care Disasters declared by the Governor or local government executive Legal protections will help health care providers get to work faster This legal protection that is currently given to volunteers, emergency workers and credentialing entities

21. Community Benefits ACA is working: Enrollment in Washington is up, need for charity care is down Medicare and DSH cuts are coming Hospitals and health systems are moving toward more population health-based model Hospitals are investing in access and care improvements Premature for legislature to increase community benefits requirement before impact on access is known

22. Hospital “Windfall?”

23. WSHA Budget Priorities

24. Mental Health 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

25. Hospital Safety Net Assessment Program Extend program through SFY 2019 without ratchet Maximize federal match rate Allocate majority of any increase in benefits to hospitals Dedicate additional state funds to support health care for Washingtonians Renew hospital contract

26. Access to Hospital Based Clinics Governor proposes to cut Medicaid payment rates for hospital-based clinics by $42 million Will hurt the ability of Medicaid patients to get both primary and specialty care

27. Meeting the Work Force Need Loan Repayment: Support state funds for loan repayment for those serving in underserved areas Medical Residencies: Provide state funds for more residency training slots Primary Care Payment: Increase Medicaid payment rate for practitioners and clinics to improve access to care

28. How You Can Help and Stay Informed

29. Heading Into Session 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

30. We Need You! Keep track of what’s happening! Stay in touch with your legislators!

31. Washington Hospital PAC Building Relationships Electing Champions for Hospitals Unifying Hospitals’ Political Voice www.wsha.org/whpac.cfm

32. 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!

33. Thank You! Questions? Comments? Cassie Sauer Senior Vice President, Advocacy & Government Affairs cassies@wsha.org  206/216-2538