1. Washington State Hospital Association The 2014 State Legislative Session

2. Washington State Hospital Association Presenters Cassie Sauer SVP, Advocacy & Government Affairs Claudia Sanders SVP, Policy Development Mary Kay Clunies-Ross VP, Communications & Public Affairs

3. Washington State Hospital Association Webcast Outline Introduction State Health Care Environment State Legislative Environment Leadership Short Session WSHA Agenda: Improving Quality, Increasing Access Policy Budget Going Forward

4. Washington State Hospital Association State Health Care Environment: Improving Quality, Increasing Access

5. Washington State Hospital Association State Health Care Environment: Improving Quality, Increasing Access Implementing ACA Promises and challenges of population health Changing payment models = uncertain sustainability Some hospitals are in severe economic crisis Innovative patient safety work: voluntary, collaborative, successful, national leadership

6. Washington State Hospital Association State Legislative Environment

7. Washington State Hospital Association Washington State Government Governor Jay Inslee Democrat

8. Washington State Hospital Association Major Leadership Changes New Republican New Democrat Leaders Leaders Returning Leader Sen. Schoesler Sen. Tom Rep. Kristiansen Sen. Nelson Gov. Inslee Speaker Chopp

9. Washington State Hospital Association WSHA Policy Priorities Support Telemedicine Support Health Care Reform, Monitor Legislation Support Transparency Goals, Monitor Legislation Oppose Staffing Mandates Collect Mental Health Data Support Suspect and Inmate Guarding Support Crisis Standards of Care Ensure Hospital Flexibility for Partnerships Fix Provider Liability under ACA Delay Federal Basic Health Encourage Breastfeeding

10. Washington State Hospital Association Support: Telemedicine HB 1448 Telehealth is when physicians use video technology to provide services Good way to deliver dermatology, mental health, post-surgery monitoring and others Goal is to assure payment for services provided using telehealth technology Does not expand services beyond those already covered by patient’s insurance policy

11. Washington State Hospital Association Support Health Care Reform: Monitor Legislation State Health Care Innovation Plan - good goals: – efficient, high-quality care – care coordination – prevention – improved population health WSHA supports reform that: – protects patient and provider choices – builds on existing local networks of care – takes into account changing payment models – does not create barriers to innovation Concerns: – Accountable Communities of Health

12. Washington State Hospital Association State reform plan relies on transparency of cost and quality Creates an all claims payer database with negotiated prices WSHA supports with concerns about accuracy of information, access to data and governance oversight Support Transparency Goals; Monitor Legislation

13. Washington State Hospital Association WSHA Transparency Website www.wsha.org/transparency.cfm Compare hospitals charges Look for these buttons on the websites of Washington hospitals

14. Washington State Hospital Association Oppose Staffing Mandates HB 1095, HB 1152, HB 1153 Staffing mandates undermine nurse-staffing committees and do not consider patient need Nurse staffing committees are good model for joint decision-making – Ratios: not shown to increase safety – Uninterrupted meal, rest breaks: takes away nurse choices on best time to break – Overtime/on-call restrictions: lead to necessary treatments being delayed

15. Washington State Hospital Association 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? We have asked DOH to step up enforcement

16. Washington State Hospital Association Support: Suspect and Inmate Guarding SB 5968 There are increasing incidences of violent suspect or inmate injuring staff and patients SB 5968 would require that all law enforcement agencies provide security when patient has history or suspicion of violent or sexual crimes

17. Washington State Hospital Association Support: Crisis Standards of Care For disasters that are declared by the Governor or local government executive, legal protections will help health care providers get to work faster When the normal amount of resources are not available to meet the need, providers cannot deliver the same kind of care

18. Washington State Hospital Association Ensure Hospital Flexibility to Form Partnerships Certificate of Need is a long, expensive, unpredictable process, and the wrong process Increased review under new rules will slow hospitals’ ability to form partnerships necessary to maintain or expand basic services Other possibilities: Conscience clauses Provider freedom Maternity services definition

19. Washington State Hospital Association Fix Provider Liability Under ACA Act allows three months coverage if premiums unpaid Insurers responsible for first month Providers responsible for care in second and third month WSHA supports WSMA fix

20. Washington State Hospital Association Delay: Federal Basic Health ACA allows Federal Basic Health for those with incomes slightly above Medicaid Premium share lower than in Exchange Concerns: – Not enough enrollment data to know whether a new program is needed – State must pay start-up costs and would be responsible for ongoing, overall costs – Providers would receive Medicaid-like rates

21. Washington State Hospital Association Support Breastfeeding Partnership with Governor and Department of Health Strategy to reduce childhood obesity Support a new recognition program for high- performing hospitals

22. Washington State Hospital Association Budget Priorities Overview Meant to make minor adjustments to biennial budget Supreme Court unfavorably reviewed education plan Revenue forecast likely better, but not great Budget Priorities Mental Health Funding Medicaid Outreach Increased Dollars for Primary Care Support

23. Washington State Hospital Association Support Mental Health Funding 2013 had improvements – Increased capacity in state hospitals – Changes to Involuntary Treatment Act, new resources – State task force – Capital budget funding + regulatory relief Years of cuts in recession still left big hole Ongoing concerns about viability of Institutes for Mental Disease

24. Washington State Hospital Association Mental Health: $20 million plus federal matching funds Budget goals: – Stability of Institutes for Mental Disease – Additional capital dollars to expand inpatient options – Additional inpatient capacity at Western State Hospital – Funding for new evaluation and treatment centers – Funding for improvement of case management for high-risk individuals

25. Washington State Hospital Association Medicaid Outreach $1.1 million plus federal matching funds WSHA supports Governor’s budget request for funding to focus on potential Medicaid enrollees – Medicaid Newly Eligible Adults: 121,258 – Medicaid Previously Eligible but not Enrolled: 55,807 – Medicaid Redeterminations (Previously Covered):156,206 Targeted outreach effort is needed

26. Washington State Hospital Association Maintain Primary Care Rates $24 million plus $24 million federal matching funds Support WSMA’s efforts to retain Medicare payment rates for Medicaid enrollees Access to primary care physicians is essential for improving population health, especially for new Medicaid enrollees

27. Washington State Hospital Association Heading Into Session 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 if you have questions or experiences you’d like to share

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

29. Washington State Hospital Association 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!

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