Washington State Legislative Wrap Up
By Susie Tracy, WA-ACEP Lobbyist
Aug. 2, 2017
“Historic” Legislative Session
The 2017 Legislative Session was historic in many significant ways, most publicized is the length of time legislators spent in Olympia. Rather than leaving on April 23 as scheduled, legislators did not depart until July 20, after three Special Sessions and 193 days of being at the State Capitol. The 2017 “session” was the longest in history. Significant work was accomplished, but a number of key issues were just left on the table.
Dealing with McCleary
At the insistence of the Washington Supreme Court, the House and Senate finally agreed on a solution to the McCleary decision, mandating full and adequate funding for K-12 legislation. Now education comprises 53% of the state’s operating budget and was funded without placing any new taxes on medical providers. A tax reduction on manufacturers was vetoed by the Governor, creating a level of political distrust on the part of some budget negotiators, which set the tone for further angst on subsequent issues. Agreement on how to fund McCleary made it possible to negotiate the State’s $43.7 billion operating budget, which passed the day before the State would have had to close much of its operations (July 31).
In addition to the death of many bills that were introduced, the final bit of wrangling surrounded the issue of yet another Supreme Court decision, known as the Hirst decision. This had a very significant negative impact on private well-drilling particularly in rural areas, and I only mention it because after extremely lengthy negotiations, the issue could not be resolved, and the Senate Republicans chose to hold the construction budget (capital budget) hostage, meaning that $4 billion of construction projects cannot move forward. Hirst negotiations continue but the Governor will not call the Legislature back into Session unless there is agreement. The inability to pass the capital budget affects health care in one way or another by approximately $63 million, particularly in mental health.
WA-ACEP Specific Issues
WA-ACEP tracked over 100 bills throughout the legislative session. Many represented just a casual interest, or were followed as a precaution in case they took on new lives of their own. Below are many bills that were closely monitored.
Balance Billing (HB 2114) took center stage in terms of our legislative focus this session. There is no meaningful way to adequately describe the process that occurred in achieving this bill’s final demise. You may recall that there were many meetings over the interim in 2016 between the Office of the Insurance Commissioner, key legislators, and representatives of WA-ACEP, the WSMA, other medical specialties, the hospitals, and the carriers. Those meetings resulted in little other than frustration. When HB 2114 was introduced by Rep. Cody, chair of the House Health and Wellness Committee, it was not intended to make any of the negotiators happy – and it did not. At hearings on the bill, all parties expressed a willingness to try to remove the problem from the patient, but none were satisfied with the proposed solutions. Thus, further negotiations were held, led by Chair Cody and Senate Health Care Committee Chair Ann Rivers. No consensus solution developed. HB 2114 was ultimately voted upon by the full House, with the tally being 81 pro to 17 con. It was then heard by the Senate Health Care Committee, and was later voted out of the committee, again with no positive testimony. It subsequently died in the Senate Ways and Means Committee. But given legislative procedures, HB 2114 was still alive during the second special session, and was once again voted upon by the full House, with an improved vote of 61-33. It received no further action by the July 20 adjournment.
There is no question that the issue will be considered again in the next legislative session, but no compromise language appears to currently be waiting in the wings for approval by all parties.
High Interest Legislation:
HB 1339: Would have required a practitioner, to prescribe an opioid drug, annually complete CME regarding best prescribing practices. With opposition from the medical community the bill did not pass. However, see HB 1427 below.
HB 1426: This bill authorized the Department of Health (DOH) to provide data in the Prescription Monitoring Program to the Health Care Authority (HCA) regarding Medicaid clients for the purposes of quality improvement, the DOH for assessing prescribing practices, a healthcare facility or provider group of five or more providers for quality improvement purposes, and a local health jurisdiction for patient follow-up and care coordination following a controlled substance overdose event. The bill failed to pass but some of its components were rolled into HB 1427 (see below).
HB 1427: This bill started out as an attempt to modernize terms dealing with opiate substitution treatment programs and other outdated terminology. As the session progressed and other bills of interest died, this bill became the vehicle for additional concepts. With HB 1427, which passed almost unanimously, DOH will use the state Prescription Monitoring Program to send quarterly reports to healthcare facilities and provider groups that show prescribing patterns. The reports are only to be used for internal quality purposes. The operating budget provided funding for prescription drug monitoring program data.
HB 1547: Exempts acute care and psychiatric hospitals from CON requirements for the addition of psychiatric beds until June 2019. There are certain restrictions on this exemption. For example, an entity that constructs a psychiatric hospital must receive a CON if it exceeds 16 beds. The bill passed.
SB 5369: The Legislature failed to consider a bill amending the practice of naturopathy. The bill would have authorized a naturopath to prescribe legend drugs and controlled substances contained in schedules III through V. WA-ACEP joined the WSMA in strongly opposing this legislation.
SB 5800: This failed legislation was an attempt to override the Supreme Court’s Volk decision. In October 2016, the court held that, in the outpatient context, the duty of health care providers to warn potential victims of violence extends to all individuals who may foreseeably be endangered by a patient who has made a specific threat. In addition to supporting the legislation WA-ACEP participated as an amicus in asking the Court to reconsider its decision. The Court chose not to do so. However, one-time funding was provided in the operating budget for the University of Washington School of Law to study the impact of the decision on mental health care services. A report is due December 1, 2017.
Other Bills of Interest:
HB 1047: Set up a system for safe and secure collection and disposal of unwanted medications, financed by pharmaceutical manufacturers, which opposed the bill. At one point, there was an amendment to share the expenses between manufacturers and prescribers, which we opposed. The bill died without a full floor vote, but will be re-introduced next Session.
HB 1122: Safe storage of firearms, making it a crime of reckless endangerment to leave a firearm where a child is likely to gain access and does gain access. Passed out of the House Judiciary Committee but no floor vote was held. A Senate companion bill also failed to pass.
SB 5436: This bill expanded patient access to health services through telemedicine by including its use in a patient’s home. The bill is now law.
SB 5514: Hospitals with emergency departments must electronically submit ED patient care information to DOH for collection, maintenance, analysis and dissemination by DOH. Data must be collected in a way that allows automated reporting by electronic transmission. The DOH must allow EDs submitting data to immediately obtain their own data and aggregate regional and statewide data within 30 minutes of submission of a query for the data once it is available in the system. The Governor signed this bill.
There are many items of interest contained in the operating budget. Here are a few highlights:
Prior to next Session key legislative committees will have a joint work session to review models in the delivery system and the impacts on medical liability.
Beginning in January of next year, funding is reduced to reflect savings achieved through the HCA implementing a single, standard preferred drug list and operating as the single pharmacy benefits manager under the prescription drug purchasing consortium.
The DOH received $12 million to address communicable disease monitoring and prevention and chronic disease and injury prevention. It also received one-time funding of $10 million to provide support to local health jurisdictions to improve their ability to address communicable disease monitoring and prevention and chronic disease and injury prevention. Also, $2 million of onetime funding was provided to DOH to implement strategies to control the spread of communicable disease and other strategies.