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1 | Northwest Health Law Advocates Summary of Health Care Access Bills that Passed the 2020 Washington Legislature | |||
2 | Bill Name | Bill/ main sponsor | Summary Description | Final Status |
3 | PUBLIC PROGRAMS | |||
4 | Improving maternal health outcomes by extending coverage during postpartum period - Vetoed | E2SSB6128 (Randall) | Extends Apple Health postpartum health care coverage from 60 days to 12 months post-pregnancy, to take effect when the state becomes eligible to receive federal financial participation. Directs HCA to seek federal matching funds through a federal waiver request by January 1, 2021. | Vetoed |
5 | Increasing outreach and engagement with access to baby and child dentistry programs | SHB2905 (Johnson, J.) | Directs HCA to develop local access to baby and child dentistry (ABCD) program fund allocation formula, key deliverables, and target metrics for increased outreach and provider engagement and support. Aims to reduce racial and ethnic disparities in access to care and oral health outcomes and to increase the percentage of Medicaid-enrolled children under the age of two accessing dental care. Directs HCA to collaborate with stakeholders to monitor progress toward these goals and to provide support to local access to baby and child dentistry programs and providers. Requires HCA to work in consultation with the Office of Equity to develop the required items and monitor progress. | Enacted |
6 | Access to baby and child dentistry program for children with disabilities | SSB5976 (Rolfes) | Changes definition of children between ages 6 and 12 who are eligible to receive services under ABCD. 2018 legislation creating this eligibility expansion specified disabilities; this bill would require HCA to establish clinical criteria to determine disability (this change is required for federal approval). Adds primary care providers to list of providers who must complete training on treating eligible children to receive enhanced ABCD fee for providing services to eligible children. | Enacted |
7 | Improving department of corrections health care administration | ESSB6063 (Wagoner) | Requires DOC establish minimum job qualifications for the position of prison medical director and requires candidates meet the minimum job qualifications to be considered for the position. DOC must implement uniform guidelines across all DOC correctional facilities, based on the health care community standard of care and in accordance with medically accepted best practices, for determining when a patient's current health status requires a referral for consultation or treatment outside DOC. | Enacted |
8 | Making jail records available to managed health care systems | HB2545 (Davis) | Authorizes the Department of Corrections to share jail records with managed health care systems including managed care organizations and behavioral health administrative services organizations, for the purpose of care coordination activities; and requires the receiving entity to hold the records in confidence and comply with state and federal privacy laws concerning any records received. | Enacted |
9 | Providing public assistance to certain victims of human trafficking | 3SSB5164 (Saldaña) | Expands eligibility for the state Food Assistance Program, the State Family Assistance program (SFA), and the Medical Care Services Program (MCS) to certain victims of human trafficking and other crimes who are not eligible due to immigration status, effective 2/1/22. Defines a "victim of human trafficking" to include noncitizens filing for a "T" or "U" visa or meeting certain other conditions, and includes their family members. Medical coverage is for individuals who qualify for SFA. | Enacted |
10 | PUBLIC HEALTH | |||
11 | State's response to the novel Coronavirus. | EHB2965 (Cody) | Appropriates $175 million state funds and $25 million federal funds to the Office of Financial Management, to be allotted to state agencies and distributed to local governments and tribes for response to the Coronavirus Disease 2019 (COVID-19). No supplanting of existing federal/state/local funds, require monthly updates to the legislature on expenditures. An additional $25 million is appropriated to supplement the unemployment trust fund. Authorizes DSHS to determine nursing facility payments to adequately resource facilities responding to the COVID-19 outbreak, limited to the current coronavirus declared emergency (expires June 30, 2021). The Medicaid payments must be determined by DSHS, as appropriate to respond to the state of emergency, and are exempt from the state's Medicaid methodology. Such nursing facility payments may not be included in the calculation of the annual statewide weighted average nursing facility payment rate. For purposes of eligibility for unemployment benefits, until June 30, 2021, an individual under quarantine or isolation during the novel coronavirus outbreak meets the requirement of being able and available to work if they are able to perform, available to perform, and actively seeking work which can be performed while under quarantine or isolation. The state board of education may administer an emergency waiver program to grant local education agencies and private schools flexibility so that students in the graduating class of 2020 or earlier who were on track to graduate before the gubernatorial declaration of emergency are not negatively impacted by measures taken by the local education agency or private school in response to the novel coronavirus (COVID-19). | Enacted |
12 | PRIVATE INSURANCE AND HEALTH BENEFIT EXCHANGE | |||
13 | Prohibiting discrimination in health care coverage | SHB2338 (Macri) | Eliminates certain exemptions from the definition of "mental health treatment" for health coverage issued or renewed on or after January 1, 2021. Expands mental health parity requirements to short term limited duration plans and student health plans. Expands health insurance nondiscrimination provisions. | Enacted |
14 | Health care benefit management - partial veto | 2SSB5601 (Rolfes) | Establishes requirements and regulations concerning all health care benefit managers (HCBM) (radiology, mental health, and pharmacy benefit managers (PBM) included). Requires all HCBMs practicing in Washington to be registered and licensed by the OIC in their respective category and to perform certain administrative record duties. Requires HCBMs to maintain a contract describing rights and responsibilities of any parties to a contract with the HCBM. HCBMs andcarriers must file contracts with the OIC. Prohibits certain conduct by HCBMs and PBMs. For example, PBMs may not cause or permit to be used any misleading or deceptive advertisements or promotions. Insurance Commissioner has power to enforce when HCBMs violate laws or regulations pertaining to HCBMs. Exempts employee benefits programs from the enforcement actions the Insurance Commissioner is authorized to impose. Establishes a work group to review and report on pharmacy fee structures and the use of performance based contracts. Partial veto: Governor vetoed the section establishing a work group. | Enacted; partial veto |
15 | Health carrier requirements for prior authorization standards (medical necessity) | 2ESB5887 (Short) | Prohibits a health carrier or its contracted entity from requiring utilization management or review of any kind --including prior, concurrent, or post-service authorization-- for initial evaluation and management visits and up to six treatment visits for chiropractic, physical therapy, occupational therapy, Eastern medicine, massage therapy, acupuncture, and speech and hearing therapies. For such visits, a health carrier or its contracted entity may not deny or limit coverage on the basis of medical necessity or appropriateness, or retroactively deny care or refuse payment for the visits. | Enacted |
16 | Reducing barriers to patient care through appropriate use of prior authorization and adoption of appropriate use criteria | ESSB6404 (Frockt) | Requires certain carriers of individual and group health plans to submit certain aggregated and deidentified data related to the carrier's prior authorization practices and experience for the prior plan year to the OIC. | Enacted |
17 | Mitigating inequity in health insurance market caused by health plans that exclude mandated benefits | SHB2554 (Stonier) | Requires health carriers and student health plans that exclude, under state or federal law, any benefit required or mandated by Title 48 RCW or rules adopted by the insurance commissioner to provide notice to consumers of the benefits that are not covered and alternate ways to access the excluded benefits. Requires the Health Benefit Exchange to provide similar notice to consumers. Requires the Insurance Commissioner to assess a fee on a health carriers and student health plans that exclude, under state or federal law, any benefit required or mandated by Title 48 RCW or rules adopted by the insurance commissioner. Permits the insurance commissioner to waive the fee on a health carrier if the commissioner finds the carrier provides alternative access to all excluded benefits. Requires insurance commissioner to provide notice on its website of carrier requirements and information on alternate ways enrollees may access excluded benefits in a timely manner. | Enacted |
18 | Requiring the insurance commissioner to review a health carrier's surplus levels as part of its rate filing review process | ESSB6097 (Rolfes) | For individual and small group rate filings for plan year 2021 and beyond, the Insurance Commissioner may review the surplus of a health insurance carrier as an element in determining the reasonableness of the carrier's proposed rate. In reviewing the surplus, the Commissioner must consider the capital facility needs for carriers maintaining and operating hospitals and clinics. | Enacted |
19 | HEALTH CARE PROVIDERS AND FACILITIES | |||
20 | Protecting Patient Care | ESHB 1608 (Macri) | Protects health care providers from retaliation including discharge, demotion, suspension, discipline, or other discrimination by a health care entity for provision of medically accurate and comprehensive information and counseling to a patient including information about available services, relevant resources, and Washington’s death with dignity act. Requires Dept. of Health to post notice of these provisions online. | Enacted |
21 | BEHAVIORAL HEALTH: MENTAL HEALTH AND SUBSTANCE USE DISORDERS | |||
22 | Removing health coverage barriers to accessing substance use disorder treatment services | ESHB2642 (Davis) | Requires health plans and managed care orgs to provide coverage for at least two days in a state-licensed substance use disorder (SUD) residential treatment facility and at least three days for withdrawal management services in a state-licensed program prior to utilization review. Prevents health plans and managed care orgs from requiring prior authorization for SUD or withdrawal management services as a condition of payment. Requires SUD residential treatment facilities and withdrawal management programs to notify payer with notice of admission within 24 hours of admission. Directs payer to arrange for seamless transfer, if transfer is recommended plan of treatment. Payers not responsible for reimbursing out-of-network facility at greater rate than in-network facilities and out-of-network facility may not balance bill. Directs HCA to develop an action plan to support improved transitions between different levels of care, including addressing barriers to timely assessments and increasing successful transitions between different levels of appropriate care. Requires HCA and OIC select a single standard set of criteria to define medical necessity and levels of care for substance use disorder treatment in WA by January 1, 2021. Also requires medical necessity reviews by payers to be based on determined criteria. | Enacted |
23 | Improving the Indian behavioral health system | SSB6259 (McCoy) | Defines new BH provider, "behavioral health aides," and directs HCA to work with CMS to reimburse BH aide services at 100%. Grants exclusive jurisdiction to tribes, unless the tribe has consented to the state's concurrent jurisdiction, or the tribe has expressly declined to exercise its exclusive jurisdiction, over behavioral health civil commitment services related to American Indian or Alaska Native persons within the boundary of the tribe. Requires designated crisis responders to share information with Indian health care providers related to civil commitment investigations of tribal health care clients.Requires that a nontribal designated crisis responder notify the tribe when a person who is American Indian or Alaska Native is in emergency detention or in detention that results after an investigation. | Enacted |
24 | Implementing a sustainable funding model for services provided through children's mental health services consultation program and telebehavioral health video call center | SHB2728 (Slatter) | Directs the authority in collaboration with the University of Washington department of psychiatry and behavioral sciences to implement a telebehavioral health video call center to provide emergency department providers, primary care providers, and county and municipal correctional facility providers with on-demand access to psychiatric and substance use disorder clinical consultation for adult patients including direct assessment of patients using televideo technology. Outlines audit and funding requirements for the PAL and the psychiatric consultation line. Clarifies calculation and data needed from entities to determine proportional share of program costs. | Enacted |
25 | Expanding adolescent behavioral health care access | SHB2883 (Eslick) | Clarifies definition of "inpatient treatment" for purposes of family-initiated treatment. Requires medical necessity reviews be conducted every 30 days while the adolescent remains in treatment. Requires HCA to develop and operate a data collection and tracking system for youth receiving family-initiated treatment. Replaces "chemical dependency" with "substance use disorder." | Enacted |
26 | Children's mental health workgroup | 2SHB2737 (Callan) | Extends the Children's Mental Health Work Group until 2026 and renames it the Children and Youth Behavioral Health Work Group. Expands the membership of the work group. Establishes an advisory group on school-based health and suicide prevention with staff support from office of the superintendent of public instruction. | Enacted |
27 | Implementing Ruckelshaus recommendations regarding residential habilitation center clients | ESSB6419 (Keiser) | Requires the Developmental Disability Administration (DDA) to develop a plan to implement the 2019 report from the William D. Ruckelshaus Center regarding residential habilitation center clients and submit a preliminary plan and report to the Governor and the Legislature by November 1, 2020, and a final implementation plan and report by September 1, 2021. Establishes a joint executive and legislative task force to oversee the development of and to approve the DDA reports prior to submission. | Enacted |
28 | PRESCRIPTION DRUGS | |||
29 | Protecting patients from excess prescription medication charges | SHB2464 (Gildon) | Limits what an insurance carrier or pharmacy benefit manager may require a person to pay for a covered prescription medication at the point of sale to the lesser of the applicable cost sharing amount or the amount the purchaser would pay for the medication if purchased without using a health plan. Prohibits a carrier or PBM from requiring a pharmacist to dispense a brand name prescription medication when a less expensive therapeutically equivalent generic drug is available. | Enacted |
30 | Reducing the cost of insulin | E2SHB2662 (Maycumber) | Caps the total out-of-pocket cost for a 30-day supply of covered insulin at $100 for two years to help increase access to medical care for diabetes and help make diabetes management less costly. (Applies to state-regulated health and disability insurance.) Prescription insulin drugs must be covered without being subject to a deductible, and any cost sharing paid by an enrollee must apply toward the enrollee's deductible obligation. The HCA must monitor the price of insulin products sold in the state. Establishes the Total Cost of Insulin Work Group to design strategies to reduce the cost of and total expenditures on insulin for patients, health carriers, payers, and the state. Allows the HCA to become, or designate a state agency to become, a licensed drug wholesaler or registered pharmacy benefit manager, or purchase prescription drugs on behalf of the state directly from other states or in coordination with other states under certain circumstances. To the extent permitted under current law, the HCA and the Consortium may begin implementation of the strategies without further legislative direction. | Enacted |
31 | Imposing cost-sharing requirements for coverage of insulin products | E2SSB6087 (Keiser) | Caps the total out-of-pocket cost for a 30-day supply of insulin at $100 for two years to help increase access to medical care for diabetes and help make diabetes management less costly. (Applies to state-regulated health and disability insurance.) The HCA must monitor the price of insulin products sold in the state. This requirement would apply to high deductible accounts with health savings plans, but if the IRS removes insulin from the list of preventative medications, then a health plan must set the out-of-pocket amount at the lowest amount allowable. Cap expires upon the implementation of a centralized state insulin purchasing program. The requirements in this bill expire on January 1, 2023. | Enacted |
32 | Establishing prescription drug affordability board - Vetoed | SSB6088 (Keiser) | Establishes the prescription drug affordability board (Board), subject to appropriation, to identify prescription drugs priced above a certain threshold, or with large price increases, including generic drugs which cost $100 or more for a 30-day supply or less which have increased in price by 200% or more in the past 12 months. Authorizes the Board to conduct cost reviews of drugs and set upper payment limits for state purchasers. Requires the Board to determine if a drug has led to, or will lead to, excess costs. Authorizes the Board to suspend payment limit if there is a drug shortage in Washington or a drug is placed on FDA's drug shortage list. House amendments: Removes the authority of the Board to set the upper payment limit for state purchased health care. Requires the Board to provide the Health Care Cost Transparency Board with recommendations for the means and methodologies to establish a cost growth benchmark for prescription drugs. Modifies the price and price increase thresholds for the drugs the Board must identify and includes any drug or biological product that exceeds the relevant benchmark set by the Health Care Cost Transparency Board. Modifies the Board's cost review process and allows the Board to consider the amount of public funding received for the development of the prescription drug or biological product. Authorizes the Board to make recommendations to mitigate the cost of certain prescription drugs, to request that drug manufacturers provide further information, to enter into negotiations to reduce the cost of certain prescription drugs, and to post the Board's proposed value on the HCA's web site. | Vetoed |
33 | OTHER HEALTH CARE ACCESS RELATED BILLS | |||
34 | Creating Washington state office of equity - Partial veto | 2SHB1783 (Gregerson) | Establishes the Washington State Office of Equity (Office) with goal of promoting access to equitable opportunities and resources that reduce disparities based on race, ethnicity, gender and other characteristics. Creates Community Advisory Board to advise the Office on its priorities and timelines. Requires state agencies to apply equity lens to agency decision-making; designate a diversity, equity, and inclusion liaison; develop plans for diversity, equity, and inclusion and for language access; and collaborate with Office to establish performance measures. Equity Office to promote access to equitable opportunities and resources that reduce disparities and improve outcomes statewide across state government. Allows the Office to develop policy positions and legislative proposals. Partial veto: The Governor vetoed the section creating a Community Advisory Board and the section directing state agencies to, among other things, develop plans and policies and provide data and information. | Partial veto |
35 | Establishing health care cost transparency board | 2SHB2457 (Cody) | Establishes the Health Care Cost Transparency Board to analyze total annual health care expenditures and health care cost growth, establish a health care cost growth benchmark and, after review and consultation with identified entities, identify health care providers and carriers exceeding the health care cost growth benchmark. Members of the Transparency Board must not have a financial conflict of interest. Directs Transparency Board to establish committee on data issues and an advisory committee of health care providers and carriers. Requires the board, in calculating total health care expenditures and cost growth, to take into account patient health status, utilization, intensity of services, and regional differences in input prices. Also requires the board, beginning in 2023, to analyze the impacts of various cost drivers to health care, and incorporate the analysis into determining the annual total health care expenditures and in establishing the annual health care cost growth benchmark. | Enacted |
36 | Services for children with multiple handicaps | HB 2599 (Eslick) | Repeals the Children with Multiple Handicaps program, a program similar to the current Medically Indigent Children's program, but that was never funded or implemented. | Enacted |
37 | Northwest Health Law Advocates | 206.325.6464 | nohla@nohla.org April 14, 2020 | |||