NoHLA Legislative Update 2017 - #2
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Northwest Health Law Advocates
Health Care Access in the Washington Legislature - Bills of Interest
Update #2 (March 15, 2017)
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Bill NameHouse Bill/ main sponsor Senate Bill/ main sponsorSummary DescriptionStatus
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PUBLIC PROGRAMS
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Health care for Pacific Islanders residing in WA under a compact of free associationSHB 1291 (Santos)Creates the COFA premium assistance program for enrollment in Qualified Health Plans in the WA Health Benefit Exchange.The program would pay premiums for persons from the compact of free association (COFA) islands (Palau, Marshall Islands, and Micronesia) who have income less than 133% of the federal poverty level. These persons generally do not qualify for Medicaid due to their specific immigration status. Bill is null and void unless funded in the budget.Senate Ways & Means
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Notice of charity care availabilityESHB 1359 (Jinkins)Requires hospital billings to include a statement notifying patients that they may qualify for a discount regardless of whether they have insurance, and providing contact information. Notice must be provided in English and the most common non-English language spoken in the hospital service area. Hospitals are not required to alter preprinted billing statements existing as of 10/1/17.Senate Health
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Oral health pilot program2SSB 5540 (Walsh)3-year pilot program ("oral health connections") to be developed jointly by WA Dental Foundation and HCA to test enhanced rates and additional periodontal services for pregnant women and adults with diabetes. This is modeled after the ABCD program that has provided better dental access to babies and children. Dental Foundation will do outreach and related services for the pilot. Annual report to legislature required.  House Health
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Hearing instrument coverage2SSB 5179 BaileyRequires coverage for hearing instruments under public employee and Medicaid programs when "medically necessary," effective 1/1/18. Coverage must include a new hearing instrument every five years or when alterations to the existing device cannot meet the needs of the patient; also includes services and supplies. Bill is null and void unless funded in the budget.House Health
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Requiring health plans to cover, with no cost sharing, all preventive services required to be covered under federal law as of 12/31/16ESHB 1523 (Robinson)Requires health plans to provide coverage for the preventive services required under the Affordable Care Act as of 12/31/16, without cost-sharing.Senate Health
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State health insurance pool 2SHB 1338 Cody Extends the current sunset date of the Washington State Health Insurance Pool (WSHIP) for non-Medicare clients from December 31, 2017 to December 31, 2022. Bill is null and void clause if funding is not appropriated in the budget.Senate Health
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PRIVATE INSURANCE AND HEALTH BENEFIT EXCHANGE
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Protecting consumers from charges for out-of-network health servicesESHB 2114 (Cody)Prohibits "balance billing" for emergency services and surgeries provided at an in-network hospital, when the patient receives treatment from an out-of-network provider - one who does not have a contract with the patient's health insurer. Emergency services is defined to include treatment for mental health and substance abuse disorder conditions. Non-emergency hospital services covered by the bill are limited to surger and ancillary services: anesthesiology, pathology, radiology, laboratory, and hospitalist services. Protections exist only in situations in which either (a) an in-network provider was unavailable; (b) the need for the services arose at the time the services were rendered and was unforeseen; or (c) the services were provided without the patient's consent. In situations covered by the bill, the patient may not be charged higher "out-of-network" copayments, coinsurance and deductibles; providers are limited to billing patients only at their insurer's in-network rates. A written explanation of benefits must be provided and various other consumer protections apply in the billing process. A dispute resolution process is available for providers and insurers to resolve payment in these situations. Detailed individual notices must be provided by the hospital 10 days before the date service is scheduled, regarding out-of-network status of their providers, insurance treatment of out-of-network costs, and other information. Provider groups and facilities must notify carriers of their network status and carriers must update provider directories within 30 days. Penalties and remedies apply for violations.Senate Health
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Fair dental insurance practicesESHB 1316 (Caldier)Requires carriers providing dental plans to have a utilization review program description and criteria based on prevention of dental disease and chronic disease implications; they may not retrospectively deny coverage of services that were prior authorized at the time care was rendered, or subject providers to additional oversight solely because the provider, on behalf of a patient, files an appeal or grievance. This does not apply to fully capitated dental plans. OIC shall convene a workgroup to examine current carrier practices related to stand-alone dental plans' explanations of benefits sent to covered persons.Senate Health
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PUBLIC HEALTH
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Foundational public health servicesESHB 1432 (Robinson)Requires the Department of Health (DOH) and local health jurisdictions to undertake a shared services project for epidemiology assessment and communicable disease monitoring and response; DOH shall also develop a public health improvement plan. Bill is null and void unless funded in the budget.House Rules
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Rapid health information network data reportingSSB 5514 (Rivers)Mandates emergency departmet syndromic surveillance reporting to the Dept of Health. Patient data may be used for public health purposes so long as patient confidentiality is maintained.House Health
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HEALTH CARE PROVIDERS AND FACILITIES
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Dental health services in tribal settings
SSB 5079 (McCoy) Authorizes dental health aide therapist services provided by Indian tribes, tribal organizations, and urban Indian organizations to promote increased dental care access for persons served in these practice settings. Requires the state to seek federal Medicaid funding for these services.Passed, Governor signed
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Telemedicine locationsSB 5436 (Becker)Amends existing telemedicine statutes. Expands patient access to health services through telemedicine by further defining where a patient may receive the service as home or "any location determined by the individual receiving the service." Applies to Medicaid managed care plans, public employee (PEB) health plans, and other health plans in the state governed by RCW 48.43. Effective 2018.House Health
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Assistance with Activities of Daily Living in Assisted Living FacilitiesSHB 1671 (Cody)Amends RCW 18.20.310 so that the definition of Activities of Daily Living now includes Medication assistance, as defined in RCW 69.41.010.Senate Rules
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PATIENT HEALTH INFORMATION, PRIVACY AND CONSENT
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Protecting nonpublic personal health information held by the OICSHB 1043 (Robinson)Nonpublic personal health information obtained by , disclosed to, or in the custody of the OIC is confidential and not subject to public disclosure. This information shall not be used by the OIC except in the course of regulatory or legal action as part of the commissioner's official duties.Senate Health
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Expanding the scope of entities to whom mental health information and records may be disclosed without the patient's authorizationSHB 1413 (Cody)SSB 5435 (Rivers)Expands the authority to disclose mental health information without a patient's authorization to all health care providers when providing care to a patient. Allows the disclosure of mental health information to certain persons who requires it to assure coordinated care and treatment of a patient. Persons who may use or disclose the mental health information must take appropriate steps to protect it.SHB 1413 - Senate Human Services; SSB 5435 - House Health
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Expanding ability of the Department of Health to share prescription monitoring program data2SHB 1426 (Robinson)Expands the list of individuals and entities with whom the Department of Health may share data from the prescription monitoring program (PMP). Expands the permissible uses of this data. Extends immunity for accessing this data to include any person authorized to receive the data, instead of only dispensers and practitioners, and clarifies that this immunity protects against disciplinary actions, and not just legal actions; the scope of legal immunity conferred by the statute is expanded as well. By 1/21/2023, entities with access to PMP data that use electronic health records and that offer state-purchased care must integrate their electronic health records into the PMP. Beginning 11/15/2017, DOH shall annually report to the Governor and applicable legislative committees on the number of entities of specified types that integraed their EHR with the PMP suing the state health information exchange. This law is null and void if funding is not appropriated for its implementation.Senate Health
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Social Security medical recordsESHB 1239 (Sullivan)Requires health care facilities and providers to provide free copy of medical records to a patient or patient representative requesting them to appeal a denial of SSI or SSDI benefits.  Senate Health
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Consent for nonemergency, outpatient, primary health care services for unaccompanied homeless youthSHB 1641 (McBride)Provisions re authority for third parties to consent to nonemergency outpatient primary care services for homeless youth are transferred from the school code in 28A.320 RCW to 7.70 RCW, to consolidate them with statutes more generally describing authority to consent for health care. A school nurse, counselor or homeless student liaison may provide informed consent for such treatment for children defined as homeless under the McKinney-Vento Act who are not in the supervision or control of a parent, guardian or DSHS. Individuals authorized to give this consent, as well as their employing school, are immune from administrative or civil liability for consenting or not consenting to care pursuant to this bill. Persons authorized to consent to these types of care for homeless youth under the listed circumstances may be required by a facility or provider to furnish a delaration stating that they have one of the positions that authorizes them to give such consent. Health care providers may rely on the representations or declarations of an individual that they have the listed qualifications to give consent for treatment of this type, if the provider does not have actual notice that these representations are false. Senate Health
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REPRODUCTIVE HEALTH
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Addressing private health plan coverage of contraceptivesSHB 1234 (Robinson)Requires a health benefit plan that includes coverage for contraceptive drugs to provide reimbursement for a twelve-month refill of contraceptive drugs obtained at one time by the enrollee.Senate Health
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Providing reasonable accommodations in the workplace for pregnant womenESHB 1796 (Farrell)Requires employers to provide reasonable work requirements for pregnancy-related conditions. Requires employers with 15 or more employees to provide reasonable accommodation for pregnancy-related conditions unless the accommodation would impose an undue hardship on the employer's business. Requires certain health care facilities to establish maternal-newborn bonding practices. Establishes a Healthy Pregnancies Advisory Committee focused on improving maternal and infant health outcomes. If specific funding not provided, act is null and void. Senate Committee on Commerce, Labor & Sports amended bill to reflect language of SSB 5835 (see below).
Senate Ways & Means
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Promoting healthy outcomes for pregnant women and familiesSSB 5835 (Keiser)Same as ESHB 1796, but also requires (1) facilities serving Medicaid clients to provide skin-to-skin placement to promote breastfeeding and post-delivery room-in practices, (2) performance measures for ARNPs and certified nurse midwives, and (3) report to Governor and Legislature on provider performance; and does not include null and void clause.House Labor & Workplace Standards
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BEHAVIORAL HEALTH--MENTAL HEALTH AND SUBSTANCE USE DISORDERS
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Requiring health care disciplining authority to establish standards for prescription of opioids; and, requiring prescribers to complete continuing education on opioid prescription. ESHB 1339 (Cody)By 7/1/2018, health care disciplining authorities must adopt rules governing opioid drug prescriptions consistent with Washington State interagency guideline; violation of these rules will constitute unprofessional conduct. Prescribers must complete an hour of continuing education on opioid prescription best practices, on a one-time basis.Senate Health
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Modernizing substance use disorder professional practice ESHB 1340 (Cody)"Chemical dependency": professionals are now referred to as "substance use disorder" professionals. "Core competencies" of SUD professionals are no longer legally required to be oriented to assist patients achieve and maintain abstinence and develop individual support systems. SUD professionals may treat patients in settings other than SUD treatment programs. Provisions transferring specified authorities from DSHS to HCA are effective only if the Legislature approves and the governor signs SHB1388, SSB 5259, or their successors, which would more broadly transfers oversight and purchasing authority for behavioral health services from DSHS to HCA. Senate Health
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Addressing the requirements and oversight of opioid treatment programs. ESHB 1427 (Cody)Shortens the list of factors that DSHS must consider in reviewing and deciding whether to grant an application for certification of an opioid treatment program. Among other things, DSHS need not demonstrate need for the program to approve its certification. Public hearing requirements are changed to require DSHS to hold a single hearing on the application in the community in which the facility is to be located. Counties and cities cannot require special use permits for citing opioid treatment programs. Removes general 350-patient limit for these programs, although counties may impose a patient limit at or above that level based on specific local conditions. Loosens program oversight and reporting requirements. References to "certification" of a program are changed to "licensing and certification" if SHB 1388 or SSB 5259 are enacted.Senate Health
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Transferring designation and related powers and duties of behavioral health authority to HCASHB 1388 (Cody)Transfers responsibilities for the oversight and purchasing of behavioral health services from the Department of Social and Health Services (DSHS) to the Health Care Authority (HCA), except for the operation of the state hospitals. DSHS and HCA share authority over ITA'd minors ordered into less restrictive treatment. Adds psychiatric ARNPs as mental health professionals in children's mental health and crisis response laws and removes the requirement that they have two or three years experience treating MH conditions. Transfers responsibilities for the certification of behavioral health providers from the DSHS to the Department of Health. Adds certain MH provider types as those who may become designated crisis responders.Senate Health
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Implementing recommendations from the children's mental health work groupE2SHB 1713 (Senn)Requires recommendations from children's mental health work group be implemented to address systemic barriers children and their families face to access necessary mental health services in order to improve mental health care access for children and their families through the early learning, K-12 education, and healthcare systems. Providers are encouraged to use behavioral health therapies and other therapies that are empirically supported or evidence-based and only prescribe medications for children and youth as a last resort. Effective dates are contingent on the availability of funds appropriated.Senate Human Services
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Concerning curricula for persons in long-term care facilities with behavioral health needsESHB 1548 (Schmick)Requires minimum competencies and standards be established for the approval of curricula for facility-based caregivers serving persons with behavioral health needs and geriatric behavioral health workers which includes at least thirty hours of training specific to the diagnosis, care, and crisis management of residents with a mental health disorder, traumatic brain injury, or dementia. Behavioral health conditions are defined as one or more behavioral
symptoms specified in Section E of the Minimum Data Set.
Senate Health
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Concerning behavioral health integration in primary careSSB 5779 (Brown)Defines “primary care behavioral health” as a health care integration model in which behavioral health care is colocated, collaborative, and integrated within a primary care setting. Requires review and adjustment to payment rules to facilitate integration of behavioral health in primary care settings by August 2017, including increased reimbursement to providers for behavioral health services provided to patients in primary care settings. Identifies outcomes upon which contract performance measures shall be developed.House Health
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Reducing certain documentation and paperwork requirements in order to improve children's mental health and safety.E2SHB 1819 (Dent)Requires the department of social and health services to take steps to reduce paperwork and documentation requirements which are inefficient or duplicative for providers of children's mental health services. Funding must be provided by June 2017 or Act is null/void.Senate Human Services
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PRESCRIPTION DRUGS
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Addressing prescription drug cost transparency2SHB 1541 (Robinson)By March 1st of each year, issuers must provide prescription drug cost and utlization data, enrolleee spending data, and a summary analyis of the impacts of prescription drug costs to a data collection organization selected by the Office of Financial Management (OFM). Beginning 10/1/17, drug manufacturers that sell prescriptions drugs in Washington must give the data organization specific types of mostly financial data regarding drugs they sold for which there was a significant increase in price in the previous 1-3 years. The data organization shall compile the data and prepare an annual report summarizing the data and submit it to OFM and designated legislative committees by 11/15/2018 and annually thereafter. OFM may adopt rules and impose fines up to $1000/day for noncompliance. By 11/15/2018, HCA will update the Legislature regarding value-based purchasing, prescription drug return on investment strategies, and recommendations for improving drug price and value transparency. This law is null and void if no specific funding is appropriated by June 30, 2017 to implement it.Senate Health
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OTHER HEALTH CARE ACCESS RELATED BILLS
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Providing public notices of public health, safety and welfare in languages other than EnglishSSB 5046 (Hasegawa)State agencies required to provide public notices to a community or area regarding an imminent or emergent risk to public health, safety or welfare, shall provide the notices in a way that has been determined to be most effective in communicating with significant segments of the communities who speak a language other than English. Emergency management contractors issuing notices during emergencies shall do this also. This doesn't apply to rulemaking govered by the state Administrative Procedures Act. "Significant segment" is defined as five per cent or more of the residents or 1000 residents of the applicable city, town or county, whichever is fewer, who have limited English proficiency. Political subdivisions shall keep or maintain access to updated demographic data and information on the languages represented in their communites and provide access to this information to those authorized to issue emergency notices on their behalf. Political subdivisions can contract to provide emergency communications to disaster victims using the methods most likely to reach significant segments of the population in a manner determined to be most effective at conveying emergency information.House Public Safety
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Expanding ability of providers and debt collectors to charge prejudgement interest on and more easily prove a claim for an alleged medical debt.ESSB 5456 (Braun)Currently, entities owed a debt may assess prejudgement interest on the debt only when the debt is "liquidated" (meaning that the amount of the debut is specifically determinable.) This bill states that debts are "deemed" liquidated (even if they are not actually determinable or contested) at dates that vary slightly depending on the type of debt. Medical debts are deemed liquidated 120 days from the due date listed in a payment demand or when transferred to a debt collector, whichever is later. Debts for "medical or other professional services," even when rendered pursuant to a contract are considered "accounts receivable," excluding obligations incurred through medical assistance programs administered by HCA or DSHS (e.g., Washington Apple Health). This enables a party to initiate (and win) a legal action to collect the debt without having to prove that there was actually an initial agreement that gave rise to the asserted debt.House Judiciary
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Establishing the legislative advisory committee on agingESSB 5180 (Bailey)Establishes the legislative advisory committee on aging through July 2019 to review issues of importance to Washingtonians with disabilities and the aging community including housing, long-term care, health and wellness, transportation, financial, and others determined by the committee.
House Health
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Northwest Health Law Advocates | 206.325.6464 | nohla@nohla.org
March 15, 2017
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