NoHLA Legislative Update 2017 - #3
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Northwest Health Law Advocates
Health Care Access in the Washington Legislature - Bills of Interest
Update #3 (March 30, 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 Ways & Means
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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. 
Amendment in House: adds leg intent that the pilot will reduce prevalence of preeclampsia and gestational diabetes in pregnant women and heart disease, kidney disease, blindness and amputations in adults with diabetes; final report must include assessment of effectiveness in doing this.
House Appropriations
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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.
Amended in House Health to remove option for more than 1 instrument in 5 years for PEBB. Rearranges but retains language allowing more often than that for Medicaid clients "if alterations to the existing hearing instrument cannot meet the needs of the patient."
House Appropriations
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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 Rules
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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 Ways & Means
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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.Senate Ways & Means
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Rapid health information network data reportingSSB 5514 (Rivers)Mandates emergency department 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 Rules
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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 Rules
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Hospital Safety Net AssessmentHB 1766 (Jinkins)Extends the expiration date from 7/1/19 to 7/1/21 for the hospital safety net assessment, a tax on hospitals that returns significant federal funds to the state for low-income health care. Makes changes to formula and hospital payment amounts; provides additional funds to hospitals based on serving low-income patients.House Appropriations
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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. OIC must obtain patient consent for each release of nonpublic personal health information, describing the information to be shared and with whom. Senate Rules
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Expanding the scope of entities to whom mental health information and records may be disclosed without the patient's authorizationSSB 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 require 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.House Rules
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Expanding ability of the Department of Health to share prescription monitoring program dataE2SHB 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 (possibly NTIB)
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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. Providers may seek payment for care provided to minor patients.Senate Rules
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REPRODUCTIVE 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 Rules
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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 Appropriations
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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. Abstinence is a goal of SUD counseling, although this doesn't bar the use of lawfully prescribed medication to treat SUDs. SUD professionals may use that title outside of programs under the Community Mental Health Services Act.Senate Rules
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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 Ways and Means
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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. HCA shall create a work group to research and report on options for contracting and delivery of intergrated behavioral health services, including the consideration of serveral specified models. The work group includes HCA, DSHS, BHOs, MCOs, counties, BH providers and legislators from each caucus and shall issue a report by Decemb er 1, 2017.Senate Ways and Means
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Concerning behavioral health system reformESSB 5894 (O'Ban)Revises the involuntary treatment act, the community mental health services act, criminally insane provisions, and public and private facilities for the mentally ill with regard to: (1) Integrating risk for long-term civil involuntary treatment into managed care by January 2020; (2) Development of community long-term involuntary treatment capacity prior to risk integration; (3) State hospital short-term reforms including enhanced capacity for community placements; (4) Improving access to assisted outpatient mental health treatment; (5) Reducing demand for forensic services; (6) Addressing managed care entities to provide fully integrated care; and (7) Data measurement.House Appropriations
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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 Ways and Means
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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 Appropriations
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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 Ways and Means
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Prescription monitoring programSSB 5248 (Rivers)Extends the entities and individuals with access to the Department of Health's (DoH's) otherwise confidential data on the Prescription Monitoring Program (PMP). DoH shall furnish to provider entities information on individual prescriber's practices for internal quality purposes, although this information can't be the sole basis for adverse actions against the prescribers. Specified commissions and boards shall adopt rules on the management of surgery and injury-induced acute pain, in consultation with agency medical directors' group, DoH, the Univesit of Washington, and professional associations. Senate Rules (possibly NTIB)
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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 (possibly NTIB)
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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)When emergencies are proclaimed by the governor or political subdivisions, life safety information shall be offered in a language or manner understood by signficant populations segments, unless technologically infeasible. Local and joint local emergency management organizations must include a comunication plan for notifying significant population segments of life safety information during an emergency, as part of their local comprehensive emergency magagement plans. Lists factors to be considered in determining the obligation to provide emergency notification to significant population segments. These communication plans must be submitted to the Washington military department emergency management division with the next emergency management plan and updated as required thereafter. The military division must report to the Legislature on December 1, 2019 and every five years thereafter on compliance with this and how and when these communications plans were deployed. "Significant segment" is defined as each limited English proficiency langauge group that constitutes five per cent or more of the residents or 1000 residents of the population of persons eligbile to be served or likely to be affected in the applicable city, town or county, whichever is fewer. Use OFM's LEP population estimates when making these calculations. Null and void if no appropriations are made by June 30, 2017.House Appropriations
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Northwest Health Law Advocates | 206.325.6464 | nohla@nohla.org
March 30, 2017
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