NoHLA Legislative Update 2018 - #2
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Northwest Health Law Advocates
Health Care Access in the Washington Legislature - Bills of Interest
Update #2 (February 20, 2018)
Bill NameHouse Bill/ main sponsor Senate Bill/ main sponsorSummary DescriptionStatus
Health care for Pacific Islanders residing in WA under a compact of free associationSSB 5683 (Saldaña)Creates the COFA premium assistance program for enrollment in Qualified Health Plans in the WA Health Benefit Exchange.The program would pay premiums and out-of-pocket costs (cost-sharing) for persons from the compact of free association (COFA) islands (Palau, Marshall Islands, and Micronesia) not eligible for federal or state medical programs who have income less than 133% of the federal poverty level and enroll in Silver plans.These persons generally do not qualify for Medicaid due to their specific immigration status. Program is subject to appropriation. Comprehensive community education and outreach is required to facilitate applications, starting no later than 9/1/18. An advisory committee to HCA and a report on implementation are required.House Appropriations
Charity care and notice requirements without restricting charity careSHB 2836
SSB 6273 (Cleveland)Hospitals must develop training programs on the hospital's charity care policy and use of interpreter services, and must post and prominently display notice of charity care availability in areas where patients are admitted or registered, in emergency departments, and financial service or billing areas where accessible to patients. Current versions of the hospital's charity care policy, a plain language summary of the policy, and the application form must be available on the hospital's website. Notice must be posted in all languages spoken by more than 10% of the population of the hospital service area. All hospital billing statements/written communications about billing/collection must include a statement prominently displayed on the first page, in English and the second most spoken language in the hospital's service area, informing people about charity care, in these or similar words: "You may qualify for free care or a discount on your hospital bill, whether or not you have insurance. Please contact our financial assistance office at [website] and [phone number]." Definitions of charity care and third party coverage are revised. Clarifies that the provision regarding charity care coverage for the full amount of hospital charges for persons with a family income below 100% FPL except to the extent that the patient has third-party coverage for the charges. House bill clarifies that for purposes of charity care eligibility, income refers to the patient's annual income at the time health care services are rendered, or at the time of application if the application is made within two years of the services, the patient has been making good faith efforts towards the payment of health care services, and the patient demonstrates eligibility for charity care; and states that hospitals may consider applications for charity care at any time. Senate Health; House Health
Increasing the personal needs allowance for people in residential and institutional care settingsSHB 2651 (Stanford)

Addresses the amount of the Personal Needs Allowance (PNA) for those on Medicaid Long-term Care programs, raising it effective January 1 2019 to $70/month from the current $57/month (for nursing home residents) and $63/month (for residents in alternate living facilities - Assisted Living and Adult Family Homes). The PNA is the amount of the person's own income they can keep for personal expenditures (clothing, shoes, cell phone, etc.) after required allocations of their income to their cost of care and certain other categories. Delays last year's Cost of Living Increase provision to start in January 2020 instead of July 2017.Senate Ways and Means

Concerning foster youth health care benefitsSHB 2530 (Senn)Allows the parent or guardian of a child who is no longer a dependent child to continue enrollment in the integrated managed health care plan for foster children for up to twelve months following reunification with the child's parents or guardian if the child meets certain criteria.Senate Ways & Means
Expanding the access to baby and child dentistry program to serve children with disabilitiesSSB 6549 (Rolfes)Expands access to the baby and child dentistry program to include children with disabilities as eligible clients until their thirteenth birthday.House Health
Requiring coverage for hearing instruments under public employee and medicaid programs.E2SSB 5179 (Bailey)Requires coverage for hearing instruments under public employee and Medicaid programs as of 1-1-19. For Medicaid, must include coverage for hearing instruments when medically necessary. Coverage must include a new hearing instrument every five years, a new hearing instrument when alterations to the existing hearing instrument cannot meet the needs of the patient, and services and supplies such as the initial assessment, fitting, adjustment, and auditory training. The public employee benefit does not include the requirement it be "medically necessary" (that may be addressed elsewhere in the public benefit laws), and it does not provide for a new instrument when alterations cannot meet the needs of the patient. The Medicaid program, but not the public employees program, is null and void unless funded in the budget.
House Health Committee 2-16 amendment: Adds licensed physicians or osteopathic physicians who specialize in otolaryngology to the list of health care professionals who may recommend or dispense a hearing instrument.
House Appropriations
Drug and gene therapy payment for medicaid MCOsESHB 2565 (Schmick)Substitute bill reframes the subject as new drugs and “innovative” therapies, instead of “gene” therapies. It eliminates provisions related to the Pharmacy and Therapeutics Committee and the assignment of financial responsibility for these treatments. Adds members from each of the Medicaid MCOs to the HCA Drug Utilization Review Board (DUR Board). Directs the DUR Board to consider “the safety, efficacy, and cost-effectiveness of new drugs and innovative therapies compared to other equally effective, more conservative, or substantially less costly courses of treatment that are available or suitable” n recommending to HCA what therapies to cover for Medicaid. HCA maintains the discretion to select other members as necessary to meet the purposes and composition of the DUR Board.Senate Health
Changing the designation of the state behavioral health authority from DSHS to HCA and transferring the related powers, functions, and duties to HCA and the department of health. 2ESHB 1388 CodyTransfers 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. Transfers responsibilities for the certification of behavioral health providers from DSHS to the Department of Health.Senate Ways & Means
Updating Health Benefit Exchange statutesSHB 2516 (Cody)Removes all references to the Affordable Care Act found in the Health Benefit Exchange (HBE) statutes. Repeals or consolidates any responsibilities and duties that were only needed to establish the Exchange. Requires members of the HBE Board to serve until a successor has assumed office, following the expiration of their term. Amends language concerning the assessment on insurers to fund exchange operations for the following calendar year, to include three months of additional operating costs. Allows HBE to offer information to consumers and small businesses about qualified small employer health reimbursement arrangements.Senate Health
Preserving access to individual market health care coverage throughout Washington state.ESHB 2408 (Cody)For 2019 only, carriers shall allow people in counties with no individual market plans offered, other than catastrophic plans, to buy a plan the carrier offers in another county within the geographic rating area. In determining network adequacy in that situation, the commissioner shall take into account the availability of telemedicine services and consider carrier requests to deliver services using all access points in the neighboring counties. WSHIP (the state high risk pool) would not be available to persons eligible to purchase coverage outside the county under this arrangement. Premium ubsidies for WSHIP in bare counties in earlier version of bill were eliminated in amended bill. Beginning in 2020, requires a health carrier to offer qualified health plans (QHPs) at both silver and gold levels in any county where it offers a fully-insured health plan approved by the School Employees' Benefits Board (SEBB) or Public Employee Benefits Board (PEBB).Senate Health
Establishment of an individual health insurance market claims-based reinsurance programSHB 2355 (Cody) Insurance Commissioner request 2SSB 6062 (Cleveland) Insurance Commissioner request Requires a reinsurance program for the individual market, contingent on getting a federal state innovation waiver to implement the program by 4/1/18, with the goal of mitigating health insurance premium increases. Program to be operated by Washington Vaccine Association and overseen by a Reinsurance Program Board. Funds collected through assessments and the federal waiver are used to reimburse insurance carriers for claims for individual enrollees that exceed an amount determined by OIC, with a total cap of $200 million per year. House bill requires assessments on all health carriers and third-party administrators (TPAs) to fund the reinsurance program, with limited exceptions. The Senate bill removed the assessment financing provision. Both bills require OIC to conduct study of alternative financing mechanisms for the program and submit recommendations to the Legislature. Additional details in bills.House Rules; Senate Rules
Protecting consumers from charges for out-of-network health servicesESHB 2114 (Cody) Insurance Commissioner requestProhibits "balance billing" for emergency services, and for non-emergency surgeries and ancillary services, provided at an in-network hospital or ambulatory surgical facility, 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 surgery and ancillary services: anesthesiology, pathology, radiology, laboratory, and hospitalist services. 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. Providers may not report adverse information to a consumer credit reporting agency or commence a civil action against the enrollee before the expiration of 150 days after the initial billing for the amount owed and may not use wage garnishments or liens on the enrollee's primary residence to collect these amounts. The carrier must pay the provider the greater of the following allowed amounts that include applicable in-network cost-sharing: (a) the median in-network amount paid to providers for the service, (b) the median out-of-network amount paid to providers for the service, (median amounts are determined through the WA All-Payer Claims Database), or (c) 175% of the Medicare rate for the service. A dispute resolution process is available for providers and insurers to resolve payment in these situations. Provider groups not employed by a hospital or ambulatory surgical facility must notify that facility of the carrier health plan provider networks in which they are in-network, including at least 45 day advance notice of any termination. Each hospital or ambulatory facility must post information on its website, if one is available: (a) a list of the carrier health plan provider networks with which the hospital or ambulatory surgical facility is an in-network provider; and (b) for each nonemployed provider group with which the facility has a contract to provide surgical or ancillary services, whether the provider group contracts with the same carrier health plan provider networks as the facility. A health care provider must provide information on its web site, if available, listing the carrier health plan provider networks with which the provider contracts. Each health carrier must keep its provider directory and website up to date and must provide information to enrollees including a clear description of out-of-network health benefits, notice of rights, and other information. Penalties and remedies apply for violations. OIC shall develop standard template notices of rights for consumers to be provided by carriers, providers and facilities. Network Adequacy: (1) Requires the Insurance Commissioner, when determining the adequacy of provider networks, to consider whether an insurer's network includes a sufficient number of contracted providers practicing at the same facilities with which the insurer has contracted for the network to reasonably ensure that enrollees have in-network access for covered benefits delivered at the facilities. (2) Requires a hospital or ambulatory surgical facility to provide an insurer with information about the network status of nonemployed provider groups that provide services at the hospital or ambulatory surgical facility. Senate Health
Exploring enforcement of a requirement to maintain minimum essential health care coverageESSB 6084 (Cleveland)States legislative intent to avoid individual market collapse by exploring options on implementing and enforcing a state "individual mandate" to maintain minimum essential health care coverage. Establishes a task force on exploring creation of individual mandate enforcement mechanisms and other options to incentivize maintaining minimum essential coverage, to report to the legislature by 12/1/18. The task force is to be open to the public and provide an opportunity for public comment.House Health
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
Insurance coverage of tomosynthesis or three-dimensional mammographySB 5912 (Kuderer)Directs OIC and HCA to clarify that existing mandates for mammography include three-dimensional mammography.House
Medical records to support an application for social security benefitsESHB 1239 (Sullivan)Requires health care facilities, providers, and insurance issuers to provide, on request, one free copy of a person's health care information if the person is appealing the denial of federal Supplemental Security Income or Social Security Disability benefits.Senate Rules
Health plan prior authorizationESSB 6157 (Short)Health carriers are prohibited from requiring prior authorization for initial evaluation and management visits; and up to six consecutive treatment visits in a new episode of care of chiropractic, physical therapy, occupational therapy, east Asian medicine, massage therapy, and speech and hearing therapies that meet the standards of medical necessity and are subject to quantitative treatment limits of the health plan. (The original bill prohibited PA for up to 12 visits in a new episode of care.) House Health
Defining community health workers and their roles2SHB 2436 (Robinson)Defines "community health worker" and their roles to create consistency across the state.House Rules
Age of individuals at which sale or distribution of tobacco and vapor products may be madeSSB 6048 (Kuderer)Raises the age at which a person may purchase and possess cigarettes, tobacco, and vapor products from 18 to 21 years of age. Requires licensed retailers to display signs stating the age restriction for purchasing tobacco or vapor products. Senate Ways & Means
Consumer directed employment programESSB 6199 (Cleveland)Authorizes DSHS to establish a program to contract with a "Consumer Directed Employer" to be the legal employer of individual care providers (serving Medicaid clients in long term care programs) for purposes of performing administrative functions. The "CDE" would address tax withholding and filing, verifying employee qualifications, and other administrative functions. The CDE and the consumer (care recipient) are "coemployers" of the worker, with the CDE the "legal employer" and the consumer the "managing employer." Establishes a rate-setting board to determine IP labor rates and CDE administrative rates. Modifies the IP overtime expenditure requirements. The CDE can refuse to employ an individual provider (IP) who may not be able to meet the needs of a particular consumer; assign an IP who has been dismissed by a consumer to a different consumer who selects the IP; provide information to a consumer about an IP's work history as an employee of the CDE; terminate the provider's employment when the individual is not meeting the needs of the consumer. House Health
Respite provider trainingHB 2435 (Kilduff) People working as IPs for personal care services as respite, and work 300 hours per year maximum, can meet training qualifications with only 14 hours of training during first 120 days after starting work as an IP (people working more than 300 hours per year must get 35 hours of training in that time period). This provision already applies to respite workers serving DD clients, but the legislation broadens this to other LTC clients.Senate Rules

Requiring training for long-term care providers on the needs of the LGBTQ populationESSB 5700 (Ranker)Requires long-term care workers, administrators, owners and resident managers of adult family homes, assisted living facilities, and nursing homes to complete training on the needs of the LGBTQ population.House Health
Concerning health care provider and health care facility whistleblower protectionsSSB 5998 (Keiser)Requires the identity of a whistleblower be kept confidential under certain circumstances and allows non-employees to bring a civil action if subject to reprisal/retaliatory action as a result of being a whistleblower.House Judiciary
Stem cell therapies not approved by USFDAESHB 2356 (Cody) Requires licensed health care professionals to notify patients when the stem cell therapy they provide has not been approved by the Food and Drug Administration (FDA).Senate Health
Better access to medical records and telemedicine for injured workersESSB 6226 (Keiser)Requires the department of labor and industries to adopt telemedicine policies developed by the telemedicine collaborative. Requires the telemedicine collaborative to develop a training program for physicians who do independent medical exams through telemedicine, and requires physicians to take the training prior to giving independent medical exams.House Labor
Protecting agricultural workers and community from pesticideE2SSB 6529 (Saldana)Establishes a work group to develop recommendations for improving the safety of pesticide applications. Group must review (1) Existing laws regulating preapplication notification and use reporting, and (2) current data and reports related to strategies to reduce pesticide drift and exposure.House Health
Discovery of privileged health care information in civil rights claimsSB 6027 (Kuderer)Provides that health is not an issue under WA Law Against Discrimination except where claimant alleges diagnosable injury, relies on testimony of health care provider, or alleges disability-related discrimination.House Judiciary
Spoken language interpreter services 2SSB 6245 (Saldana) Requires consolidation of the procurement of spoken language interpreter services for state agencies and limits testing of new interpreters by DSHS based on language. Excludes interpreters for sensory-impaired persons. House Labor
Providing women with timely information regarding their breast health.ESSB 5084 (Rolfes)Requires information that identifies the patient's individual breast density classification to be included in the summary of mammography report provided to patients.House Health
Expanding the classes of persons who may provide informed consent for certain patients who are not competent to consentESHB 2541 (Kilduff)Expands the hierarchy of persons authorized to provide informed consent to health care on behalf of a patient who is not competent to consent to include adult grandchildren, nieces and nephews, aunts and uncles, and other adults that meet certain criteria.Senate Law & Justice
Enacting the employee reproductive choice actSSB 6102 (Ranker)Requires employers who provide health insurance to its employees as part of an employee's benefit package to provide contraceptive coverage at no cost to the employee. Prohibits a health plan, issued on or after January 1, 2019, that includes coverage for contraceptive coverage, from imposing a deductible, coinsurance, copayment, or other cost-sharing requirement on the contraceptive coverage provided.House Judiciary
Concerning health plan coverage of reproductive health careSSB 6219 (Hobbs)Requires a health plan, issued on or after January 1, 2019, to cover: all FDA approved contraceptive methods and voluntary sterilization free of deductibles, coinsurance, copayment, or other cost-sharing requirements; all FDA approved over-the-counter contraceptives without a prescription; abortion services in a substantially equivalent manner as maternity care and services, subject to the same cost-sharing as maternity coverage. Requires the governor's interagency coordinating council on health disparities to conduct a literature review and report its findings by January 1, 2019 on disparities in access to reproductive health care.
House Rules
Concerning midwifery and doula services for incarcerated womenSHB 2016 (DeBolt)Requires the Department of Corrections and jails to make reasonable accomodations for the provision of available midwifery or doula services to inmates who are pregnant or who have given birth in the last six weeks.Senate Rules
Concerning hospital notification of availability of sexual assault evidence kit collectionSHB 2585 (Caldier)Requires any hospital that does not provide sexual assault evidence kit collection, or that may not have appropriate providers available to provide sexual assault evidence kit collection at all times, to develop a plan to assist individuals with obtaining sexual assault evidence kit collection at a facility that provides such collection and provide notice within two hours to every individual who presents to the emergency department of the hospital requesting a sexual assult evidence kit collection that the hospital does not provide such collection or does not have the appropriate providers to do so.Senate Health
Restricting the practice of conversion therapySB 5722 (Liias)Makes it unprofessional conduct for a licensed healthcare provider to perform conversion therapy on a patient under the age of 18. Conversion therapy involves seeking to change an individual's sexual orientation or gender identity, including efforts to change behaviors or gender expressions or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex.House
Concerning opioid use disorder treatment, prevention, and related servicesESHB 2489 (Cody) Governor requestDeclares opioid use disorder is a public health crisis and requires providers inform patients of all evidence-based treatment options including medication, counseling, and social supports. House amended to require the Department of Health to establish a data collection plan for determining the number of opioid-related overdoses occurring in non-English speakers and permits telemedicine for prescriber discussions with the patient for first-time opioid prescriptions.Senate Ways & Means
Removing health coverage barriers to accessing substance use disorder treatment services2SHB 2572 (Cody)Requires health plans and behavioral health organizations cover certain types of substance use disorder treatment without prior authorization or utilization management barriers for the first 24 hours after an enrollee presents for is referred to the services.Senate Human Services & Corrections
Concerning suicide prevention and behavioral health in higher education, with enhanced services to student veteransSSB 6514 (Brown)Creates a statewide resource for behavioral health and suicide prevention for the state's post-secondary institutions that includes representation from a veterans training support center and establishes the suicide prevention in higher education grant.House Higher Education
Strengthening school district plans for recognition, screening, and response to emotional or behavioral distress in studentsSSB 6141 (McCoy)Requires the office of the superintendent of public instruction to develop and make available a one-hour online training module for school staff on recognition, screening, and response to emotional or behavioral distress in students. Requires each educational service district to identify a regional mental health coordinator.
House Education
Improving the behavioral health of people in the agricultural industry2SHB 2671 (Wilcox)Requires the state office of rural health to convene a task force to review issues specific to behavioral health and suicide prevention in the agricultural industry. The task force is to report its findings and recommendations to the governor and the legislature by December 1, 2018. Establishes a pilot program by March 1, 2019 to support behavioral health improvement and suicide prevention efforts for members of the agricultural industry workforce. Senate Ways & Means
Improving access to mental health services for children and youthE2SHB 2779 (Senn)Reestablishes the Children's Mental Health workgroup through December 2020, adds eating disorders in children and youth as an area of focus, adds an additional child/adolescent residency position at University of Washington, and requires DSHS convene an advisory group of stakeholders to review and provide recommendations on the parent-initiated treatment process. Senate Human Services & Corrections
Improving students' mental health by enhancing nonacademic professional services2SHB 1377 (Ortiz-Self)Requires first-class school districts provide a minimum of 6 hours of professional collaboration per year for school counselors, social workers, and psychologists with local mental health centers focused on recognizing emotional/behavioral distress in students and making appropriate referrals. Second-class districts are encouraged but not required to provide the professional collaboration. Convenes a task force on school counselors, psychologists, and social workers to determine the projected need for these professionals in school districts and the current capacity of the state for meeting this need. The task force must report its findings to the legislature by December 1, 2018.Senate Early Learning
Concerning the addition of services for long-term placement of mental health patients in community settings that voluntarily contract to provide the services2EHB 2107 (Schmick)Permits community hospitals and evaluation and treatment centers to become certified to provide long-term mental health placements.Senate Human Services & Corrections
Establishing the mental health field response teams programHB 2892 (Lovick)Requires the Washington association of sheriffs and police chiefs develop and implement a mental health field response team grant program to incorporate mental health professionals into the agencies' mental health field response planning and response.Senate Law & Justice
Expanding the activities of the children's mental health services consultation programSSB 6452 (Brown)Requires the Health Care Authority, in collaboration with the University of Washington department of psychiatry and Seattle Children's Hospital to implement a two year pilot program called the partnership access line for mothers and children to support health care providers to appropriately assess, diagnose, and refer children, pregnant women and new mothers to behavioral health services. House Early Learning & Human Services
Increasing the availability of assisted outpatient behavioral health treatmentESSB 6491 (O'Ban)Modifies involuntary treatment act provisions to include a person with a substance use disorder and creates a process for initial evaluation and filing of a petition for assisted outpatient behavioral health treatment.House Judiciary
Protecting consumers from excess charges for prescription medications SHB 2296 (Slatter)Prohibits a contract between a pharmacy benefit manager or insurer and a pharmacist or pharmacy from penalizing their disclosure of certain information to a customer regarding: (1) the cost of the medication to the person, and (2) the availability of therapeutically equivalent alternative medications or alternative methods of purchasing the medication. As of 1/1/19, the maximum a person is required to pay for a covered medication is the lesser of the applicable cost-sharing or the amount the person would pay if they purchased it without using a health plan or any other source of prescription medication benefits or discounts. Requires OIC to study and report to the Legislature on the impact of laws in other states that include the allowable reimbursement or claim amount as one of the amounts to be considered. If no adverse impact, Legislature intends to amend the law to enact a similar provision.Senate Health
Prescription drug insurance continuity of careSSB 6147 (Rivers)For health plans that include prescription drug coverage, an issuer may not, outside of an open enrollment period, deny continued coverage or increase the copayment or coinsurance for a prescription drug to a medically stable enrollee under certain conditions. Issuers may require generic substitution during the plan year and may add new drugs to its formulary, but the changed formulary would apply only to new prescriptions, not existing ones. A prescribing provider may prescribe a different drug that is covered by the plan and medically appropriate. The issuer may remove a drug from its formulary for reasons of patient safety, drug recall, or removal from the market. A pharmacist may substitute a generically equivalent drug or interchangeable biologic in accordance with existing law. Effective 1/1/19.House Health
Protecting the public's health by creating a system for safe and secure collection and disposal of unwanted medicationsESHB 1047 (Peterson)Requires manufacturers that sell drugs in Washington to operate a drug take-back program to collect and dispose of prescription and over-thecounter drugs from residential sources.Senate Health
Rx drug cost transparency 2SHB 1541 (Robinson)Requires drug manufacturers and insurers to report certain Rx drug pricing data on a yearly basis to a data organization contracted by the WA Office of Financial Management that must summarize the data and report to the legislature. Requires drug manufacturers to report price increases and written justification for the increases to purchasers. Requires reporting by pharmacy benefit managers regarding acquisition costs, discounts, rebates, reimbursements to retail pharmacies, negotiated prices with health plans, ownership interests, and appeal results. Requires Rx wholesalers to report discounts and rebates for 25 most frequently sold Rx drugs, and wholesale price for 25 most frequently sold Rx drugs to pharmacies and hospitals. Fines up to $1000 per day for failure to comply.Senate Health
Uniform emergency volunteer health practitioners act.ESSB 5990 (Van De Wege)Establishes the uniform emergency volunteer health practitioners act which applies to volunteer health practitioners registered with a volunteer health practitioner registration system, who provide health or veterinary services in WA for a host entity while an emergency declaration is in effect. Addresses out-of-state licensed practitioners, registration, sanctions/discipline, worker's compensation, liability. House Health

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February 20, 2018
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