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1 | Northwest Health Law Advocates Health Care Access in the Washington Legislature - Bills of Interest Update #2 (February 21, 2020) | ||||
2 | Bill Name | House Bill/ main sponsor | Senate Bill/ main sponsor | Summary Description | Status |
3 | PUBLIC PROGRAMS | ||||
4 | Improving maternal health outcomes by extending coverage during postpartum period | E2SSB6128 (Randall) | Extends Apple Health postpartum health care coverage from 60 days to 12 months post-pregnancy, phased in by income brackets over four years starting with lowest income in 2021, eventually reaching 193% FPL in 2024. Directs HCA to seek federal matching funds through a federal waiver request. Once federal funding is available, 12-month coverage is provided for all postpartum persons with countable income up to 193% of FPL. | House Appropriations | |
5 | Increasing patient access rights to timely and appropriate postacute care | 2SSB6275 (Cleveland) | Directs DSHS to work with hospitals in assisting patients and their families to find and gain timely access to long-term care services of their choice. A hospital may choose to contract with DSHS to allow the hospital to support DSHS's functional assessment for patients hospitalized and likely to need LTSS, and submit preassessment information to DSHS. Provides timelines for DSHS to complete the assessment, subject to appropriation. Also subject to appropriations, DSHS must develop specialty contracts that prioritize the transition of difficult to discharge patients with complex medical and behavioral needs. Requests for additional personal care services and increased daily rate may be submitted by a patient, client, health care provider, hospital, facility, or department case manager to the department's exception to rule committee, and the committee must provide the requesting person or entity and the client, hospital or longterm care facility a copy of the decision. DSHS must track and make publicly available data on the number of requests and decisions by the committee. Directs the Washington State Institute of Public Policy to review the DSHS long-term services and supports assessment tool and eligibility determination process and provide a report including recommendations by 9-1-21 to OFM, HCA-RDA, and the legislature. Requires DSHS to report certain information about patients who remain in the hospital setting due to barriers in accessing community alternatives to OFM and the legislature by 11-15-21. Requires DSHS and HCA to submit a waiver request to the federal government to authorize presumptive eligibility for LTSS. | House Health | |
6 | 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. | Senate Ways & Means | |
7 | Access to baby and child dentistry program for children with disabilities | SSB5976 (Rolfes) | Changes definition of who is eligible to receive services under ABCD to include language that eligible children must meet clinical criteria established by HCA to determine disability. 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. | House Appropriations | |
8 | Asking congress to include dental care in Medicare | SHJM4014 (Riccelli) | Requests the U.S. President and Congress (House and Senate leaders and Washington's delegation) to include dental coverage in the federal Medicare program to provide for equitable access to oral health care for older adults and people with disabilities receiving Medicare. Calls for comprehensive Medicare dental benefits with access to all community dental providers licensed in the state to improve seniors' health status and overall well-being, and to reduce medical expenses. | Senate Health | |
9 | 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. | House Public Safety | |
10 | 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 to determine eligibility for certain services and to allow for the provision of treatment to inmates during confinement or after release. Requires managed health care systems to comply with state and federal privacy laws concerning any records received. | Senate Human Services, Reentry & Rehab | |
11 | Requiring medicaid managed care organizations to provide reimbursement of health care services provided by substitute providers | SSB6358 (Randall) | Aims to protect patients and ensure that they benefit from seamless quality care when contracted providers are absent from their practices or when there is a temporary vacancy in a position while a hospital, rural health clinic, or rural provider is recruiting to meet patient demand. Permits hospitals, rural health clinics, and rural providers to use substitute providers in certain circumstances. Requires Medicaid Managed Care Organizations (MCOs) to reimburse substitute providers that provide services to MCO beneficiaries. | Senate | |
12 | Providing reentry services to persons releasing from prison, jail, and other institutions | ESSB6638 (Wilson, C.) | Aims to improve reentry services for incarcerated or civilly committed releasing persons so they successfully reintegrate into the community. Adds reentry services, meaning supportive services provided to a person immediately before or after release from incarceration or civil commitment to support community reintegration and recovery, to optional benefits under the Community Behavioral Health Services Act. Allows the Health Care Authority (HCA) to restore suspended Medicaid benefits up to 90 days but not less than 7 days before a person's release from incarceration or civil commitment to facilitate reentry and recovery services. This starts January 1, 2022. No federal funds are to be used unless permitted by federal requirements. After federal guidance is released, HCA is to apply for a Medicaid waiver to allow use of federal funding. Requires HCA by January 1, 2021 to revise contracts with managed care organizations and behavioral health administrative services organizations to require them to contract with providers to ensure reentry program services are available to their eligible clients in every regional service area. Establishes a work group to examine how to expand effective reentry services programs. | House Public Safety | |
13 | Providing public assistance to certain victims of human trafficking | 3SSB5164 (Saldaña) | Expands eligibility for the state Food Assistance Program, the State Family Assistance Program, and the Medical Care Services Program (MCS) to certain victims of human trafficking and other crimes. Defines a "victim of human trafficking" to include noncitizens and qualifying family members for purposes of certain public assistance programs, including MCS if they are not eligible for other federal or state health insurance programs. The HCA shall enter into performance -based contracts with one or more managed health care systems for the provision of medical care services under this section. The contract must provide for integrated delivery of medical and mental health services. The HCA shall establish standards of assistance and resource and income exemptions, which may include deductibles and coinsurance provisions. In addition, the HCA may include a prohibition against the voluntary assignment of property or cash for the purpose of qualifying for assistance. | House Human Services & Early Learning | |
14 | PRIVATE INSURANCE AND HEALTH BENEFIT EXCHANGE | ||||
15 | Establishing and funding the health insurance affordability account | HB2821 (Cody) | Establishes the health insurance affordability account. Imposes a state premium tax on health carriers and managed care organizations and deposits the proceeds in the health insurance affordability account. The tax, which replaces an expiring federal tax, is levied on the total amount of premiums for health benefit plans, dental only plans, vision only plans, and prepayments for health care services provided by managed care organizations collected and received during the preceding calendar year. Expenditures from the account may be used only for low-income health insurance programs. | House Finance | |
16 | 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. | Senate Health | |
17 | Health care benefit management | 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 and carriers 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 Commioner has power to enforce when HCBMs violate laws or regulations pertaining to HCBMs. | House Health | |
18 | 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 --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. | House Health (passed) | |
19 | Reducing barriers to patient care through appropriate use of prior authorization and adoption of appropriate use criteria | ESSB6404 (Frockt) | Requires carriers 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. Establishes the prior authorization work group to enhance the understanding and use of prior authorization in WA. The work group is to make recommendations on which services require prior authorization or appropriate use criteria instead of prior authorization. | House Health | |
20 | 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. Permits 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. Senate version also 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. Senate version includes additional requirement that beginning November 1, 2021 the insurance commissioner on its website provide notice of the carrier requirements and information on alternate ways in which enrollees may access excluded benefits in a timely manner. | Senate Health | |
21 | Providing health care premium assistance by imposing a tax on claims paid | HB2901 (Riccelli) | Requires health carriers, third party adminstrators, and employers offering self-funded coverage to pay a tax of one percent of all paid claims into a premium assistance account. The account is to be used for sliding-scale premium assistance to individuals enrolled in a Qualified Health Plan in the Health Benefit Exchange, with income between 133-500% of federal poverty. | House Finance | |
22 | 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 nonprofit health 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 and whether a carrier's insurance holding company system offers a qualified health plan in the individual market in every county of the state. | House Health | |
23 | Funding for individuals who aren’t eligible for federal insurance subsidies and for foundational public health services | SHB2679 (Robinson) | Requires carriers with a surplus greater than 600% of the carrier's Risk-Based Capital requirements to pay 3% of the excessive surplus to the OIC for deposit into the newly created Nonprofit Health Carrier Community Benefit Fund. Expenditures from the Fund must be used for: subsidies for individuals purchasing individual market insurance coverage who are not eligible for federal insurance subsidies; and foundational public health services. Imposes a 3% tax on for-profit health carrier's depreciation deductions taken on the previous tax year's federal income tax return. | House Rules | |
24 | HEALTH CARE PROVIDERS AND FACILITIES | ||||
25 | 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. | Senate Health | |
26 | End-of-life care policies | SHB2326 (Macri) | Requires hospitals to submit policies related to end-of-life care and death with dignity act to the Department of Health (DOH). Requires DOH create, in consultation with stakeholders, a form hospitals must submit to DOH that provides the public with specific information about which end-of-life services are and are not generally available at each hospital. | Senate Health | |
27 | Health system transparency | ESHB2036 (Macri) | Requires entities that operate health systems to report financial and patient discharge data related components and services that comprise the health system, as well as data regarding certain financial exchanges. Requires that hospitals provide additional detail regarding expenses and revenues in financial reports to the Department of Health. Requires ASFs to report the number of patient encounters, utilization data by service provided, acquisition of diagnostic or therapeutic equipment in excess of $500,000, and capital expenditure projects. Eliminates the exemption from reporting information about facility fees for off- campus clinics or providers that are located within 250 yards from the main hospital building. Requires the community needs assessment submitted by nonprofit hospitals to include a public addendum containing certain information about activities identified as community health improvement services. Requires hospitals to report any revenue-gathering agreement between the hospital and debt collection entities and to make the hospital's debt collection practices visible in billing materials and online. | Senate Health | |
28 | REPRODUCTIVE HEALTH | ||||
29 | Student health plans | HB2252 (Thai) | Requires student health plans issued or renewed on or after January 1, 2021 that provide coverage for maternity care and services to also provide substantially equivalent abortion coverage. | Senate Health | |
30 | BEHAVIORAL HEALTH: MENTAL HEALTH AND SUBSTANCE USE DISORDERS (See also: Prescription Drugs) | ||||
31 | 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. Requires medical necessity reviews by payers to be based on American Society of Addiction Medicine criteria. 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. | Senate Behavioral Health | |
32 | Establishing the state office of the behavioral health ombuds | 2SHB2386 (Cody) | Requires the Dept. of Commerce to contract with a private nonprofit org to serve as the State Office of the Behavioral Health Ombuds (SOBHO) to coordinate the activities of behavioral health ombuds across the state. Requires existing regional BH ombuds programs be integrated into and certified by SOBHO. Defines powers and duties of SOBHO including: developing a process to train and certify all behavioral health ombuds; facilitating access to ombuds services for patients, residents, and clients; establishing a uniform reporting system related to complaints, conditions, and service quality provided by BH providers/facilities; and establishing procedures to protect the confidentiality of ombuds records. Directs SOBHO to develop working agreements with each MCO, BH administrative services organization, state and private psychiatric hospitals, and all appropriate state and local agencies. Requires BH providers/facilities post notice of SOBHO's toll free number, website, and description of services provided by SOBHO. Requires referrals to agencies occur according to mutually established working agreements that set roles of SOBHO and agencies, as well as processes and procedures. | Senate Behavioral Health | |
33 | Improving the Indian behavioral health system | SSB6259 (McCoy) | Defines new BH provider, "behavioral health aides," and directs the 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. | House Health | |
34 | Allowing the learning assistance program to support school-wide behavioral health system of supports and interventions | SB6132 (Wellman) | Expands Learning Assistance Program (LAP) to support school-wide behavioral health system of supports and interventions including social workers, counselors, instructional aides, and other school-based health professionals. | House Education | |
35 | 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. Requires HCA and UW submit a report to the governor and legislature on the partnership access line. Outlines audit and funding requirements for the partnership access line and the psychiatric consultation line. | Senate Ways & Means | |
36 | 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." | Senate Behavioral Health | |
37 | Establishing a telehealth training and treatment program to assist youth | 2ESSB5389 (Becker) | Directs the University of Washington, collaborating with the Extension for Community Healthcare Outcomes project, to design a training curriculum and training delivery system to train middle, junior high, and high school staff to identify students who are at risk for substance abuse, violence, or suicide. Requires the training delivery system to utilize teleconference techonology to deliver trainings to school staff. Requires employees at each school to be trained on student risk assessments beginning in the 2021-2022 school year. Requires UW to seek grants, gifts, and donations to fund the development of training curriculum and reimbursement for health care services provided by psychiatrists and psychologists for the provision of teleconsultations to students. Requires certain school staff to screen students for risk of substance abuse, violence, or youth suicide, if a student is identified to potentially be at risk. | House Education | |
38 | PRESCRIPTION DRUGS | ||||
39 | 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. | Senate Health | |
40 | 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. | Senate Health | |
41 | Creating central insulin purchasing program | SSB6113 (Keiser) | Establishes the Central Insulin Purchasing Work Group to design a purchasing strategy to allow the existing (HCA-established) Prescription Drug Purchasing Consortium to act as the single purchaser for insulin in the state with the goal of lowering the cost of insulin. State purchased health care programs are exempt from the requirements of this program if they can demonstrate they can achieve greater discounts and cost savings than would be achieved through participation in the Consortium. Work Group to report to the legislature regarding the plan by July 1, 2021. | House Health | |
42 | Imposing cost-sharing requirements for coverage of insulin products | 2SSB6087 (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. For every $100 increase in the cost of insulin for a health plan from the previous year, the plan may request the OIC to increase the cost-sharing cap for a 30-day supply by five dollars. This requirement would apply to high deductible accounts with a health savings, but if the IRS removes insulin from the list of preventative medications care, 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. | House Health | |
43 | Establishing prescription drug affordability board | SSB6088 (Keiser) | Establishes the prescription drug affordability 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 Health | |
44 | Creating pathways to recovery from addiction by eliminating a tax preference for the warehousing of opioids and other drugs | HB2734 (Davis) | Eliminates a tax preference for the warehousing of opioids and other drugs. Revenue would fund non-Medicaid reimbursable pretreatment substance use disorder and recovery support services. | House Rules | |
45 | Establishing the opioid epidemic response advisory council | ESHB2786 (Robinson) | Creates the Opioid Epidemic Response Advisory Council, convened by the Attorney General to make recommendations to the Legislature on the distribution and use of penalties received as a result of litigation against an opioid manufacturer or distributor relating to acts or omissions by the manufacturer or distributor that contributed to increased rates of opioid addiction in Washington. The advisory council shall submit to the Legislature recommendations on use of funds for prevention and treatment of opioid addiction and shall consider compensation for the most affected victims of the opioid epidemic. | Senate Ways & Means | |
46 | OTHER HEALTH CARE ACCESS RELATED BILLS | ||||
47 | Creating Washington state office of equity | 2SHB1783 (Gregerson) | Establishes the Washington State Office of Equity (Equity Office) witth aim of
reducing health disparities based on racial, ethnicity, and gender inequities. Creates Community Advisory Board to advise Equity 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 Equity Office to develop performance measures. Equity Office to promote access to equitable opportunities and resources that reduce disparities and improve outcomes statewide across state government. | Senate State Gov & Tribal | |
48 | Establishing health care cost transparency board | 2SHB2457 (Cody) | Establishes the Health Care Cost Transparency Board to annually calculate the total health care expenditures in Washington and establish a phased plan for the health care cost growth benchmark that begins with the highest cost drivers in the health care system. Directs Transparency Board to establish committee on data issues and an advisory committee of health care providers and carriers. Requires Transparency Board to provide analysis on factors impacting trends in health care cost growth and must, 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. | Senate Health | |
49 | Northwest Health Law Advocates | 206.325.6464 | nohla@nohla.org February 21, 2020 | ||||
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