The 2015 Legislative SessionWhat Does it Mean for Hospitals and Health Care?

Presenters

Cassie Sauer Claudia SandersChelene Whiteaker

Objectives• Understand the policy successes and what you should

be doing

• Understand the status of budget negotiations and key health care issues in the budget

• Begin preparations for next session

State Legislative Environment

House Split Senate SplitBefore 2014 Election

Democrats, 23Republicans, 25

Switcher, 1

Democrats, 51Republicans, 47

Ideas into Laws

Introduced 3390

Passed 604

Vetoed 6

Enacted 598

Percentage 18%

Last Biennium

WSHA Policy Priorities

Key Partners

WSHA Proactive Policy Priorities

Successes:• Mental Health• Telemedicine• Pharmacy• Suspect and Inmate Care• All-Payer Claims Database

Unfinished Business:• Work Force Flexibility• Crisis Standards of Care

www.wsha.org/policyadvocacy.cfm

• In Re Detention of D.W. • Patient plaintiffs won, with WSHA’s

support• Short-term solutions• Long-term solutions• What would it take to get more psych

beds and keep people out of inpatient treatment?

Mental Health

Support Mental Health System Improvements• SB 5649 passed

Mandates data collection on ER cases when no bed available Requires regional support networks to administer an adequate

network of evaluation and treatment services to ensure access to treatment

Exempts time prior to medical clearance from ITA timelines • HB 1450 passed: Establishes mandatory outpatient treatment

Ruling that bans ‘psychiatric boarding’ has health officials scrambling

Other Mental Health Issues• SB 5269: Family input into detention process

More people will be detained Passed

• HB 1713: Chemical dependency

crisis services Parallel to ITA Costly House is refusing to concur with Senate

amendments (Senate made it a study)

Telemedicine Payments: SB 5175 Passed• Ensures payment for services provided using telemedicine

technology• Includes “essential health benefits” requirement• Signed by Governor• Effective January 2017

Pharmacy Access: SB 5460 Passed

• Jointly supported by WSHA and DOH

• Allows hospitals to dispense “pre-pack” medications when pharmacies are not open

• Changes burdensome licensing requirements for clinic pharmacies

Suspect and Inmate Care: SB 5593 Passed

• Jointly proposed by WSHA and law enforcement

• Requires that all law enforcement agencies guard hospital patients in law enforcement custody for violent or sexual crimes

• Unless otherwise negotiated, payment for hospital services will be Labor & Industries (L&I) rates

All-Payer Claims Database: SB 5084 Passed

• Broad coalition• Mandates that insurers

contribute data• WSHA and hospitals can

access quality data• Limited access to payment

data

Governor Action• Signed SB 5175, telemedicine• Vetoed problematic section of SB 5052, cannabis

patients• WSHA has made requests

on many other bills

Next Year: Rethinking HB 1340 and HB 1944• Work force flexibility: Are there important

scope of practice legal issues preventing a new work force?

• Crisis standards of care: Can we counter plaintiffs’ attorneys?

What You Should Be Doing Now• Understand new opportunitiesExample: Pharmacy pre-pack and licensingExample: Telemedicine

• Make sure partners are following new lawsExample: Designated Mental Health Professional reporting

• Reach out to your local partnersExample: Law enforcement on guarding and payment

• Join WSHA educational eventsWebcasts, Chelan, Annual Meeting

• Levying a new 6% tax on hospitals

• Prohibiting hospital partnerships

• Mandating staffing regulations

• Creating Extended Stay Centers with no hospital regulations

• Cutting Medicaid hospital clinic payments

• Banning non-compete clauses for MDs

• Returning to psychiatric boarding

• Dozens of others opposed or amended

Issues We Successfully Opposed

New Medical School: HB 1559 Passed • WSHA was aggressively neutral• Amends a century-old state statute that gave exclusive

rights to provide medical education to UW• Focus on rural and community-based training• Funding for accreditation process and startup?• Funding for residency slots?

Budget: Where Are We Now?

Special Session

Budget ChasmStructural issues• Education funding• Class size initiative funding• State employee salaries and

raises• Lean savings• Transportation budget

Health care issues• Hospital Safety Net

Assessment• Mental health capital• Mental health operating• Health Benefit Exchange

budget• Residencies

To Tax or Not To Tax?

WSHA’s Position• Reasonable reforms and cuts• Responsible revenues to fund essential services• More equitable tax system

WSHA Budget Priorities

Outstanding Issue: SB 6045Hospital Safety Net Assessment Program

• Extends program through SFY 2019 without ratcheting down

• Maximizes federal match rate• Renews hospital contract• Senate version: Disproportionately benefits the

state• House version: Shares increase in benefits

between state and hospitals• How to fund residencies?

Outstanding Issue: Mental Health Funding

Goals:

• Sufficient funding to reduce or end psychiatric boarding for adults, adolescents and children

• Resources need to be:• Statewide• Inclusive of inpatient and outpatient

services• Include appropriate community

support services

Mental Health in the Two Budgets

House Senate

Services Funded

$100M new state funds• New evaluation and treatment beds• Outpatient assisted treatment• Family input • Western/Eastern expansion and

improvements• Crisis substance abuse

$90.5M new state funds• New evaluation and treatment beds• Outpatient assisted treatment• Family input • Western/ Eastern expansion/

improvements, not psychiatrist pay

Cuts $49M in community services • Services for Medicaid and non-

Medicaid clients from RSNs• Services not paid for by Medicaid

Capital Funding

• $9M for hospital and residential E&T facilities ($3M earmarked)

• $2M for substance abuse facilities

• $18M earmarked• $12M competitive grants

Outstanding Bill Tied to Capital Budget: CN for Mental Health Beds – Support HB 2212• Psychiatric beds needed quickly• Certificate of Need is a time and money barrier to

opening new beds • Capital budget grant application and evaluation

duplicates CN process• HB 2212: Narrow, short-term exemption tied to grant

award• Not yet passed

How You Can Help and Stay Informed

Stay informed• Inside Olympia, Weekly Report• Bulletins and Calls to Action• Policy and Advocacy Website–Priorities– Issue Briefs

Stay connected• Feel free to contact Cassie,

Claudia, or policy directors

• Respond to requests for action• Come to Olympia to testify or meet with

your legislators• Schedule an in-district meeting; consider

including your neighbors• Highlight your care improvements

What Can You Do?

Possible Non-Legislative Solutions

• Charity care application and notification

• Community benefit

• Non-compete clauses

• Observation status

Thank You!

Your advocacy with your legislators, your testimony, your connections with

local leaders and media, and your contributions to the PAC are

essential to our success.Please keep up the good work!

More Information to Come!

Questions?

Cassie SauerSenior Vice PresidentAdvocacy and Government Affairscassies@wsha.org 206/216-2538