Our Government Affairs team is hard at work reviewing the first bills of session, and the nursing unions and their allies have officially announced that they will once more be attempting to pass legislation mandating staff-to-patient ratios. WSHA is proposing an alternative package of legislation that will help to address the workforce shortage in Washington State, which we announced in a press release on Thursday, Jan. 5. Expect more information on this issue soon, and see more information below about WSHA’s legislative packages to address the workforce shortage.
Below are the top issues WSHA will be working to advance:
- Increase the Hospital Safety Net Assessment Program (SNAP) payments to hospitals. WSHA is asking to replace the current Safety Net Assessment Program to comply with new federal regulations. In 2024, hospitals would either pay an increased tax on non-Medicare revenue or participate in intergovernmental transfers to draw down additional funding for Medicaid. No state general fund would be sought. Most hospitals in Washington State are in financial crisis due to inflation and a labor shortage. By 2024, the Medicaid shortfall – difference between the hospital cost of care for Medicaid patients versus actual payments – is expected to be $2 billion a year across the state. Hospitals need a significant Medicaid increase to bridge this gap. Statewide, hospital losses from operations from Jan. 1, 2022, to Sept. 31, 2022, were $1.6 billion. Urban hospitals have not had a rate increase from Medicaid in more than 20 years.
- Preserve flexibility in hospital staffing and support investments to retain and attract nurses. Given the nationwide nursing workforce shortage, nurse-to-patient ratios would result in hospitals reducing patient services to meet the ratios. On-call limitations would also restrict the ability to provide lifesaving services, from organ transplants to care for heart attacks in cardiac catheterization labs to staffing maternity units in rural hospitals. Staffing challenges stem from the inability to discharge patients and a national labor shortage. There is no single solution to these challenges. WSHA’s priorities are to:
- Establish a statewide collaborative to investigate and spread innovations in hospital staffing
- Make Washington a destination state for already-trained nurses by developing a student loan repayment assistance program for hospital-employed nurses
- Join the nurse licensure compact with 37 other states recognizing licensure from participating states
- Require nurse traveler agencies to register with the state and provide transparency on average costs
- Continue and expand the Washington State Nursing Preceptorship Incentive Program, standardize clinical placement hours across educational institutions, and fund regional coordination of nursing programs and clinical placement sites to expand the number of sites and clinical placements available for nursing students
- Strengthen Washington’s model nurse staffing committee law by requiring committee charters, standardizing the format of nurse staffing plans, and increasing executive accountability when staffing plans change
- Difficult to Discharge: Increase post-acute care funding for patients who are ready to be discharged. No one should live in a hospital, but some patients are not able to be discharged to a more appropriate community settings (such as a skilled nursing facility, adult family home or residential setting). The pandemic has exacerbated this situation – skilled nursing has lost more than 2,000 beds due to inability to staff. WSHA’s priorities are to increase funding to long-term care for the most complex clients, increase slots for undocumented residents and provide payment to hospitals for patients who qualify for Medicaid home and community services (as well as adjust the administrative day rate for those who are eligible for skilled nursing services).
- Difficult to Discharge: Ensure Medicaid patients subject to a guardianship proceeding can discharge to appropriate long-term care settings while waiting for a guardian to be appointed. DSHS interpretation of federal and state law has led to a significant increase in patients in hospitals who must have a guardian appointed by a court to move out of the hospitals and into long-term care placement. WSHA supports allowing a court to order, as part of guardianship proceeding, appropriate hospital discharge and long-term care placement for an individual in a hospital.
- Develop and fund new behavioral health 23-hour crisis receiving centers. Washington State’s behavioral health crisis system needs modernization, as recognized by the CRIS Committee. Currently, there are very few options for people in a behavioral health crisis besides the emergency department. WSHA supports the development of a sustainable funding model, and recognition in law, for a new type of facility. These facilities will function as an ‘urgent care’ for people experiencing a behavioral health crisis and offer an alternative to the emergency department.
- Allow hospitals to continue to merge, affiliate and engage in business transactions. The ability for hospitals to enter appropriate business transactions should be maintained. Health care mergers in our state have led to continued access to health care services for patients in local communities across the state. In recent cases where hospitals could not partner it led to hospital closure, disrupting services for patients. WSHA supports maintaining access to abortion services in the event of a health care transaction.
Most significant bill of the week: SB 5120: Establishing 23-hour crisis relief centers in Washington state
WSHA strongly supports SB 5120, which creates the statutory structure for licensing or certification that organizations could use to establish 23-hour crisis facilities, and it creates a payment model for this type of crisis center. WSHA’s input played a key role in crafting this bill and will testify in support and offer amendments to improve the bill.
This bill follows E2SHB 1477 from 2021, which established the “988” call line and referenced these 23-hour crisis stabilization units – based on the living room model – as one source of crisis stabilization services. This model has also been described and outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA). Washington State’s behavioral health system has become only more strained during the COVID-19 pandemic and many patients in crisis have ended up in far-from-ideal settings, like emergency departments, which do not address their needs. The bill is scheduled for its first hearing at 8 a.m. Friday, Jan. 13 in the Senate Committee on Health and Long Term Care. (Cara Helmer)
Legislative Session Kickoff webinar rescheduled for Jan. 18
Our Legislative Session Kickoff webinar from 10-11 a.m. Wednesday, January 18. This members-only webinar will cover what to expect during the 2023 legislative session and give an overview of WSHA’s legislative priorities and hot topics. It will also include an opportunity to ask questions of WSHA’s Government Affairs leaders. Register now!
WSHA Weighing In: Jan. 9-13
WSHA is weighing in on the following bills this week:
Monday, Jan. 9
- House Community Safety, Justice & Reentry
- HB 1028: Supporting crime victims and witnesses by promoting victim-centered, trauma-informed responses in the legal system. (Jaqueline Barton True)
Tuesday, Jan. 10
- House Consumer Protection & Business
- HB 1051: Concerning robocalling and telephone scams. (Cara Helmer)
- House Labor & Workplace Standards
- HB 1068: Concerning injured workers’ rights during compelled medical examinations. (Remy Kerr)
Wednesday, Jan. 11
- House Innovation, Community & Economic Development, & Veterans
- HB 1009: Concerning military spouse employment. (Ashlen Strong)
- House Health Care & Wellness
- HB 1027: Concerning telemedicine. (Remy Kerr)
Thursday, Jan. 12
- Senate Health and Long Term Care
- SB 5036: Concerning telemedicine. (Remy Kerr)
- Senate Law & Justice
- SB 5010: Including synthetic opioids in the endangerment with a controlled substance statute (Cara Helmer)
- SB 5181: Concerning medical assistants. (Katerina LaMarche)
Friday, Jan. 13
- House Postsecondary Education & Workforce
- Senate Health and Long Term Care
- SB 5120: Establishing 23-hour crisis relief centers in Washington state. See article above. (Cara Helmer)