Inside Olympia: Nurse staffing bill to get a hearing this week

January 18, 2022

Though we are only in the second week of this year’s legislative session, numerous important bills are quickly being introduced and given hearings. Most notable is HB 1868, which is a union-backed omnibus bill that enacts staffing ratios and many other requirements that would adversely affect a hospital’s ability to care for patients. We are very concerned about the far-reaching negative impacts of this bill on our health care system and patient access.

HB 1868: Improving worker safety and patient care in health care facilities by addressing staffing needs, overtime, meal and rest breaks, and enforcement

WSHA strongly opposes HB 1868, which is an omnibus bill that would impose rigid staffing minimums and extend other workplace regulations that will only further hamper hospitals’ ability to mitigate the impacts of staffing shortages and ensure patients receive the care they need, when they need it.

For years, nursing unions have proposed legislation that would dictate what constitutes safe staffing levels. Now, at the height of a nationwide hospital staffing crisis, they are proposing immediate implementation of hefty fines, undue administrative burden and even increased legal jeopardy for hospitals with capacity challenges — essentially punishing Washington hospitals for being hit with the worldwide pandemic. Adequate hospital staffing is a complex process that changes on a shift-by-shift basis and requires close coordination between management and staff based on a variety of factors, such as patient acuity, nurses’ expertise, and day-to-day adjustments, like sick or family leave and daily census changes. Advancing staffing mandates when Washington State hospitals have over 6,000 RN vacancies and staff are calling in sick by the hundreds due to the impact of the Omicron variant is ill-timed at best.

California is the only state in the country with a nurse-to-patient staffing ratio and has the highest average RN salary in the nation, but the state is still facing a widespread staffing shortage. The law also did not result in improved quality or patient outcomes. Further, this bill undermines several laws that were carefully negotiated over the last several years to include key patient safety measures. The House Committee on Labor & Workplace Standards will hold a public hearing on HB 1868 at 10 a.m. Wednesday, Jan. 19. WSHA plans to testify in opposition. (Ashlen Strong)

HB 1862: Concerning facility fees charged by certain health care providers

WSHA opposes HB 1862, which would significantly restrict billing for the facility component of off-campus hospital-based clinics. The bill would affect off-campus clinics and departments. Hospital clinics and departments serve a high proportion of Medicaid patients for highly specialized care, including cancer treatment and infusion services for chronic conditions as well as other important services like primary care and behavioral health. Medicaid payment pays below costs and the bill would further reduce payment. WSHA has significant concerns that these proposed deep cuts will result in fewer vulnerable patients having access to these critical services. The House Committee on Appropriations held a public hearing on HB 1862 Monday, Jan. 17. WSHA and member hospitals testified in opposition. (Andrew Busz)

SB 5688: Concerning material changes to the operations and governance structure of participants in the health care marketplace

WSHA opposes SB 5688, which introduces a host of new requirements, restrictions, barriers and expenses for hospital and health systems that are entering into a merger or acquisition. The Legislature passed a law in 2019 requiring health care entities to provide pre-transaction notice to the state Attorney General’s Office (AGO) 60 days before a merger, acquisition or contracting affiliation. This bill expands on the 2019 bill.

SB 5688 sets out to block any health care transactions that could be perceived to have a negative impact on health care for consumers. The bar is exceptionally high and would prevent almost all health care transactions from being approved. The bill also requires a heavy documentation burden from hospitals 120 days prior to a proposed transaction, requires the AGO to hire an independent contractor to perform a health equity assessment and shifts the costs of implementation to hospitals through an application fee. The transaction will then be subject to review for 10 years, with required annual reporting. The AGO may request documents and conduct on-site compliance at hospitals expense. Additionally, there are fines for noncompliance.

WSHA supports the ability of hospitals and health systems to work collaboratively and sustain services. The Senate Committee on Law & Justice will hold a public hearing on SB 5688 at 10:30 a.m. Tuesday, Jan. 18. WSHA plans to testify in opposition. (Zosia Stanley)

SB 5736: Concerning partial hospitalizations and intensive outpatient treatment services for minors

WSHA strongly supports SB 5736, which requires the Health Care Authority to take the steps necessary to add partial hospitalization/intensive outpatient treatment programs for children under 18 years old as a covered benefit under the Medicaid state plan by Jan. 1, 2023. WSHA has also included a partial hospitalization/intensive outpatient treatment pilot expansion as one of our budget priorities for the session. The Senate Committee on Health & Long Term Care will hold a public hearing on SB 5736 at 10:30 a.m. Friday, Jan. 21. WSHA plans to testify in favor. (Ashlen Strong)

HB 1821: Concerning the definition of established relationship for purposes of audio-only telemedicine

HB 1821 modifies the established relationship component in the state’s audio-only telemedicine law. WSHA strongly supports maintaining the in-person visit requirement, as audio-only telemedicine is a supplement to in-person care, not a replacement for it. WSHA supports the proposed exception for behavioral health services to allow an audio-visual telemedicine visit to establish the relationship, as in-person interaction may not be necessary for all behavioral health patients. WSHA also supports the proposal to extend the established relationship time period to 3 years for behavioral health services and 2 years for all other services to increase access to care. However, WSHA is concerned about the proposal to allow access to medical records to establish the patient-provider relationship. The House Committee on Health Care & Wellness held a public hearing on this bill on Monday, Jan. 17. WSHA testified with concerns regarding the proposed medical record access provision. Read more from WSHA’s issue brief. (David Streeter)

Join us for Hospital Advocacy Days Jan. 24-28

This is your last chance to register for WSHA’s Advocacy Days, Jan. 24-28, 2022! This will be our fourth-annual Advocacy Days, and once more we will hold our activities and meetings virtually. We will spend the time advocating for our priorities, talking with legislators and telling the hospital story. Attendees will also be able to attend a legislative briefing for an overview of the political landscape and our top issues as well as an advocacy bootcamp to learn how to shape their stories and prepare for legislative visits. Please register as soon as possible so our team can schedule meetings with legislators. Register online at and contact Joanna Castellanos at with questions.

WSHA Weighing In: Jan. 17-21

WSHA is weighing in on the following bills this week:

Monday, Jan. 17

  • House Appropriations:
    • HB 1862: Concerning facility fees charged by certain health care providers. See article above. (Andrew Busz)
  • House Children Youth & Families
    • HB 1890: Concerning the children and youth behavioral health work group. (Ashlen Strong)
  • House College & Workforce Development
    • HB 1805: Concerning the opportunity scholarship program. (Ed Phippen)
  • House Finance
    • HB 1789: Establishing a property tax exemption for adult family homes serving people with intellectual or developmental disabilities and owned by a nonprofit. (Zosia Stanley)
  • House Health Care & Wellness
    • HB 1821: Concerning the definition of established relationship for purposes of audio-only telemedicine. See article above. (David Streeter)
    • HB 1852: Concerning language requirements for prescription drug labels. (David Streeter)
    • HB 1877: Addressing expired certifications for certain health professions. (Ed Phippen)
  • Senate Health & Long Term Care
    • SB 5499: Concerning credentialing of medical assistant-hemodialysis technicians. (Ed Phippen)
    • SB 5518: Concerning the occupational therapy licensure compact. (Ed Phippen)

Tuesday, Jan. 18

  • Senate Law & Justice
    • SB 5688: Concerning material changes to the operations and governance structure of participants in the health care marketplace. (Zosia Stanley)
  • Senate Ways & Means
    • SB 5620: Concerning Medicaid expenditures. (Andrew Busz)

Wednesday, Jan. 19

  • House Labor & Workplace Standards
    • HB 1868: Improving worker safety and patient care in health care facilities by addressing staffing needs, overtime, meal and rest breaks, and enforcement. See article above. (Ashlen Strong)
  • Senate Health & Long Term Care
    • SB 5532: Establishing a prescription drug affordability board. (Andrew Busz)
    • SB 5610: Requiring cost sharing for prescription drugs to be counted against an enrollee’s obligation, regardless of source. (Andrew Busz)
  • Senate Labor, Commerce & Tribal Affairs
    • SB 5517: Concerning employment of individuals who lawfully consume cannabis. (David Streeter)

Thursday, Jan. 20

  • House Health Care & Wellness
    • HB 1866: Assisting persons receiving community support services through medical assistance programs to receive supportive housing. (Cara Helmer)
  • Senate Environment, Energy & Technology
    • SB 5813: Establishing data privacy protections to strengthen a consumer’s ability to access, manage, and protect their personal data. (Cara Helmer)

Friday, Jan. 21

  • Senate Behavioral Health Subcommittee to Health & Long Term Care
    • SB 5736: Concerning partial hospitalizations and intensive outpatient treatment services for minors. (Ashlen Strong)
  • Senate Health & Long Term Care
    • SB 5618: Protecting consumers from charges for out-of-network health care services, by aligning state law and the federal no surprises act and addressing coverage of treatment for emergency conditions. (Andrew Busz)
    • SB 5702: Requiring coverage for donor breast milk. (Ed Phippen)


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