The WSHA team is excited that this week many of the bills we worked closely with lawmakers to craft will get their first hearings! This includes bills streamlining eligibility for difficult-to-discharge patients, standardizing prior authorization, improving service to home health shortage areas and improving regulations for substitute providers. (See the bill articles below for more information.) We are also excited that this week is our second-annual Hospital Advocacy Days in Olympia! The events begin Wednesday afternoon, and we will spend Thursday meeting with lawmakers and telling the hospital story. We look forward to seeing you there.
Meanwhile, the WSHA Government Affairs team remains hard at work analyzing and fixing bills, as we are one week closer to the Feb. 7 deadline for bills to pass out of their committee of origin (unless they are deemed necessary to implement the budget). Bills that pass their committees of origin are next heard by budget or rules committees, which is the last hurdle to pass before a full chamber vote.
SB 6275: Increasing patient access rights to timely and appropriate post-acute care
WSHA strongly supports SB 6275 (and companion HB 2597) to expedite hospital discharge for Medicaid patients in need of post-acute care. These patients are frequently stuck in hospitals because the state is unable to place them in a post-acute care setting in a timely manner. WSHA’s input played a key role in crafting this legislation.
Currently, only staff from the Department of Social and Health Services (DSHS) can assess and complete a patient’s functional eligibility for long-term supports and services. This process takes weeks and weeks to complete. This assessment drives the daily rate DSHS will pay a post-acute care setting, such as an assisted living facility or adult family home. The process is further slowed because the state struggles to find community partners that will accept their low payment rate. Meanwhile, patients are left living in the hospital, which is not the right care setting and takes up resources needed by other patients.
This bill would require DSHS to complete assessments in a couple of weeks rather than months and would improve transparency about exceptions to the rule process and decisions. It would also direct the state to seek the Centers for Medicare and Medicaid Services’ approval to establish presumptive eligibility for long-term services and supports, streamlining the process. Read WSHA’s issue brief for more information.
SB 6275 will be heard Monday, Jan. 27 in the Senate Committee on Health & Long Term Care. (Zosia Stanley)
SB 6404: Adopting prior authorization and appropriate use criteria in patient care
WSHA strongly supports SB 6404 (and House companion HB 2568), which would create uniform criteria for when prior authorization is used. It would form a prior authorization work group to annually select and review services requiring prior authorization to create more consistency for patients. WSHA’s input played a key role in crafting this legislation.
In the last few years, health plans have dramatically expanded the services requiring prior authorization. While prior authorizations are used to ensure treatment is appropriate, it can create significant and unnecessary delays to patient care when it is not clinically necessary. This bill would require health plans to provide data to the Office of the Insurance Commissioner regarding the volume — as well as the approval and denial rates — of services requiring prior authorization. The governor would appoint members of the work group, and a sub-group of providers with specific clinical expertise would make recommendations to the larger group on the specific services to consider. Read WSHA’s issue brief for more information.
SB 6404 will be heard Friday, Jan. 31 in the Senate Committee on Health & Long Term Care. (Andrew Busz)
SB 6358: Requiring Medicaid managed care organizations to provide reimbursement details of health care services provided by substitute providers
WSHA strongly supports SB 6358 (and House companion HB 2598), which would require Medicaid managed care organizations (MCOs) to follow Medicare policy in how substitute providers are reimbursed when they fill in at a facility for longer than 60 days. It would also expand the instances in which substitute providers could be used. WSHA’s input played a key role in crafting this legislation.
Currently, Medicaid MCO reimbursement for substitute providers who fill in for longer than 60 days is effective when the provider’s application with the carrier is approved. However, getting approval can take months, so even if a substitute provider begins the process immediately, it can leave a gap between the 60 day-mark and approval. Access to care can be impacted when services provided are left unpaid. This bill would allow for backdated reimbursement to the application submission date, given the application is later approved.
This bill would also allow hospitals and rural providers to use substitutes to fill in while recruiting for an open position, since recruiting in rural areas can take several months. Also, rural facilities frequently use ARNPs and PAs to deliver care. SB 6358 would allow these highly trained mid-level providers to also serve as substitute providers, enabling rural organizations to better respond to their communities’ health care needs. Read WSHA’s issue brief for more information.
SB 6358 will be heard Friday, Jan. 31 in the Senate Committee on Health & Long Term Care. (Lauren McDonald)
HB 2621 / SB 6359: Creating regulation exemptions for rural health clinics providing services in a designated home health shortage area
WSHA strongly supports HB 2621 / SB 6359, which would allow RHCs in shortage areas to offer a limited scope of services — including home nursing visits — to homebound patients, increasing access to critical services in underserved communities. The bills follow federal law and allow rural health clinics (RHCs) to request designation by the state Department of Health (DOH) of a home health shortage area. For designated RHCs, the bill also exempts them from both licensing and Certificate of Need requirements to provide these needed services in the community. The Centers for Medicare and Medicaid Services would need to approve the designation. WSHA’s input played a key role in crafting this legislation.
The bill would help residents stay out of higher-cost facilities, such as skilled nursing facilities or hospital wings. Under the current system, home health agencies serve large geographic areas and routinely face challenges as a result, such as staffing shortages and long travel times that can go unreimbursed. WSHA has worked with DOH, the Home Care Association of Washington and key rural hospital leaders throughout the last 18 months to establish a process that works for all parties involved. The designation of a health care shortage area would be re-evaluated every two years. Read WSHA’s issue brief for more information.
HB 2621 will be heard Friday, Jan. 31 in the House Committee on Health Care & Wellness. SB 6359 will be heard Wednesday, Jan. 29 in the Senate Committee on Health & Long Term Care. (Jacqueline Barton True)
SB 6311: Concerning patients with substance use disorder
WSHA supports increasing access to substance use disorder services for patients. However, WSHA opposes SB 6311, which requires that any patient who comes to a health care facility with indication of substance use disorder (SUD) receive:
- SUD evaluation
- Medically necessary services for SUD until care can be transferred to an appropriate treatment facility
- Information about the availability of clinically appropriate treatment services for SUD, including detox, stabilization, medication-assisted treatment, referrals to clinicians with expertise in SUD treatment and recovery coach services provided by certified SUD peer counselors
WSHA will testify and raise strong concerns that a requirement for SUD treatment services in hospitals is not the correct avenue. In many instances substance use disorder services are provided in less-expensive, non-hospital community settings. Resources would be better focused on building SUD treatment capacity and stronger referral linkages.
SB 6311 will be heard Friday, Jan. 31 in the Behavioral Health Subcommittee of the Senate Committee on Health & Long Term Care. (Lauren McDonald)
WSHA Weighing In: January 27-31
Monday, Jan. 27
- House Education (1:30pm)
- HB 2708: Establishing a work group on school-based health centers. (David Streeter)
- Senate Health & Long Term Care (1:30pm)
- SB 6250: Concerning nursing facilities. (Zosia Stanley & Andrew Busz)
- SB 6275: Increasing patient access rights to timely and appropriate postacute care. (Zosia Stanley)
- SB 6384: Establishing a statewide tracking system for difficult to discharge patients. (Zosia Stanley)
- SB 6396: Ensuring the continued viability of skilled nursing facilities. (Zosia Stanley & Andrew Busz)
- SB 6413: Establishing the primary care collaborative. (David Streeter)
- SB 6515: Adjusting the Medicaid payment methodology for skilled nursing facilities. (Andrew Busz)
- House Appropriations (3:30pm)
- HB 2728: Implementing a sustainable funding model for the services provided through the children’s mental health services consultation program and the telebehavioral health video call center. (Jaclyn Greenberg)
Tuesday, Jan. 28
- Senate Labor & Commerce (8:00am)
- SB 6234: Concerning the use of third parties by employers to dispute unemployment claims. (David Streeter)
- SB 6372: Concerning structured settlements. (David Streeter)
- SB 6373: Allowing self-insurers to accept certain industrial insurance claims. (David Streeter)
- SB 6440: Concerning industrial insurance medical examinations. (David Streeter)
- SB 6552: Eliminating the three-day waiting period for receiving industrial insurance compensation. (David Streeter)
- House Rural Development, Agriculture, & Natural Resources (10:00am)
- HB 2541: Creating the Washington rural development act. (Jacqueline Barton True)
- House Health Care & Wellness (1:30pm)
- HB 2448: Concerning enhanced services facilities. (Shirley Prasad)
- Senate Human Services, Reentry & Rehabilitation (1:30pm)
- SB 6428: Providing funding for medical evaluations of suspected victims of child abuse. (Lauren McDonald)
Wednesday, Jan. 29
- House Innovation, Technology & Economic Development (8:00am)
- HB 2604: Fostering economic growth in Washington by supporting a certain regulatory environment for blockchain and distributed ledger technology solutions. (David Streeter)
- Senate Health & Long Term Care (1:30pm)
- SB 6359: Creating regulation exemptions for rural health clinics providing services in a designated home health shortage area. (Jacqueline Barton True)
- SB 6534: Creating an ambulance transport quality assurance fee. (Andrew Busz)
- House Health Care & Wellness (1:30pm)
- HB 2416: Concerning disclosures of information and records related to forensic mental health services. (Zosia Stanley)
- HB 2554: Mitigating inequity in the health insurance market caused by health plans that exclude certain mandated benefits. (Andrew Busz)
- HB 2642: Removing health coverage barriers to accessing substance use disorder treatment services. (Andrew Busz)
- House Human Services & Early Learning (1:30pm)
- HB 2737: Updating the children’s mental health work group. (Jaclyn Greenberg)
- House Appropriations (3:30pm)
- HB 2786: Establishing the opioid epidemic response advisory council. (Lauren McDonald)
- Senate Transportation (3:30pm)
- SB 6580: Concerning organ transplant vehicles. (Andrew Busz)
Thursday, Jan. 30
- House Commerce & Gaming (8am)
- HB 2546: Concerning the potency of marijuana products. (Lauren McDonald)
- Senate Ways & Means (3:30pm)
- SB 6040: Concerning the budgeting process for certain state waiver services for individuals with developmental disabilities. (Zosia Stanley)
Friday, Jan. 31
- Senate Health & Long Term Care (8:00am)
- SB 6358: Requiring Medicaid managed care organizations to provide reimbursement of health care services provided by substitute providers. (Lauren McDonald)
- SB 6404: Adopting prior authorization and appropriate use criteria in patient care. (Andrew Busz)
- House Health Care & Wellness (8:00am)
- HB 2621: Creating regulation exemptions for rural health clinics providing services in a designated home health shortage area. (Jacqueline Barton True)
- House Innovation, Technology & Economic Development (10:00am)
- 2SHB 1854: Concerning the management and oversight of personal data. (Jaclyn Greenberg)
- Senate Behavioral Health Subcommittee to Health & Long Term Care (1:30pm)
- SB 6109: Ensuring persons with serious mental illness and substance use disorders receive proper care and assistance. (Jaclyn Greenberg)
- SB 6311: Concerning persons with substance use disorders. (Lauren McDonald)
