Senate Budget Proposal on Hospital Safety Net Assessment Program
WSHA is still working to clarify the Senate proposal for the hospital safety net program, but it’s becoming clear that some of our information was incorrect, and that the picture for hospitals is significantly worse than it initially appeared.
In order to maintain their “no new tax” commitment and still raise additional revenue to fund the state services, the Senate budget increased the assessment rate, took a disproportionate share of funds for state services, and is requiring hospitals divert some of their benefits to other state health programs.
Remember that the hospital safety net assessment is a carefully structured tax that is used to leverage federal dollars to help cover the cost of hospital services provided to Medicaid patients (Medicaid only pays about 70 percent of the cost of care). The program was designed to allow both the state and hospitals to benefit when revenues increase from the assessment pool.
Compared to the House proposal for safety net, the Senate program uses the House assumptions that the program will deliver an additional $143.1 million to the state general fund in the upcoming biennium and then takes a full $47 million more for the state general fund. It gives significantly less revenues to hospitals. In addition, the Senate proposal diverts an additional $20 million from the hospital benefits over the biennium to fund family residencies.
The House funds family practice residencies at only $4.9 million and does not fund the integrated psychiatry program. The $4.9 million for residencies comes from the general fund. Since the safety net assessment already contributes to the general fund, it should not also be used as direct funding for other health programs.
In 2010, the state raided the assessment revenue and used both the state and the hospital funds to fill gaps in the state budget. Given this background, WSHA requested the legislature consider certain protections for hospitals if the program were to be continued. Specifically, the board charged WSHA staff to develop a new program under which:
- The majority of additional funds are used to provide hospital care for vulnerable Medicaid patients;
- There are legal protections, including another sunset date.
The WSHA Board is hosting a special meeting on Wednesday April 8 to discuss the WSHA position as the House and Senate begin negotiations. WSHA has testified in strong opposition to the Senate proposal.
A Better Path Forward for Pharmacy Practice
As the 2015 legislative session progresses, two key pharmacy bills remain. WSHA’s primary focus is on SB 5460, which allows hospitals to distribute emergency medication to patients being discharged from an emergency department when twenty-four hour pharmacy services are not available. The bill also clarifies how medications are transferred and handled between a hospital pharmacy and a clinic.
WSHA worked closely with the Washington State Department of Health over several weeks to achieve consensus on this bill and it has moved quickly through both the Senate and the House. We would like to thank DOH staff for their help and continued commitment to ensuring patients have access to the medications they need, when they need them.
The other pharmacy bill, HB 1625 allows hospitals to provide drugs to emergency medical services, thereby ensuring access while providing more cost-effective options for local emergency medical service providers. WSHA worked hard to amend this bill, removing language that limited the volume of drugs a hospital could provide. Again, we appreciate the Department’s support and the passage of this bill will provide a needed service to local communities.
Pharmacy issues had not traditionally been part of WSHA’s policy agenda, but we heard members’ concerns around some of these issues. We are now devoting substantial resources and time to addressing pharmacy policy, both on the legislative end as well as through regulatory work with the state’s Pharmacy Commission. Our initial efforts are paying off and we are excited to be making improvements on behalf of our members and out communities.
We would also like to thank Senator Linda Parlette and Representatives Joe Schmick and Eileen Cody for their help and support in improving the practice of pharmacy in Washington State. (Ian Corbridge, 206-216-2514)
The majority of the legislative work next week will take place on the floor as bills get voted out of their second house and on their way to conference committees. Bills are still being heard in the appropriations committees, but the schedule for these is fast-moving.