State Regulatory Issues

State regulations have a big impact on hospitals, health systems and their patients. WSHA tracks rulemaking activity throughout the state and works closely with regulatory agencies, as well as other groups, to advocate for a reasonable regulatory environment. All statewide rulemaking activity is published in the Washington State Register.

Click here to see WSHA’s Top Priority State Rules Tracker

(Updated: March 18, 2022)

There are several regulatory issues at the top of WSHA’s current priority list, including:

Acute Care Hospital Fines- The Department of Health is beginning rulemaking to implement HB 1148, a bill which increased DOH’s oversight and enforcement abilities of acute care hospitals licensed under 70.41 RCW. The rulemaking will create a fine matrix to establish fines that DOH will have the option to assess against hospitals based on the severity and scope of violation. Please see WSHA’s bulletin for more information about HB1148. DOH has released CR101 draft language for the bill which can be previewed here. WSHA has recently worked closely with DOH on a similar rulemaking for psychiatric hospitals and this CR101 draft language is modeled on the language that came out of that process. DOH will conduct a series of workshops with stakeholders to revise the language before a CR102 is released. WSHA will work with members and the DOH to support hospital interests in the development of these new rules. (Cara Helmer)

Hospital Data Reporting and Transparency – The Department of Health (DOH) issued a CR 101 pre-proposal to begin rulemaking to implement E2SHB 1272, which created new data reporting requirements for hospitals. According to the CR 101, E2SHB 1272 “requires hospitals to report patient discharge information related to race, ethnicity, gender identity, sexual orientation, preferred language, disability status, and zip code of residence. It also requires the department to develop a waiver and grant process to assist hospitals that are certified by the Centers for Medicare and Medicaid Services (CMS) as a critical access hospital, certified by CMS as a sole community hospital, or qualifies as a Medicare dependent hospital to comply with the requirements.” WSHA actively participated in the legislative debate over E2SHB 1272 and will be engaged in the rulemaking. WSHA will provide updates as the rulemaking process progresses. (Ashlen Strong)

As part of the rulemaking for HB 1272, DOH is working with hospitals to develop the addendum form for the Community Health Improvement Services (CHIS) and the Charity Care reporting form. WSHA has provided member feedback to the department on the CHIS form’s design and will be participating in the next workshop at 1 PM on April 5, 2022. Please email carrie.baranowski@doh.wa.gov for the Microsoft Teams link and calendar invitation. Feedback on the latest versions of the CHIS Addendum and Charity Care forms (both are Excel sheets) can be shared directly with Carrie Baranowski at DOH directly or provided to David Streeter and Abby Berube for sharing with DOH. (David Streeter and Abby Berube)

Public Option Contracting– The Health Care Authority (HCA) issued a CR 101 preproposal announcing the rulemaking process to implement the public option contracting provisions passed in E2SSB 5377. According to the CR 101, “This bill provides that if a public option plan is not available in each county during plan year 2022 or later, hospitals licensed under chapter 70.41 RCW receiving payment from one of the agency’s benefit programs or its medical assistance program must contract with at least one public option plan to provide in-network services to that plan’s enrollees. The bill also provides that the agency may adopt rules including levying fines and taking other actions necessary to enforce compliance when a hospital must contract with a public option plan.” WSHA actively participated in the legislative discussion on E2SSB 5377 and this is rulemaking is a top priority. We will provide updates as this rulemaking progresses. Please see WSHA’s bulletin on E2SSB 5377 for additional information about hospitals’ participation in the public option program. (Ashlen Strong)

Whistleblower Complaints in Healthcare Settings – DOH has issued a CR 102 proposal that contains updates to protections provided to “whistleblowers” that report to DOH or who initiate, participate, or cooperate in investigations which raise quality of care concerns. The rules establish rights of whistleblowers and procedures for filing, investigation, and resolution of whistleblower complaints. WSHA has been actively engaged in the rulemaking process. This rulemaking is in response to the passage of SHB1049 in 2019.  Please see WSHA’s bulletin on SHB1049 for more information on the law and WSHA’s participation in the legislative process. (Cara Helmer)

Washington State Energy Code – The Washington State Building Code Council (WSBCC) released its’ CR 102 proposal that contains two proposed energy code updates that would uniquely impact hospitals. Two of WSBCC’s code proposals would eliminate the use of fossil fuel power sources for primary water and space heating equipment in all commercial buildings. WSHA testified to WSBCC in the fall that this requirement poses a significant risk for patient safety and conflicts with federal backup power requirements for hospitals. Currently, hospitals’ backup power is provided through fossil fuel sources since battery storage technology is not feasible on a scale that meets hospitals’ needs. WSBCC’s proposal would make it more difficult for hospitals to power their primary water and space heating sources in the event of a power outage. Because of this, WSHA is seeking the addition of a health care exception for the water and space heating proposals. Representatives from WSHA member hospitals testified about these issues at the March 2022 public hearing for the code proposals, and WSHA supplemented their testimony with a comment letter that contains specific recommendations to accommodate hospitals. WSHA will provide an update once the final code is released in April 2022. (David Streeter)

Prescription Label Translation– The Pharmacy Quality Assurance Commission (PQAC) adopted a petition for rulemaking to require translated prescription medication labels for patients (the petition is found pages 134-135 in the January 2022 PQAC meeting packet). This rulemaking will occur in place of HB 1852, which died at the end of the 2022 legislative session. HB 1852 would have created a statutory requirement for prescription label translations and contained specific requirements for pharmacies and PQAC. The bill was laudable in that it sought to offer prescription labels in additional languages, but unfortunately it created operational challenges for hospitals and health systems as written. Before the bill died, WSHA successfully narrowed the bill’s applicability to outpatient prescriptions for home use and exempted prepackaged opioid reversal medications from translation requirements. WSHA also amended the bill to include liability protections and a minimum of 120 days to prepare for compliance. WSHA will work to ensure that rules adopted by PQAC reflect the amendments and address other concerns raised by hospitals during the legislative session. In preparation for the rulemaking, WSHA will convene a Hospital Pharmacy Workgroup to participate in the regulatory process. Hospitals that would like to participate in the workgroup should email David Streeter for additional information. (David Streeter)

Drug Take-Back Program– The Department of Health released a CR 101 pre-proposal to initiate rulemaking to implement 2SHB 1161 (2021), which modifies the state’s Drug Take-Back program.  The CR 101 summarizes 2SHB 1161’s program modifications as: “(1) Allowing multiple program operators, (2) allowing new potential operators to apply periodically, (3) requiring a proposal review fee for applications, (4) requiring coordination between approved program operators, (5) referencing the department’s authority to adopt rule and set fees, and (6) other changes.” WSHA will monitor this rulemaking to ensure that the changes are workable for hospitals and minimize disruptions to existing practices for collecting unwanted medication from patients. (David Streeter)

Semi-Annual Rulemaking Agendas– Several state agencies relevant to hospitals issued their semi-annual rulemaking agendas. The agendas show what rules are currently in progress and what rules are forthcoming this year. Click the agency below to view its’ agenda:

Note: the DOH agenda includes rules for the Washington Medical Commission, State Board of Health, Pharmacy Quality Assurance Commission, and Nursing Care Quality Assurance Commission. (David Streeter)

Click here to see WSHA’s Top Priority State Rules Tracker – **2022 Completed Rules**

Click here to see WSHA’s Top Priority State Rules Tracker – **2021 Completed Rules**

Click here to see WSHA’s Top Priority State Rules Tracker – **2020 Completed Rules**

Click here to see WSHA’s Top Priority State Rules Tracker – **2019 Completed Rules**

Click here to see WSHA’s Top Priority State Rules Tracker – **2018 Completed Rules**


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