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: August 30, 2021)

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

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)

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)

Behavioral Health Agencies – The Department of Health (DOH) has started Phase 2 of a multi-year, multi-phase rulemaking project to update and modernize the licensing regime for behavioral health services in Washington (Chapter 246-341 WAC).  Weekly DOH rulemaking workshops for Phase 2 began on July 20, 2021 and will continue through September.  The focus of Phase 2 rulemaking will largely be focused on streamlining and improving certifications.  WSHA is an active participant in these workshops and has convened a workgroup of interested members to evaluate DOH’s rulemaking proposals and provide feedback throughout the process.  Phase 1 took place in summer and fall 2020, over the course of five months and 17 workshops. The final rules –effective July 1, 2021, (compliance date January 1, 2022)—are a product of those workshops. This phase concentrated on updating language, refining inconsistencies across services, and addressing other obvious areas of improvement.  You can find more information about the conclusion of Phase 1 and new final regulations in this WSHA Bulletin.  Phase 3 of this project will take place in the summer of 2022. (Brooke Evans)

Audio-Only Telemedicine– The Office of the Insurance Commissioner (OIC), Health Care Authority (HCA), and the Washington State Telehealth Collaborative are currently working to implement HB 1196. The OIC recently issued a CR 101 pre-proposal and convened a stakeholder group to discuss potential topics in HB 1196 for rulemaking. Key topics identified for potential rulemaking include the patient consent provision and the payment parity requirement. HCA issued its own CR 101 pre-proposal and will convene stakeholders soon. Additionally, HB 1196 requires the Washington State Telehealth Collaborative to “study the need for an established patient/provider relationship before providing audio-only telemedicine, including considering what types of services may be provided without an established relationship.” Additionally, the Collaborative “must submit a report to the legislature on its recommendations regarding the need for an established relationship for audio-only telemedicine.” To fulfill its mandate, the Collaborative discussed the established relationship provision at its June 24, 2021 meeting and surfaced three tentative recommendations that are open to stakeholder feedback:

  1. Change the term “clinic” in the “established relationship” definition to “shared group practice.”
  2. Change the established relationship time period from 1 year to 3 years.
  3. Allow an audio-visual telemedicine visit to satisfy the in-person visit requirement that is part of the established relationship.

WSHA is participating in the OIC, HCA, and Telehealth Collaborative processes and encourages members to join our Telemedicine Workgroup to stay engaged in the rulemaking. To join the workgroup or provide feedback on the Telehealth Collaborative’s potential recommendations, please contact David Streeter. (David Streeter)

Prescription Monitoring Program (PMP)- HCA issued its final CR 103 rule to implement PMP checks for Medicaid patients mandated by the federal SUPPORT Act. The new rule applies to all prescribers and outpatient pharmacies. Under the rule, prescribers must check the PMP before prescribing a controlled substance to Medicaid patients and pharmacists must check the PMP before dispensing a controlled substance to Medicaid patients. The new rule takes effect October 1, 2021 and HCA will be issuing additional information to prescribers and pharmacists to ensure compliance. WSHA submitted concerns about this rule during the rulemaking process and successfully narrowed the rule’s scope to only outpatient pharmacies. WSHA published a bulletin on the new rule that is available here. (David Streeter)

Physician Assistant Practice Laws- In 2020 the Washington State Legislature passed legislation to modernize the state’s physician assistant (PA) laws. Currently, PA’s and physicians work together under delegation agreements approved by the Washington Medical Commission (WMC). Beginning July 1, 2021, the delegation agreement process will be replaced with the new practice agreement system outlined in HB 2378 (2020). Current delegation agreements will still be valid after July 1, 2021, unless the contents of a delegation agreement changes, or the PA changes jobs. WMC hosted a webinar explaining the changes, which can be viewed here. The webinar covers the components of a practice agreement, changes regarding remote sites, and supervision expectations. Additionally, WMC posted its’ new practice agreement form on its website alongside other PA practice resources. WMC is also in the process of updating chapter 246-918 WAC to reflect the new PA practice laws. The CR 102 proposal is available here and a public hearing on the proposed rules will be held on September 22, 2021 at 4 PM. WSHA’s bulletin on the new PA laws is available here. (David Streeter)

Emergency Heat and Wildfire Smoke Rules- The Washington State Department of Labor & Industries (L&I) filed two new emergency rules concerning wildfire smoke and severe heat that apply to all employees who primarily work outside. Most hospital employees will not be impacted by these rules since they work inside. However, hospital employees potentially covered by these rules include landscaping and maintenance staff, security staff, parking attendants, and any other employee who works predominantly outside of the hospital. The wildfire smoke rules require employers to determine smoke levels at their worksite and inform employees of potential hazards. Employers must also provide respiratory protection under serious smoke conditions and implement training and procedures for staff potentially exposed to severe wildfire smoke. The severe heat rules build on existing rules and require employers to provide “suitably cool” drinking water and allow employees working outside on days when the temperature is above 100 degrees Fahrenheit to take 10 minute cooldown breaks every two hours. Employers are also required to have written outdoor heat exposure policies and train their employees about heat exposure safety. Both the wildfire smoke and severe heat rules were filed on a temporary emergency basis and will be replaced with permanent rules later this year. Click to read the plain language summaries in L&I’s press releases on the wildfire smoke rules and severe heat rules. (David Streeter)

Employment Relationships and Hours Worked Policies- L&I released two administrative policies that provide interpretive guidance concerning employment relationships and hours worked by employees. ES.C.2 is an updated version of L&I’s existing administrative policies concerning hours worked. One new policy adopted in ES.C.2 classifies the time employees spend undergoing security and health screenings as hours worked, which may require your hospital to update its internal policies. ES.A.14 is a new administrative policy that provides guidance to employers on employment relationships under the Minimum Wage Act and independent contractors. WSHA participated in L&I’s stakeholder process for the two documents in coalition with the broader business community and provided hospital feedback to the Department. Please review ES.A.14 and ES.C.2 to understand L&I’s latest administrative guidance for employers.  (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:

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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