2023 State Legislative Agenda

Background

Hospitals are anchor institutions in Washington State communities, operating 24 hours a day, 7 days a week, 365 days a year to provide lifesaving inpatient and outpatient treatments. The Washington State Hospital Association (WSHA) strives to ensure that all our state’s diverse communities and patients have access to high-quality and equitable health care.

In 2022, Washington’s hospitals employed more than 121,000 people. In 2020, hospitals invested more than $285 million in community-building activities and provided more than $330 million in charity care. Hospitals also absorbed unpaid costs of $1.4 billion in Medicaid and $1 billion in Medicare.

WSHA’s 2023 legislative priorities are grounded in the following key principles:

Ensure patients have health coverage and access throughout the care continuum before, during and after hospitalization.
Ensure hospitals are stable institutions serving their communities, long into the future.
Maintain flexibility for hospital operations while mitigating new burdensome and costly regulations.

Budget Priorities

Increase Hospital Safety Net Assessment Program (SNAP) payments to hospitals. WSHA is asking to replace the current Safety Net Assessment Program to comply with new federal regulations. In 2024, hospitals would either pay an increased tax on non-Medicare revenue or participate in intergovernmental transfers to draw down additional funding for Medicaid. No state general fund would be sought. Most hospitals in Washington State are in financial crisis due to inflation and a labor shortage. By 2024, the Medicaid shortfall – the difference between the hospital cost of care for Medicaid patients versus actual payments – is expected to be $2 billion a year across the state. Hospitals need a significant Medicaid increase to bridge this gap. Statewide, hospital losses from operations from January 1 to September 31, 2022 were $1.6 billion.
Difficult to Discharge: Increase post-acute care funding for patients who are ready to be discharged. No one should live in a hospital, but some patients are not able to be discharged to more appropriate community settings (such as a skilled nursing facility, adult family home or residential setting). The pandemic has exacerbated this situation – skilled nursing facilities have lost more than 2,000 beds due to inability to staff. WSHA supports:
- Increase funding to long-term care for the most complex clients, including individuals who have experienced traumatic brain injuries and people with developmental disabilities, who remain in hospitals for months. ($28.8 million state; $49.2 million total);
- Increase slots for undocumented residents who would otherwise qualify for long-term care or disability services. ($9 million state); and
- Provide payment to hospitals for patients who qualify for Medicaid home and community services and adjust the administrative day rate for those who are eligible for skilled nursing services. (Funding TBD). WSHA also supports increased Medicaid payment rates for long-term care to ensure the chronically underfunded long-term care system can attract and retain staff ($272 million state; $547 million total).

Continue funding for distressed hospitals in the 2023-2025 biennium. ($8 million)

Policy Priorities

Protect Patient Safety & Access: Preserve flexibility in hospital staffing and support investments to retain and attract nurses. The entire health care community must do their best to ensure access to care for all patients. Given the nationwide nursing workforce shortage, nurse to patient ratios would result in hospitals reducing patient services to meet the ratios. On-call limitations as proposed would also restrict the ability to provide lifesaving services from organ transplants to care for heart attacks in cardiac catheterization labs. Staffing challenges stem from the inability to discharge patients and a national labor shortage. There is no single solution to these challenges.
To retain the existing hospital workforce, attract already-trained nurses to Washington, and develop more new nurses through education and training, WSHA supports the Protect Patient Safety & Access legislative package:
- Establish a statewide collaborative to investigate and spread innovations in hospital staffing;
- Make Washington a destination state for already-trained nurses by developing a student loan repayment assistance program for hospital-employed nurses. Larger hospitals and the state would contribute to funding the program. Rural hospitals would receive increased state assistance. (Funding TBD);
- Participating in the nurse licensure compact with 37 other states;
- Require nurse traveler agencies to register with the state and provide transparency on average costs;
- Continue funding for the Washington State Nursing Preceptorship Incentive Program ($6 million) and fund a facilitation mechanism for improved communication for nursing programs and clinical placement sites (Funding TBD) to expand the number of sites and clinical placements available for students; and
- Strengthen Washington’s model nurse staffing committee law by requiring committee charters, standardizing the format of nurse staffing plans, and increasing executive accountability when staffing plans change.

Difficult to Discharge: Ensure Medicaid patients subject to a guardianship proceeding can discharge to appropriate long term care settings while waiting for a guardian to be appointed. DSHS interpretation of federal and state law has led to a significant increase in patients in hospitals who must have a court appointed guardian to move out of the hospitals and into long-term care placement. WSHA supports allowing a court to order, as part of guardianship proceeding, appropriate hospital discharge and long-term care placement for an individual in a hospital.
Develop and fund new behavioral health 23-hour crisis receiving centers. Washington State’s behavioral health crisis system needs modernization, as recognized by the CRIS Committee. Currently, there are very few options for people in a behavioral health crisis besides the emergency department. WSHA supports the development of a sustainable funding model and recognition in law for a new type of facility that will function as an alternative to the emergency department for people experiencing a behavioral health crisis. (Funding TBD)
Allow hospitals to continue to merge, affiliate and engage in business transactions. The ability for hospitals to enter appropriate business transactions should be maintained. Health care mergers in our state have led to continued access to health care services for patients in local communities across the state. In recent cases where hospitals could not partner it led to hospital closure, disrupting services for patients. WSHA supports maintaining access to abortion services in the event of a health care transaction.
Delay the clean-building requirements for hospitals until 2028. Hospitals are in dire financial distress. The clean-buildings law requires investments at a time when hospitals face significant and unsustainable losses. For large sized hospitals to meet the law’s requirements in 2026 and medium sized hospitals to meet the law’s requirements in 2027, investments need to start now. Delaying the law for all hospitals to 2028 will allow hospitals to recover from the pandemic and make the necessary investments to become more energy efficient and compliant with the law.
Oppose private “bounty hunter” type enforcement of employment laws (qui tam). WSHA opposes allowing individuals to sue employers for violating employment laws in exchange for a portion of the monetary proceeds. Washington State has an array of employment laws related to wages, safety, overtime, and leave. California is the only state in the nation to have this type of law, and it has proven to generate frivolous lawsuits.
Support a regulatory structure for pharmacy benefit managers. WSHA supports the creation of a regulatory structure for Pharmacy Benefit Managers (PBMs), including PBMs that control pharmacy benefits of insurers and groups not currently regulated by the state.
Maintain recognition of health privacy laws in consumer data privacy. WSHA supports efforts to enhance consumers’ access and control of their personal data. However, general consumer privacy laws must not disrupt the existing privacy and security standards of health information already regulated under state and federal laws, including the federal Health Information Portability and Accountability Act (HIPAA).
Support protections for providers and patients related to reproductive services. WSHA supports protections in state law for reproductive health care provided in Washington State, including preserving access to abortion services and protecting provider and patient information from legal process from states with more restrictive laws.
Support the in-person care provision for audio-only telemedicine. WSHA supports the “established relationship” definition enacted via HB 1821 (2022) that requires an in-person visit for audio-only telemedicine providers to receive reimbursement for physical health services beginning July 1, 2024.
Ensure state business laws recognize unique hospital considerations. WSHA supports ensuring that new business laws recognize and appropriately address the unique differences between hospitals and other types of businesses. Any changes to our state’s business or environmental laws must account for the critical contributions our industry makes for patients and the economy.