2021 State Legislative Agenda


Hospitals are anchor institutions in Washington State communities 24 hours a day, 7 days a week, 365 days a year – providing both needed health services and employment opportunities. The Washington State Hospital Association (WSHA) strives to ensure that all our state’s communities and patients have access to high-quality health care. This has become even more critical for Washingtonians during the current COVID-19 pandemic. Our priorities are grounded in the following areas:

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

Budget Priority

  • Protect and maintain access to health care and safety net services. WSHA strongly opposes cuts to health care or safety net programs that would undermine Washingtonians’ access to services – including priority areas of behavioral health and Medicaid long-term care (critical to patients who are stuck in the hospital). WSHA will be the prime voice against any reductions to hospitals, including Medicaid payment rate cuts or cuts to critical access hospitals, and a supporting voice against other cuts proposed to health care services.
  • Ensure difficult to discharge patients have placement for memory care. No one should live in a hospital. But some patients are not able to be discharged to more appropriate post-acute care settings (such as a skilled nursing facility, adult family home or nursing home). The lack of memory care services for Medicaid patients living with dementia, Alzheimer’s and traumatic brain injury is a significant barrier to post-acute placement for community hospitals. WSHA supports targeted increases to Medicaid long-term care payment rates to support patients who need memory care in a specialized facility.
  • Increase access to long-term psychiatric services by establishing a sustainable Medicaid payment rate methodology. In 2019 and 2020, the legislature established a work group to create a per diem payment rate methodology for community hospitals caring for patients on 90- and 180-day civil commitment orders. WSHA has been working with the Health Care Authority on the methodology to ensure that it establishes a sustainable rate, that at a minimum, covers the cost of caring for these complex and vulnerable patients. In 2021, WSHA supports the legislature adopting a sustainable payment rate methodology for community hospitals willing to serve this patient population.

Policy Priorities

  • Enact the nurse licensure compact. WSHA supports adopting the Nurse Licensure Compact. This will allow nurses who hold a multistate license from one of the 34 states that are part of the Compact to practice in Washington State. The COVID-19 pandemic has illustrated the critical need for out-of-state specialty nurses (intensive care and emergency room) to be able to rapidly fill critical demand in Washington. Our state is severely disadvantaged in getting needed staff to relieve our tired workforce.
  • Provide liability protections for health care providers and facilities that recognizes the evolving standards of care during COVID-19. WSHA supports establishing a clear method for determining the standard of care for providers and facilities caring for COVID-19 patients that reflect the realities of this challenging time. Supply shortages, evolving treatment, and changing government directives on what and when services can be provided make it impossible to fairly evaluate the practice of care according to the existing legal standards. Physicians, nurses, and facilities should be held to a standard of care that specifically and accurately addresses the practice conditions during this unprecedented time.
  • Establish core state law waivers to prepare for future emergencies. WSHA supports a law to enable waivers of key state health laws during any state declared emergencies to ensure health care system response readiness. Our state needs to learn from the current crisis to prepare for future emergencies, even those long into the future. The law would also create a clearer process to address state laws that are equivalent to federal laws waived during a federally declared emergency.
  • Ensure reasonable requirements for hospital operations. WSHA believes it is important for state requirements related to hospital reporting of data on prices, costs, and community benefits to be reasonable and consider reporting burdens. The state’s ability to meaningfully and timely handle the reporting and the public’s need for the information should also be considered; hospitals currently report many things that few ever access. Additionally, the ability for hospitals to enter into appropriate mergers and affiliations should be maintained.
  • Preserve flexibility in workforce and staffing. As the entire health care system confronts these extremely challenging times, we must do our absolute best to ensure access to care for all patients. WSHA wants to enable current nurse staffing laws to work and maintain flexibility at the local level. Hospitals must be able to staff for patients during a pandemic and would oppose burdensome new mandates that impact the workforce.
  • Use data to improve access to inpatient behavioral health treatment. Too often, people experiencing a mental health or substance use-related crisis are stuck in emergency departments because no appropriate inpatient bed is available. The problem is that not all involuntary psychiatric beds are alike, and we are without a clear picture of the differences. WSHA will conduct an inpatient capacity data project to dovetail with developing recommendations by the legislature. We believe this information is necessary before the legislature acts. A clear picture of inpatient capacity is crucial to increasing access and avoiding unintended consequences that may undermine it.
  • Increase patient access to health services through audio-only telemedicine. The COVID-19 pandemic has brought to light the importance of audio-only services for patients. At the same time, these services need to integrate with hands-on health care. WSHA supports requiring payment for these services by Medicaid, commercial insurance, and Public Employee Benefits Board/State Employee Benefits Board for patients who have an established relationship with their provider.
  • Oppose private 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. State agencies already have significant powers to enforce these laws. Evidence from California shows private enforcement is a tool ripe for abuse that prioritizes litigation over correcting alleged violations.
  • 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 under state and federal laws, including Health Information Portability and Accountability Act (HIPAA).
  • Extend the certificate of need (CN) exemption for psychiatric beds. WSHA supports renewing the CN exemption for psychiatric beds. The current law is set to expire on June 30, 2021. The extension would allow hospitals to increase their psychiatric bed capacity without going through the CN process. WSHA supports extending the exemption for four years and including a new one-time provision for freestanding psychiatric hospitals to add up to 30 beds for patients on 90- and 180-day civil commitment orders. The legislature has renewed this exemption three times.
  • Ensure general 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 businesses. Any changes to our state’s business laws must account for the critical contributions our industry makes to patients and the economy during this tragic pandemic.
  • Support public health. Hospitals and public health departments work very closely but have done so even more during this pandemic. WSHA is part of a broader coalition encouraging additional support for public health services in Washington State.

Chelene Whiteaker, Senior Vice President, Government Affairs
Updated: February 10, 2021


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Washington State Hospital Association
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Seattle, WA 98104

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