Hospitals are anchor institutions in Washington State communities, providing both needed services and stable jobs 24 hours a day, 7 days a week, 365 days a year. The Washington State Hospital Association strives to ensure that all our state’s communities have access to high-quality health care. The following document represents WSHA’s priorities for the 2019 legislative session. (And click here to download all WSHA’s issue briefs in one file.)
Ensure hospitals can be stable institutions serving their communities, long into the future
- Hospital safety net assessment program. The safety net assessment authorizing statute needs to be updated and the assessment needs to be reenacted. (Support/WSHA bill/Budget)
- Rural multi-payer model. Some rural hospitals are struggling financially. There is significant interest in the legislature to “transform” rural health delivery and financing. The specifics are not yet clear but WSHA supports reasonable guardrails for the model, such as voluntary participation and the need for it to work for all sizes of rural hospitals. WSHA has developed guiding principles that will be used to evaluate any proposal as it comes forward. (Support/WSHA bill; Evaluate other proposals)
- Medical debt: ensure hospitals are paid for care provided. Hospitals must be financially stable in order to provide quality, safe, affordable health care. Hospitals and providers will be harmed if laws are passed that encourage people to pay medical debt last. WSHA supports measures to ensure that consumers are aware of amounts owed for medical services and have the information to resolve their accounts, including charity care. (Oppose/Amend)
- Wrongful death: maintain a stable structure. Changes to the wrongful death statute should be limited to the removal of residency requirements. WSHA has significant concerns about expanding the damages and liability exposure as seen in 2018 legislation. (Neutral on residency requirement/Oppose)
- Ambulatory surgical facilities (ASFs): certificate of need or other expansions. WSHA is neutral in clarifying a Certificate of Need (CN) exemption for small physician-owned ASFs as proposed in 2018. We oppose further exemptions to allow ASFs to bypass the CN process. (Neutral/Oppose)
- A public option on the individual market. WSHA supports efforts to expand access to health care and coverage. WSHA has been a leading advocate for expanding coverage for children and adults. We support a comprehensive strategy to stabilize the individual insurance market and develop funding mechanisms to increase coverage for low- and middle-income Washingtonians. However, hospitals have concerns about proposals to reimburse providers below the cost of delivering patient care. This includes benchmarking rates to Medicare. Currently, hospital and health system financing is a delicate balance with commercial plans, including those on the exchange, paying above the cost of care in order to offset the known underpayments from Medicare and Medicaid. (Support comprehensive plan for stable market and coverage/oppose artificially capped payment rates)
Improve the behavioral health system for patients
- Increase access to mental health services. WSHA supports a comprehensive behavioral health plan, including policy areas that improve the behavioral health system, such as:
- Long-term mental health care in the community. Direct the state to contract with community hospitals to provide long-term care and treatment for mental health services in communities across the state for 90- and 180-day commitment orders. (Support/WSHA bill)
- Certificate of need for psychiatric beds. Continue to exempt licensed hospitals for two years from the arduous certificate of need process for psychiatric beds. (Support/WSHA bill)
- Opioids: combating the crisis. WSHA supports efforts to combat the opioid crisis. We are working with WSMA and the state Department of Health (DOH) to implement new laws to give providers timely information on opioid prescribing and overdose events to decrease over-prescribing and save lives. Provider boards and commissions adopted new requirements for opioid prescriptions in fall 2018. Given these advancements, WSHA opposes limits of opioid prescribing in legislation. Many larger health systems have or are in the process of integrating their electronic health record systems with the prescription monitoring program (PMP). WSHA remains concerned about a mandate to require integration with the PMP and the unintended fiscal consequences for rural hospitals and clinics. (Support reasonable paths forward; oppose new mandates on providers and hospitals)
Help patients during and after hospitalization and at end of life
- Health care decision making for incapacitated patients. WSHA supports a bill to improve decision making for patients who lack capacity. The bill would: 1) amend the informed consent law to add more options for decision makers when a patient lacks capacity; and 2) expand choices for executing advance directives by adding the option of a notary and clarifying some witness requirements – easing the process for patients while still protecting against fraud and abuse. (Support/WSHA bill)
- Timely access to quality care for sexual assault survivors. WSHA supports a clear process for notifying patients seeking sexual assault forensic evidence kit collection if the hospital cannot provide the service and helping patients access kit collection at another facility. We oppose proposed penalties on hospitals. (Support clear process for notifying patients/WSHA bill)
Maintain flexibility for hospital operations while preventing burdensome and costly new regulations
- Uninterrupted meal/rest breaks mandate and restrictions to on-call and mandatory overtime. A bill proposed in 2018, HB 1715, would mandate uninterrupted meal and rest breaks for RNs and other clinical staff, as well as significantly restricting the use of prescheduled on-call and mandatory overtime. Washington hospitals need the flexibility to determine staffing according to patient care needs. This legislation would add unnecessary costs to patient care, without increasing patient safety or improving access to services. It provides no proven solution to address the expressed concerns of fatigue and patient safety. WSHA strongly opposed the bill. (Oppose)
- Preserve access to care in communities through partnerships and affiliations. Affiliations and contractual relationships among physician offices, hospitals and health systems can maintain access to care, increase efficiency and improve care coordination. Often, these arrangements subsidize the cost of physician practices serving Medicaid patients and allow more standardization of care. New barriers to affiliations do not preserve competition and may force independent providers to close, thereby reducing access to primary and specialty care in communities. (Oppose)
- Protect the quality and safety of care. WSHA has significant concerns with a proposal to prohibit hospitals from appropriately managing the types and quality of services provided in their facilities. We support providing patients with information – and a referral where possible and appropriate– to locations that provide care not offered by the hospital. (Oppose)
- Balance billing. WSHA agrees that patients should be taken out of the middle of contract disputes between providers and insurers. We support reasonable efforts to inform patients of the network status of providers. However, the burden of solving contract disputes should not be placed on hospitals. We also have concerns about any proposals that would alter the balance of power in insurer-provider negotiations. (Oppose/Amend)
- Workplace violence prevention. WSHA supports efforts to prevent workplace violence. We agree improvements are needed to current law, but need to ensure hospitals have the flexibility to train staff according to local needs and risks. (Support/Amend)
- Noncompete agreements: maintain flexibility in clinician contracts. WSHA supports preserving this important contracting option that allows hospitals to invest in recruiting and supporting providers and certain staff. (Oppose/Amend)
- Consumer privacy law alignment with existing health privacy protections. WSHA supports efforts to enhance consumers’ access and control of their personal data. WSHA has concerns that state legislation would mandate new onerous requirements over and above those set out by several state and federal laws, including HIPAA. Hospitals and health systems already maintain stringent privacy and security standards. (Concerns/Amend)
- Reasonable standards for pharmacies. WSHA supports the Department of Health’s efforts to modernize laws around electronic prescriptions and out-of-state pharmacies that send drugs to Washington. (Support)
WSHA Budget Asks (In Order of Priority)
- Hospital Safety Net Assessment Program. Update the Hospital Safety Net Assessment program so it continues for another four years. This program provides both Medicaid hospitals and the state about $146 million per year to support health care for low income Washingtonians.
- Difficult to discharge patients: Patients should not be stuck living in hospitals, yet hospitals are unable to discharge certain patients to more appropriate post-acute care settings (such as a skilled nursing facility, adult family home or nursing home).
- Memory care. The lack of memory care services for Medicaid patients living with dementia is a significant barrier to post-acute placement for community hospitals. WSHA supports increasing Medicaid long-term care payment rates for patients living with dementia. A funding request is about $10 million in state funds; total of $20 million with federal funds.
- Noncitizen patients. Some noncitizen patients are stuck in hospitals for literally years waiting for state funded long-term care slots. WSHA supports increasing slots for noncitizen residents who do not qualify for Medicaid. A funding request is about $21 million in state funds.
- Mental health: WSHA supports a comprehensive plan to address the needs of mental health patients, including the challenges at the state hospitals. Specifically, we support:
- Partial hospitalization and intensive outpatient programs for Medicaid mental health patients. These services, currently not authorized by Medicaid, provide patients with mental health services to help prevent hospitalizations or provide intensive services after a hospitalization to avoid readmissions. A partial hospitalization and intensive outpatient program funding request is about $13.9 million in state funds; total of $37.4 million with federal funds.
- 90/180-day involuntary commitment beds in the community. The Governor has proposed closing or significantly limiting 90/180-day civil commitment beds at Western and Eastern State Hospitals. Some community hospitals, as well as other community mental health providers, are willing to serve this population. Medicaid currently pays hospitals about 75 percent of the cost of care. Hospitals need a rate that is sustainable and covers, at a minimum, the cost of care.
- Continued funding for WRHAP hospitals. The smallest critical access hospitals are working on care transformation via the Washington Rural Health Access Preservation project and SHB 1520. Hospitals are seeking the original appropriation of $4.4 million for the 2019-2021 biennium since a permanent new payment model has not been implemented. Additional funding or policy changes related to the Health Care Authority-driven Rural Multi-Payer Model may be needed to transform the current payment system for all rural hospitals. (Support/WSHA bill)
- Outpatient provider Medicaid rate increase for behavioral health. Access to early diagnosis and treatment of behavioral health conditions is a key piece of the state’s overall behavioral health efforts. Current Medicaid rates for outpatient clinicians are not sufficient to ensure sustainable access for these services. WSHA is working to finalize a proposal for a targeted Medicaid rate increase for primary care visits involving a behavioral health diagnosis. Currently, Medicaid pays less than half the cost of the visits.
Capital Budget (In Order of Recommended Priority)
- Support capital for new mental health and long-term care facilities, including:
- Increase 90/180-day bed capacity in hospitals. $19.2 million total to support hospitals in serving patients on long-term involuntary mental health commitments (90/180-day treatment).
- Improve memory care units. Support for capital projects to expand memory care capacity statewide.
- Housing for patients living with a mental illness. Studies show that patients without stable housing have more unresolved medical conditions and worse outcomes. These issues play out in hospitals and emergency departments. WSHA supports more resources for housing programs.
- Increase bonding authority. Support for increasing mental health bonding capacity to support capital projects that help patients before they need hospitalization and afterwards.
- Dental care in rural health clinics. Some rural health hospitals are interested in providing needed dental care in their communities through rural health clinics. WSHA is supportive of individual member requests for capital dollars to expand access to dental services in rural communities.
Non-WSHA Budget Asks We May Support (In Order of Recommendation)
- Loan repayment funding. Increase funding for the state student loan repayment program for behavioral health providers.
- Community mental health funding. Adequate community mental health funding is critical to caring for people living with a serious mental illness. Hospitals support investments in community mental health to ensure patients receive care in the community and before they need hospitalization.
- Foundational public health. The state Department of Health is seeking an increase in funding. The Governor’s budget identified $22 million in permanent funds, however, public health stakeholders are asking for $100 million. Funding would provide support to address communicable diseases, environment health and surveillance.