washington state hospital association the 2014 state legislative session

Washington State Hospital Association

The 2014 State Legislative Session


Presenters

Cassie SauerSVP, Advocacy & Government Affairs

Claudia SandersSVP, Policy Development

Mary Kay Clunies-RossVP, Communications & Public Affairs


Session Overview• Short session• New leadership (4/5 of key players)• Majority Coalition – interesting political

dynamics• Even with complicated political dynamics, some

great steps forward and no steps backward for hospitals


The Budget

Mental Health Funding Hospital Owned Clinics

Medicaid Outreach Maintain Primary Care Rates


State BudgetOverview• Non-budget session – House and Senate

differed on willingness to spend• Revenue forecast was better, but not great• Supreme Court reiterated mandate for more

education funding, days before session began• Budget gaps filled with marijuana tax revenue• No capital budget


Mental Health Funding

Bad news: No capital funding Good news: $17.7 million for mental health services• $4.5 million for non-Medicaid backfill– Includes Institutes for Mental Disease

• Funding for 3 new Evaluation and Treatment centers• PACT teams for those at high risk for rehospitalizations• Recovery services for those returning to the community


Hospital-Owned ClinicsWSHA Goal: Preserve Medicaid funding for hospital-owned clinicsProposed cut would have limited access to primary and specialty care for Medicaid enrollees

Result: • No cut• HCA will study/make recommendations for reducing

payment rates • Could have big impacts on patients’ access to care


Bills Enacted

Emergency Credentialing Grace Period Notification

Behavioral Health Integration Health Care Innovation

Safety Net Assessment Fix Confidentiality

Training for PHDs


HB 2692: Support Emergency Credentialing

WSHA Goal: Allow for emergency credentialing for out-of-state health care workers and provide immunity for health care workers in emergencies

Result: HB 2692 passed with emergency credentialing provision

Future: Continue to work on provider immunity


SB 6103: Support Notification for Delinquent Exchange Premiums

WSHA Goal: Minimize confusion regarding payment for care delivered during 3 month grace period • Insurers responsible for first month of coverage, but

can deny payment in second and third month• Providers must be notified that patient has not paid

premium

Result: SB 6013 passed


SB 6312: Support Integration of Behavioral Health

WSHA Goal: Support patient-centered integration of state purchased mental health, chemical dependency, and medical services • Task force to make recommendations• Goal of full integration by 2020 through managed

care plans• CON waiver for conversion of hospital beds to

psychiatric care

Result: SB 6312 passed by legislature


Support Innovation and Transparency

WSHA Goals: Support reform that does not create barriers to care or innovation; Support access to cost and quality data and common performance measuresResult: HB 2572 and SB 6228 passed Savings: $2.8 million 2014-2015 And $57 million 2015-2017


HB 2572: Communities of Health

• A regionally based voluntary collaborative• Broad membership including hospitals• No identified boundaries or specified number

of collaboratives• Grants for two pilots


HB 2572: Physician Extension Program

• Aimed to help primary care and behavioral health providers– Better coordinate care– Become patient centered

medical homes


HB 2572: All Payer Claims Database

• Office of Financial Management establishes statewide database, with lead organization

• Mandates data from Medicaid/public employees

• Advisory committees include hospitals• Protects confidentiality but allows for access• Comparisons must account for differences in

acuity, impact of uninsured and government patients and teaching expenses


HB 2572 and SB 6228: Common Performance Measures

• New state committee; members include WSHA representative

• Measures determined by January 2015:– Prevention and screening– Management of chronic care– Key health outcomes– Care coordination and patient safety– Preventive, acute, and chronic conditions


SB 6228: Transparency Tools

• Better information tools for consumers, including about hospital cost and quality for both inpatient and outpatient care

• Thank you for posting links to WSHA transparency site on your website!


SB 6570: Hospital Safety Net Assessment Technical Fix

WSHA Goal: Fix assessment technical and timing issues to allow approval by Centers for Medicare and Medicaid Services• Bill enacted as WSHA wanted• State expects approval shortly• Did not change ratcheting schedule• More information soon


SB 6265: Confidentiality

• Heighten protections of CHARS data• Fixes provisions about accounting for mental

health disclosures• Urge Governor to sign!


Public Hospital Districts

AWPHD Goal: Increase access to training regarding the Public Records Act, Open Public Meetings Act, and records retention• Bill proposed to provide consistent, accessible training Result: SB 5964 passed

AWPHD Goal: Increase transparency without jeopardizing Board ability to conduct business

• Bill clarifies that posting agendas in advance of meeting does not prevent later agenda changes

Result: HB 2105 passed by legislature


Bills Not Enacted

Telemedicine Staffing Mandates

Federal Basic Health Suspect and Inmate Care

Medical Records Payment Rates Breastfeeding

Public Hospital Districts


Telemedicine

WSHA Goal: Assure payment for services provided using telemedicine technology• Passed House 98-0 • Unfounded concerns about

“webcam abortions” killed the bill in the Senate

Result: HB 1448 not enacted


Staffing MandatesWSHA Goal: Defeat unworkable nurse staffing legislation that endangers patients

Nursing union proposals:– Nurse staffing ratios– Uninterrupted meal and rest breaks– Overtime/on-call restrictions

Result: We defeated all these bills, againFuture: These bills will be back, again


Careful Evaluation of Federal Basic Health

WSHA Goal: Delay creation of new program without more complete analysis of impacts • ACA allows Federal Basic Health for those with incomes

slightly above Medicaid• Concern regarding lack of data supporting program

and potential costs to state and providersResult: Bill to create program not enactedFuture: Track issues of affordability


Suspect and Inmate CareWSHA Goals: • Defeat attempts to limit payment to no more than

Medicaid • Protect staff and patients by requiring adequate

law enforcement guarding of patients who are suspected or convicted of a violent or sexual crime

Result: Neither issue was enacted, but important stakeholder conversations have begun


Medical Records RequestsWSHA Goal: Ensure hospitals can charge the same rates for electronic and paper medical record requests • Bill proposed to mandate that hospitals respond to

medical record requests in electronic form and cap record fees at $20

Result: HB 2074 was modified to be acceptable, but was not enacted


Support Breastfeeding

WSHA Goal: Support breastfeeding as a strategy to improve infant health and reduce childhood obesity

Result: HB 2329, SB 6298 defeatedFuture: Work on voluntary efforts


Public Hospital Districts – Good ResultsAWPHD Goal: Maintain local decision-making and affiliations• Bill prohibited district boards from delegating certain

management functions-- affiliations virtually impossible

Result: SB 6425 defeated


Public Hospital Districts – Good Results for Bills Targeted at Large Districts

AWPHD Goal: Ensure larger public hospital districts may elect at-large commissioners

Result: SB 6004 defeated

AWPHD Goal: Defend hospital districts from unduly burdensome personal income reporting requirementsResult: SB 6348 defeated


Public Hospital Districts – Disappointing Results

AWPHD Goal: Allow public hospital districts to recover costs relating to public records requests for commercial purposesResult: HB 1037 died


Policy Work Before 2015 Session

• Nurse staffing• Transparency and Innovation• Future of Certificate of Need• Mental health funding and

integration• Enrollment and expansion


Washington Hospital PAC

Building RelationshipsElecting Champions for HospitalsUnifying Hospitals’ Political Voice

www.wsha.org/whpac.cfm


Thank You!

We couldn’t do it without you!

Thank you for your good work!


Questions? Comments?

Cassie SauerSenior Vice President, Advocacy & Government Affairs

[email protected] 206/216-2538

washington state hospital association the 2014 state legislative session

Documents

care slide

hospital owned clinics

phds slide

legislature slide

community slide

capital budget slide

conversion of hospital

mental health services