2019 legislative session and current issues•renewal of safety net assessment program 12. difficult...
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2019 legislative session and current issues
Andrew Busz, Policy Director, Finance
March 6, 2019HFMA
Objectives
• Identify the most impactful state issues facing hospitals for 2019
• Discuss other current issues facing Washington hospitals
• Introduce WSHA and its work
• Recognize the political dynamics in Olympia and how they will shape WSHA’s legislative agenda
What is WSHA?• Member organization/funded by member dues
• Includes all 107 hospitals and health systems in the state
• Work to represent the best interests of our members and
their patients by advocating at the state and federal levels for
policies that increase access and improve quality.
• “Face” of hospitals to HCA, DOH and other state agencies
• Legislative advocacy
• Rulemaking
What is WSHA?
WSHA Patient Safety Program has provided a forum for urban
and rural health care providers to share best practices and
address issues of safety and quality, improving health care
delivery and making care better and safer for all.
• Currently contracted with CMS for health improvement work
Washington Hospital Services supports hospitals and health
systems through the delivery of services and products to support
hospital operations.
• Peer review and quality improvement
• Worker’s compensation
• Unemployment claims
• Absence management
What Happens During Legislative Session• Introduce proactive bills to address known issues
• Review of all bills that could potentially impact hospitals
• Communicate with member hospitals to determine impact and position (Support, Neutral, Oppose)
• Prepare testimony, identify testifiers, or testify ourselves
• Develop amendment language to address bill concerns
The 2019 Legislative Session
2019 Legislative Session
• 2017 Session• Democratic-controlled
House• Republican/Majority
Caucus Senate
• 2018 Session• D’s controlled both House
and Senate, but by narrow margins
• Moderate legislation
Post-Election Results
Democrats gained seats in both chambers
5739
House
Ds Rs
2820
1Senate
D R D
State Leadership: 2019
Governor Jay Inslee (D) – 2nd term
Senate Majority Leader Andy Billig (D) – Spokane (New!)
House Speaker Frank Chopp (D) - Seattle
Senate Minority Leader Mark Schoesler (R) – Ritzville
House Minority Leader J.T. Wilcox (R) – Yelm (New!)
2019: Themes
McCleary (K-12)
Behavioral Health
Higher Education
RevenueAffordable
Housing
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Budget picture
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WSHA Budget Priorities
• Difficult to discharge patients
(patients living in the hospital)
• Behavioral health: funding the
continuum of care
• Outpatient Medicaid rate
increase for providers
• Continued funding for WRHAP
hospitals
• Renewal of safety net assessment
program
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Difficult to Discharge
• WSHA member workgroup
• Policy and budget work in 2019 and
beyond
• 2019 budget items
• Memory care – raise Medicaid rate
for specialized dementia
• Noncitizens – increase state long
term care funding for noncitizen
patients
• Developmental disabilities – require
data reporting
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Behavioral Health
• Partial hospitalization and intensive
outpatient programs for Medicaid
mental health patients
• 90- and 180-day involuntary
commitment beds in the community
• Community hospitals need a sustainable rate that covers the cost of care
• Capital funding to support the infrastructure needs
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Governor’s Budget (Released December 13)
• Significant funding for behavioral health
• Includes primary care provider fee schedule rate increase
• Dental managed care?
• Funded though capital gains tax, increased real estate taxes,
and increase to B&O tax rate on certain services
Policy Priorities
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Opioids
Improving Access and Helping Patients
(WSHA bills)
Decision making for incapacitated patients
Rural multi-payer model
Continue CON exemption for mental health and 90/180 day commitments
Sexual assault forensic evidence collection
Nurse fatigue
Preserve flexibility and maintain/lower costs
Nurse staffing: meal & Rest breaks, prohibiting on-call
Expansion of wrongful death
Balance billing prohibitions
Restrictions on health care entities
Notice requirements on mergers and affiliations
Expansion of ambulatory surgical centers without CON
Restriction on medical debt
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Certificate of Need Exemption for Psychiatric Beds and 90/180 Commitments
• CN exemption for psychiatric beds expires on June 30, 2019
• WSHA is advocating for continuing to exempt community hospitals for an additional two years
• Some hospitals want to develop and contract to serve patients on 90/180 day commitments
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Proactive bill
Medical Decision Makers
• WA law limits who can make decisions when a patient lacks capacity
• Expand WA law to allow more family members or a close friend to make decisions
• Amend advance directive law to allow notary to witness an advance directive
Proactive bill
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Nurse Staffing
SB 5190/HB 1155: Applies to nurses and certain technicians/technologists:
• Mandates uninterrupted meal and rest breaks
• Restricts use of pre-scheduled on call
• Expands mandatory overtime prohibitions
• WSHA remains opposed
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Nurse Staffing
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Proactive bill
SB 5344: • Applies the complaint process for nurse staffing committee
to missed breaks, including complaints to DOH
• Establishes 60 hr week limit for RNs for direct patient care
• Hospitals must work to find a replacement if a nurse is called in before/after a regularly scheduled 12 hour shift AND indicates they are fatigued and cannot work
• Developed with significant input from members
Rural Alternative Payment Model
Rural hospitals need help. HCA needs to create several pathways to a more value-based approach.
• WSHA supports HB 1810 setting parameters on the negotiations between HCA and CMS
Increase Regulation of Labor RelationsBroadly applicable labor relations bill capturing hospitals• Restrictive scheduling (HB1491/SB5717) – WSHA seeks amendment to
clarify, this bill is meant for retail, hospitality and food services; would
impose stringent standards around scheduling and hiring practices
• Independent contractor (HB1515/SB5513) – WSHA seeks amendment to
exclude hospitals and providers from this bill, which would essentially
prohibit the use of independent contracts in WA
• Whistleblower/Qui Tam relator (HB1965) – WSHA opposes allowing
employees to sue employers on behalf of the state for workplace violations
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Consumer data privacy• Consumer Privacy Act (HB1854/SB5476) – WSHA supports
increasing consumer access and awareness around their personal
data while advocating for recognition of the extensive privacy and
security standards hospitals already maintain under existing state
and federal law
• Increasing Consumer Data Transparency (HB2046) – WSHA is
seeking amendments for clarity and consistency with this bill,
addressing the sale of personal data, and clear exemptions for
hospitals, as covered entities under HIPAA, among other regulations
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Opioid Epidemic• WSHA has worked to advocate &
implement state opioid legislation
• New opioid prescribing guidelines are now in effect, aimed at curbing unnecessary prescriptions
• Governor proposed legislation this session that is largely focused on preventing deaths from opioid overdose and increasing access to medication-assisted treatment options
• Rural specific impact
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Partnerships and Affiliations- Required Notifications
• HB 1607 (2019) less expansive, but still required entities to provide sensitive, proprietary transaction details
• WSHA engaging in extensive negotiations with Attorney General’s Office and sponsor
• Likely outcome (WSHA would be neutral):• Entities required to report limited information to AGO
• No requirement to provide sensitive, proprietary documents
• New language to protect information provided to AGO from disclosure
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Wrongful Death
• The Seattle Ride the Ducks accident illustrated limitations of our state’s wrongful death statute
• WSHA and WSMA do not oppose expansion to non-US residents, but strongly oppose:
• Expanding who can recover, incl. anyone with an interest in estate
• Expanding the categories of recoverable damages
• Broadly expanding exposure for “deep pocket” defendants due to joint and several liability standard
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Medical Debt
• Significant legislative interest in the cost of health care debt
• Early proposals would encourage people to pay medical debts last by prohibiting or limiting prejudgment, post-judgment, and garnishment only for medical debt.
• WSHA negotiated strongly and the bill requires more notice to consumers and limits prejudgment interest
• HB 1531 changes prejudgment interest from 12% to 9%
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Public Option Health Plans• Governor Inslee and Rep. Cody want to see public option
health plans offered in the state
• To address affordability for people who don’t have employer sponsored coverage and don’t qualify for Medicaid
• WSHA supports comprehensive strategies to increase coverage for low- and middle-income Washingtonians
• WSHA has concerns about any proposal that would reimburse providers below the cost of delivering patient care, including benchmarking rates to Medicare 29
“Surprise Billing”• OIC bill would prohibit balance billing on:
• Out of network emergency services
• Out of network anesthesia, lab, radiology, surgery if at in-network facility
• Payors subject to “commercially reasonable” standard
• Arbitration process/criteria
• ERISA opt-in
• Information to providers
Federal: Site Neutral/OPPS Cuts
• Proposed CY 2019 OPPS Rule:
– Reduces payment for clinic visits in grandfathered hospital based departments
– 30 percent/$15 million loss in 2019 for hospital systems/clinics
– 60 percent/$30 million loss in 2021; $440 million over 10 years
• Advocacy
– WSHA opposed the cut with CMS
– Engaged WA Congressional delegation to oppose the cut through dear-colleague letter
– AHA challenging cuts in court, suit includes Olympic Medical Center
Federal: 340B Drug Program
• Beginning 2018, CMS reduced Medicare payment for 340B
drugs from ASP plus 6 percent to ASP minus 22 percent
• For 2019, cuts extended to nonexcepted PPS hospital sites
• WSHA and AHA are encouraging hospitals to pledge to
calculate and document how savings are used to benefit your
community
• Federal court determined CMS action exceeded the authority
given by Congress - remedy to be determined
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CMS Transparency Requirement
• Effective January 1, 2019
• Applies to “all hospitals” including CAHs
• Requires posting of chargemaster information for “all items
and services provided by the hospital”
• Machine readable format
• Please see our recent bulletin for additional information
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For More Information
On WSHA Website Newsletters page:
Subscribe to:
• Weekly
• Inside Olympia
• Inside DC
• Fiscal Watch
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