The 2014 State Legislative Session

1. The 2014 State Legislative Session

2. Presenters Mary Kay Clunies-Ross VP, Communications & Public Affairs Claudia Sanders SVP, Policy Development Cassie Sauer SVP, Advocacy & Government Affairs

3. 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

4. The Budget • Mental Health Funding • Hospital Owned Clinics • Medicaid Outreach • Maintain Primary Care Rates

5. State Budget Overview • 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

6. 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

7. Hospital-Owned Clinics WSHA Goal: Preserve Medicaid funding for hospital-owned clinics Proposed 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

8. Bills Enacted • Emergency Credentialing • Grace Period Notification • Behavioral Health Integration • Health Care Innovation • Safety Net Assessment Fix • Confidentiality • Training for PHDs

9. 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

10. 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

11. 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

12. 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 measures Result: HB 2572 and SB 6228 passed Savings: $2.8 million 2014-2015 And $57 million 2015-2017

13. 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

14. HB 2572: Physician Extension Program • Aimed to help primary care and behavioral health providers • Better coordinate care • Become patient centered medical homes

15. 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

16. 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

17. 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!

18. 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

19. SB 6265: Confidentiality • Heighten protections of CHARS data • Fixes provisions about accounting for mental health disclosures • Urge Governor to sign!

20. 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

21. Bills Not Enacted • Telemedicine • Staffing Mandates • Federal Basic Health • Suspect and Inmate Care • Medical Records Payment Rates • Breastfeeding • Public Hospital Districts

22. 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

23. Staffing Mandates WSHA 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, again Future:These bills will be back, again

24. 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 providers Result: Bill to create program not enacted Future:Track issues of affordability

25. Suspect and Inmate Care WSHA 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

26. Medical Records Requests WSHA 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

27. Support Breastfeeding WSHA Goal: Support breastfeeding as a strategy to improve infant health and reduce childhood obesity Result: HB 2329, SB 6298 defeated Future:Work on voluntary efforts

28. Public Hospital Districts – Good Results AWPHD Goal: Maintain local decision-making and affiliations • Bill prohibited district boards from delegating certain management functions-- affiliations virtually impossible Result: SB 6425 defeated

29. 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 requirements Result:SB 6348 defeated

30. Public Hospital Districts – Disappointing Results AWPHD Goal: Allow public hospital districts to recover costs relating to public records requests for commercial purposes Result:HB 1037 died

31. Policy Work Before 2015 Session • Nurse staffing • Transparency and Innovation • Future of Certificate of Need • Mental health funding and integration • Enrollment and expansion

32. Washington Hospital PAC Building Relationships Electing Champions for Hospitals Unifying Hospitals’ Political Voice www.wsha.org/whpac.cfm

33. Thank You! We couldn’t do it without you! Thank you for your good work!

34. Questions? Comments? Cassie Sauer Senior Vice President, Advocacy & Government Affairs cassies@wsha.org 206/216-2538