The 2013 State Legislative Session: What’s Happened What Comes Next

1. The 2013 State Legislative Session: What’s Happened What Comes Next

2. Today’s Presentation • Overview of state legislative session • Major policy decisions done • Budget and policy decisions remaining • Planning for 2014 legislative session

3. A Tough Session! • Long, budget writing session • Budget shortfall after budget shortfall • Many contentious issues • Big gaps remain

4. Washington State Government Governor Jay Inslee Democrat Rs

5. Special Session: Starts May 13 • Operating budget – the big deal • Education reform, DUI laws, Medicaid bill – all possibilities • Governor wants to revive dead bills – Reproductive Parity Act, DREAM Act, gun control

6. Select Issues Completed: • Bills Enacted • Peer Review • Electronic Health Records • Bills Not Enacted: • Nurse Staffing • Telemedicine • POLST

7. Peer Review: SB 5666 WSHA Goal: Ensure a strong system of quality improvement and peer review • Result:SB 5666 passed by legislature – peer review is strengthened! • Future: WSHA will provide more guidance

8. SB 5666 as Passed • Clarifies that limitation on remedies in RCW 7.71.030 applies when hospital does not qualify for immunity based on federal law • Allows more than one Quality Improvement Committee to review different health care services • Requires sanction procedures to comply with medical staff bylaws

9. SB 5666 as Passed, continued • Adds “professional conduct” as matter to be considered during medical staff review/sanction process • Reduces required “look-back” for prior privileges and employment to five years; but allows granting facility to ask for information going back more than five years

10. Electronic Health Records: SB 5601 WSHA Goal: Allow donations to community physicians • Legislation introduced in response to Attorney General Opinion • Inconsistency with federal law • Bill allows donations from hospitals, hospital clinical labs, but not freestanding clinical labs • Other federal allowances protected Result: SB 5601 passed by legislature – EHR donations are safe!

11. Nurse/Technologist Staffing WSHA Goal: Defeat unworkable nurse staffing legislation that endangers patients Nursing union proposals: • Nurse staffing ratios • Take away CEO authority on nurse staffing plans • Uninterrupted meal and rest breaks • Overtime/on-call restrictions Result: We defeated all these bills Future: These bills will be back

12. Telemedicine WSHA Goal: Assure payment for services provided using telehealth technology • Critical services can be provided via telehealth • Need assurance of payment before investing in expensive technology Result: HB 1448 not enacted – seen as an insurance mandate Discussion: Pursue legislation without payment parity?

13. Physician Orders for Life-Sustaining Treatment (POLST) WSHA Goal: Ensure patients’ wishes are honored by giving providers immunity • “Simple immunity bill” • Lots of politics • Lots of positive media coverage Result: HB 1000 passed the House, but not the Senate Future: We will try again next year! Faith-based hospitals’ involvement is key

14. Issues Remaining: • State Budget • Medicaid Expansion • Hospital Safety Net Assessment • Mental Health • Care for Inmates

15. State Budget WSHA Goal: Avoid disproportionate cuts to hospitals and health care Washington State Supreme Court: Initiatives that require two-thirds majority for tax hikes unconstitutional Washington state budget outlook predicts shortfall

16. How Is the Budget? • Mostly good for hospitals and health care • Comparison document available at wsha.org

17. Medicaid Expansion WSHA Goal: Enact the full Medicaid expansion • One million Washingtonians have no insurance • ACA anticipated a mandatory expansion • Supreme Court: expansion is too coercive • Timeline: • State must act in 2013 for a 2014 expansion • Enrollment begins October 2013 • Coverage begins January 2014

18. Medicaid Enrollment: 325,000 More

19. Uninsured Who Will Qualify for Medicaid Data source: What’s at stake: The Affordable Care Act in Washington state: A county‐by‐ county analysis, Washington State Office of the Insurance Commissioner, 2012.

20. Health Insurance Exchange • Online health insurance marketplace • Compare health plans • Determine eligibility for tax credits or reduced co-pays and deductibles • Get help enrolling in a health plan

21. Hospital Fiscal Implications of the Expansions • Total: $3 billion over 10 years • Medicare rate cuts • Disproportionate Share Hospital cuts • We pay whether we expand or not • Uninsured and underinsured will remain

22. Bill or Budget? • Medicaid bills have been introduced • Not necessary to implement the policy • Contain problematic provisions: • High cost sharing • Circuit breaker • Premiums for kids • Moving kids and adults to the exchange • WSHA very concerned about the bills (SB 5894, SB 5914)

23. What You Can Do • Approach contracting with care • Commercial rates in the exchange: increased margins • Medicare rates in the exchange: decreased margins • Ensure robust outreach • Help people enroll!

24. Hospital Safety Net Assessment WSHA Goal: Create an assessment that benefits hospitals • In 2010, hospitals supported creation of the Safety Net Assessment program • Hospitals pay a tax to bring in federal matching funds • Hospitals receive additional Medicaid payments to offset the tax paid and improve Medicaid hospital payments • Mitigated 2009 hospital cuts • Avoided a lawsuit • Provided significant benefit to the state • Raided in 2011

25. Hospital Safety Net Assessment: Board of Trustees Direction The current assessment is unacceptable. Without legislative action, the assessment will expire July 1, 2013. Hospitals will consider support for a new assessment if: • The bulk of the benefit goes to additional hospital payments for care provided to Medicaid patients. • The tax rate does not increase beyond the levels the board approved. • A new sunset date is included. • There are protections from a future legislative raid of assessment funds. If a reasonable approach to the assessment cannot be achieved, hospitals will advocate for the full sunset of the assessment.

26. Future of the Assessment:HB 2016 and SB 5913 Hospitals will support a new assessment if: • The bulk of the benefit goes to additional hospital payments for care provided to Medicaid patients – YES – HOSPITALS GET 10% MORE • The tax rate does not increase beyond the levels the board approved – YES • A new sunset date is included – YES – FOUR YEARS • There are protections from a future legislative raid of assessment funds – YES – CONTRACTUAL PROTECTIONS • Key difference: ratcheting (SB 5913) or no ratcheting (HB 2016)

27. Future of the Assessment (Biennial Impact)

28. Contractual Protections in the Assessment • Health Care Authority will offer contracts to hospitals • Prevent future legislative action that could result in hospitals receiving less than expected • Prevent an increase in the assessment level beyond what is allowed in the law • Prevent the state from using funds for any other purpose • Hospitals agree not to challenge the rollback of hospital reimbursement rates to July 1, 2009, levels, which results from the elimination of assessment-supported rate restorations and increases, under 42 U.S.C. Sec. 1396a(a)(30)(a)

29. Mental Health Positive movement! • No cuts • Increased capacity in state hospitals • Changes to Involuntary Treatment Act • State task force • Capital budget funding + regulatory relief

30. Care for Inmates • WSHA Goal: Ensure adequate payment for difficult-to-treat inmates • 2 bills defeated • Policy snuck into sentencing/corrections bill, SB 5892 • WSHA working to remove that provision • Contact your House members!

31. Preparing for 2014 • Nurse Staffing • Transparency • Certificate of Need • Mental Health

32. Nurse Staffing: What You Can Do • This is an area for significant leadership focus: • How is your nurse staffing committee functioning? • Do you use overtime or mandatory call? How much? • What are the longest shifts people work? • Are your staff getting their breaks? • We have asked DOH to step up enforcement

33. Transparency WSHA Goal: Create meaningful transparency about cost and quality of health care • Charges can be misleading • Must be married with quality data Result: Bills defeated Future: WSHA will work with legislators and Puget Sound Health Alliance

34. Transparency: What You Can Dowww.wsha.org/transparency.cfm • Link to WSHA’s pricing transparency page in a prominent way • Inform your community • Support our efforts to create outpatient pricing information • Discuss with your legislators

35. Transparency: Discussion How can we provide useful information to: • Patients • Payers • Policy makers?

36. Certificate of Need WSHA Goal: Ensure a “level playing field” for hospitals • SB 5017 eliminated CoN for everyone but hospitals – WSHA opposed • SB 5225 exempted public hospital districts from CoN – WSHA neutral Result: Both bills died in committee Future:Need a clear WSHA position on the future of CoN

37. Certificate of Need: Discussion • What should WSHA’s position on CoN be? • If you want to see improvements, what specifically would they be?

38. Mental Health • What you can do • Support capital budget request • If you provide mental health, keep doing it! • Consider expanding or partnering • What can the state or WSHA do? • How can we support maintaining or expanding existing capacity?

39. Building Relationships Electing Champions for Hospitals Speaking with One Powerful Voice www.wsha.org/whpac.cfm

40. Thank You! Your advocacy with your legislators, your testimony, your connections with local leaders and media, and your contributions to the PAC are essential to our success. Please keep up the good work!

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