Concurrent Strategy SessionWednesday, October 7, 2015, 3:15 ‐ 4:30
Building on Success: Getting Ready for the 2016 State Legislative Session
(and a little federal too)
• Cassie Sauer, Senior Vice President, Advocacy & Government Affairs, WSHA
• Zosia Stanley, Policy Director, Access, WSHA• Lisa Thatcher, State Lobbyist, WSHA & AWPHD• John Flink, Federal Lobbyist, WSHA
Sponsored by
Objectives• Understand the policy and budget successes in 2015 and
new opportunities for you• Understand what we think we can tackle on our own• Learn about the 2016 political climate• Understand what we will be working on in 2016• Hear a quick federal update
The 2015 State Legislative SessionVery Successful for Hospitals and Health Systems
• Overall: A great session for hospitals and health care• Mental Health: Major progress on policy and funding issues• Hospital Safety Net Assessment: Ultimately adopted in
alignment with WSHA board guidance• Care Transformation and Access to Care: Telemedicine, all‐
payer claims database, pharmacy issues, affiliations and staffing, inmates and suspects
• Partnerships: Essential
Themes of 2015
Politics Remain Very Divisive
Key Partners
Proactive Agenda Successes:• Telemedicine• Pharmacy• Suspect and Inmate Care• All‐Payer Claims Database• Mental Health• Safety Net Assessment
www.wsha.org/policyadvocacy.cfm
Telemedicine Payments: SB 5175 Passed
• Ensures payment for services provided using telemedicine technology
• Includes “essential health benefits” requirement• Establishes covered sites of service• Effective January 2017• What you should be doing now
Pharmacy Access: SB 5460 Passed
• Jointly supported by WSHA and DOH
• Allows hospitals to dispense “pre‐pack” medications when pharmacies are not open
• Changes burdensome licensing requirements for clinic pharmacies –implementation difficulties
• What you should be doing now
Suspect and Inmate Care: SB 5593 Passed
• Jointly proposed by WSHA and law enforcement• Requires that all law enforcement agencies guard hospital
patients in law enforcement custody for violent or sexual crimes
• Unless otherwise negotiated, payment for hospital services will be Labor & Industries (L&I) rates
• What you should be doing now
All‐Payer Claims Database: SB 5084 Passed
• Broad coalition
• Mandates insurers contribute data
• WSHA and hospitals can get quality and volume data
• Limited access to payment data
• What you should be doing now
Successfully Included: Hospital Safety Net Assessment Program
• Extends program through SFY 2019, no ratchet
• Maximizes federal match rate
• Renews hospital contract
Provides $146 million for hospitals for SFY 2016
Provides $153 million for state for SFY 2016
• Funds residencies: Integrated psychiatric Hospital‐based family residencies
• SB 5649 Mandates data collection on ER cases when no bed available Requires regional support networks to administer an adequate
network of evaluation and treatment services Exempts time prior to medical clearance from ITA timelines
• HB 1450: Establishes mandatory outpatient treatment
• SB 5269: Family input into detention process
• More than $130 million in new investments
• What you should be doing now
Mental Health System Improvements
Solving Issues on Our Own
Interim Policy Work: Charity Care
• HB 1504 would have mandated uniform application developed by the state
• WSHA committed to developing a model application and notification
• Work underway
• We need you to adopt!
Interim Policy Work: Community Benefit
• Belief: Charity care decline means no more hospital community benefit
• Hospitals need to ensure community benefit work is meaningful
• Work with other hospitals in the area or other community groups
• Ensure policy makers and community leaders understand the community benefit you provide
Interim Policy Work: Non‐Compete Clauses
• Several bills in 2015 session to limit ability to use non‐compete clauses
• Hospitals’ use of them is all over the map
• Is there a reasonable policy path forward?
• Can you justify the reasonableness of your own non‐competes?
• Issue will be back in 2016
Debate over non-compete clauses divides Washington state medical community
Getting Ready for 2016
Context for 2016 Legislative Session
• McCleary K‐12 funding
• Charter schools ruling
• Leadership changes
• Budget challenges
Initiative 1366: Pick Your PoisonWhat It Does• Directs the Washington State Legislature to approve a constitutional
amendment requiring a two‐thirds vote to raise revenue or repeal any existing tax exemptions
• If the legislature does not pass the constitutional amendment by April 2016, the state sales tax would automatically be cut from 6.5% to 5.5%
Impact of Two‐Thirds RequirementGives one‐third control
Impact of Sales Tax CutLoss of $2 billion per biennium in funding for our schools, universities, health care, and other public services
Possible Legislative Priorities for 2016:Pharmacy Issues
• Ongoing concerns with unreasonable pharmacy inspections and enforcement actions
• What is the role of DOH facilities inspection vs. pharmacy commission oversight?
• Concerns about overreach and retaliatory action
• Anti‐trust cases are informing our thinking
Possible Legislative Priorities for 2016:Rural Flexibility
• Smallest hospitals at risk• New payment and delivery model Core health services Ambulatory not inpatient
• State legislation would allow continuance with Critical Access if new model does not work
Possible Legislative Priorities for 2016:Prior Authorization
• Resource‐intense on both hospital and insurer side• Are there policy solutions?• Legislative or regulatory?Create a “gold card” systemCarve out certain agreed‐upon services from prior authorization
Authorize a full treatment path given a diagnosis
Possible Legislative Priorities for 2016:Mental Health
• Ensure good implementation of 2015 successes
• Work force issues
• Chemical dependency
• More capital funding
Possible Legislative Priorities for 2016:Interstate Physician Licensure Compact
• Expedited process to license physicians in multiple states• Eleven states have passed the legislation (including ID and MT) • Aligns licensure renewals and disciplinary action among participating states
• Particularly applicable to telemedicine• Potential concern: Could make it easier for non‐Washington State physicians to practice here
• Should WSHA support?
Possible Legislative Priorities for 2016:Public Hospital District Issues
• Charges for public records requests
• Capital Projects Advisory Review Board: considering allowing bid limits and job order contracting
• Nursing home rates for rurals and DSH payments
Rethinking HB 1340 and HB 1944
• Work force flexibility: Are there important scope of practice issues preventing work force innovation?
• Crisis standards of care: Can we counter plaintiffs’ attorneys?
Issues We Will Likely Need to Oppose• Levying a new 6% tax on hospitals• Prohibiting hospital partnerships• Mandating staffing regulations • Creating Extended Stay Centers with
no hospital regulations• Cutting Medicaid hospital clinic payments• Banning non‐compete clauses for MDs• Returning to psychiatric boarding
• Many other exciting ideas!
Healthier Washington
www.wsha.org.healthierwashington.cfm
Key Federal Issues
Federal Issues: All Hospitals• Site neutral payments• Two midnights• Telemedicine• 340B• Volume to value: SGR and beyond
Federal Issues: Rural Hospitals
• Critical Access Hospital status• ACO rural attribution• 96 hour rule• New payment and delivery model for smallest hospitals
Connect with the Congressional Delegation!
• Meetings in the home district• Come to D.C.AHA Annual Meeting in MayRural Advocacy Days in September
• John can help! [email protected]
Thank You!
Your advocacy with your legislators, your testimony, and your connections
with local leaders and media are essential to our success.