Advocacy

Legislation of Note

Firearm violence

• HB 1240 – Assault weapons ban (Peterson)
  • Bill Passed
  • This bill generally prohibits the manufacture and sale of semi-automatic “assault weapons,” including firearms such as the AR-15 and AK-47.
  • Why is this important?
    • Assault weapons are exceptionally deadly firearms commonly used in mass shootings.
• HB 1143 – Firearm purchase requirements (Berry)
  • Bill Passed
  • To be eligible to purchase firearms, this bill requires individuals to have recently completed a firearm safety training program and undergo a background check and 10-day waiting period.
  • Why is this important?
    • Background checks and waiting periods for the purchase of firearms are proven to help prevent gun violence.
• SB 5078 – Firearm industry liability (Pedersen)
  • Bill Passed
  • This bill establishes “reasonable controls” on firearm industry members to comply with state and federal firearm laws and prevent diversion of firearms. A right of action is created against firearm industry members in circumstances where violence results from their conduct such as advertising targeted at minors and promoting the illegal conversion of firearms.
  • Why is this important?
    • With the passage of this bill, Washington joins a growing number of states that have established that the gun industry can be held legally labile for gun violence.

Abortion, reproductive health, and gender-affirming care

• HB 1340 – Medical license protections (Riccelli)
  • Bill Passed
  • This bill establishes that the performance of reproductive health and gender affirming care services consistent with Washington state standards of care (even in a state where such services are prohibited) does not qualify as unprofessional conduct under the Uniform Discipline Act for the purpose of Washington state licensure and discipline.
  • Why is this important?
    • Physicians should be able to provide the full range of health care services to their patients without fear of jeopardizing their medical license. While the Washington Legislature cannot address the laws of other states, HB 1340 ensures that our current physician community and those who move here are protected from negative licensure actions in the state of Washington.
• HB 1469 – Shield law (Hansen)
  • Bill Passed
  • This bill establishes liability protections for patients and health care professionals from criminal and civil actions based on the provision or receipt of abortion services and gender affirming care consistent with Washington state law. This includes prohibiting law enforcement from participating in investigations and the courts from imposing penalties of other states, among other actions. The bill also makes health care professionals eligible for the state’s Address Confidentiality Program.
  • Why is this important?
    • The U.S. Supreme Court’s Dobbs decision has resulted in a patchwork of evolving legalities across the country, with some states establishing additional protections for abortion services while others move to criminalize or impose civil infractions associated with such care. The purpose of this bill is to insulate Washington state health care professionals and patients to the extent possible from the restrictive actions of other states.
• SB 5242 – Abortion cost-sharing (Cleveland)
  • Bill Passed
  • Beginning January 1, 2024, this bill generally prohibits the imposition of cost-sharing for abortion services.
  • Why is this important?
    • Despite access to abortion services remaining legal in Washington, cost remains a significant barrier to access to care and exacerbates existing health disparities.
• SB 5768 – Mifepristone access (Keiser)
  • Bill Passed
  • This bill gives the Department of Corrections the authority to distribute and sell mifepristone to health care providers and clinics around the state.
  • Why is this important?
    • As of this writing, legal cases are pending that challenge the FDA’s approval of mifepristone, which could also have an impact on manufacturing of the drug. In order to ensure continued access, the state purchased a three-year supply of mifepristone to be stored and distributed by the DOC through its existing pharmacy infrastructure.

Mental/behavioral health

• SB 5120 – 23-hour crisis relief centers (Dhingra)
  • Bill Passed
  • This bill directs the Department of Health to license or certify 23-hour crisis relief centers, a new type of crisis diversion facility, to provide services to address mental health and substance use crisis issues (among other conditions), coordinating connections to ongoing care when appropriate.
  • Why is this important?
    • There is a significant need to expand resources for urgent behavioral health care services.

Scope of practice

• SB 5389 – Optometry (Cleveland)
  • Bill Passed
  • This bill expands scope of practice for optometrists to include increased prescriptive authority, the ability to perform certain surgical procedures and to provide injections (among other provisions). Led by the ophthalmologists, the physician community was successful in advocating to narrow the bill from the form in which it was introduced, notably to remove the ability of optometrists to perform laser procedures.
  • Why is this important?
    • There are few, if any, functions of the human body more important to a person’s quality of life than their ability to see the world clearly and without pain. The complications that can arise during eye surgery are serious and often irreversible. Optometrists are valued members of the health care team, but their education and training does not prepare them to perform surgical procedures.
• HB 1310 & SB 5633 – Physician assistants (Riccelli & Conway)
  • Bills Died
  • These bills would have removed the requirement that physician assistants practice under the supervision of a physician, allowing physician assistants to work in collaboration agreements with an employer or one or more physicians.
  • Why is this important?
    • Among the physician community there were concerns about the broad proposed nature of collaboration agreements under these bills.
• SB 5411 – Naturopathy (Short)
  • Bill Died
  • This bill would have expanded the scope of practice for naturopaths to include increasing their prescriptive authority to encompass all drugs in schedules II through V (including opioids), broadened their ability to perform “minor office procedures” to include all primary care services, and allowed them to sign an attestation to any document that a physician may sign that’s within the naturopath’s scope of practice.
  • Why is this important?
    • Among other concerns, a naturopath’s education and training does not include the comprehensive medical and pharmacological background needed to prescribe potentially dangerous drugs.
• SB 5373 & HB 1495 – ARNP reimbursement mandate (Randall & Simmons)
  • Bills Died
  • These bills would have required insurance carriers to reimburse advanced registered nurse practitioners and physician assistants at the same rate as physicians for providing the same service in the same service area.
  • Why is this important?
    • The physician community has sought to ensure the ability of insurance carriers to make distinctions in reimbursement to recognize distinctions in skill, training and expertise between physicians and other providers of health care.
• HB 1041 – Psychologist prescriptive authority (Bateman)
  • Bill Died
  • This bill would have granted psychologists the authority to prescribe psychotropic drugs upon the attainment of certain education and training and when working in “an ongoing collaborative relationship” with a health care provider who oversees the patient’s general medical care.
  • Why is this important?
    • Psychologists have an important role in the treatment of mental and behavioral health conditions. This bill would have had the effect of increasing access to psychotropic drugs but would not have necessarily increased access to care. Given the patient safety concerns raised, the potential for harm outweighed any benefit that could have been achieved.
• HB 1038 & SB 5184 – Anesthesiologist assistants (Taylor & Rivers)
  • Bills Died
  • These bills would have established the licensure and scope of practice for anesthesiologist assistants, who would be licensed by the Washington Medical Commission to assist in developing and implementing anesthesia care plans for patients under the supervision of an anesthesiologist or group of anesthesiologists.
  • Why is this important?
    • A growing number of states have helped address anesthesia workforce needs by licensing anesthesiologist assistants, who provide high-quality patient care working in physician-led care teams.
• HB 1073 – Medical assistants (Harris)
  • Bill Passed
  • This bill makes several changes to the circumstances under which medical assistants may work, allowing MAs to work while being certified, allowing medical assistants-registered to administer intramuscular injections under the general (rather than “direct visual) supervision of a health care professional, and allowing medical assistants-certified to work under the general (rather than “direct visual”) supervision of a health care professional when administering IV injections for diagnostic or therapeutic agents.
  • Why is this important?
    • These changes will help address workforce strain by updating MA regulations to reflect their education and training and in some circumstances to align with flexibilities that were established during the pandemic. The WSMA secured changes to the bill that ensured important patient safety guardrails.

Budget/taxes

• HB 1850 – Hospital safety net assessment (Macri)
  • Bill Passed
  • This bill updates the state’s hospital safety net assessment, which is a system by which revenues from taxes levied on hospitals are returned to hospitals in the form of increased Medicaid reimbursement rates (among other appropriations). Established for hospitals in 2010, the safety net assessment model has subsequently been used to increase Medicaid rates for nursing homes and ambulances. HB 1850 increases revenue associated with the assessment and makes it permanent. The bill maintains investments in physician residencies through the assessment, totaling $4.1 million for family medicine residencies and $2 million for integrated psychiatry residencies in each two-year state budget cycle.
  • Why is this important?
    • Like Medicaid reimbursement rates for physicians, rates paid to hospitals fail to cover the cost of delivering care and hadn’t been updated in decades. The state has an obligation to ensure access to care for Medicaid enrollees. Utilizing safety net assessments can increase revenues into the Medicaid program and in turn facilitate rate increases.
• SB 5767 – Highly compensated hospital employee tax (Randall)
  • Bill Did Not Get Consideration
  • This bill would have levied a tax of 7.5 percent on the “excess compensation” of a hospital’s five highest compensated employees who make more than ten times the state’s average wage and who do not have any direct patient responsibilities.
  • Why is this important?
    • While the bill was introduced late in session and did not get consideration this year, it signals a broader interest from majority party Democrats to explore additional excise tax options following the state Supreme Court’s recent ruling that it is constitutional to apply excise tax to income.
• SB 5523 – Forensic pathologists (Dhingra)
  • Bill Passed
  • This bill establishes a loan repayment program for forensic pathologists, with awards to eligible board-certified forensic pathologist applicants of up to $25,000 for up to four years. It also requires a study on the shortage of forensic pathologists, with recommendations due to the Legislature later this year.
  • Why is this important?
    • Like many other states, Washington is currently facing an acute shortage of trained forensic pathologists.

Business & liability

• SB 5241 & HB 1263 – Mergers and affiliations (Randall & Simmons)
  • Bills Died
  • These bills would have imposed numerous new restrictions and requirements on the ability of physician organizations, hospitals, and other entities to enter into partnerships such as mergers and sales.
  • Why is this important?
    • This proposal would have jeopardized the financial viability of physician practices in limiting their ability to partner with other organizations. If physician organizations were forced to go out of business rather than entering into partnerships it could have the effect of limiting access to care in communities.
• HB 1508 & SB 5519 – Health Care Cost Transparency Board (Macri & Robinson)
  • Bills Died
  • These bills would have, among other provisions, authorized the state’s Health Care Cost Transparency Board to subject health care professionals, health care facilities, and insurance carriers to discipline and fines in the event they exceed the “benchmark” rate for increases in health care costs (set at 3.2 percent annually, decreasing to 2.8 percent by 2026). The bill also granted the HCCTB authority to mandate data collection from physician organizations and other entities.
  • Why is this important?
    • Granting the HCCTB sweeping powers so recently after its 2020 enactment and before it has accomplished the initial tasks it was charged with is premature. Further, the benchmarks for health care cost increases established by the HCCTB are unrealistic and subjecting physician organizations to fines based on the benchmark is inappropriate.
• SB 5236 – Nurse staffing (Robinson)
  • Bill Passed
  • This bill generally revises provisions related to hospital staffing committees to direct their operations, increase representation of nurses that provide direct patient care, and to assess fines for circumstances where a hospital is operating without a current staffing plan.
  • Why is this important?
    • This bill represents a compromise between relevant stakeholders, opting to establish additional requirements for the existing hospital staffing committee system, among other provisions. As originally introduced, WSMA opposed language that would have mandated nurse to patient staffing ratios due to concerns about potential adverse impact on access to care.

Prior authorization

• HB 1357 – Prior authorization modernization (Simmons)
  • Bill Passed
  • WSMA brought forward this priority legislation to modernize and standardize insurance carrier prior authorization practices. HB 1357 expedites turnaround times for all prior authorizations and mandates that insurance carriers develop electronic processes for prior authorization that integrate into electronic medical records for both health care services (by 1/1/25) and prescription drugs (by 1/1/27). The bill also mandates that insurance carriers base their prior authorization requirements on peer-reviewed clinical review criteria and update it regularly.
  • Why is this important?
    • Prior authorization delays patients’ access to care, drives cost and administrative burden for physicians, and diverts health care work force from care delivery. Reforming prior authorization has consistently been identified by the physician community as a top priority for our legislative advocacy.