2021 WSMA Interim Priorities
After the state legislative session adjourns each spring, the WSMA turns
its undivided attention to the regulatory arena and rulemaking. On this
page is an overview of the issue areas we are engaged in on your behalf
during this “interim” period. (Note: During the interim period between
legislative sessions, lawmakers return to their home districts. This is
the perfect time to start
building relationships with your elected representatives.)
Here are five topics in which we are engaged in on your behalf.
Balance Billing/No Surprises Act
In the months ahead, the WSMA will be focused on a possible effort to
reconcile the state's Balance Billing Protection Act with the federal No
Surprises Act that was passed in December and goes into effect next year.
With federal rulemaking still underway, rendering informed decisions on
whether or how state law should be adjusted to accommodate the new
national act will be extremely difficult. However, we are engaged with the
Office of the Insurance Commissioner to help shape any future regulation
or legislation. This work is complex, particularly how the rules will
apply to state-regulated insurance plans versus self-insured ERISA plans
that are regulated at the federal level.
Network adequacy and rebalancing the contracting dynamic between
physicians and carriers are our top priorities in any balance billing
discussion. Since the inception of the state balance billing law, carrier
contracting behavior has markedly shifted, resulting in physician groups
struggling to get carriers to negotiate on reasonable terms, or, in some
cases, being unable to get carriers to come to the table at all. We have
made a separate inquiry to the OIC on this issue, noting that insurance
carriers cannot be allowed to use the balance billing law as a substitute
for contracting with physician organizations.
Washington Medical Commission
WSMA staff are tracking several items of interest at the Washington
Medical Commission, including:
Recently initiated rulemaking seeking to define licensure and standard
of care for services provided over telemedicine.
Implementation of updates to physician assistant regulations per
Rulemaking to more closely regulate collaborative drug therapy
Rulemaking to create a limited license for international medical
- Licensure and disciplinary process improvements.
The WSMA has heard concerns from members who were not able to work due to
delays in the licensure process at the commission, in addition to concerns
about the disciplinary process. Your WSMA has been advocating on these
issues during monthly meetings with commission leadership. In addition, we
are encouraged by the Legislature's budget provision calling for a
performance audit of the commission. Specifically, the state auditor's
office is directed to: "… conduct a performance audit, which must address
the length of time required to license individuals and comparatively
analyze disciplinary processes with those of other states. The audit
should address the obstacles contributing to inefficiencies and make
recommendations for improvement."
Health Care Cost Transparency Board Advisory Committee
During the 2020 legislative session, the Legislature passed House Bill
2457, establishing a health care cost transparency board. This board is
responsible for reducing Washington's health care cost growth by:
- Determining the state's total health care expenditures.
Identifying cost trends and cost drivers in the health care system.
Setting a health care cost growth benchmark for providers and payers.
Reporting annually to the Legislature, including providing
recommendations for lowering health care costs.
The board has appointed an advisory committee made up of health care
providers and carrier representatives. Representing the WSMA on the
committee will be WSMA President-Elect Mika Sinanan, MD, PhD.
Prescription Monitoring Program Hardship Waiver
The Department of Health has proposed rulemaking to create a hardship
waiver for the state's prescription monitoring program integration mandate
required by Senate Bill 5380 from 2019. The WSMA was successful in
securing the hardship waiver and continues to influence the direction of
the rulemaking. While there are still several items to address, we believe
the waiver will be helpful to groups with 10 or more prescribers that
attest to being unable to meet the mandate due to certain conditions. For
more information, review the
Electronic Prescribing Of Controlled Substances Hardship Waiver
The Pharmacy Quality Assurance Commission has proposed rulemaking to
create a hardship waiver for the electronic prescribing mandate required
by Senate Bill 5380 from 2019. While there are still several items to
address, we believe the waiver will be helpful to groups with 10 or more
prescribers that attest to being unable to meet the mandate due to certain
conditions. For more information, review the
proposed rule. In response to WSMA's request, the secretary of health has delayed
implementation of the EPCS mandate from Oct. 1, 2021 until Jan. 1, 2022.