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2021 WSMA Interim Priorities

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 WSMA-supported legislation.
  • Rulemaking to more closely regulate collaborative drug therapy agreements.
  • Rulemaking to create a limited license for international medical graduates.
  • 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 proposed rule.

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.

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