PPE Reimbursement, SB 5169
This WSMA-championed legislation requires state-regulated commercial
insurance carriers to reimburse for personal protective equipment cost
increases due to the COVID-19 pandemic. For the duration of the
federal public health emergency, a physician or nonphysician
practitioner may use the 99072 CPT code for $6.57 in reimbursement per
patient encounter in which health care services were provided in
person. The WSMA recommends billing the code liberally in appropriate
circumstances as those health plans which are not subject to the law
may opt to reimburse the code. The bill took effect when it was signed
by the governor on April 16, 2021.
Audio-only Telemedicine, HB 1196
This WSMA-championed legislation requires insurers to provide coverage
and reimbursement for audio-only telemedicine services at parity with
in-person visits. To be reimbursed, the service provided via
audio-only telemedicine technologies must meet similar requirements as
required for audio/visual telemedicine, including:
The service is medically necessary and can be safely and effectively
provided over audio-only telemedicine.
The service is an essential health benefit under the Affordable Care
The technology meets state and federal standards governing privacy
and security of protected health information.
The patient consents to billing before the service is provided.
The bill takes effect on July 25, 2021, with the exception of a
provision that requires a patient to have an in-person “established
relationship” with a physician or a clinic for the coverage and
payment elements to be effective, which takes effect beginning January
2023. HB 1196 puts in place similar coverage and parity requirements
currently in effect for audio-only telemedicine via the state Office
of the Insurance Commissioner’s COVID-19 emergency orders.
Medical Assistants, HB 1378
Allows a medical assistant assisting with a telemedicine visit to be
supervised by a practitioner remotely through interactive audio and
video telemedicine technology. A medical assistant and a patient can
be in one location while the practitioner is supervising through
audio/visual technology at a different location. The legislation
includes an emergency clause and is now in effect.
Mental Health Advance Directives, SB 5370
Updates the mental health advance directive form and underlying law.
- Streamlining and simplifying language in the form.
Adding a section for the principal to describe what works for the
principal and the principal’s diagnoses, medications, and best
approach to treatment.
Granting power to the agent to act as the principal’s personal
representative for the purpose of HIPAA.
Additionally, substance use disorder professionals may participate in
incapacity determinations, and the bill permits a notary to make
acknowledgment of a mental health advance directive instead of
requiring two witnesses. This measure takes effect on July 25, 2021.
If your patients regularly utilize mental health directives, please
review the legislation, as the form itself and the requirements for
using the form will be changing as detailed above.
Telemedicine Consultations, SB 5423
Permits a physician who is licensed in Washington state to utilize
telemedicine to consult with a physician licensed in another state
regarding the diagnosis or treatment of a patient located in
Washington state. This measure takes effect on July 25, 2021.
Capacity and Informed Consent, SB 5185
Modifies the standard for informed consent as it applies to an
individual’s capacity to make health care decisions. A person who is
of the age of consent to make a health care decision is presumed to
have capacity. The presumption of capacity may be overcome if the
physician reasonably determines the person lacks the capacity to make
a particular health care decision due to a demonstrated inability to
understand and appreciate the nature and consequences of a health care
condition or proposed treatment. The bill requires the physician or
nonphysician practitioner to document the basis for the determination
of capacity in the medical record. The legislation takes effect Jan.
1, 2022. The WSMA recommends reviewing the legislation and consulting
with your legal counsel should these issues arise in your practice.
Naloxone Access, SB 5195
Requires hospital emergency departments and certain community
behavioral health agencies to provide opioid overdose reversal
medication to a patient with symptoms of an opioid overdose or opioid
use disorder. The WSMA was successful in securing an amendment to the
bill protecting the ability for physicians to exercise clinical and
professional judgement when determining if dispensing overdose
reversal medication is appropriate. The measure includes a provision
of a state-run bulk purchasing and distribution program to address
potential reimbursement gaps for the medication. These changes take
effect Jan. 1, 2022.
Health Care Workers and Presumptive Benefits During a Public Health
Emergency, SB 5190
Provides health care workers with presumptive benefits during a public
health emergency. Health care employees who have had to leave work to
quarantine during a public health emergency will be eligible for
unemployment insurance benefits and worker’s compensation coverage
because a presumption is established that infectious diseases subject
to a public health emergency are occupational diseases contracted at
The bill contains an emergency clause and takes effect immediately.
For more detailed information on how employees can utilize these
benefits, please review the legislation.
Health Equity CME, SB 5229
This WSMA-championed legislation requires the boards and commissions
of health care professionals with existing CME requirements licensed
under Title 18 of the Revised Code of Washington (RCW) to adopt rules
requiring health equity training at least once every four years. The
course may teach skills that enable a health care professional to
effectively care for patients from diverse cultures, groups, and
communities, varying in race, ethnicity, gender identity, sexuality,
religion, age, ability, and socioeconomic status. The regulatory
authorities will establish the conditions in which licensees will meet
this requirement, which goes into effect Jan. 1, 2024, and provide
licensees with information about available courses by July 1, 2023, in
advance of the requirement coming online.
Health Emergency Labor Standards Act, SB 5115
Establishes health emergency labor standards. Standards including:
Creating an occupational disease presumption for certain front-line
employees during a public health emergency for the purposes of
workers’ compensation (this provision does not apply to health care
workers, which are separately addressed in SB 5190).
Requiring employers with 50 or more employees to notify the
Department of Labor & Industries when a certain percentage of their
workforce becomes infected during a public health emergency.
Requiring employers to provide written notice to employees and their
union of potential exposure to infectious disease during the public
Prohibiting discrimination against an employee who is high risk for
seeking accommodation that protects them from the disease or using
all available leave options if no accommodation is reasonable.
The bill contains an emergency clause and takes effect immediately.
The WSMA recommends practice managers closely review this legislation.
COVID-19 Liability, SB 5271
Amends the necessary elements of proof of injury due to the COVID-19
pandemic. Amended elements include:
The physician or nonphysician practitioner failed to exercise the
degree of care, skill, and learning expected of a reasonably prudent
practitioner in the profession, in the state of Washington, acting
in similar circumstances and at the same time; and
Such a failure to exercise the standard of care was the primary
cause of injury.
When determining whether a physician or nonphysician practitioner
failed to follow the accepted standard of care during the state of
emergency, the court must consider if:
The physician or nonphysician practitioner was acting in good faith
based on guidance, direction, or recommendations from federal,
state, or local officials in response to the pandemic and applicable
to the physician or nonphysician practitioner;
or the injury was due to a lack of resources directly attributable
to the COVID-19 pandemic.
The bill includes an emergency clause and takes effect immediately.
The WSMA recommends reviewing this legislation. If you have questions
about what these changes mean for your liability, please contact your
malpractice provider or legal counsel.
Pregnancy and Miscarriage-Related Care, SB 5140
Prohibits health care facilities from restricting physician or
nonphysician practitioners from providing services related to
pregnancy complications. If a practitioner is acting in good faith,
within their scope of practice, education, training, and experience,
and within the accepted standard of care, a health care facility may
not prohibit the physician or nonphysician practitioner’s provision of
health care services related to complications of pregnancy in cases
when not providing the service would:
- Violate the accepted standard of care.
Pose a risk to the patient’s life or irreversible complications.
- Cause impairment to the patient’s body.
Health care services related to complications of pregnancy include,
but are not limited to, services related to miscarriage management and
treatment for ectopic pregnancies. This measure takes effect on July
Health Insurance Discrimination, SB 5313
Establishes that health carriers and the state Health Care Authority
may not deny coverage for medically necessary gender-affirming
treatment or apply blanket exclusions to gender-affirming treatment.
It also requires health carriers and the HCA to ensure access to
medically necessary gender-affirming treatment. The bill takes effect
on July 25, 2021. If your practice provides these services, please
consider reviewing SB 5313 as the requirements for state-regulated
health insurance plans will change.