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Physicians view legislative and regulatory advocacy as an essential role for the WSMA. And the WSMA delivers.

Legislative & Regulatory

One of the strongest ways your WSMA represents the profession of medicine is with our legislative and regulatory advocacy, both at the state and federal levels.

Breaking news

Read WSMA's Advocacy Report for the latest legislative and regulatory news out of Olympia and Washington, D.C. affecting Washington physicians and patients.

2019 Legislative Report

Each year, the WSMA publishes a legislative report providing members an overview of the state legislative session. The report includes a summary of policy outcomes, a look a new laws impacting practice management, a legislator report card, and information on how to become a grassroots advocate on behalf of medicine and your patients. The report is mailed to all members; download a pdf version at the link below.

Download the 2019 WSMA Legislative Report.

Previous reports:

2018 WSMA Legislative Report
2017 WSMA Legislative Report

2019 state legislative session wrap-up

WSMA’s lead lobbyists Katie Kolan and Sean Graham provide an overview of how health care fared during session in this webinar originally presented on Wednesday, May 15, 2019. Click here to download the webinar slides.


Legislative and regulatory affairs team

The WSMA has an experienced, dedicated team in Olympia that works every day to educate lawmakers and other state officials on physicians' priorities. Visit the WSMA staff page to meet our legislative team and find their contact information. If you have any questions about our legislative and regulatory advocacy, contact our staff directly, or call the WSMA Olympia office at 360.352.4848 or 800.562.4546.

The Value of WSMA Advocacy in 2019

The 2019 state legislative session saw WSMA's advocacy moving the needle on some timely issues and achieving important victories for the physician community, including:

  • Raising the purchase age for tobacco and vapor products
  • Eliminating the personal and philosophical exemption for the MMR vaccine
  • Reaching an agreement on balance billing legislation that protects patients from unexpected bills and is fair for the physician community
  • Expanding physician whistleblower and peer review protections

If you haven't yet read about WSMA's work on these and other important victories from session, be sure to review the 2019 WSMA Legislative Report, available at the top of this page.

Minimizing the impact of bad policy

As we all know, bad news happens. So, too, sometimes bad legislative and regulatory policy is passed. Often in these instances, one of the values of WSMA advocacy is minimizing the impact of bad policy on Washington state's physician practices and clinics.

During the 2019 state legislative session, several policies were passed that stand to impact your bottom line—and potentially hinder your ability to provide the best possible care to your patients. In each instance, the WSMA worked to protect you, working with lawmakers and stakeholders to limit the impact where possible.

How the WSMA protected you in 2019

As originally proposed, the following policies passed by lawmakers in 2019 would've impacted physician practices far more dramatically if not for WSMA advocacy.

B &O tax increase
WSMA opposed the 67% increase proposed by Gov. Jay Inslee. A lower 20% increase was passed.
PMP integration mandate
WSMA successfully advocated for a provision to exempt practices with 10 or fewer prescribers as well as a hardship exemption for larger groups.
EPCS mandate
WSMA added language to this bill to exempt practices with 10 or fewer prescribers.
Telehealth CME mandate
WSMA amended SB 5386 to make the bill's telemedicine training voluntary.

For a typical clinic or group of 10 or fewer physicians, WSMA's advocacy on these four policies saved the clinic $96,000-146,000; for a typical mid-sized clinic or group practice, WSMA's advocacy on these four policies saved the practice potentially as much as $268,000-318,000.

To help our members visualize these dollar values, we've created two "Explanation of (WSMA) Benefits:"

EOB for a clinic/group of 10 or fewer physicians

EOB for a mid-sized clinic or group practice

Still more work to be done

In the instance of the B&O tax increase, it's small comfort to know that the tax could have been much higher. A 20 percent tax hike is still a significant financial burden for independent physicians and practices in our state.

Rest assured, the WSMA has not given up on this issue. We will continue to vehemently oppose this surcharge. You can help—learn how .

Raising the physician voice…and PAC funds

WAMPAC, the WSMA's nonpartisan campaign arm, works to ensure the physician's voice is heard in the Legislature, by building relationships between our members and their elected officials, and on the campaign trail, by supporting physician-friendly candidates. You can help us advance an advocacy agenda that bolsters the profession and improves patient care throughout Washington by making a donation. Your contribution really does make a difference—give to WAMPAC today .

New Laws Impacting Practice Management

A look at WSMA priority policy enacted in 2018-19 that may impact your practice—and the dates when these new laws take effect.

2019 Policy

Effective July 28, 2019

Medical Debt Collection, HB 1531 & HB 1602

Caps interest rates on medical debt at 9 percent. Under HB 1531, practices are prohibited from selling or assigning medical debt to a collection agency until 120 days after the initial bill statement is sent to the patient. Both measures establish new requirements for collection agencies in the state, including increasing the limits on wage garnishment in some instances and notification of a debtor’s possible qualification for charity care.

Mergers and Acquisitions, HB 1607

Hospitals, hospital systems, and provider organizations are required to provide written notice to the state attorney general at least 60 days prior to the effective date of any transaction that results in a material change in governance or operations. Notice must include the names of the parties and their current business addresses; identification of all locations where health services are provided by each party; and a brief description of the nature and purpose of the material change and the anticipated effective date of the proposal. If the transaction requires the parties to file under federal premerger notice requirements (Hart-Scott-Rodino Act), a copy shall be provided to the state attorney general. Noncompliance could result in a civil penalty of no more than $200 per day while in violation.

Telemedicine and Physician Credentialing, SB 5387

Permits an originating-site hospital to rely on a distant-site hospital’s credentialing and privileging process for telemedicine services. Physicians seeking credentials or clinical privileges to perform services related to telemedicine and/or store and forward must provide the name of any hospital or facility with which you have had any association during the prior five years. You must also disclose: whether you have been or are in the process of being denied, revoked, terminated, suspended, restricted, reduced, limited, sanctioned, placed on probation, monitored, or not renewed for any professional activity listed; or ever voluntarily or involuntarily relinquished, withdrawn, or failed to proceed with an application for any professional activity listed in order to avoid an adverse action or to preclude an investigation or while under investigation relating to professional competence or conduct.

Vaccines, HB 1638

You may no longer sign certification forms exempting children from the MMR vaccine based on personal or philosophical objection. The Department of Health will provide updated certificate of exemption forms prior to the law’s effective date. For more information, the DOH has created a dedicated webpage at doh.wa.gov/MMRexemption.

Whistleblower Protections, HB 1049

Expands protections to non-employee health care providers who whistleblow in good faith and provides a civil remedy to non-employee whistleblowers who experience retaliatory action. If subject to retaliatory action, review your rights and protection under the law. A directive from the WSMA House of Delegates, this legislation responds to an evolving health care delivery landscape that often finds physicians providing care at facilities at which they are not an employee. Protections also apply to the peer review setting.

Wrongful Death, SB 5163

Increases physician, physician assistant, medical group practice, and other providers’ exposure to liability by broadly expanding who can sue in cases of wrongful injury or death and what types of damages they can recover. This applies prospectively and retroactively and may result in increased medical malpractice premiums. To learn more, contact your Physician’s Insurance representative.

Effective Oct. 1, 2019

Sexual Misconduct Disclosure, HB 1198

Requires physicians and other health care providers who have been sanctioned for sexual misconduct to provide written notice of the misconduct to any patient scheduled for an appointment. Once signed by the patient (or their surrogate decision-maker), the disclosure must be kept in the patient’s file. The disclosure must include:

  • A copy of the public order or stipulation.
  • A description of all sanctions placed on the license.
  • The duration of all sanctions.
  • The disciplining authority's telephone number.
  • An explanation of how the patient can find more information about the license holder on the DOH or disciplinary authority’s website.

The notice may be provided to the patient by a designee, such as a medical assistant.

Effective Jan. 1, 2020

Balance Billing, HB 1065

Prohibits out-of-network physicians, providers, and facilities from balance billing for emergency or non-emergency surgical or ancillary services provided to an enrollee at an in-network hospital or ambulatory surgical facility. Applies to fully insured health plans, as well as self-insured health plans that opt to comply with the law. For care that is provided under those circumstances, insurers must pay a “commercially reasonable amount” within 30 days of receiving a claim, based on the insurer’s payments for similar services provided in a similar geographic area. The payment must be sent directly to the provider rather than routed through a patient. Enrollees are responsible for the equivalent of their in-network cost-sharing for the services (as delineated by the insurer). If an out-of-network provider or facility wishes to dispute the insurer’s payment, they may initiate a dispute resolution process. The process consists of a 30-day informal negotiation period between the two parties, followed by arbitration. Claims bundling for arbitration is allowed provided that the claims occurred within two-months; involved the same two parties (i.e. insurer and provider/facility); and involved the same or related CPT codes relevant to a particular procedure.

HB 1065 is a detailed and complex law and there are other important provisions, including requirements relating to network adequacy and transparency. If you have questions or are interested in a comprehensive summary of the law, contact Sean Graham at sean@wsma.org.

B&O Tax Increase, HB 2158

Imposes a 20 percent business and occupation surcharge on the income from service and other activities of select businesses to train Washington students for Washington jobs. The tax increase imposes disproportionate harm to the economic viability of doctors in private practice and independent medical clinics. Most notably:

  • The Legislature enacted no notable rate increases for Medicaid reimbursement. As a result, this surcharge may put physician practices in the position of having to limit or close access to Medicaid patients.
  • May exacerbate the trend toward consolidation of health care facilities and necessitate more sales of physician practices to hospital systems.
  • Limits physician practices’ ability to make investments in areas like staffing and technological improvements.

Non-Competition Clauses, HB 1450

Limits the circumstances under which non-compete clauses may be validly used. Non-compete clauses will only be enforceable if: an employee earns more than $100,000 a year; an independent contractor earns $250,000 a year from the employer proposing a non-compete; the employer discloses terms of the non-compete at or prior to making an employment offer; the employer compensates employees who are laid off but still subject to non-compete agreements; and the non-compete agreement covers a period no longer than 18 months. If you are imposing or subject to a non-compete agreement, review non-compete policies and contracts and be aware of applicable laws.

Public Option Health Plan (aka Cascade Care), SB 5526

Caps reimbursement for care provided under the new “public option” health plan at 160 percent of Medicare rates, based on an insurer’s average aggregate contracting in the plan. For primary care services (as defined by the HCA) provided by a family physician, general internist or pediatrician, reimbursement must be at least 135 percent of Medicare rates. Creates a B&O tax exemption for “amounts received by a health care provider for services performed on patients covered by a Cascade Care plan, including reimbursement from the QHP and any amounts collected from the patient as part of his or her cost-sharing obligation.”

The statutory limitations on reimbursement could impact your ability to participate in the public option plan. When entering 2020 negotiations, pay close attention to your contracting practices as these caps may impact the payment you receive from certain insurers and plans. Note that the bill prohibits insurers from requiring as a condition of participating in the public option plan that a provider or facility accept a reimbursement rate for other health plans offered by the insurer at the same rate as the public Cascade Care plan.

More information about how this change will affect your practice will be available in upcoming publications.

Reproductive Health Care, SB 5602

Prohibits discrimination based on an individual’s gender identity or expression for reproductive health services purchased or contracted for by the Health Care Authority, including the use of automatic denials of coverage by managed care organizations. Effective Jan. 1, 2021, health plans and student health plans must provide coverage for certain reproductive treatments and services. Insurers must bill and collect payment with a single invoice that includes all covered benefits and services, and segregation plans must include a certification that the billing and payment processes meet the Office of the Insurance Commissioner’s requirements.

Step Therapy, HB 1879

If all necessary information is provided for a step therapy exception request, insurance carriers must approve or deny your request within one business day; if this timeline isn’t met, the exception is deemed granted. If an exception is denied, the clinical review criteria used to make the determination must be clearly provided in the denial notice. It’s critical that practices notify the WSMA and/or the Office of the Insurance Commissioner when insurance carriers are not meeting these new requirements. For more details, contact billie@wsma.org.

Substance and Opioid Use Disorder, HB 5380

While containing important provisions to improve the treatment of pain and increasing access to medication-assisted treatment and naloxone, HB 5380 contains several notable provisions impacting medical practice:

  1. No prior authorization: Requires insurance companies to cover, without prior authorization, at least one federal Food and Drug Administration-approved product for the treatment of opioid use disorder in the drug classes opioid agonists, opioid antagonists, and opioid partial agonists;
  2. PMP and prescribing mandates: Requires groups with 10 or more “prescribers” to integrate their certified electronic health record with the state’s prescription monitoring program by 2021 and requires prescriptions for controlled substances to be communicated electronically beginning Jan. 1, 2021.

The WSMA was able to obtain exemption processes for both mandates that consider economic hardship, technological limitations, or other exceptional circumstances. The WSMA will report to members when the Department of Health drafts rules outlining the exemption process.

Contact your EHR vendor and the state PMP to assess your connectivity. You should also ensure your practice managers are aware of these changes. For practice management support, contact the Washington State Medical Group Management Association.. More information will be forthcoming from WSMA publication once these policies go into effect.

Workplace Violence Prevention, HB 1931

Hospitals, ambulatory surgical centers, and other facilities such as home care agencies and psychiatric facilities must develop and implement a violence prevention plan every three years that outlines strategies focused on security considerations and risk of violence factors. A review of workplace violence incidents and issues must be conducted annually. Violence prevention training must be provided to employees, volunteers, and contracted security personnel by July 1, 2020. Records of violent acts must be kept for at least five years after the act reported.

2018 Policy

Effective June 6, 2018

Medical record requests, HB 1239

Requires physicians (or the facility at which they are employed) to provide a patient appealing the denial of federal Supplemental Security Income or Social Security disability benefits one free copy of their medical record upon request. In those circumstances, practices will no longer be able to charge a fee for providing medical records. If a patient has already made this request and has been provided a free copy of their medical record in the last two years, physicians are not required to provide the information free of charge. Physicians may provide medical records in paper or electronic format.

Prior authorization for integrative treatments, SB 6157

Prohibits health insurers from requiring prior authorization for initial evaluation and management visits and up to six consecutive treatment visits in a new episode of care for chiropractic care, East Asian medicine, massage therapy, occupational therapy, physical therapy, and speech and hearing therapies. The goal is to reduce administrative burden while ensuring that patients have access to these treatments when clinically indicated.

Medicaid Fraud Control Unit, SB 6051

Authorizes the state attorney general’s office to operate the Washington State Medicaid Fraud Control Unit to detect and deter fraud, abuse and neglect in the Medicaid program. Physicians and practices should strive to understand the laws intended to protect the Medicaid program and identify “red flags” that could lead to potential liability in law enforcement and administrative actions. The Office of the Inspector General for the U.S. Department of Health & Human Services offers related educational materials for physicians, including a road map for physicians on how to avoid Medicare and Medicaid fraud and abuse.

HIV testing, SB 6580

Repeals HIV informed consent laws that state HIV testing is voluntary and may be undertaken only after the patient or a patient’s authorized representative has been told that an HIV screening is planned and that the screening will be performed unless the patient declines. Repealing the laws specific to requiring patient consent for HIV testing means these services are now subject to the same notification and consent requirements that apply to any other medical tests.

Prescription drug disposal, HB 1047

Creates a statewide system for the safe and secure collection and disposal of unwanted medications, financed and operated by pharmaceutical manufacturers. A secure and convenient statewide drug take-back program ensures that all citizens of Washington, regardless of where they reside, will have the ability to properly dispose of unwanted prescription medications, reducing risks of misuse, poisonings and overdoses, and reducing the number of pharmaceuticals that make their way into Washington’s waterways.

Maintenance of certification and licensure, HB 2257

Prohibits the Washington State Medical Commission and Board of Osteopathic Medicine and Surgery from requiring board certification as a condition of licensure or licensure renewal. For some physicians, maintenance of certification can be burdensome, expensive and clinically irrelevant. Pursuant to policy established at by the House of Delegates, the WSMA sought protection in state law prohibiting this requirement.

Medical Student Loan Program, HB 2143

Creates the Medical Student Loan Program to provide low-interest loans to resident students who declare an intention to work in a rural underserved area in Washington state, another step toward increasing the state’s physician workforce and ensuring access to care for all Washingtonians.

Emergency volunteer health practitioners, HB 5990

Clarifies liability protections for health care practitioners volunteering during a state of emergency. The Emergency Management Assistance Compact, of which Washington state is a member, is a mutual aid agreement enabling states to share resources during a disaster. This legislation provides a process for outof- state medical professionals not covered by EMAC to provide services during an emergency. If a volunteer practitioner is licensed and in good standing in another state, they can practice under that license while an emergency declaration is in effect.

3D mammography, SB 5912

Requires the Office of the Insurance Commissioner and the Health Care Authority to clarify that the existing mandate to provide mammography services at no out-of-pocket cost to the insured patient includes coverage for tomosynthesis. This legislation brings current breast health preventive service coverage up to date by including digital breast tomosynthesis, a newer imaging technique that can improve the visibility of cancers in dense breast tissue.

Effective June 6, 2018, subject to implementation

Medicaid reimbursement rate increase for pediatric care and for medication-assisted treatment, SB 6032

Primary care provider rates for pediatric care and vaccine services are increased and rates are increased for clinicians treating patients suffering from opioid use disorder with medication-assisted treatment (MAT). Raising Medicaid rates for pediatric services will improve access to care for this vulnerable population, and higher rates for MAT will incentivize more clinicians to treat patients suffering from opioid use disorder.

For primary care services, the increase will likely apply to E&M codes that were used under the temporary increase provided in 2013 and 2014 by the Affordable Care Act.

Information about medication-assisted treatment and buprenorphine training for physicians is available through the Substance Abuse and Mental Health Services Administration. Having access to treatments for addiction within your practice, either directly or by referral, improves the health of your community and the value of your practice to the population you serve.

The WSMA will work with the Health Care Authority to provide information to members on when they can expect these rate increases to become available and how to take advantage of them.

Enrollment begins Nov. 1, 2018

Health care for Pacific Islanders, SB 5683

Creates the Compact of Free Association (COFA) Premium Assistance Program. This program will assist in paying premiums and out-of-pocket costs associated with a qualified health plan purchased by a Washington resident who is a citizen of a COFA nation (citizens of the Republic of the Marshall Islands, the Federated States of Micronesia and the Republic of Palau), is enrolled in a Silver plan, has an income that is less than 133 percent of the federal poverty level, and does not qualify for federal or state medical assistance programs administered by the Health Care Authority.

Effective Jan. 1, 2019

Breast health, SB 5084

Requires health care facilities, after performing a mammogram, to send information to patients identifying their individual breast density classification based on the breast imaging reporting and data system established by the American College of Radiology. This notification requirement encourages patients with dense breast tissue to discuss screening options with their physician. The bill was amended to omit potentially alarming language referencing increased risk of breast cancer for patients with dense breast tissue.

Reproductive health, SB 6219

Requires health plans issued or renewed in 2019 to provide coverage for: all contraceptive drugs, devices and other products approved by the Food and Drug Administration; voluntary sterilization; and any consultations, examinations, procedures and medical services that are necessary. Requiring coverage of reproductive health services and contraception provides consistent access, resulting in healthier pregnancies and reduced disparities in the population you serve.

Preventive health, HB 1523

Requires health plans to provide coverage for the same preventive services required by the Affordable Care Act and any federal guidance in effect on Dec. 31, 2016. Health plans may not impose cost-sharing requirements for preventive services. This legislation protects access to preventive health care coverage and services.

Hearing instruments, SB 5179

Requires Medicaid and public-employee health plans to cover hearing aids and related accessories. Coverage of hearing aids for Medicaid-eligible adults and public employees was eliminated in 2010. Restoring coverage will improve access to aural health for the 50 percent of people aged 75 and older who have disabling hearing loss.

Effective Jan. 1, 2020

Individual market coverage, HB 2408

Requires insurers approved to offer health plans to state and public-school employees to offer a least one plan on the state’s insurance exchange in each county they operate in. For 2019 only, the bill also allows patients in a county with no individual market health plans to purchase subsidized coverage through the high-risk pool. with health plan offerings having decreased dramatically in some areas of our state, this legislation can help ensure insurance coverage is availability to all Washingtonians, regardless of where they live.

Understanding the Regulatory Process

In a typical year, the WSMA tracks a dozen or more rules and submits comments on a wide array of issues impacting medicine to various regulatory bodies, including the Washington Medical Commission, the Department of Health, the Health Care Authority, the Office of the Insurance Commissioner, Labor & Industries, and the Department of Licensing. While our Olympia team has an intimate understanding of how the process works and a strong grasp on how a proposal will impact your practice, we are not clinicians; your feedback is critical to help guide our approach.

How it works

For all the attention given to the legislative process, rules quietly written by bureaucrats carry the same force of law as those written by elected officials.

In Washington state, language from bills that pass the Legislature and are signed into law by the governor is added to the Revised Code of Washington (RCW), the compendium of all state laws in force. Legislative language will contain specific concepts and goals, while often directing regulatory agencies and departments to fill in the details through rulemaking.

Lawmakers do this for several reasons, including a hesitancy to place complicated policy (think about the ever-evolving practice of medicine) in the RCW because it is so difficult to update; you have to pass another law. Deferring to regulatory bodies provides flexibility.

It also offers a more deliberate and comprehensive policymaking arena that facilitates expert input through a process not subject to the pressures and time constraints of the legislative session. Plus, regulatory bodies have the authority to conduct emergency rulemaking any time of year (not just when the Legislature is in session) to address issues that arise or when required to advance the agency's objectives.

The Administrative Procedures Act (APA) outlines how the rulemaking process must be conducted in our state. In short, an agency or department must release a "preproposal statement of inquiry," officially referred to as a CR-101, which is a "heads up" to the public that they intend to write a rule. The second step, the CR-102, includes draft language and an opportunity to comment. The CR-103 is the final, adopted rule. Once finalized, rules are added to the Washington Administrative Code (similar to the RCW, the WAC catalogues all state regulations).

How you can help

Each year, the WSMA tracks a dozen or more rules and submits comments on a wide array of issues impacting medicine. For example, in 2017, the Legislature passed House Bill 1427, which directs relevant boards and commissions to write opioid rules for the professions they regulate. We worked on the bill while it was under consideration by the Legislature and participated in every stage of the rulemaking. We were successful in many of our goals, but only because we solicited feedback from WSMA members and urged them to submit their thoughts to the state or endorse our comprehensive comment letter. The APA requires that each comment be considered during the rulemaking process; in short, your feedback matters.

The WSMA will alert members of opportunities to participate in rulemaking in its various email communications, including the Membership Memo, Weekly Rounds, and direct calls to action. On the WSMA website, be sure to check the WSMA Advocacy Report for the latest news on rules under consideration. For a comprehensive look at all rules being monitored by the WSMA, contact Alex Wehinger at the WSMA Olympia office, alex@wsma.org or 360.352.4848.

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