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.
Read WSMA's Advocacy Report for the latest legislative and regulatory news out of Olympia and Washington, D.C. affecting Washington physicians and patients.
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.
2018 WSMA Legislative Report
2017 WSMA Legislative Report
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.
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 2019 state legislative session saw WSMA's advocacy moving the needle on some timely issues and achieving important victories for the physician community, including:
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.
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.
As originally proposed, the following policies passed by lawmakers in 2019 would've impacted physician practices far more dramatically if not for WSMA advocacy.
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
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 .
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 .
A look at WSMA priority policy enacted in 2018-19 that may impact your practice—and the dates when these new laws take effect.
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.
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.
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.
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.
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.
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.
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:
The notice may be provided to the patient by a designee, such as a medical assistant.
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 firstname.lastname@example.org.
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:
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.
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.
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.
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 email@example.com.
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:
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.
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.
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.
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.
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.
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.
Creates a statewide system for the safe and secure
collection and disposal of unwanted medications,
financed and operated by pharmaceutical
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.
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 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.
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.
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
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.
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.
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.
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.
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.
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
This legislation protects access to preventive health care
coverage and services.
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
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
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.
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).
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, firstname.lastname@example.org or 360.352.4848.