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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.

Get up to speed on 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 state legislative session wrap-up webinar

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.

2018 & 2017 state legislative session reports

Each year, the WSMA publishes a legislative report providing members a summary of policy outcomes from the state legislative session. The report also features a look a new laws impacting practice management as well as the WAMPAC Vote Tracker, a handy guide to how your legislators voted on priority health care legislation.

2018 WSMA Legislative Report
2017 WSMA Legislative Report

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.

New Laws Impacting Practice Management

A look at WSMA priority legislation enacted in 2017-18 that may impact your practice—and the dates when these new laws take effect.

2018 Legislation

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.

2017 Legislation

Various effective dates:

Appropriate prescribing, HB 1427

Based on recommendations from the WSMA/WSHA Joint Opioid Safe Practices Task Force. Implements an overdose feedback system through the state’s prescription monitoring program; allows physicians and facilities to review reports from the program to understand their prescribing practices relative to their peers in the same specialty; requires professional boards and commissions, including the Medical Quality Assurance Commission, to adopt rules for prescribing opioids by 2019; and other changes.

Children’s mental health services, HB 1713

Based on recommendations by the Children’s Mental Health Work Group, created by the Legislature in 2016. Requires the state Health Care Authority to provide payment and resources for additional children’s mental health services. Also requires behavioral health organizations to reimburse physicians for mental health services provided through telemedicine. Creates a 24-month child psychiatry residency at the Washington State University Elson S. Floyd College of Medicine.

Effective May 4, 2017:

Sunscreen at schools, SB 5404

Permits students, parents and school personnel to possess and apply over-the-counter, FDA-regulated sunscreen without a prescription or note from a licensed health care professional. As parents will no longer be required to obtain a note from a physician before sending their child to school with sunscreen, physicians will likely see a decline in these kinds of requests.

Effective May 5, 2017:

Prescription drug donation program, HB 1765

Fixes an unintended consequence of previous legislation that acted as a barrier to prescription drug donations. Under previous Washington Prescription Drug Program rules, physicians were only allowed to donate medications if they were stored using the drug’s time/temperature indicator—drugs that did not have this indicator were ineligible. Under this new legislation, drugs that do not have an indicator may be donated provided the donor completes and signs a form that the drug has never been opened, used, adulterated or misbranded.

Effective July 23, 2017:

Interstate Medical Licensure Compact, HB 1337

Authorizes the Medical Quality Assurance Commission to participate in the Interstate Medical Licensure Compact. Physicians may now apply for expedited licensure to practice medicine in multiple states that are a member of the compact, replacing a fragmented, administratively burdensome process to practice medicine across state borders and increasing access to care for patients (particularly in border communities).

Mental health paperwork reduction, ESSHB 1819

Requires the Department of Social and Health Services to immediately review its behavioral health services documentation and paperwork requirements and eliminate duplication and inefficiencies, and by April 2018, provide agencies a single set of streamlined regulations covering mental health, substance use disorder and cooccurring disorder treatments for children.

Disability parking permits, HB 1515

Brought to legislators by the WSMA, this legislation increases the number of ways health care practitioners can authorize disability parking permits. Legislation from 2014 required health care practitioners authorizing disabled parking permits to use a prescription pad or paper. This bill modernizes the statute and eases administrative burden by allowing for authorization of parking permits on office letterhead or by electronic means. The Department of Licensing will establish rules governing electronic authorization.

Right to try, SB 5035

Authorizes an eligible patient and his or her treating physician to request that a manufacturer make an investigational product available for treatment of the patient. This bill allows a patient suffering from a serious, potentially life-threatening disease or condition to request access to an investigational product, upon a recommendation by his or her treating physician.

Contraceptive coverage, HB 1234

Requires a health benefit plan that includes coverage for contraceptive drugs to provide reimbursement for a 12-month refill of contraceptive drugs obtained at one time by the enrollee. This bill makes accessing birth control more convenient for women and helps to prevent disruption in access, promoting greater medication compliance and reducing unintended pregnancies.

Health Care Authority auditing, HB 1314

Requires that Health Care Authority audits meet certain standards related to timelines, recovery of payments, the use of statistical sampling and the submission of records. Provides relief for physicians faced with administratively burdensome and costly HCA audits. For example, the HCA must now provide 30 calendar days’ notice of an onsite audit, and a preliminary report or draft audit finding must be produced within 120 days of receipt of requested information. 

Disclosing PHI to a patient’s friends or family, HB 1477

Permits physicians and other health care providers to disclose protected health information without patient permission to family or close friends involved with a patient’s health care or payment related to medical services. PHI may also be disclosed without patient permission when notifying a family member or a personal representative of the patient’s location, general condition or death. In situations where the patient is not present, or if obtaining authorization is unfeasible, physicians and other health care providers are now permitted to exercise their professional judgement in the best interest of the patient. If the patient is being treated for a mental disorder, the disclosure may include the patient’s diagnosis and treatment recommendations; safety concerns related to the patient; information about available resources (such as case management support); and the process to ensure safe transitions to different levels of care. 

Physician practices should update their privacy policies to reflect this important change, including their “notice of privacy practices” for patients. While the bill provides for immunity from civil liability when making or not making these kinds of disclosures, physicians should familiarize themselves with these new privacy requirements. For example, disclosure requirements are different when a patient is present versus not present.

Disclosing PHI for the purposes of referrals, SB 5435

Permits disclosure of protected health information to a physician or other health care provider involved in a patient’s care regardless of whether that physician or provider is a licensed mental health professional or a licensed health care professional. PHI may be disclosed to any person who is working in a care coordinator role or who is under agreement pursuant to HIPAA and who requires the information and records to assure coordinated care and treatment of the patient.

Informed consent for unaccompanied homeless youth, HB 1641

Retains the ability of a school nurse, school counselor or homeless student liaison to consent for health care for a homeless student under certain conditions. Consent is required for nonemergency outpatient primary care services, including physical examinations, vision examinations and eyeglasses, dental examinations, hearing examinations and hearing aids, immunizations, treatments for illnesses and conditions, and routine follow-up care customarily provided by a health care provider in an outpatient setting, excluding elective surgeries. Physicians and other providers may request the person authorized to consent to provide a declaration signed and dated under penalty of perjury stating he or she is a school nurse, school counselor or homeless student liaison, and that the minor meets statutory requirements.

Educating patients on coverage for breast reconstruction, SB 5481

Requires the Health Care Authority and the Department of Health to create and implement a campaign to educate breast cancer patients about the availability of insurance coverage for breast reconstruction and breast prostheses. Educational materials developed by the by the agencies must be made available to physicians and other providers for distribution to patients.

Statewide case management system for coroners and medical examiners, HB 1794 (Klippert)

Permits the Forensic Investigations Council to use funds to create a statewide case management system for coroners and medical examiners. The Washington Association of Coroners and Medical Examiners will participate in the selection of the new system and will train counties when the system is operational.

Effective Jan. 1, 2018:

Telemedicine “home,” SB 5436

Defines “home” as “any location determined by the individual receiving the service” for telemedicine reimbursement purposes. Enables physicians to receive payment for services provided to a patient and more reliably provide services to patients in their home and other places convenient to the patient. Ensuring that physicians receive payment for these services and expanding the variety of settings where these services can occur will help to meet a growing demand and ultimately increase access to care, particularly for patients in Washington’s rural and underserved communities, including those who cannot conveniently travel to see specialists.

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, or 360.352.4848.

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