Regulatory Priorities
Bills that are signed into law, as well as executive orders, often
require rulemaking for implementation. State agencies, boards, and commissions and the federal government use
rulemaking to decide the finer details of policy changes required by
legislation or executive order. These details may ultimately decide how
the policy change impacts physicians, physician assistants, and practices.
The WSMA policy team both monitors and engages on rules impacting the
house of medicine.
State-Level Priorities
PQAC begins accessible label rulemaking
The state Pharmacy Quality Assurance Commission is conducting stakeholder
outreach on its
accessible label rulemaking
with the goal of ensuring that every Washington patient has access to the
critical health information they need. This rule will be applicable to
physicians and physician assistants who dispense medication. While the
WSMA is supportive of the rule, we have requested an exemption for sample
medications. Read
WSMA’s comments on the PQAC rulemaking.
WMC moves forward with health equity continuing education rulemaking
The Washington Medical Commission is in the process of writing
rules
that will implement WSMA
legislation
requiring licensed health professions to participate in health equity
continuing medical education. The WSMA supports the model rules
established by the Washington State Department of Health requiring two
hours of health equity CME every four years. Read
WSMA’s comments on the commission’s health equity CME rulemaking.
Board of Naturopathy considers non-surgical cosmetic procedures
The state Board of Naturopathy is continuing its years-long effort to
expand naturopaths’ scope of practice to include nonsurgical cosmetic
procedures—specifically the use of botulinum toxin—without stipulating
additional education requirements or training. The WSMA is opposed to this
rulemaking
and has commented extensively throughout the rulemaking process. Read
WSMA’s comments on the Board of Naturopathy rulemaking.
DOH providing flexibilities for the medical assistant profession
The Washington State Department of Health is
updating
the Washington Administrative Codes that regulate the medical assistant
profession. MAs are valued members of the care team and the
CR-102
will make it easier for them to join or rejoin the workforce. In response
to the workforce shortages physician practices are facing, the WSMA is
supportive of the DOH eliminating barriers and increasing flexibilities
for our partners in the MA profession.
DOH implementing limited prescriptive authority for licensed midwives
Last year, the Legislature approved a limited prescriptive license for
licensed midwives to improve access. The WSMA engaged on both the sunrise
review and legislation. Because of important patient safeguards in place,
the WSMA didn’t oppose this scope of practice increase. We are requesting
similar safeguards be included in the
draft WAC
implementing the legislation. Read
WSMA’s comments on the DOH licensed midwives rulemaking.
DSHS moving forward with TANF diaper benefit
The state Department of Social and Health Services released a
proposed rule
allowing the issuance of a diaper-related payment to all Temporary
Assistance to Needy Families or State Financial Assistance households with
a child under the age of 3. The proposed rule is intended to reduce
financial barriers to accessing diapers—necessary hygiene products—and the
WSMA is supportive of this rulemaking due to
relevant policy
in this space. Read
WSMA’s comments on the DSHS rulemaking regarding diaper-related
payments to TANF and SFA recipients.
L&I taking action on surgical smoke
The state Department of Labor and Industries released a
proposed rule
regulating exposure to surgical smoke in hospitals and ambulatory surgical
centers. The proposed rule is intended to limit medical staff exposure to
surgical smoke by requiring employers to use surgical smoke evacuation
systems when feasible during planned surgical procedures that are likely
to generate surgical smoke.
L&I adopting permanent rules to protect outdoor workers
The state Department of Labor and Industries released a
proposed rule
regarding outdoor ambient heat exposure. The proposed rule is intended to
prevent heat-related illness and reduce traumatic injuries related to heat
exposure. In line with
WSMA policy on heat exposure protection for outdoor workers, the WSMA is supporting this rulemaking. Read
WSMA’s comments on L&I’s rulemaking regarding outdoor ambient heat
exposure.
Federal Priorities
HHS implementing civil, criminal protection for reproductive health care
professionals
The U.S. Department of Health and Human Services released a rule
prohibiting the disclosure of personal health information for the purpose
of an investigation into or proceeding against an individual or regulated
entity for the provision, receipt, or facilitation of legal reproductive
health care services. The proposed rule is intended to protect physicians,
physician assistants, and health care professionals from criminal and
civil liability for providing legal and necessary reproductive health care
services—including abortion—to their patients. The WSMA plans to support
this rulemaking.
CMS aims to improve interoperability, prior authorization processes
This Centers for Medicare and Medicaid Services
proposed rule
seeks to improve the electronic exchange of health care data and
streamline processes related to prior authorization with the goal of
improving efficiency in health care. This rulemaking would apply to
Medicare Advantage organizations, state Medicaid and Children’s Health
Insurance Program fee-for-service programs, Medicaid managed care plans
and CHIP managed care entities, and qualified health plan issuers on the
federally facilitated health insurance exchanges. The WSMA extended
support of this rulemaking in a
comment letter submitted in February.
CMS proposes changes to Medicare Advantage risk-adjustment model
This
notice
proposes changes to the risk-adjustment model for Medicare Advantage plans
by transitioning the diagnostic coding system from ICD-9 to ICD-10,
removing physicians’ ability to use nearly 2,300 codes ranging from
behavioral health services to chronic conditions. The WSMA raised concerns
with this proposed change in a
comment letter. In the final policy released in March, the risk-adjustment model was
transitioned to ICD-10 codes and now includes clinically based adjustments
to ensure conditions are stable predictors of costs.
DEA implementing pandemic-era telemedicine flexibilities: Buprenorphine
The federal Drug Enforcement Administration has issued a
proposed rule
to expand certain COVID-19 telemedicine flexibilities beyond the end of
the federal public health emergency by allowing DEA-registered physicians,
physician assistants, and health care professionals to prescribe a
one-time, 30-day supply of buprenorphine for the treatment of opioid use
disorder for a narrow set of telemedicine consultations. Prescribing
buprenorphine beyond the allowed 30-day supply would require the physician
or PA to satisfy an in-person medical evaluation requirement. In a
comment letter submitted in March, the WSMA provided general support of this rulemaking while echoing the
American Medical Association’s recommendations to extend the 30-day
timeframes proposed under this rulemaking.
DEA implementing pandemic-era telemedicine flexibilities: Controlled
substances
This
proposed rule—the second of two Drug Enforcement Administration rule proposals which
seek to extend pandemic-era telemedicine flexibilities—would allow
DEA-registered physicians, PAs, and health care professionals to prescribe
a one-time, 30-day supply of non-narcotic controlled substances in
Schedules III-V for a narrow set of telemedicine consultations.
Prescribing a narcotic controlled substance or any controlled substance in
Schedules II-V would require a physician or health care professional to
satisfy the in-person medical evaluation requirement. In a
comment letter submitted in March, the WSMA provided general support of this rulemaking while echoing the
American Medical Association’s recommendations to offer more flexibilities
for the prescribing of controlled substances.
The DEA intended to finalize these two proposed rules in advance of the
end of the COVID-19 federal public health emergency on May 11 to ensure
patient continuity of care. In response to receiving over 38,000 comment
letters, the DEA filed the below temporary rule while it considers
comments and revisions to the two proposed rules.
DEA extending pandemic-era telemedicine flexibilities
This
temporary rule
extends telemedicine flexibilities implemented during the COVID-19 federal
public health emergency to avoid lapses in patient care. This rule is
effective from May 11, 2023, through Nov. 11, 2023, and includes a
provision allowing practitioner-patient telemedicine relationships that
have been or will be established on or before Nov. 11, 2023, the full set
of telemedicine flexibilities regarding prescribing of controlled
substances for a one-year grace period through Nov. 11, 2024. The WSMA is
pleased to see this extension.
WSMA Member Support Available
Do you have questions about how changes from the state legislative session
will apply to your practice? Are you frustrated by administrative burden
or a particular state or federal regulation? The WSMA Policy Department is
here to help. As a WSMA member, you have access to policy experts who can
assist with your questions and provide information on the latest health
care policies and proposals. Your questions and feedback help us shape our
policy agenda in partnership with the House of Delegates, our legislative
team, and state and federal agencies, and may lead to direct WSMA-led
action before the state to address issues facing physicians.
We need to hear from you! Reach out to us with your questions and ideas at
policy@wsma.org.