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.