The 2014 State Legislative Session

1. The 2014 State Legislative Session

2. Presenters Cassie Sauer SVP, Advocacy & Government Affairs Claudia Sanders SVP, Policy Development Mary Kay Clunies-Ross VP, Communications & Public Affairs

3. Webcast Outline Introduction State Health Care Environment State Legislative Environment Leadership Short Session WSHA Agenda: Improving Quality, Increasing Access Policy Budget Going Forward

4. State Health Care Environment: Improving Quality, Increasing Access

5. State Health Care Environment: Improving Quality, Increasing Access • Implementing ACA • Promises and challenges of population health • Changing payment models = uncertain sustainability • Some hospitals are in severe economic crisis • Innovative patient safety work: voluntary, collaborative, successful, national leadership

6. State Legislative Environment

7. Washington State Government Jay Inslee Democrat Governor Rs

8. Major Leadership Changes New Republican New Democrat Leaders Leaders Returning Leader Speaker Chopp Gov. Inslee Rep. Kristiansen Sen. Tom Sen. Nelson Sen. Schoesler

9. WSHA Policy Priorities • Support Telemedicine • Support Health Care Reform, Monitor Legislation • Support Transparency Goals, Monitor Legislation • Oppose Staffing Mandates • Collect Mental Health Data • Support Suspect and Inmate Guarding • Support Crisis Standards of Care • Ensure Hospital Flexibility for Partnerships • Fix Provider Liability under ACA • Delay Federal Basic Health • Encourage Breastfeeding

10. Support: TelemedicineHB 1448 • Telehealth is when physicians use video technology to provide services • Good way to deliver dermatology, mental health, post-surgery monitoring and others • Goal is to assure payment for services provided using telehealth technology • Does not expand services beyond those already covered by patient’s insurance policy

11. Support Health Care Reform: Monitor Legislation • State Health Care Innovation Plan - good goals: • efficient, high-quality care • care coordination • prevention • improved population health • WSHA supports reform that: • protects patient and provider choices • builds on existing local networks of care • takes into account changing payment models • does not create barriers to innovation • Concerns: • Accountable Communities of Health

12. Support Transparency Goals; Monitor Legislation State reform plan relies on transparency of cost and quality Creates an all claims payer database with negotiated prices WSHA supports with concerns about accuracy of information, access to data and governance oversight

13. WSHA Transparency Websitewww.wsha.org/transparency.cfm • Compare hospitals charges • Look for these buttons on the websites of Washington hospitals

14. Oppose Staffing MandatesHB 1095, HB 1152, HB 1153 • Staffing mandates undermine nurse-staffing committees and do not consider patient need • Nurse staffing committees are goodmodel for joint decision-making • Ratios: not shown to increase safety • Uninterrupted meal, rest breaks: takes away nurse choices on best time to break • Overtime/on-call restrictions: lead to necessary treatments being delayed

15. Hospital Leadership on Nurse Staffing • Hospital leaders are encouraged to ask themselves tough questions, including: • How is your nurse staffing committee functioning? • Do you use overtime or mandatory call? How much? • What are the longest shifts people work? • Are your staff getting their breaks? • We have asked DOH to step up enforcement

16. Support: Suspect and Inmate GuardingSB 5968 • There are increasing incidences of violent suspect or inmate injuring staff and patients • SB 5968 would require that all law enforcement agencies provide security when patient has history or suspicion of violent or sexual crimes

17. Support: Crisis Standards of Care • For disasters that are declared by the Governor or local government executive, legal protections will help health care providers get to work faster • When the normal amount of resources are not available to meet the need, providers cannot deliver the same kind of care

18. Ensure Hospital Flexibility to Form Partnerships • Certificate of Need is a long, expensive, unpredictable process, and the wrong process • Increased review under new rules will slow hospitals’ ability to form partnerships necessary to maintain or expand basic services • Other possibilities: • Conscience clauses • Provider freedom • Maternity services definition

19. Fix Provider Liability Under ACA • Act allows three months coverage if premiums unpaid • Insurers responsible for first month • Providers responsible for care in second and third month • WSHA supports WSMA fix

20. Delay: Federal Basic Health • ACA allows Federal Basic Health for those with incomes slightly above Medicaid • Premium share lower than in Exchange • Concerns: • Not enough enrollment data to know whether a new program is needed • State must pay start-up costs and would be responsible for ongoing, overall costs • Providers would receive Medicaid-like rates

21. Support Breastfeeding • Partnership with Governor and Department of Health • Strategy to reduce childhood obesity • Support a new recognition program for high-performing hospitals

22. Budget Priorities Overview • Meant to make minor adjustments to biennial budget • Supreme Court unfavorably reviewed education plan • Revenue forecast likely better, but not great Budget Priorities • Mental Health Funding • Medicaid Outreach • Increased Dollars for PrimaryCare Support

23. Support Mental Health Funding • 2013 had improvements • Increased capacity in state hospitals • Changes to Involuntary Treatment Act, new resources • State task force • Capital budget funding + regulatory relief • Years of cuts in recession still left big hole • Ongoing concerns about viability of Institutes for Mental Disease

24. Mental Health:$20 million plus federal matching funds • Budget goals: • Stability of Institutes for Mental Disease • Additional capital dollars to expand inpatient options • Additional inpatient capacity at Western State Hospital • Funding for new evaluation and treatment centers • Funding for improvement of case management for high-risk individuals

25. Medicaid Outreach$1.1 million plus federal matching funds • WSHA supports Governor’s budget request for funding to focus on potential Medicaid enrollees • Medicaid Newly Eligible Adults: 121,258 • Medicaid Previously Eligible but not Enrolled: 55,807 • Medicaid Redeterminations (Previously Covered):156,206 • Targeted outreach effort is needed

26. Maintain Primary Care Rates$24 million plus $24 million federal matching funds • Support WSMA’s efforts to retain Medicare payment rates for Medicaid enrollees • Access to primary care physicians is essential for improving population health, especially for new Medicaid enrollees

27. Heading Into Sessionwww.wsha.org/policyadvocacy.cfm • Stay informed • Inside Olympia, Weekly Report • Bulletins and Calls to Action • Policy and Advocacy Website • Priorities • Issue Briefs • Stay connected • Feel free to contact Cassie, Claudia, or policy directors if you have questions or experiences you’d like to share

28. Washington Hospital PAC Building Relationships Electing Champions for Hospitals Unifying Hospitals’ Political Voice www.wsha.org/whpac.cfm

29. Thank You! Your advocacy with your legislators, your testimony, your connections with local leaders and media, and your contributions to the PAC are essential to our success. Please keep up the good work!

30. Thank You!Questions? Comments? Cassie Sauer Senior Vice President, Advocacy & Government Affairs cassies@wsha.org 206/216-2538