Fiscal Watch – April 3, 2024

WSHA is continuing to communicate with state agency staff about the impacts of the Change Healthcare cyber-attack and the critical needs of Washington’s hospitals and the patients we serve. While we are focused on current barriers to payment, we are also mindful of downstream impacts. WSHA recommends hospitals and providers document their efforts and challenges obtaining prior authorization or providing inpatient notification to health plans. The Office of the Insurance Commissioner requires carriers to have processes for extenuating circumstances where authorization cannot be provided in advance. WSHA asks members to notify us of any challenges they are facing in getting payment due to prior authorization issues related to disruptions to Change Healthcare.

As a resource to members, WSHA created and will continually update a resource page with links to updates from federal and state agencies and from individual health insurers. (Andrew Busz, andrewb@wsha.org).

A new state law, E2SHB 1357, reduces the timeframes for state regulated carriers to respond to prior authorization requests for medical services and prescription drugs with the changes effective January 1, 2024. The new timeframes are in the table below. Note, “electronic” includes  existing electronic methods for prior authorization requests and is not limited to prior authorization through an application programming interface (API). Also, the new requirements apply to state regulated insurance (individual and small group) and may not apply to enrollees of self-funded groups.

If a hospital or provider believes a carrier is not complying with the new prior authorization response timelines for state-regulated programs they may contact the Office of the Insurance Commissioner (OIC) here.
 
E2SHB 1357 ensures that federal requirements for carriers to provide an API process for prior authorization will also apply for state-regulated insurance. At this point, the API requirements will apply to state regulated insurance for medical services effective January 1, 2026, and January 1, 2027 for prescription drugs. API requirements for federal programs, including Medicare and Medicare Advantage, will be effective January 1, 2027. More information and a link to OIC’s implementation update is available here. (Andrew Busz, andrewb@wsha.org)

WSHA’s Government Affairs team recently updated its Top Priority Rules Tracker, which shows the highest-priority ongoing state rulemaking activities impacting hospitals and health systems as part of its State Regulatory Issues webpage. Members will find a comprehensive view of the status of state rulemaking activities that affect them and the appropriate WSHA staff contact.  Recent updates include:

• Temporary Practice Permits for Nurses 
• Trauma Designation Proposed Rulemaking Withdrawn
• Clean Buildings Emergency Rulemaking
• Health Care Worker Unemployment Eligibility During a Public Health Emergency

(Mary Storace, marys@wsha.org)

With conclusion of the 2024 legislative session, WSHA Government Affairs staff will provide member bulletins and implementation resources for laws passed during session. Members are encouraged to periodically check our New Law Implementation Guide page for new bulletins and resources. (Mary Storace, marys@wsha.org)