WSHA Fiscal Watch – March 7, 2024

The Washington State Legislature released its final 2024 supplemental budget March 6. This is a supplemental budget year, which means this budget provides updates to the 2023-2025 biennial budget passed last session. Given this is a supplemental budget session and last year’s historic funding levels, we expected to have a smaller budget this year.

We are pleased that both budgets funded the Washington Reproductive Access Alliance, a new residential treatment facility for children/youth with developmental disabilities and complex behaviors, and expanded funding for distressed hospital grants, which includes funding for hospitals at risk of reducing labor and delivery services. However, we are disappointed the budget did not include funding for long-term care slots for complex discharge patients who are undocumented, Medicaid coverage of partial hospitalization/intensive outpatient treatment programs for adults or Medicaid payment increases for specialty providers.

Highlights of the budget, as well as a link to WSHA’s full budget comparison table are available in our recent Inside Olympia. (Andrew Busz, andrewb@wsha.org)

Friday, March 1 was the last day for the legislature to pass bills from the opposite chamber, except for initiatives, budgets and matters necessary to implement budgets. Differences between versions passed in the House and Senate need to be concurred or reconciled prior to the end of session. Below are some of the health care policy bills that have passed with concurrence. WSHA supported all these bills.

• SB 5986- Balance Billing- Ground Ambulance Services. This bill expands the state’s balance billing protection act to protect patients from balance billing for out-of-network ground ambulance services provided on an emergency basis and for medically necessary transfers. The bill includes a minimum payment threshold for out-of-network services to ensure financial viability of ground ambulance services.
• SB 5802- Nursing Facility Rate Calculation. This bill replaces the existing skilled nursing acuity adjustment with the new adjustment mechanism supported by the Centers for Medicare and Medicaid Services. This will help ensure Medicaid payment for skilled nursing facilities more closely reflects the relative acuity and cost of services, particularly for facilities serving complex patients.
• SB 5825- Guardianship. This bill creates a process to identify assign guardians more quickly for patients who are unable to make care decisions nor have someone that can legally make them on their behalf. This bill will help reduce the time to place patients awaiting discharge due to lack of guardianship to a more appropriate facility.
• SB 5213- Pharmacy Benefit Managers. This bill creates a regulatory structure for pharmacy benefit managers as a type of health care benefit manager. The bill includes important protections for patients and pharmacies.
• SB 5940- Medical Assistants and Emergent Medical Technicians. This will allow EMT-basic, EMT-advanced and paramedics to work in hospitals through a new medical assistant credential using their existing training and education. This will particularly benefit rural hospitals and emergency medical services (EMS) systems.

For a list of other policy bills that passed this session, see our Inside Olympia.
WSHA will be providing members more details regarding these and other bills through bulletins and will update WSHA’s New Law Implementation Guide as more information is available. (Andrew Busz, andrewb@wsha.org)

The Office of the Insurance Commissioner (OIC) announced it will be extending the dispute resolution process under the state’s Balance Billing Protection Act (BBPA) through at least June of 2025. In response to OIC’s request for information, WSHA submitted comments supporting extension of the BBPA process.

OIC’s announcement cited pending litigation and ongoing issues with the federal Independent Dispute Resolution (IDR) process under the No Surprises Act.

The state’s BBPA dispute resolution process applies to state-regulated carriers (individual and small group) as well as self-funded groups that have elected to participate in the BBPA. The BBPA uses a “commercially reasonable” payment standard and median payment amounts established through the state’s all payer claims database for its dispute resolution process. Hospitals and providers may want to consider if some disputed out of network claims, including those for ERISA self-funded groups that may have elected to participate under the BBPA can be resolved through the state’s process. More information is on the OIC Website. (Andrew Busz, andrewb@wsha.org)