End of session report

The legislature passed its final 2019-21 operating budget on April 28. The final budget was largely good for health care. Of WSNA’s three budget priorities, it is notable that only school nurses did not receive new funding.

Breaks and Overtime Protections – PASSED
The breaks and overtime protections bill was WSNA’s top priority in 2019. Two bills were introduced: SB 5190 in the Senate and HB 1155 in the House. The Senate version was killed on the Senate floor when more than 30 amendments were proposed by those opposing the bill. HB 1155 passed the House (63-34) with bipartisan support. In the Senate, HB 1155 the bill was amended on the floor – including an amendment to restricted nurses to an 8-hour workday, and an amendment to exclude Critical Access Hospitals from the bill. The House refused to concur with these amendments, sending the bill to conference committee. The conference report (final version of the bill) removed the 8-hour limit language, delayed implementation for techs, and included Critical Access Hospitals and sole community hospitals with a two-year implementation delay. This final version of the bill passed the Senate (32-16) and the House (70-24) and was signed into law by the Governor on May 8. This bill takes effect for most hospitals on January 1, 2020, and for Critical Access Hospitals and sole community hospitals on July 1, 2021. This victory marks the culmination of years of hard work and action by nurses across the state.

Workplace Violence Prevention – PASSED
HB 1931 updates our state’s workplace violence in health care statute to provide more specificity about what hospitals must include in their required workplace violence prevention plans and requires those plans to be updated every three years, with an annual review of any violent incidents informing that plan. This bill also updates training requirements with more specificity to ensure that hospitals are providing uniform and effective training around the state – currently, some hospitals provide excellent hands-on training, while others use an online module that allows workers to “pre-test” out. This new law will ensure that quality, hands-on training is available in all hospitals.This bill passed the House (97-0) and the Senate (48-0) unanimously in the first year it was introduced. The Governor signed this bill into law on May 21. It takes effect on January 1, 2020.

Surprise Billing (Medical Debt) – PASSED
HB 1065 addresses the practice of “balanced billing” or “surprise billing” occurs when a patient goes to an in-network hospital and doesn’t realize that they may be seen by an out-of-network provider even though they were conscientious about being seen in an in-network facility. In these cases, the patient has been charged for the difference of seeing an out-of-network provider to “balance the bill”. This practice has resulted in patients receiving surprise medical bills of hundreds to tens of thousands of dollars. This bill passed the House (95-0) and the Senate (47-0). It was signed into law by the Governor on May 21.

Access to Mental Health – PASSED
HB 1593 creates the Behavioral Health Innovation and Integration campus within the University of Washington School of Medicine (UWSOM). Requires the UWSOM to create a plan to develop and site a teaching facility that provides inpatient care and workforce training with the input of allied health programs, including the UW School of Nursing. This bill passed the House (95-0) and Senate (48-0) unanimously. It was signed into law by the Governor on May 9.

Nursing Education Funding – PASSED
HB 2158 provides just over $40 million dollars to increase salaries for nurse educators. These salary increases will help retain and recruit nurse educators in Community and Technical Colleges, where current nurse educators holding Master’s degrees make less than the first year nurses they are graduating with a two-year Registered Nurse degree. Currently, the nursing faculty shortage means that 800 qualified nursing school applicants are turned away from Washington’s nursing programs each year. This bill passed the Senate (25-22) and the House (52-46). It was signed into law on May 21.

Foundational Public Health Services – PASSED
HB 1497 codifies Foundational Public Health Services and requires the Washington State Department of Health, local health jurisdictions, and sovereign tribal nations work together to determine how state allocated public health funds are to be used. This bill passed the House (94-4) and the Senate (44-1). It was signed into law by the Governor on April 3.

NURSING

Increasing SANE Education in Rural and Underserved Areas – DEAD
HB 1942 requires Washington State University (WSU) College of Nursing to establish a program to provide nurses with sexual assault nurse examiner (SANE) online and clinical training. It also requires WSU College of Nursing to establish a regional SANE leader pilot program to gather information and develop recommendations to increase the number of SANEs in rural and underserved communities. This bill died in the policy committee. WSNA supported this bill.

Services Provided by Health Care Professional Students – PASSED
HB 1726 permits pharmacy students, allopathic and osteopathic medical students, and nursing students to perform tasks under the supervision of a licensed pharmacist, licensed allopathic or osteopathic physician, registered nurse, or advanced registered nurse practitioner, so long as those tasks fall within the scope of practice of both the student and the supervisor and certain other conditions are met. This bill passed the House (95-0) and Senate (48-0) and was signed into law by the Governor on May 7.

Health Profession Fees – PASSED
HB 1753 requires the State Department of Health or certain disciplining authorities, that set or adjust fees affecting health professions, to prepare a statement of inquiry under chapter 34.05 RCW regarding the administrative procedure act. Currently, DOH is not required to take any stakeholder input when proposing a licensing fee increase; DOH announces the fee increase and holds a public hearing. HB 1753 requires DOH to treat proposed licensing fee increases like any other proposed rule, with time allowed for stakeholder input beforethe fee is proposed. This would allow WSNA and other stakeholders to weigh in with DOH on any proposed licensing fee increase for nurses.This bill passed the House (98-0) and Senate (48-0) unanimously and was signed into law by the Governor on May 8.

Nurse Licensure Compact – DEAD
HB 1882/ SB 5460 establishes the interstate nurse licensure compact of 2019. This bill creates and establishes a joint public entity known as the interstate commission of nurse licensure compact administrators which is an instrumentality of the party states. It requires the Nursing Care Quality Assurance Commission to: 1) Obtain fingerprints from each applicant for a multistate license and submit them through the Washington state patrol to the federal bureau of investigation for criminal background checks; and, 2) Use the results of the record search in making multistate licensure decisions. WSNA opposed this bill due to implementation concerns both from other states that have implemented the compact and specifically related to implementation in Washington state.

Hospital Privileges for ARNPs and PAs – PASSED
HB 1432 requires hospitals or health care facilities to collect information from physician assistants (PAs) and advanced registered nurse practitioners (ARNPs) before granting or renewing clinical privileges or associations with the hospital, and requires PAs or ARNPs to provide that information. It requires hospitals or facilities to notify the Nursing Care Quality Assurance Commission or Medical Quality Assurance Commission of any denied privileges. This bill passed the House (98-0) and passed the Senate (46-0) unanimously. It was signed into law by the Governor on April 23.

PREVENTION

Tobacco 21 – PASSED
EHB 1074 raises the legal age to 21 years for the lawful sale or distribution of tobacco and vapor products. This bill also authorizes the Governor, in recognition of the sovereign authority of tribal governments, to seek government-to-government consultations with tribes regarding raising the minimum legal age of sale in certain compacts. This bill passed the House (66-30) and Senate (33-12) and was signed into law by the Governor on May 7.

Opioid Use Disorder Treatment and Prevention – PASSED
SSB 5380 declares that opioid use disorder is a public health crisis. This bill also requires state agencies to: (1) Increase access to evidence-based opioid use disorder treatment services; (2) Promote coordination of services within the substance use disorder treatment and recovery support system; (3) Strengthen partnerships between opioid use disorder treatment providers and their allied community partners; (4) Expand the use of the state prescription drug monitoring program; and (5) Support comprehensive school and community-based substance use prevention services. Additionally, it requires agencies that administer state purchased health care programs to: (1) Coordinate activities to implement this act and the state interagency opioid working plan; (2) Explore opportunities to address the opioid epidemic; and (3) Provide status updates as directed by the joint legislative executive committee on health care oversight to promote legislative and executive coordination. This bill passed the House (97-0) and Senate (45-1) and was signed into law by the Governor on May 8.

Fruits and Vegetables Access – PASSED
SHB 1587 establishes the Fruit and Vegetable Incentives Program at the State Department of Health (DOH). This program consists of three components: 1) Farmers’ Market Basic Food Incentives which gives additional funding that may be used by a recipient of Basic Food benefits to purchase fruits and vegetables at a farmers’ market authorized by DOH; 2) Grocery Store Basic Food Incentives which may be used by a recipient of Basic Food benefits to purchase fruits and vegetables at a grocery store authorized by DOH; and, 3) Fruit and Vegetable Vouchers which are cash-value vouchers that may be distributed by a health professional to a patient who is eligible for Basic Food and has a qualifying health condition, as defined by DOH, or who is food insecure (the vouchers may be redeemed at a participating retailer, including an authorized farmers’ market or grocery store). This bill passed the House (84-10) and Senate (47-1) and was signed into law by the Governor on April 29.

Maternal Mortality Reviews – PASSED
SB 5425 changes the composition and duties of the maternal mortality review panel. It authorizes the State Department of Health to request and receive data for specific maternal deaths from the State Department of Children, Youth, and Families and its licensees and providers. The bill also requires hospitals and licensed birth centers to make an effort to report deaths that occur during pregnancy or within 42 days of the end of pregnancy to the local coroner or medical examiner. It also requires a county to be reimbursed from the death investigations account, if the county bears the cost of an autopsy related to maternal mortality. This bill passed the Senate (47-0) and House (98-0) unanimously and was signed into law by the Governor on May 8.

HEALTH CARE

Sexual Assault Kit Notice – PASSED
HB 1016 requires hospitals that do not provide sexual assault evidence kit collections, or have appropriate providers available to provide the collection at all times, to develop a plan by July 1, 2020, to assist individuals with obtaining kit collection. Requires hospitals that do not provide kit collection or have appropriate providers available to: 1) Provide notice, within two hours of a request, to an individual who presents in the emergency department and requests a collection that the hospital does not perform these services or have the appropriate providers available; and 2) coordinate care with the local community sexual assault agency and assist the patient in finding a facility with appropriate provider available. This bill passed the House (96-0) and Senate (46-0) unanimously and was signed into law by the Governor on May 7.

Health Care Whistleblowers – PASSED
SHB 1049 provides a civil remedy to non-employee whistleblowers at health care facilities who have been subject to retaliatory action. It also establishes standards for the sanction process against medical staff. This bill passed the House (97-0) and Senate (47-0) and was signed into law by the Governor on April 19.

Hospital Safety Net Assessment – PASSED
SSB 5734 extends the Hospital Safety Net Assessment (HSNA) program through July 1, 2023. It continues to allow funds from the HSNA program to be used in lieu of State General Fund payments for Medicaid hospital services through the 2021-23 biennium. It also continues to allow funds from the HSNA program to be used for integrated evidence-based psychiatry and family residency programs through the 2021-23 biennium. Finally, this bill allows the Health Care Authority to make offsets to payments to hospitals failing to make assessment payments within 90 days of the due date. This bill passed the Senate (96-1) and House (48-1) and was signed into law by the Governor on May 8.

Affordable Care Act Protections – PASSED
HB 1870 codifies certain provisions of the federal Affordable Care Act in state law. These include topics such as protections for pre-existing conditions, defining the ten essential health benefits, putting in place out-of-pocket maximums, and restricting lifetime coverage limits for essential health benefits. This bill passed the House (56-35) and Senate (28-17) and was signed into law by the Governor on April 17.

Health Network Adequacy – PASSED
HB 1099 requires the Insurance Commissioner's rules to be amended to require each health carrier to include in its electronic provider directory a notation of any mental health or substance abuse provider whose practice is closed to new patients, and it requires the Insurance Commissioner to publish an annual report on consumer complaints regarding network access to mental health treatment and substance abuse treatment providers. It also requires a health carrier to publish certain information about network access on its website. Both WSNA and AAPPN supported this bill. It passed the House (97-0) and Senate (45-0) unanimously and was signed into law by the Governor on April 3.

Informed Consent for Pelvic Exams – DEAD
SB 5282 prohibits a licensed health care provider from knowingly performing or authorizing a student practicing under their authority to perform a pelvic examination on a patient who is anesthetized or unconscious. This bill was never brought to the Senate floor and died in the Senate Rules Committee. WSNA supported this bill.

Indian Health Improvement – PASSED
SB 5415 establishes the Washington Indian health improvement act. It creates the governor's Indian health advisory council and directs the council to: (1) Adopt the biennial Indian health improvement advisory plan; (2) Address policies or actions that have tribal implications that are not able to be resolved or addressed at the agency level; and (3) Provide oversight of certain service organizations or entities to address their impacts on services to American Indians and Alaska Natives and relationships with Indian health care providers. It also, creates the reinvestment committee of the council and requires the committee, with assistance from the state health care authority, the American Indian health commission for Washington state, and other member entities of the advisory council, to prepare a biennial Indian health improvement advisory plan. Creates the Indian health improvement reinvestment account. This bill was supported by WSNA. It passed the House (96-0) and Senate (42-0) unanimously and was signed into law by the Governor on May 7.

Individual Health Insurance Market (Public Option) – PASSED
ESSB 5526 requires the state health benefit exchange, in consultation with the insurance commissioner, the state health care authority, an independent actuary, and other stakeholders, to establish up to three standardized health plans for each of the bronze, silver, and gold levels. It also requires the state health care authority, in consultation with the state health benefit exchange, to contract with one or more health carriers to offer silver and gold qualified health plans on the state health benefit exchange for plan years beginning in 2021. This bill requires the state health benefit exchange, in consultation with the state health care authority and the insurance commissioner, to develop a plan to implement and fund premium subsidies for individuals whose modified adjusted gross incomes are less than five hundred percent of the federal poverty level and who are purchasing individual market coverage on the health care exchange. This bill passed the Senate (36-13) and the House (54-38). It was signed into law by the Governor on May 13.

Prescription Drug Transparency – PASSED
HB 1224 requires health carriers, pharmacy benefit managers, pharmacy services administrative organizations, and drug manufacturers to report certain prescription drug pricing data to the Health Care Authority (HCA). It also requires manufacturers to provide advance notice to HCA before increase the price of certain drugs, and it requires HCA to analyze the data and provide an annual report to the Legislature. This bill passed the House (92-5) and the Senate (48-0). It was signed into law by the Governor on May 9 and takes effect on July 28, 2019.

OCCUPATIONAL AND ENVIRONMENTAL HEALTH

Preventing Toxic Pollution – PASSED
SSB 5135 directs the Department of Ecology to identify priority consumer products for at least five priority chemicals every five years, with the first process beginning in 2020. This bill authorizes Ecology to take regulatory actions with respect to priority consumer products containing priority chemicals, including restricting or prohibiting the manufacture, sale, or use of a priority chemical in a priority consumer product, or requiring a manufacturer to disclose certain information about the use of a priority chemical in a priority consumer product. It also authorizes Ecology to require manufacturers to provide certain information about their use of a chemical to support the identification of priority consumer products containing priority chemicals. This bill passed the Senate (27-22) and passed the House (60-37) and was signed into law by the Governor on May 8.

CHILDREN'S MENTAL HEALTH

Children’s Mental Health Bill – PASSED
SB 5903 requires the development of a funding model for Partnership Access Line activities. It directs school districts to use a professional learning day for training in behavioral health topics. This bill also expands residencies in child and adolescent psychiatry and requires statewide coordinated specialty care for early identification and intervention for psychosis. It etablishes mental health consultants to support child care providers and coaches. AAPPN supported this bill. This bill passed the Senate (48-1) and passed the House (87-9) and was signed into law by the Governor on May 9.

BEHAVIORAL HEALTH

Behavioral Health Facilities – PASSED
HB 1394 establishes intensive behavioral health treatment facilities and provides for the licensing and certification of these facilities by the Department of Health and establishes a pilot program for mental health drop-in centers and requires the Health Care Authority to submit reports on the results to the Governor and the appropriate committees of the Legislature by December 1, 2020, and December 1, 2021. This bill directs the Health Care Authority to assess the capacity of hospitals and evaluation and treatment facilities to become credentialed to provide long-term mental health placements and to contract with those hospitals and evaluation and treatment facilities that choose to provide such services. It suspends certificate of need requirements for certain hospitals that are either adding new psychiatric beds, changing the use of current beds to psychiatric uses, or constructing new psychiatric hospitals. This bill also establishes mental health peer respite centers to be credentialed by the Department of Health as peer-operated programs. It requires the Department of Social and Health Services to track and monitor certain information about clients of the Developmental Disabilities Administration who are taken to a hospital. AAPPN supported this bill. It passed the House (96-0) and passed the Senate (48-0) unanimously and was signed into law by the Governor on May 9.

Behavioral Health Integration – PASSED
SB 5432 deals with fully implementing behavioral health integration for January 1, 2020, by removing Behavioral Health Organizations from law; clarifying the roles and responsibilities among the Health Care Authority, Department of Social and Health Services, and Department of Health, and the roles and responsibilities of Behavioral Health Administrative Services Organizations and Medicaid Managed Care Organizations; and making technical corrections related to the behavioral health system. AAPPN supported this bill. It passed the Senate (49-0) and the House (95-0) and was signed in the law by the Governor on May 9.

SUBSTANCE USE DISORDER

Substance Use Disorder Professional Practice – PASSED
HB 1786 revises standards and procedures governing protection orders, no-contact orders, and restraining orders, including standards governing the surrender of firearms, dangerous weapons, and any concealed pistol license (CPL) under these orders. It requires any protection order, no-contact order, or restraining order that includes an order to surrender firearms, dangerous weapons, and a CPL to be served by a law enforcement officer. This bill also establishes a procedure for surrender of firearms, dangerous weapons, and any CPL to law enforcement, and authorizes courts to issue a warrant to seize firearms and dangerous weapons where there is probable cause to believe the respondent has failed to comply with the order. It also makes it Unlawful Possession of a Firearm when a respondent possesses a firearm in violation of a qualifying order that meets certain criteria and that includes an order to surrender firearms and a prohibition on possessing firearms. AAPPN supported this bill. It passed the House (26-21) and passed the Senate (55-40) and was signed into law by the Governor on May 7.

Substance Use Disorder Treatment System – PASSED
HB 1907 limits the amount of time that an agency-affiliated counselor (AAC) working as a peer counselor in a behavioral health agency must spend in a substance abuse monitoring program to one year. It prohibits the Department of Health (DOH) and certain employers from automatically denying employment to an applicant for a position as an AAC in certain instances if the applicant has a past conviction for a disqualifying offense, and encourages a pathway for dual licensure as both an evaluation and treatment facility and a secure withdrawal management and stabilization facility. This bill requires the Health Care Authority (HCA) to produce an update to the designated crisis responder statewide protocols to address issues related to behavioral health integration and the applicability of commitment criteria to individuals with substance use disorders by December 1, 2019. This bill also directs the HCA to certify substance use disorder (SUD) peer counselors and include reimbursement for SUD peer services in the Medicaid state plan. It directs the DOH to conduct sunrise reviews to evaluate the transfer of the current peer support counselor certification from the HCA to the DOH and the need for the creation of an advanced peer support specialist credential. And it removes the 60-day provisional time period for an applicant who applies for registration as an AAC and allows the applicant to work while their application is pending with the DOH, as long as required documentation is provided within reasonable time limits set by the DOH. AAPPN supported this bill. It passed the House (94-0) and passed the Senate (48-0) and was signed into law by the Governor on May 21.

MENTAL HEALTH – LEGAL AND LAW ENFORCEMENT

Involuntary Treatment Procedures – PASSED
SB 5181 imposes a six-month suspension on a person's right to possess a firearm where the person is detained under the Involuntary Treatment Act on the grounds of likelihood of serious harm and not subsequently committed for involuntary treatment. It allows a person whose firearm rights are suspended for six months to petition for restoration of firearm rights upon release from detention and imposes the burden of proof on the state to establish the person does not meet restoration criteria. The bill also establishes requirements for entering information on a person whose firearm rights are suspended into the National Instant Criminal Background Check System and removing the information when the right is restored, and creates procedures for a six-month suspension of the person's concealed pistol license. AAPPN supported this bill. It passed the Senate (25-20) and passed the House (54-42) and was signed into law by the Governor on May 7.

STUDENT LOAN REPAYMENT

Washington Health Corps – PASSED
HB 1668 establishes the Washington Health Corps to encourage health care professionals to work in underserved areas by providing student loan repayment. It also establishes the Behavioral Health Loan Repayment Program to provide student loan repayment to health care professionals who serve in underserved behavioral health areas. AAPPN supported this bill. It passed the House (93-1) and passed the Senate (48-0) and was signed into law by the Governor on May 8.

NOTE: SNOW also supported the children’s mental health bills listed in the AAPPN section above.

VACCINE PREVENTABLE DISEASES

Promoting Immunity Against Vaccine Preventable Diseases – PASSED
EHB 1638 prohibits a philosophical or personal objection from being used to exempt a child from the measles, mumps, and rubella vaccine. SNOW and WSNA supported this bill. It passed the House (56-40) and the Senate (25-22) and was signed into law by the Governor on May 10.

MEDICATIONS IN SCHOOLS

Administration of Marijuana to Students for Medical Purposes – PASSED
HB 1095 requires a school district to permit a student who meets certain requirements to consume marijuana concentrates for medical purposes on school grounds, aboard a school bus, or while attending a school-sponsored event. This bill requires the board of directors of a school district, upon request of a parent or guardian who meets certain requirements, to adopt a policy that authorizes parents or guardians to administer marijuana concentrates to a student for medical purposes while the student is on school grounds, aboard a school bus, or attending a school-sponsored event. SNOW opposed this bill. It passed the House (79-16) and the Senate (41-4) and was signed into law by the Governor on April 30.

SCHOOL SAFETY

Non-Firearm Measures to Increase School Safety and Student Well-Being – PASSED
HB 1216 requires each Educational Service District to establish a Regional School Safety Center with certain duties, subject to state funding. It requires school districts to establish a School-Based Threat Assessment Program that meets certain requirements, by the beginning of the 2020-21 school year. This bill codifies the School Safety Center and the Student Wellbeing Advisory Committee, and makes the duties subject to state funding. It requires the Office of the Superintendent of Public Instruction to monitor certain safety-related programs and plans, subject to state funding. This bill also directs the Joint Legislative Audit and Review Committee to complete a study on the first responder mapping information system by January 21, 2020. The bill further adds a representative of OSPI to the Emergency Management Council and directs the Council to consult with certain organizations on issues that involved early learning, K-12, or higher education. The bill also includes requirements for safe school plans and school safety drills. This bill also establishes requirements for optional school district School Resource Officer (SRO) programs related to SRO training and law enforcement-school district agreements. It creates a grant program to fund training for SROs and makes SRO training materials available, subject to state funding. SNOW supported this bill. It passed the House (81-15) and the Senate (47-0) and was signed into law by the Governor on May 9.