2009 Legislative Wrap Up

The 2009 legislative session adjourned on April 26, 2009. The legislature had the unenviable task of closing a $9 billion dollar budget deficit. A portion of the budget deficit was covered by federal funds however some significant cuts were necessary with many coming from health care. The Basic Health Plan will be reduced by about 40,000 people. The Medical General Assistance - Unemployable was eliminated. This cuts coverage for people who have had temporary Medicaid assistance while unable to work or while waiting for a disability evaluation. Higher education also took many cuts and this will affect nursing education. Some specific bills that passed are:

SB 5608 Concerning genetic counselors
This bill establishes the genetic counseling profession. Testimony was provided regarding how ARNPs already provide genetic counseling services within their scope of practice and that registered nurses also provide some aspects of genetic counseling. The exclusive use of the title “genetic counseling” and the restriction of the use of similar titles do not prevent ARNPs or RNs from continuing current practice. The bill passed the legislature and has been delivered to the Governor for signature.

HB 2041 Tamper-resistant prescriptions
This law requires that every prescription written in this state by a licensed practitioner be written on a tamper-resistant prescription pad or paper approved by the Board of Pharmacy.

SB 5891 Medical Home Reimbursement Demonstration Pilot Project
HCA and DSHS must design, oversee implementation, and evaluate one or more primary care medical home reimbursement pilot projects. ARNPs are included of this legislation. The agencies must determine the number and location of the pilots; determine criteria to select primary care clinics to serve as pilot sites; select pilot sites from those clinics that currently include activities typically associated with medical homes or from sites that have been selected by DOH to participate in the medical home collaboratives; determine reimbursement methods to be tested; and identify performance measures for clinical quality, chronic care management, cost, and patient experience.

HB 1071 An act relating to Advanced Registered Nurse Practitioners
Advanced registered nurse practitioners are specifically added to the list of mental health professionals who can recommend and provide certain mental health treatment including evaluations for involuntarily detained psychiatric patients. This bill was a technical correction to complete legislation from 2008 that inadvertently omitted certain statues that needed to be amended to make this authorization complete.

SB 5945 Washington Health Partnership Plan
This is a health care reform bill that aims to expand insurance coverage for Washington families through a Medicaid waiver. Beginning October 1, 2009, the Governor must convene quarterly meetings with the Washington Health Partnership Advisory Group to monitor health reform efforts, including Medicaid waivers that are submitted as directed in this act, efforts to consolidate state purchasing of health care, reforms in the private health insurance market to provide more affordable health insurance options, and progress of health care reform at the federal level.

2009 Legislative Agenda

Priority Issue: Equal reimbursement for the same service

• Current law has allowed insurance companies to reimburse ARNPs at a rate lower than that of physicians for the same service. The Washington State Department of Labor and Industries’ internal policy is to reimburse ARNPs at 90% of the physician fee schedule for the same services. When a health plan reduces reimbursement to an ARNP, the patient is billed the same amount and receives no reduction in premium or co-pay. The reduced ARNP reimbursement benefits the health plan while reducing access to care for patients.
• The proposed legislation would require health plans and state agencies to provide the same rate of reimbursement for ARNPs as physicians receive when the same service is provided. This would be based on the use of national, standardized billing codes.

Monitoring:

• Health care bills that affect ARNP autonomy
• Health care bills that affect Washington residents’ access to care
• Health care bills to ensure ARNPs are included in the language wherever “physician” is written
• Health care bills affecting funding for state health plans, public health, and nursing education
• Rules for pharmacies and pharmacists in filling prescriptions they may find objectionable

Support:

Legislation of advanced practice nursing and other nursing organizations that is consistent with ARNPs United of Washington State’s legislative agenda