End of session report

The Washington State Legislature passed its final 2021-23 operating budget on April 25, appropriating $10.6 billion in COVID-19 federal stimulus funds and $59 billion in state revenue. While the legislature originally anticipated limited revenue, funding from the Federal American Rescue Plan Act allowed for the state to make significant one-time investments. The Legislature also passed a Capital Gains Tax to fund the expansion and affordability of childcare, early learning, and K-12 education. Notably, the final budget makes significant investments in our state’s public health system and provides new funding to double the investment in the School Nurse Corps – two long-time WSNA budget priorities.

All dollars reflect funds received through the federal American Rescue Plan Act.

All dollars reflect General Fund – State operating funds unless otherwise noted.

Additionally, there were several budget provisos of interest:

Health Profession Loan Repayment: Nurse Educators
After June 1, 1992, the department, in consultation with the office and the department of social and health services, shall:

(a) Determine eligible credentialed health care professions for the purposes of the health professional loan repayment and scholarship program and the behavioral health loan repayment program authorized by this chapter. Eligibility shall be based upon an assessment that determines that there is a shortage or insufficient availability of a credentialed profession so as to jeopardize patient care and pose a threat to the public health and safety. The department shall consider the relative degree of shortages among professions when determining eligibility. The department may add or remove professions from eligibility based upon the determination that a profession is no longer in shortage. Should a profession no longer be eligible, participants or eligible students who have received scholarships shall be eligible to continue to receive scholarships or loan repayments until they are no longer eligible or until their service obligation has been completed;

(b) Determine health professional shortage areas for each of the eligible credentialed health care professions; and

(c) Determine underserved behavioral health areas for each of the eligible credentialed health care professions.

For the 2017-2019, 2019-2021, and 2021-2023 fiscal biennia, consideration for eligibility shall also be given to registered nursing students who have been accepted into an eligible nursing education program and have declared an intention to teach nursing upon completion of the nursing education program.

Nursing Commission: Performance Audit
Within amounts appropriated in this section from the health professions account, the Washington nursing commission shall contract with the state auditor's office to conduct a performance audit, specifically addressing the length of time required to license individuals who come from other states. The audit should address the obstacles contributing to any delay and make recommendations for improvement.

Nursing Commission: Timely Licensure Processing
Within amounts appropriated in this section, the Washington nursing commission must hire sufficient staff to process applications for nursing licenses so that the time required for processing does not exceed seven days.

Public Health Districts – PASSED
HB 1152 establishes a statewide Public Health Advisory Board under the DOH and includes a seat for WSNA. The Advisory Board will monitor the performance of, and provide recommendations to, the governmental public health system and will also evaluate public health emergency response and the use of FHPS funding. The bill also creates a new requirement that local boards of health must include non-elected members that are public health practitioners, consumers of public health, and community stakeholders. Boards that are currently comprised of only elected officials can retain current composition if the local health jurisdiction had a public health advisory committee or board within its bylaws established by January 1, 2021. The bill passed the House, 56-41, and the Senate, 26-22. Governor Jay Inslee signed the bill on April 22, and it went into effect July 25, 2021.

Health System Transparency – PASSED
HB 1272 requires hospital to provide additional detail regarding expenses and revenues in financial reports to DOH. The bill eliminates the exemption from reporting information about facility fees for off-campus clinics or providers that are located within 250 yards of the main hospital building. The bill also updates Community Benefit requirements, including that Community Health Needs Assessments made public by hospitals include an addendum which must contain certain information about activities identified as community health improvement services. The bill requires hospitals to post information on their websites if they have an ownership interest in a debt collection agency or have certain exchanges of revenue with debt collection agencies. Considering COVID and increased awareness on health equity, this year’s version of the bill also included requirements for hospitals to collect and report on demographic information of discharged patients (voluntary participation from the patient). The 2021 version of the bill also includes an interdisciplinary study on outcomes related acute care hospital staffing; UW School of Nursing is named as the lead entity for the study, which must be completed by September 2022. The bill passed the House, 58-40, and the Senate. 27-21. The governor signed the bill on May 3, and it went into effect July 25, 2021.

Presumptive Eligibility for Health Care Workers – PASSED
SB 5190 provides "presumptive eligibility" for health care workers during COVID-19 or any other federal or state declared health emergency. This means that the state will assume nurses and other health care workers contracted the virus or disease that is the subject of the health emergency at work, by virtue of the fact that nurses are working around it every shift. During COVID-19 or another declared health emergency, this bill makes it easier for nurses and other health care workers to access workers compensation and unemployment benefits. It has a “clear and convincing” evidence standard for employers to rebut the presumption. The bill received bipartisan support in both legislative chambers: it passed the Senate, 34-14, and the House, 84-14. The governor signed the bill on May 11, and it went into effect immediately.

Health Emergency Labor Standards Act – PASSED
SB 5115 creates presumptive eligibility for non-health care essential workers for workers compensation and unemployment during a declared federal health emergency of a declared state emergency in every county of the state. Additionally, the bill requires employers to notify their employees and their employees’ union(s) within 24-hours of a known or suspected high-risk exposure to a disease that is the subject of a public health emergency. The bill passed almost unanimously out of the Senate, 48-1, and passed the House, 68-30. The governor signed the bill on May 11, and it went into effect immediately.

Anti-Retaliation – PASSED
HB 1097 provides additional anti-retaliation protections for workers and provides L&I with additional tools to address workplace safety hazards. The bill was Governor request legislation. It increases the time for whistleblowers to file a complaint with L&I from 30 days to 90 days. The bill also defines appropriate relief when retaliation occurs, which includes giving employees their job back and/or civil penalties. The bill passed the House, 53-47, and the Senate, 30-19. The governor signed the bill on April 20, and it went into effect July 25, 2021.

Worker Protection Act - DEAD
HB 1076 provides a way for workers to effectively raise safety complaints and have them addressed in a timely, just manner. The bill gives workers and their advocates the ability to enforce labor and anti-discrimination laws on behalf of the state when the state is unable to do so itself. This is especially critical for enforcement of existing labor and workplace protections. HB 1076 passed out of the House, 53-44 votes. The bill was never brought up for a vote in the Senate Ways & Means Committee.

Health Equity Zones – PASSED
SB 5052 requires DOH to create health equity zones statewide. The zones are tasked with developing projects that address and meet the needs of individual regions of the state. The bill allows for communities to self-identify as a health equity zone and develop their own projects. The budget appropriates $1.4 million dollars to fund the bill. The bill passed the Senate, 30-17, and the House, 57-40. The governor signed the bill on May 12, and it went into effect July 25, 2021.

Continuing Education for Medical Providers on Equity - PASSED
SB 5229 requires licensed health professionals to complete continuing education training on health equity. Individual licensing boards are required to conduct rule making on the specific requirements for the Continuing Education credit. Training must be taken at least every four years. The bill also requires that a free option of the CE credit be offered. The bill passed the Senate, 35-14, and the House 57-41. The bill was signed by the governor on May 12 and went into effect July 25, 2021.

Rosa Franklin Legislative Internship Scholarship Program - PASSED
SB 5431 establishes a scholarship for Washington students who are accepted into and participate in the legislative internship program in the Senate or House of Representatives. Students qualify based on financial need. Rosa Franklin was a long-time legislator and a nurse. The bill passed unanimously out of the Senate and with a House vote of 95-3. The bill was signed into law on April 16 and goes into effect July 25, 2021.

Department of Health Civil Penalties for Hospitals - PASSED
HB 1148 establishes civil fines and stop placements for hospitals that fail or refuse to comply with state licensing standards. The bill also allows for DOH and the Office of Attorney General to recover enforcement costs associated with inspections. This bill provides stronger enforcement mechanisms, particularly around patient safety and well-being violations. The bill passed the House, 60-37, and the Senate 32-16. The bill was signed into law by the governor on April 16 and took effect July 25, 2021.

Nurse Delegation (Glucose) – DEAD
HB 1124 allows a registered nurse to delegate glucose monitoring and testing to a registered or certified nursing assistant or a certified home care aide. This bill passed the House unanimously but was never pulled to the Senate floor for a vote.

Victims of Sexual Assault - PASSED
HB 1109 requires the Office of the Attorney General, in consultation with the Washington Association of Sheriffs and Police Chiefs, to collect status updates on cases tied to previously unsubmitted sexual assault kits collected prior to July 24, 2015. It also requires the Criminal Justice Training Commission to conduct an annual case review program to review sexual assault investigations and prosecutions for the purposes of improving training and case outcomes. Finally, the bill expands the statutory rights for sexual assault survivors. This bill passed the House and Senate unanimously. It was signed by the governor and went into effect on April 26, 2021.

Making Juneteenth a Legal Holiday - PASSED
HB 1016 designates June 19, a state holiday. June 19 is celebrated as "Juneteenth" or Emancipation Day to commemorate the abolishment of slavery and recognize the contributions of Black/African Americans to society. The bill passed the House, 89-9, and the Senate 47-1. The bill was signed by the governor on May 13 and went into effect July 25, 2021.

Diversity, Equity, Inclusion and Anti-Racism Training in Higher Education – PASSED
SB 5227 requires that a professional development program on diversity, equity, inclusion (DEI), and anti-racism for faculty and staff is established at each public institute of higher education beginning the 2022-23 academic year. The program must also work to improve academic, social, and health and wellness outcomes for students from historically marginalized communities. The program must be developed in partnership with administration, faculty, staff, and student leadership. This bill passed the Senate, 35-14, and the House, 67-31. The bill was signed by the governor on May 12 and went into effect July 25, 2021.

Equity and Access in Higher Education (Community & Technical Colleges) – PASSED
SB 5194 requires that, beginning in 2022, all community and technical colleges must submit to the State Board of Community & Technical Colleges strategic plans for achieving diversity, equity, and inclusion on their campuses. The state board must develop a model faculty diversity program to aid in recruitment and retention of faculty from diverse backgrounds. Additionally, this bill converts 200 part-time faculty positions to full-time faculty positions and requires the State Board to collect data and assess the impact of these conversions on student outcomes. This bill passed the Senate, 30-19, and the House, 60-38. The bill was signed by the governor on May 12 and went into effect July 25, 2021.

Health Equity in Medical Training – PASSED
SB 5228 requires each public medical school to develop curriculum for medical students on health equity by January 1, 2023. The objective of the health equity curriculum must be to provide tools for eliminating structural racism in healthcare systems and to build cultural safety. Each UWSOM and WSUCOM student must complete a course, or courses, on health equity prior to graduating. This bill passed the Senate, 31-17, and the House, 56-42. It was signed into law by the governor on April 16.

Issuance of a Certificate of Birth Resulting in Stillbirth - PASSED
HB 1031 allows a person who gave birth resulting in a stillbirth to request and receive a certificate of birth resulting in stillbirth from the state or local registrar. The bill passed unanimously out of the Senate and 85-13 out of the House. The bill was signed into law by the governor on April 16.

Expansion of Paid Family Medical Leave Program – PASSED
HB 1073 expands on the 2017 law. The bill provides grants to certain employee’s ineligible for paid family and medical leave benefits due to insufficient hours worked. The bill also provides grants to smaller employers with employees taking leave in receipt of a grant. The bill passed the House, 56-40, and the Senate 29-20. The bill was signed into law on April 21.

Expanded Coverage of Paid Family and Medical Leave – PASSED
SB 5097 expands the definition of "family member" for Paid Family and Medical Leave to include any individual who regularly resides in the employee's home or where the relationship creates an expectation that the employee care for the person, and that individual depends on the employee for care. It passed the Senate, 29-19, and the House, 55-42. The bill was signed by the governor on May 10 and went into effect on July 25, 2021.

Universal Health Care Commission – PASSED
SB 5399 establishes a Universal Health Care Commission with the purpose of creating immediate and impactful changes in Washington's health care access and delivery system. The commission is tasked to prepare the state for the creation of a health care system to provide coverage and access through a universal financing system, including a unified financing system once federal authority has been acquired. The bill passed the Senate, 28-20, and the House 57-40. The bill was signed by the governor on May 13 and went into effect July 25, 2021.

Menstrual Products in K-12 Schools - PASSED
HB 1273 requires school districts, private K-12 schools, charter schools, state tribal compact schools, and public and private institutions of higher education to make menstrual hygiene products available at no cost by the beginning of the 2022-23 academic year. The cost of supplying the products is put on the schools. The bill passed the House, 91-7, and the Senate 43-5. The bill was signed by the governor on May 3 and went into effect July 25, 2021.

Lead in Drinking Water - PASSED
HB 1139 directs school districts and schools to communicate information and take mitigation measures when lead concentrations are found to be above state mandated thresholds. Schools and school districts are required to adopt an action plan for addressing lead in drinking water. The bill makes DOH the principal agency for lead testing and remediation for schools instead of community water systems. The bill requires school districts, charter schools, the state School for the Blind, and the state School for the Deaf to cooperate with the DOH or contract for sampling and testing for lead contamination at drinking water outlets in school buildings built, or with all plumbing replaced, before 2016. The bill passed out of the House, 94-4, and passed the Senate unanimously. The bill was signed by the governor on May 3 and went into effect July 25, 2021.

Audio-only Telemedicine – PASSED
HB 1196 requires reimbursement for audio-only telemedicine services. This bill expands the definition of telemedicine for purposes of hospital privileging to include audio-only telemedicine services and requires the Insurance Commissioner and the Collaborative for the Advancement of Telemedicine to study and make recommendations regarding telemedicine. This bill passed the House, 94-3, and the Senate, 45-4. The bill was signed by the governor on May 3 and went into effect July 25, 2021.

Maternal Health Outcomes – PASSED

SB 5068 provides one-year of postpartum coverage through Apple Health (Medicaid) – expands from previous postpartum coverage of 60 days. The implementation date is June 1, 2022. It passed the Senate unanimously and the House, 96-1. The governor signed this bill into law on April 16, and it went into effect July 25, 2021.

Provider Reimbursement for PPE – COVID-19 – PASSED
SB 5159 requires, for the duration of the federal public health state of emergency related to COVID-19, that health benefit plans reimburse health care providers who bill for incurred PPE expenses. This bill passed both the Senate and House unanimously. It was signed into law by the governor on April 16 and went into effect July 25, 2021.

Employee Voluntary Use of PPE – PASSED
SB 5254 requires that during a public health emergency, every employer who does not require employees or contractors to wear a specific type of PPE must accommodate an employee's or contractor's voluntary use of that specific type of PPE, if:

• the voluntary use of these protective devices and equipment does not introduce hazards to the work environment and is consistent with the WISHA and L&I rules;
• the use of facial coverings does not interfere with an employer's security requirements; and
• the voluntary use of these protective devices and equipment does not conflict with standards for that specific type of equipment established by the Department of Health or L&I.

This bill passed the Senate, 40-7, and the House, 97-1. The governor signed this bill into law, and it went into effect April 26, 2021.

Protecting Students with Seizure Disorders - PASSED
HB 1085 requires school districts to provide individual health plans (IHPs) for students with epilepsy or other seizure disorders. The bill requires the Washington State School Director’s Association to adopt a model policy and procedure that school districts may use to implement IHP requirements. The bill also provides criminal and civil immunity provisions for persons, who in good faith, aid or provide services to students with epilepsy or other seizure disorders. The bill passed the both the House and Senate unanimously. The governor signed the bill into law on April 14 and it went into effect July 25, 2021.

School Based Health Centers - PASSED
HB 1225 creates a School Based Health Centers (SBHC) program office in DOH. SBHC is defined as a collaboration between the community, the school, and a sponsoring agency that operates the school-based health center, which is a student-focused health center located in or adjacent to a school that provides integrated medical, behavioral health, and other health care services such as dental care. SNOW and WSNA participated in an interim work group on SBHCs out of which this bill was developed. This bill passed the House, 60-36, and the Senate unanimously.

Procuring Computers and Devices for Public School - PASSED
HB 1365 requires the Office of the Superintendent of Public Instruction (OSPI) to develop and implement a technology grant program. The bill requires each Educational Service District to provide technology consultation and training to schools. OSPI is required to provide biannual updates to the legislature on the status of attaining universal student access to learning devices. The bill passed the House, 59-39, and the Senate, 36-13. The bill was signed by the governor on May 13 and went into effect July 25, 2021.

Student Access to Behavioral Health Resources - PASSED
HB 1373 requires public schools to share contact information for behavioral health organizations on their website and social media. The bill passed the House, 93-5, and passed the Senate unanimously. The bill was signed by the governor on May 3 and went into effect July 25, 2021.

Equity Training in K-12 Schools - PASSED
SB 5044 adds equity, diversity, inclusion, and anti-racism to existing cultural competency training and professional development programs for school board directors, district staff, and school staff. The bill also revises the definition of, and model standards for, cultural competency to include anti-racism. The bill directs school districts to prioritize one of three state-funded professional learning days to focus first on these topics. The bill passed the Senate, 30-19, and the House, 57-40. The bill was signed by the governor on May 5 and went into effect July 25, 2021.