End of Session report

The Washington State Legislature passed its supplemental 2023-25 operating budget on March 7^th. This is a supplemental budget which means this budget provides updates to the 2023-25 biennial budget passed in 2023. This year’s budget adds an additional $2.1 billion in spending before June 30, 2025 to the $69.8 billion approved in the 2023 session for the biennium.

The focus for 2024 legislative session was behavioral health, housing and homelessness, climate, and transportation. With that, the final budget includes maintenance level increases for Medicaid, assistance for food for kids and seniors, K-12 enrollment caseloads, as well as money for increasing school staff salaries, behavioral health, electric school buses, utility customer rebates, more money for ferries, funds to combat substance abuse disorder and the opioid epidemic, special education, school construction, an increase to state childcare reimbursements, some funding set aside for housing and homelessness programs, and more.

It is worth noting that $249 million acquired from the Climate Commitment Act is spread around the budget. These are proceeds from sales of emission allowances to the state’s largest polluters. Because of a pending ballot initiative to erase the law, some of those dollars cannot be spent until January 2025 when voters’ decision is final. It is also worth noting that three of six initiatives to the legislature were heard by lawmakers and passed off the floor this session. The other three initiatives will go to the ballot this November for voters to decide and if turned down will have an impact on future budgets. Lastly, a number of legislators are leaving the legislature by either retiring or running for another office this election year and therefore we should expect to see some shifts before the next legislative session in 2025.

Healthcare budget items of interest

All dollars reflect General Fund – State operating funds and any additional noted in description.

Labor budget items of interest

SNOW budget items of interest

ARNP Reimbursement Parity — DEAD

SB 5373 requires all health carriers to reimburse ARNPs & Physician Assistants at the same rate as physicians for providing the same service in the same service area. The bill started in the Senate Ways & Means Committee where it left off in the 2023 legislative session. Ultimately, it was not voted out the Ways & Means Committee by executive session and therefore died in committee. One of the concerns indicated was the potential costs to the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs which are state funded.

Standing Order for Medication for School Nurses — PASSED

HB 1608 creates statewide standing orders allowing school nurses to administer the emergency medication epinephrine or epinephrine injectors. The bill builds on existing law that provides standing orders for Narcan in school settings. The bill started in the House Committee on Education and was ultimately voted for unanimously in both the House and Senate. It was delivered to the Governor on March 4^th and signed into law on March 14^th. The bill takes effect 90 days after the adjournment of session.

Property Tax Cap — DEAD 

SB 5770 lifts the property tax cap ceiling from 1% to 3% allowing Counties the ability to raise revenue that is to pay for things like Public Health, law enforcement, parks and other services provided by the County. This bill picked up in the Senate Ways & Means committee where it left off in the 2023 legislative session. After the public hearing and executive action was taken to pass it out of Ways & Means, it was announced that House and Senate leadership and the Governor’s office would not be supporting the bill this session due to the contention and opposition surrounding the bill. It died there in Ways & Means and the issue of funding for Public Health, most notably in King County where it has been stated public health clinics would be closed if a funding source did not come to fruition, remains an outstanding issue. WSNA represents nurses at King County public health and a handful of other public health departments around the state.

Keep Our Care Act (KOCA) — DEAD

SB 5241 known as the Keep Our Care Act (KOCA), or ‘mergers and acquisitions bill’ adds oversight and transparency by the Office of the Attorney General to the mergers and acquisitions process of health care entities. It was in its fourth year in front of the legislature and made more progress in this session than it had in past sessions. This year it successfully made it out of the Senate by a floor vote of 28-21 and then moved over to the House. It passed both the House Civil Rights & Judiciary and Appropriations committees. A number of amendments were proposed to the bill by both sides of the aisle. After a large and ultimately successful push in opposition of the bill, it was determined that there was not enough support to see it voted off the House floor and was not brought to a vote and died.

SB 5184 - Concerning licensure of anesthesiologist assistants (AAs). — PASSED

This bill creates a license for AAs and establishes a new health profession in the state. An AA is a person who is licensed by the Medical Commission to assist in developing and implementing anesthesia care plans for patients under the supervision of an anesthesiologist or group of anesthesiologists approved by the Commission to supervise. Supporters asserted this would help address workforce shortage issues, while the Washington Association of Nurse Anesthetists (WANA), WSNA and others argued it does not address the need as there are already licensed health care professionals equipped to help address the shortage, namely CRNAs, who can practice independently. This bill was ultimately passed into law despite our opposition and testimony against it.

SB 5940 - Creating a medical assistant-EMT (MA-EMT) certification. — PASSED

This bill creates a medical assistant-emergency medical technician certification. A MA-EMT is defined as a person who holds basic or advanced EMT certification, or a paramedic certification, and is certified by DOH to perform certain authorized functions as prescribed in the law, under the supervision of a health care practitioner. It states that any person with these qualifying certifications need no additional training or examination requirements if they are in good standing. Supporters of the bill asserted this would help address workforce shortage issues, namely in rural settings where people with these certifications who are looking for work might be able to address gaps. WSNA opposed this bill and testified against it citing that the level of training varies widely for EMTs, advanced EMTs, and paramedics and that this bill combining the varying level of training into one credential was not advisable. The scope of practice is concerning, in particular for nurses who would be tasked with supervising these MA-EMTs. This bill was ultimately passed into law despite our opposition and testimony against it.

HB 2295 - Concerning hospital at-home services. — PASSED

This bill requires Department of Health to adopt rules to add hospital at-home services to the services that a licensed acute care hospital may provide and establish standards for the operations of a hospital at-home program. It extends the current program authorized at the federal level set to expire at the end of 2024. Under this program, physicians may deem certain patients eligible to continue receiving care in their home by a physician or RN after being discharged if they meet criteria. It is intended to free up beds in facilities and is reported to have good patient outcomes. WSNA supported this bill.  It passed the Legislature unanimously and has been signed into law.

SB 6127 - Increasing Access to HIV Postexposure Prophylaxis (PEP) Drugs or Therapies. — PASSED

This bill requires hospitals to adopt policies dispensing post-exposure prophylaxis (PEP) human immunodeficiency virus drugs. It includes a directive to provide a 28-day supply of PEP drugs or therapies in their dispensing or deliver of PEP to the patient with the patient’s informed consent. WSNA supported this bill and worked with a SANE nurse in delivering testimony in support. This bill passed both the Senate and the House unanimously and has been signed into law.

SB 6286 – Addressing the anesthesia workforce shortage by reducing barriers and expanding educational opportunities to increase the supply of certified registered nurse anesthetists in WA. — PASSED

This bill establishes a grant program to incentivize certified registered nurse anesthetists to precept nurse anesthesia residents. It also directs the Center for Health Workforce Studies at the University of Washington to study the workforce shortages in anesthesia care in each facility providing anesthesia services. WSNA ultimately supported this bill. It passed both chambers and has been signed into law.

SB 6060 – Concerning the acceptance of electronic signatures by the public employment relations commission for new organizing petitions. — PASSED

This bill requires the Public Employment Relations Commission to accept electronic signatures for new organization petitions to form a new bargaining unit of unrepresented workers or to add unrepresented workers to an existing bargaining unit. WSNA supported this bill. This bill passed both the House and Senate and was signed into law.

HB 1893/ SB 5777 – Concerning unemployment insurance benefits for striking or lockout workers. — DEAD

This bill allows individuals unemployed due to a labor strike to receive up to four weeks of unemployment insurance (UI) benefits following a specified disqualification period and the waiting week, provided that the labor strike is not prohibited by federal or state law or court order. It removes the provision disqualifying an individual for UI benefits based on an employer-initiated lockout resulting from a strike against another employer in a multi-employer bargaining unit. This bill was part of the Washington State Labor Council’s (WSLC) legislative agenda this year and WSNA did support this bill throughout its journey in the state legislature by signing in support while in committee, signing onto letters of support to key legislators, participating in a rally on the Capitol steps, and other means of support as needed along the way. This bill passed the House, but ultimately died in the Senate as it did not have the support needed in the Senate to bring it to a vote on the floor. For more information on this bill or WSLC’s 2024 legislative agenda you may read here.

SB 5778/ HB 1940 – Protecting the rights of workers to refrain from attending meetings or listening to their employer's speech on political or religious matters. It is also known as “Employee Free Choice Act.” — PASSED

This bill, also part of the WSLC legislative agenda, prohibits an employer from taking adverse action against an employee for refusal to attend or participate in an employer-sponsored meeting or refusal to listen to speech, the primary purpose of which is to communicate the employer's opinion concerning religious or political matters. WSNA did support this bill. It passed both the House and Senate and was signed into law.