2016 Legislative Session Summary

The 2016 legislative session opened on January 11. It was supposed to be a short 60-day session, with the primary focus on K-12 education funding and passing a supplemental budget. Of course, health care issues, especially mental health, were plentiful during the session, with WSNA playing an important role in developing health care policy. WSNA’s priorities were bills that increased access to nursing care, while ensuring patient safety.

Unfortunately, the Legislature didn’t finish their work within the 60-day session and went into overtime, with Governor Inslee calling legislators into a special session. On March 29, day 20 of the first (and only) special session, the Legislature adjourned sine die. The House and Senate passed the supplemental budget, the corresponding bills related to the budget, and voted to override the 27 bills that were vetoed by Governor Inslee.

Here are the bills WSNA prioritized during the 2016 session:

HB 1713 – Mental health, chemical dependency system integration

This bill creates an involuntary chemical dependency treatment provision that parallels existing involuntary mental health treatment provisions. This bill directs a Washington State Institute for Public Policy study to evaluate the effect of the integration of the involuntary treatment systems for chemical dependency and mental health. This bill also adds physician assistants to the list of providers who can involuntarily commit a patient and clarifies that psychiatric ARNPs can also do so. This bill passed the Legislature and was signed into law by Governor Inslee.

HB 2080 – Fingerprint-based background checks

This bill authorizes the Washington State Patrol and Department of Health to participate in the new Rap Back background check service offered by the FBI. It also authorizes disciplining authorities under the DOH to adopt rules authorizing fingerprint checks for applicants and licensees in the professions it regulates. This was Nursing Commission request legislation. WSNA testified in support of the bill. However, it died in the Appropriations Committee.

HB 2350 - Medical assistants/Rx administration

This bill clarifies that retrieving medication and applying the medication to a patient is included in the definition of "administering medication" under the medical assistant law. This bill passed the Legislature and was signed into law by Governor Inslee. WSNA testified against this bill, citing patient safety concerns.

HB 1790 – School nurse supervision

An act relating to clarifying the authority of a school nurse working in a school setting-that only a registered nurse or advanced registered nurse practitioner may supervise, direct or evaluate a licensed nurse working in a school setting with respect to the practice of nursing. The bill passed out of the House and received a hearing and passed out of the Senate Early Learning and K-12 Education Committee. Unfortunately, in the pandemonium of the last days of session, bills that are not critical fall to the bottom of the pile, and the bill died in Rules.

SB 6272 – Medicaid payment parity

This bill requires Medicaid payment for primary care services furnished by a nurse practitioner, a physician with a primary specialty designation of family medicine, general internal medicine or pediatric medicine or provided by subspecialists within these primary specialties, and physician assistants on a fee-for-service basis as well as through managed health care systems, to be at a rate not less than one hundred percent of the payment rate that applies to those services and providers under Medicare. WSNA supported this bill. Unfortunately, it died in the Appropriations Committee.

SB 6440 – Restricting use of flame-retardant chemicals

This bill prohibits the manufacturing, sale or distribution of any children’s product or residential upholstered furniture that contains certain flame retardants.

The bill also authorized the Department of Health to promulgate rules to implement the bill. However, the Department must first report to the Legislature on the populations that are likely to be exposed to the chemical; toxicity data to evaluate health concerns; and whether a safer alternative has been identified. WSNA testified in support of this bill. It died in the Senate Rules Committee.

SB 6445 – Role of PAs in delivering mental health services

This bill clarifies the role of physician assistants in the delivery of mental health services. A physician assistant is able to sign a petition for a fourteen-day involuntary detention if his or her supervising physician is able to review the petition before it is filed. Both physician assistants and osteopathic physician assistants may provide services that they are competent to perform based on their education, training and experience and that are consistent with their commission-approved delegation agreement. Physician assistants may not practice beyond the scope of their supervising physician's own scope of expertise and practice. This bill passed the Legislature and was signed into law by Governor Inslee. AAPPN opposed this bill as introduced but worked with stakeholders throughout the legislative session to achieve a compromise that they could support.

SB 6519 – Collaborative for the Advancement of Telemedicine

This bill expands patient access to health services through telemedicine and establishes a collaborative for the advancement of telemedicine. The Collaborative for the Advancement of Telemedicine (Collaborative) is created to enhance the understanding of health services provided through telemedicine. By July 1, 2016, the Collaborative shall be convened by the University of Washington Telehealth Services, and participants shall include representatives of the academic community, hospitals, clinics, health care providers in primary care and specialty care, health insurance carriers and other interested parties. This bill passed the Legislature and was signed into law by Governor Inslee. WSNA will have a representative on the Collaborative.

SB 6656 – Concerning state hospital practices

This is the omnibus bill to address the serious challenges of patient care and safety at Western State Hospital. WSNA and AAPPN advocated in support of two sections of the bill, Sections 9 and 12. These sections direct the Department of Social and Health Services to create a staffing model that recognizes ARNPs and PAs to use their full scope of practice. The bill includes language that recognizes that ARNPs and PAs are underutilized by state hospitals. This section directs the Office of Financial Management to create a job classification for psychiatric ARNPs and PAs, allowing practice at the top of their scope. It directs the state hospital to hire ARNPs and PAs to reduce reliance on psychiatrists. It goes on to require any future Collective Bargaining Agreement negotiated or renegotiated must be consistent with the expanded use of ARNPs and PAs. This bill passed the Legislature.

However, in a surprise move, Governor Inslee vetoed several sections of this bill including Sections 9 and 12. Stating that while he agreed with the policies stipulated in Section 9, these policies must be vetted with the consultants hired to examine the current configuration and financing at Western State.

In vetoing Section 12, Governor Inslee stated, "Section 12 requires the Office of Financial Management to create a job class for Advanced Registered Nurse Practitioners (ARNP) and Physician Assistants (PA) to allow them to work at the top of their practice. While I agree that allowing ARNPs and other mid-level professionals to practice in our hospitals should be an important part of the state’s strategy to address workforce shortages, the requirement to create the job class is not consistent with the process provided in law for creation of classified positions. I have therefore vetoed Section 12."

WSNA registered its alarm over these vetoes in a letter to Governor Inslee. WSNA pointed out that it’s well documented that the state has not been able to recruit an adequate number of psychiatrists to work at Western State, leading to patient safety concerns. At the same time, a skilled and clinically appropriate provider group, psychiatric ARNPs, is denied access to work there.