Washington State Hospice and

Palliative Care Organization

2015 Public Policy and Legislative Update

Leslie Emerick, WSHPCO Director of

Public Policy and Outreach

October 2015

Thank you Lisa Butler, MN, RN-BC!!!

Lisa Butler, former WSHPCO Director of Public Policy and Outreach shaking hands with Governor Jay Inslee for the Palliative Care Bill April 17, 2015.

Palliative Care Committee

Dr. David Brecher, MultiCare Palliative Care;

Dr. Bob Bray, Hospice of Spokane;

Sharmon Figenshaw, ARNP, Skagit Valley Hospital Palliative Care;

Dr. Juan Iregui and David Bucher, MSW, Franciscan Palliative Care;

Candace Chaney, RN, Assured Hospice;

Cynthia Tomik, MSW, and Dr. David Kregenow, Evergreen Hospice & Palliative Care;

Dr. Stephanie Cooper, UW & Harborview Palliative Care Services; and

Dr. Katie Schlenker, UW Palliative Care Services.

Sue Curry, RN, PeaceHealth Hospice Southwest.

Dr. Daniel Lam, Harborview Palliative Care Services, and Northwest Kidney Centers.

Palliative Care Networking Calls

“On-boarding Palliative Care Social Workers,” presented by Cynthia Tomik, LICSW, Julie Cicero, LICSW, ACHP, and Sara Puckey, MSW, November 2014.

“On-boarding Palliative Care RN’s,” presented by Heidi Johnson, RN, Providence St. Peter Hospital Palliative Care, January 2015.

“Honoring Choices Pacific Northwest,” presented by Jessica Martinson, WSMA, March 2015.

“POLST Update for Professionals 2015,” presented by Sharmon Figenshaw, ARNP, Washington POLST Taskforce, May 2015.

“Use of the Volandes Videos for Advance Care Planning Conversations,” presented by David Kregenow, MD, Cynthia Tomik, LICSW, and a panel from Providence Oregon Region including Jennifer Lui, John Niemitz, and Jennifer Levi, July 2015.

“Cannabis in Hospice and Palliative Care”, presented by Dr. Gregg Vandekieft, System Lead Physician for Palliative Care and SW Regional Palliative Care Medical Director for Providence Health and Services, September 2015,”

Pediatric Palliative Care Committee

Peg Isenhower, MultiCare Good Samaritan Hospice, Tacoma;

Tammy Retzloff, MultiCare Mary Bridge Palliative Care, Tacoma.

Kathie Belsky and Stacey Jones, Providence Hospice of Seattle.

Ron Jetter and Debra Roe-Johnson, Heart Links Hospice, Yakima;

Maggie Hood, MD, Seattle Children’s Hospital Palliative Care Service.

Pediatric Palliative Care Network Call

“Peds Palliative Care Complex Case Presentation,” presented by Dr. Wendy Knowlton, Providence Sacred Heart Palliative Care, Spokane, February 2015.

“Pediatric End of Life Ethics,” presented by Dr. Andrea Chatburn, Providence Health & Services, Eastern Washington Region, June 2015.

“Supporting Bereaved Children & Families,” presented by Lisa Duke, MSW, Bridges Center for Grieving Children, MultiCare Health System, August 2015.

“End of Life Care for Medically Intensive Children” Presented by Mike Pugsley, Director of Business Development at Ashley House that provides care to medically fragile children and young adults in home-like settings.

2015 Historical legislative session-3 Special Sessions. New budget July 1.

McCleary Decision-Requires Legislature to fully fund education under state’s constitutional requirements. August 2015, Supreme Court holding legislature in ”contempt of court”, $100,000-a-day fine.

Initiative 1351-WA Class Size Reduction Measure passed w/o funding. Supreme Court Decision-psychiatric “boarding” of mental health

patients unconstitutional, required funding for more beds and treatment.

Legislators & Governor working on “4 Corners” solution, 4th Special Session? 2016 is an Election Year!

Legislative Update!Overview of Political Landscape

WA State Biennial Legislative Cycle

Regular Session: Long session is 105 days, odd-numbered years (2015)• 2 -Year Operating, Capitol & Transportation Budgets. Operating Budget is where

funding for social services and health care programs live.

Short Session: Even-numbered year (2016) are 60 day• Develop Supplemental Budgets

Special Sessions: called by Governor to address specific issues, usually the budget or a court decision.

Sessions Start 2nd Monday - January 11, 2016

WA State Operating Budget-2 year

No cuts to home health or hospice this year.

Medicaid/Low Income Health Care, Corrections and Education consume majority of state budget.

As much as 2/3 of budget is essentially off limits for cuts because of federal requirements, state law or constitutional mandates.

Among the restricted areas are basic K-12 education, debt service and certain funding for Medicaid, pensions, courts and other programs.

2015-17 State Operating budget included funding increase for DOH Certificate of Need to pay for additional 2.3 FTE

SB 5165 Palliative Care Covered in Commercial Insurance Plans

Authorizes palliative care in conjunction with treatment or management of chronic or life threatening illness by eliminating the homebound requirement in the states commercial health insurance laws.

Allows advanced registered nurse practitioners to sign and attest to certain documentation within their scope of practice.

HB 1259-ARNP Global Signature

Health insurance carriers and Medicaid Managed Care must reimburse a provider for a health care service delivered through telemedicine if: the plan provides coverage of the health care service when

provided in person; the health care service is medically necessary; and the health care service is a service recognized as an essential

health benefit under the ACA. Effective July 24, 2015

SB 5175 Telemedicine Bill

The one-time suicide training requirement for nurses is delayed until January 1, 2016.

The delay does not affect the acceptability of training completed between June 12, 2014, and January 1, 2016.

By June 30, 2016, DOH must adopt rules establishing minimum standards for training programs on the model list.

HB 1424 Suicide Prevention

Creates Liquor and Cannabis Board (LCB). Medical use of marijuana is regulated through the structure provided in Initiative 502.

Specific provisions for the medical use of marijuana are: the terminal or debilitating medical conditions that qualify a patient for the medical use of marijuana must be severe enough to significantly interfere with activities of daily living.

Beginning July 1, 2016, health care professionals who authorize the medical use of marijuana must use an authorization form developed by DOH.

SB 5052 Medical Marijuana

SB 5591 EMS Community Assistance Referral and Education Services Programs

Local Fire Department “CARES” programs around the state. Each program that is established must annually measure: (1) the reduction in the number of phone calls from those that

repetitively used the 911 emergency system; (2) the reduction in avoidable emergency room trips attributed to

implementation of the program; and (3) the estimated amounts of Medicaid funding that would have

been spent on emergency room visits if the CARES program had not existed.

ESB 5577-Pharmaceutical Waste Workgroup

Dept. of Ecology “shall convene a work group to identify the problems of properly managing pharmaceutical wastes and recommend solutions to improve management of these wastes at the site of generation through treatment or disposal by commercial waste management facilities.”

Recommendations to the appropriate fiscal and policy committees of the legislature are due by December 31, 2015.

WSHPCO is a member of the workgroup.

SB 5149 -Concerning the Certificate of Needs appeals process

SB 5919 -Informed decision making for the Death with Dignity Act”

SB 5270 -FBI Fingerprint Background Checks for Nurses and other

professions

HB 1355-$12 an hour minimum wage phased in over four years.

Interstate Nursing Compact (NCQAC 2017)

2016 Potential Legislative Issues-Bills live for 2 years in biennial legislature!

Value Based Purchasing

Washington aims to drive 80 percent of state-financed health care and 50 percent of the commercial market to value-based payment by 2020.

Performance Measures

Statewide Common Set of Measures is a core element of Healthier Washington and provides the foundation for accountability and measuring performance across all areas of Washington.

Accountable Communities of Health (ACH)

Establish collaborative decision-making on a regional basis to improve health and health systems, focusing on social determinants of health, clinical-community linkages, and whole person care.

Healthier Washington

Alzheimer’s Disease Working Group developed a state plan to address the growing population of elderly citizens in our state who will develop the disease.

DSHS must submit a report providing findings and recommendation of the working group, including any draft legislation necessary to implement the recommendations, to the Governor and the Health Care Committees of the Senate and House by January 1, 2016.

Dr. Mimi Pattison, Franciscan represented hospice interests. Presentations on dementia and Alzheimer's patients at the end of life.

WA State Alzheimer’s Plan

DOH Rulemaking for CoN for Hospice

DOH Certificate of Need (CoN) hospice services standards and forecasting methods rulemaking on September 17, 2015. Discussed the basic framework for revisions to WAC 246-310-290; explained

the state’s rulemaking process and timeline; Invited program staff, members of the public and other interested parties to

discuss the basic framework for revisions to WAC 246-310-290; brainstorming other related issues

Discussed dates, times and locations of proposed rules meetings and workshops to be scheduled in 2015 and 2016.

DOH Rulemaking for In-Home Services

DOH In-Home Services Rules Update (Chapter 246-335 WAC). A CR101 was filed with the Office of the Code Reviser on September 1, 2015. The IHS rules include regulations for Home Care, Home Health, and Hospice agencies.

Why DOH is updating the rules in 2015: The department is required to regularly review and update all of its rules

The IHS rules are 13 years old (last updated in 2002)

Over the years, licensees, the industry, and department staff have identified numerous areas of the rules that need clarification or updating.

The department will host a series of rules workshops on the following dates:

November 24, 2015 (DOH - Tumwater, WA)

December 18, 2015 (DOH - Tumwater, WA)

Additional workshops will be scheduled in early 2016. DOH anticipates the rule updating process will take approximately 18 months to complete.

HB 1424 requires DOH to set standards for Continuing Education criteria for suicide prevention training.

Stakeholder Meeting on October 19th, 1-4 pm at DOH in Kent, WA

Goal of meeting is to get feedback on standards for training content and quality.

DOH Suicide Prevention Rules

In-Home Services Day, February 26, 2015

WSHPCO/HCAW Regional Legislative Meeting-Vancouver WA, September 10

Community Home Health and Hospice, New Hospice Facility

WSHPCO Legislative Advocacy

WSHPCO must constantly educate new Legislators on our issues impacting hospice and palliative care. Respond to legislative alerts to call your local legislators!

Partner with other associations such as WSNA, ARNP United, HCAW and WSHCA associations on issues of mutual concern.

Join the WSHPCO Legislative Policy Committee Establishes WSHPCO state positions on issues Develop written comments and submit to committees, hearings or on proposed rules.

Attend In-Home Services Day in Olympia Set up meetings with your local legislators

Personal Ways to Contact Legislators

Find your legislator! WA State Legislature Website

Personal visit with in district with your legislators or their staff during

interim.

Attend a Town Hall Meeting in their district.

Write or fax a letter, or send an e-mail message.

Call the WA State Legislative Hotline:

1-800-562-6000

Successful Education & Advocacy

Get involved in our hospice advocacy and educational efforts! Every voice is important and adds to the strength of your profession.

You can make a difference!