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AMTA-WA Key Legislative Issues

Monday, April 29, 2019   (0 Comments)
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The 2019 Legislature has now adjourned. The following is a summary of the key issues that AMTA-WA has been tracking throughout the session, together with the addition of legislation that will create a lower cost benefit plan for those Washington residents in the individual market.

B&O tax. Despite strong opposition from stakeholders, the Legislature decided to increase the B&O tax by 20%, from 1.5% to 1.8%, for LMTs and other health care providers beginning with income earned on or after January 1, 2020.

ESSHB 2158 [PDF] just barely passed both the House and Senate. But a majority is all it takes. The legislation is on its way to the Governor for his signature.

The main section that deals with health care is section 74, starting on page 83. What’s confusing about this legislation is that different tax categories are being used that sync up with federal, but not state, designations. Apparently, the Department of Revenue recognized this and asked that language be inserted into the introductory paragraph in Section 74 that says “the provisions of this act (are) to be applied broadly in favor of application of the surcharges.”


Note also Section 74(7): “ (7) The department has the authority to determine through an audit or other investigation whether a person is subject to the surcharges imposed in this section. The department's determination that a person is subject to the surcharge is presumed to be correct unless the person shows by clear, cogent, and convincing evidence that the department's determination was incorrect. The increased evidentiary standard under this subsection (7) does not apply after January 1, 2022.”


Here are the health care subsections:


(ff) The independent practice of general or specialized medicine or surgery by businesses comprised of one or more health practitioners having the degree of doctor of medicine or doctor of osteopathy. These practitioners operate private or group practices in their own offices or in the facilities of others, such as hospitals or health maintenance organization medical centers;


(gg) Providing a range of outpatient services, such as family planning, diagnosis and treatment of mental health disorders and alcohol and other substance abuse, and other general or specialized outpatient care by businesses with medical staff;


(oo) The independent practice of general or specialized dentistry or dental surgery by businesses comprised of one or more health practitioners having the degree of doctor of dental medicine, doctor of dental surgery, or doctor of dental science. These practitioners operate private or group practices in their own offices or in the facilities of others, such as hospitals or health maintenance organization medical centers. They may provide either comprehensive preventive, cosmetic, or emergency care, or specialize in a single field of dentistry;


(pp) The independent practice of general or specialized medicine or surgery, or general or specialized dentistry or dental surgery, by businesses comprised of one or more independent health practitioners, other than physicians and dentists;


(qq) Providing ambulatory health care services.


AMTA-WA believes that LMTs will be required to pay the surcharge.


Prior authorization. SB 5887 failed to advance during the final days of the session. As you may recall, it was introduced by our friends, the chiropractors, to do some clean up on 2018 legislation after the insurers found ways to circumvent the legislative intent behind RCW 48.43.016. Unfortunately, serious technical issues were created by House amendments, and the House was unwilling to make the necessary changes. This legislation will return in 2020.


Photo identification. Legislation failed to progress that contained the controversial requirement that a massage therapist or reflexologist must have government-issued photo identification on his or her person or have it be available for inspection by city, county, or state law enforcement or Department of Health personnel at all times when practicing massage therapy or reflexology. The legislation will return in 2020.


Sexual misconduct. SHB 1198 [PDF], advocated for by health care consumer organizations, requires a health care provider to notify a patient if the provider has been sanctioned for acts of unprofessional conduct involving sexual misconduct and is subject to an order or stipulation issued by a disciplining authority. WAC 246-16-100 defines sexual misconduct. This legislation has been signed by the Governor. It is effective October 1, 2019.

Public option. On a party-line vote, the Legislature passed ESSB 5526 [PDF], which will give Washington residents a lower-cost option for health insurance through the Exchange. This legislation was heavily debated with WSHA, WSMA and some insurers on one side, and Regence and Premera on the other. The main issue of disagreement was rate caps.


The legislation allows carriers to offer a public option health plan with a rate cap for all covered benefits, excluding pharmacy. The rate cap would be set at 160% of the aggregate amount Medicare would pay. We’re uncertain how health care services that aren’t reimbursed by Medicare would be dealt with in terms of rates. In addition, there is a requirement for the development of a standard plan of benefits.


Insurers may not require providers participating in a public option plan network to accept the lower public option reimbursement rates for other health plan products offered by that insurer. Also, the amount insurers reimburse providers through the public option plan is not subject to B&O tax. This also includes any amounts these providers collect from patients through cost sharing.


There will be rule-making, and AMTA-WA will closely track the implementation of this legislation. The legislation is effective January 1, 2021.


AMTA-WA Government Relations Committee 2019


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