April 4, 2025

All Eyes on Olympia After Opposite House Cutoff

While much of the focus in Olympia has shifted to the budget, policy bills are still making their way through the legislative process-as long as they are still "alive" following the April 2 opposite house cutoff deadline.

As a quick reminder, bills need to be approved by their chamber of origin and advance from the opposite chamber's policy committee in order to continue to be eligible for consideration this year. For example, WSMA priority legislation House Bill 1718, which establishes confidentiality protections for physician well-being programs, passed the House (its chamber of origin) unanimously and has been approved by the Senate Health and Long Term Care Committee (its opposite chamber policy committee).

A number of bills supported by WSMA are advancing:

• HB 1531: Ensures that local governments cannot bar the implementation and promotion of evidence-based responses to control the spread of communicable diseases.
• SB 5093: Repeals the crime of "concealing a birth" and removes deaths related to abortion, premature birth, and stillbirth from circumstances where authority for review and custody is vested in the county coroner or medical examiner.
• HB 1215: Removes language from health care directives that nullifies directives if the patient is pregnant.
• SB 5632: Updates the state's patient and provider shield law to require Washington businesses to notify the attorney general's office if the business receives a subpoena that seeks information on protected health care services under certain circumstances, among other provisions.
• SB 5577: Requires the Health Care Authority to provide coverage to Medicaid enrollees for all HIV antiviral drugs approved by the FDA without prior authorization or step therapy.
• SB 5498: Applies the requirement that health plans reimburse for a 12-month supply of contraceptives to all prescriptions, instead of only refills.
• SB 5568: Requires the Office of Financial Management, in coordination with stakeholders, to update the state health plan by developing a statewide health resources strategy.
• HB 1432: Incorporates the Federal Mental Health Parity Act into state law to improve access to appropriate mental health and substance use disorder services.
• SB 5480: Exempts medical debt from being included on a consumer's credit report, among other provisions.

Legislators will spend the next week in fiscal committees, holding public hearings on bills with an impact on the state budget and then the remaining weeks of session will focus on floor debates and budget negotiations. The 2025 legislative session is scheduled to adjourn on April 27.

April 4, 2025

DOH Begins Sunrise Review of Pharmacist Scope of Practice

The Washington State Department of Health has accepted a request from Sen. Annette Cleveland (D-Vancouver) to review House Bill 2116 specific to prescriptive authority for pharmacists. The bill was brought forward by the Washington State Pharmacy Association and would move our state away from the collaborative drug therapy agreement currently utilized.

Instead, the proposal would grant the Pharmacy Quality Assurance Commission the ability to set a pharmacist's scope of practice. We are aware of no precedent for this level of legislative delegation of authority for setting scope of practice to a board or commission. The proposal contemplates pharmacists treating "minor ailments, initiating and modifying treatment for chronic conditions, providing preventative care, and managing emergency situations that present in a pharmacy." There are no additional education or training requirements for pharmacists performing these services.

The WSMA, along with the Washington Osteopathic Medical Association and several physician specialties, submitted this comment letter opposing the proposal citing concerns not limited to patient safety and care coordination, as this proposal doesn't include any meaningful safeguards. Furthermore, the Legislature-not a regulatory board- sets a profession's scope of practice and this bill would set a dangerous precedent for both the practice of pharmacy and other professions.

We want to thank the numerous physicians who shared their concerns with the DOH via written comment. The next step in the process will be a public hearing held via Zoom on Wednesday, May 14 at 1 p.m. If you have any interest in participating in this hearing, please contact WSMA Associate Policy Director Billie Dickinson.

April 4, 2025

How to Avoid 2024 Performance Period MIPS Penalty Due to Nationwide IV Fluid Shortage

In response to advocacy from the physician community, the Centers for Medicare and Medicaid Services has announced it will accept new extreme and uncontrollable circumstances hardship exception applications to avoid a Merit-based Incentive Payment System penalty due to the nationwide IV fluid shortage.

Physicians will be able to submit an EUC hardship exception application until April 14, 2025 to avoid a MIPS penalty of up to -9% if they were affected by the shortage. This hardship exception will apply to the 2024 performance period, which will adjust Medicare payments in 2026.

To avoid a MIPS penalty, physicians who were affected by the IV fluid shortage should submit an EUC application requesting reweighting of all four MIPS categories: quality, cost, promoting interoperability, and improvement activities. Note that CMS will not reweight any performance category for which the agency has received data. However, if three performance categories are reweighted to 0% and only one performance category can be scored, then the physician or group will earn a final score equal to the performance threshold and avoid a MIPS penalty.

Additionally, because the MIPS cost performance category relies entirely on claims-based measures that do not require submission from physicians or groups, we recommend requesting reweighting of this category if a physician or group needed to conserve IV fluids, use alternatives, restrict access to elective surgery, or take any other measures due to the nationwide IV fluid shortage. In addition, CMS is extending the MIPS data submission window for the 2024 performance period for two weeks from March 31 until April 14, 2025, at 5 p.m. PT. Download this factsheet for more information.