By Diana Thompson, LMT, and Susan Sherman, LMT, Government Relations Co-Chairs

The following is an overview of the work of the Government Relations Committee. It covers legislation of interest from the recently concluded 2022 legislative session, as well as other relevant topics to include continuing education waiver for hands-on CE, health equity CE, Patient Safety Improvement Task Force, Board of Massage rule-making re transfer programs, and working with eviCore to develop a training for LMTs.

The following is a list of legislation that may be of interest to AMTA-WA members in your role as massage therapists, business owners, as well as health care consumers. The links below take you to the bill’s main web page. Each bill will have a Final Bill Report. These documents, written by nonpartisan legislative staff, are a good summary, and have been used in preparing this update.

Here’s a guide to understanding the bill numbers:

  • HB=House Bill
  • SHB=Substitute House Bill
  • 2SHB=Second Substitute House Bill
  • E=Engrossed to signify a floor amendment
  • SB=Senate Bill
  • SSB=Substitute Senate Bill
  • 2SSB=Second Substitute Senate Bill
  • E=Engrossed to signify a floor amendment.

SHB 1616 Concerning the charity care act. This legislation standardizes hospital charity care requirements. For health systems with three or more acute care hospitals, and some larger hospitals, some percentage of charity care is available up to 400% of the federal poverty level (FPL). For other hospitals, some level of charity care is available up to 300% of FPL. A person’s assets may be considered in making charity care determinations.

Status: Governor signed. Effective 6/9/2022.

E2SSB 1688 Protecting consumers from charges for out-of-network health care services. This legislation was requested by the Office of the Insurance Commissioner, and it syncs the state’s Balance Billing Protection Act (BBPA) with the federal No Surprises Act (NSA). This was “must pass” legislation because the federal NSA took effect on January 1, 2022, so technically, our state’s BBPA is in conflict. This legislation:

  • Expands of services covered by the balance billing prohibitions to include post-stabilization services and air ambulance services in alignment with federal law;
  • Expands the definition of emergency services to include post-stabilization services and emergency services provided by behavioral health emergency services providers;
  • Modifies the dispute resolution process for carriers, health care providers, and facilities for bills covered by the balance billing prohibitions; and
  • Requires the Insurance Commissioner to submit a report and any recommendations on how balance billing for ground ambulance services can be prevented and if ground ambulance services should be subject to the balance billing prohibitions.

Status. Governor signed. This legislation has an emergency clause, and will be effective upon the Governor’s signature on 3/31/2022.

SHB 1732 Delaying the implementation of the long-term services and supports trust program by 18 months. This legislation has been signed by the Governor and became effective on January 27. The legislation:

  • Delays the start date for the premium assessments under the Long-Term Services and Supports Trust Program (LTSS Trust Program) from January 1, 2022, to July 1, 2023;
  • Delays the date benefits become available under the LTSS Trust Program from January 1, 2025 to July 1, 2026;
  • Allows individuals born before January 1, 1968, who do not meet the LTSS Trust Program’s vesting requirements, to receive partial benefits based on the number of years of premium payments; and
  • Requires employers to refund employees any LTSS Trust premiums collected before July 1, 2023.

Status: Governor signed. Effective 1/27/2022

ESHB 1733 Establishing voluntary exemptions to the long-term services and supports trust program for certain populations. The legislation:

  • Establishes exemptions from the payment of premiums under the Long- Term Services and Supports Trust Program for certain veterans, spouses and registered domestic partners of military service members, nonimmigrant temporary workers, and employees who work in Washington and maintain a primary residence outside of Washington.

Status: Governor signed. Effective date 6/9/2022

ESHB 1821 Concerning the definition of established relationship for purposes of audio-only telemedicine. An “established relationship” with a health care provider is required in 2023 in order to be reimbursed for audio-only telemedicine. An “established relationship” is currently defined as an in-person visit once every 12 months. The legislation, as passed:

  • Modifies existing law to require an in-person visit every three years for behavioral health, and every two years for other health care;
  • Allows an established relationship to be an audio and visual visit, as an alternative to in-person for all health care—except that the audio and visual visit will sunset for non-behavioral health in 2024.
  • Allows the appointment to be with a provider in the same medical group or integrated delivery system in addition to the same clinic; and
  • Requires, in all circumstances where an established relationship is required, that the audio-only telemedicine provider have access to sufficient health records to ensure safe, effective, and appropriate care services.

Status: Governor signed. Essentially effective in 2023 when the requirement for an “established relationship” takes effect.

SSB 5753 Increasing board and commission capacities.

  • This legislation makes numerous changes to include: (1) increasing payment for members of boards, such as the Board of Massage (Board) , from $50 to $250 per meeting; (2) adding two members of the Board, to include one LMT and one massage educator who doesn’t need to be an LMT; (3) clarifying and simplifying requirements for the consumer Board member; and (4) amending a Board statute to define a quorum in a way that allows the Board to be able to continue to function when there are vacancies.

Status: Governor signed. Effective date 6/9/2022.

ESSB 5761 Concerning employer requirements for providing wage and salary information to applicants for employment. This legislation:

  • Modifies the requirements to provide wage information to require employers to provide the wage scale or salary range in job postings and to include a general description of all benefits and other compensation, rather than providing wage scale or salary information only upon request of an applicant after the initial job offer;
  • Removes the requirement that if no wage scale or salary range exists, the employer must provide the minimum wage or salary expectation prior to posting the position, making a position transfer, or making the promotion;
  • Limits the persons who are entitled to remedies to a job applicant or an employee; and
  • Applies to employers with 15 or more employees.

Status: Governor signed. Effective 1/1/23.

ESSB 5980, Providing substantial tax relief for small businesses to mitigate structural deficiencies in Washington’s business and occupation tax and lessen long-term negative economic consequences of the pandemic that have disproportionately impacted small businesses.

  • The main change is to raise the exemption from filing B&O taxes from $46,000 to $125,000 beginning in January 2023.

Status: Governor signed. Effective 6/9/2022.

Other updates:

  • Health Equity Continuing Education (CE) Rule Development. Beginning on January 1, 2024, LMTs will be required to take health equity CE every four years. The exact number of hours will be determined by the Board—probably influenced by the model rules that the Department of Health (DOH) is in the process of writing. The Board will consider those DOH model rules in 2023, and decide whether to adopt or modify. AMTA-WA is monitoring rule development related to model rules.
  • Patient Safety Improvement Task Force. This Department of Health (DOH) Task Force was formed in response to an article in The Seattle Times about the length of time it was taking DOH to adjudicate sexual misconduct complaints. Unfortunately, some of the examples were related to the massage profession. The Task Force recently released its draft recommendations. There are two key issues, one much more complex than the other. First, there’s the issue of shortening the timelines. Goal #1 reads: “Shorten the timeframe for resolution of sexual misconduct cases.” The Task Force’s draft recommendations contain numerous suggestions about how this might occur to include more management oversight, as well as more frequent board and commission meetings. Some of the recommendations would mean hiring more staff, which could lead to fee increases—although those increases would be spread over the 500,000 health care professionals that DOH regulates.

By far the more complex recommendation is Goal #2. It reads: “Make information about sexual misconduct cases available to the public earlier in the process.” DOH is exploring whether to inform the public when a health care provider is under investigation. This would be a change from current practice.  Currently DOH posts information on the provider credential search feature of its website when statements of charges have been filed, when matters have been resolved by stipulation to informal discipline, or when final adjudication occurs. All these steps occur after an investigation has taken place.

The problem, as discussed in The Seattle Times article, is that it is difficult for the public to know whether a provider is under investigation for misconduct of any type. Complaints are protected from public disclosure until a decision is made whether to investigate. While investigations are publicly disclosable,  the public is not widely aware of this fact because they’re only disclosable through a complex process. “The task force discussed the merits of posting this information as well as the potential for harm to a provider’s reputation and employment comment which could occur even if an investigation does not result in any charges. Due to the complexity of this topic, the task force concluded that more research is needed.” (Page 12-13)

  • eviCore Training for LMTs. AMTA-WA is working with AMTA at the national level and eviCore with the goal of developing a training to assist LMTs. This is not an endorsement of eviCore, or an indication of agreement with all of their clinical guidelines. However, it is an important opportunity to develop a training that will hopefully help LMTs who provide care to patients who are managed by eviCore. AMTA-WA is pleased that Diana Thompson, LMT will be the lead AMTA coordinator with eviCore.
  • Continuing Education (CE) Waiver for Hands-On CE. The following information was received from the Board of Massage. “At the March 11, 2022, Board of Massage (board) meeting, the board addressed the continued challenges related to hands on continuing education (CE) during the coronavirus 2019 (COVID-19) pandemic. The board reviewed policy number BOM 20-01.5, Continuing Education Requirements During the COVID-19 Response, and voted to extend the expiration date of the policy. Policy number BOM 20-01.5 will remain in effect until June 30, 2022. Policy number BOM 20-01.6 will take effect July 1, 2022, and be in effect through December 31, 2022. The policy will be re-evaluated at the September 23, 2022 board meeting.”
  • Massage Transfer Programs. In 2016, AMTA-WA wrote and advocated for legislation to establish transfer programs. The rationale for the legislation was to allow massage therapy students to be able to transfer credits from one educational institution to another. Fast forward six years, and the Board of Massage (Board) received a rules petition requesting the Board to review the transfer process to make it a standard process that does not vary from school to school depending on the number of hours of massage education the school offers. Over time, schools have developed transfer programs that mirror the number of hours required in their “regular” massage programs, and some of those programs exceed the current 625 minimum hours. As a result of this petition, the Board of Massage will hold a rules workshop on May 20 to determine whether the WACs should be amended to require a “one size fits all” for transfer programs.