Legislative Updates as of February 24, 2014

Legislative Update from Lobbyist Melanie Stewart

I’m writing this article just as the 2014 Winter Olympics are concluding. And so I find myself thinking about the type of Olympic sport that would equate to the legislative arena. My answer is Snowboard Cross, where 6 athletes at a time snowboard down a hill over different obstacles, to include each other, to the finish line. It’s competitive, messy, and while skill is important, luck is equally so. And all of those words could be used to describe a typical legislative session.

The 2014 legislative session began on January 13th, and the last official day of this 60 day session will be March 14th. Historically, short sessions, held in even numbered years, were focused on “clean up” of legislation from the previous year. That is no longer the case. This session hundreds of pieces of legislation were introduced, creating an even more frenetic atmosphere to the legislative session as committees struggled to hear as much legislation as possible during this election year.

The following is a summary of some key legislation of interest to the massage profession, and its status as of February 24th.

ESSB 6016, concerning the grace period of enrollees of the Washington Health Benefit Exchange. In a little known provision of the Affordable Care Act (ACA) enrollees of Exchange plans are allowed a ninety day grace period to pay their premiums. While this sounds very consumer friendly, and it is, it places providers and health plans at risk. While the ACA requires health plans to pay all claims during the first thirty days of the grace period, the ACA allows the health plans to “pend” or hold claims made from day thirty-one through ninety. When this happens, providers don’t get paid.

In response to this problem for providers, the Washington State Medical Association (WSMA) wrote legislation that would require the Health Benefit Exchange to notify a health plan that an enrollee has not paid his or her premium. In addition, a health plan must notify a provider or facility that an enrollee is in a grace period when the provider or facility submits a request or claim during the second or third month of the enrollee’s grace period. It’s not a perfect solution, but it’s a step forward. This legislation is a work-in-progress and many thanks to WSMA for its tireless work on behalf of all providers. ESSB 6016, passed the Senate, and was heard in House Health Care on February 24th.

E2SSB 5540, expanding opportunities to purchase health care coverage from out-of-state carriers. This legislation would allow the Insurance Commissioner to enter into reciprocal agreements with other states to allow those states to sell policies in Washington State. While this sounds simple enough, I testified against this legislation because out of state carriers would not be required to adhere to our state’s mandated benefits, and other consumer protections. In particular, there was the very real risk that resolving disputes with out of state insurers would not be under the jurisdiction of our Insurance Commissioner.

Our position was also in line with our state’s insurers who did not want to see a creation of an uneven playing field in the name of competition. From their perspective, and they’re right, if an out of state plan comes in and has lower premiums because it does not have to offer the level of benefits provided by Washington State insurers, individuals who are more likely young and healthy will gravitate to that cheaper plan…leaving those with more health care needs in the higher cost plan. Over time, the higher cost plan becomes more expensive because the young and healthy folks have pulled out. Unfortunately, this legislation passed the Senate, as well as the House Health Care Committee. It’s now in an Appropriations Committee subcommittee, and my hope is that it stays there.

SB 6304, preserving patient and practitioner freedom to obtain and provide health care by prohibiting unfair and deceptive practices in contracting for and managing health care delivery under health plans. This legislation, written by the chiropractors and optometrists, was a valiant effort to put more fairness in the current insurance system, by prohibiting health plans from imposing cost sharing that requires a covered person to pay more than 50 percent of the amount the health plan allows for coverage. In addition, health plans could not require prior authorization for routine health care services for which a person may self-refer.

The legislation directed health plans to disclose the criteria and methods for limits on access to network providers, and the methods and clinical protocols for authorizing coverage of services, including the carrier’s method for determining initial visit limits for a particular service.

I testified in support of the legislation for AMTA-WA in a hearing before Senate Health Care, as did many other provider groups. Unfortunately, the legislation did not progress, but its introduction and hearing put a spotlight on the challenges providers face in this new health care environment.

Finally, thank you to those AMTA-WA members who participated in Massage Awareness Days. Your donation of time and energy makes a difference!