2007 Legislative Session Final Report
Lynn Carrigan and Lu Brown
LAC Co-chairs
The NASW Washington State Chapter had a good year at the State Capitol. We monitored many issues and introduced legislation on social work title protection. We had over 250 social workers attend 2007 Lobby Day. The members’ support of the issues was outstanding.
Senate Bill 5930 – Blue Ribbon Commission health care recommendations
Prime sponsor: Sen. Karen Keiser (D-33, Kent)
Passed Senate 31-17, House 63-35, signed by Governor Gregoire
SB 5930 grew out of the Governor’s 2006 Blue Ribbon Commission on Health Care Costs and Access. This legislation is an extensive and detailed effort to improve quality and reduce the cost of health care for Washington’s residents. In all, the provisions of fourteen different bills were amended into SB 5930.
Under 5930, state agencies are required to implement a number of new quality improvement projects. Among those that will hopefully include opportunities for public input include:
- developing a five-year plan by September 1, 2007, to change reimbursement to reward quality and incorporate evidence-based standards;
- designing and implementing a program of “medical homes” for clients in the “aged, blind, and disabled” category, and evaluating chronic care management and expansion of best practices for the medical and long-term care programs;
- seeking federal waivers and state plan amendments that seek to expand coverage and leverage all available funding, explore alternative benefit designs, and expand enrollment in employer-sponsored insurance premium assistance programs (Note: depending on how this is implemented, there are concerns about potential efforts to expand the funding available for covering more people by reducing benefits to Medicaid enrollees);
- creating a “Washington State Quality Forum” with the Puget Sound Health Alliance and others, to collect research and health care quality data;
- requiring DOH to provide training and technical assistance for providers of primary care, focused on caring for people with chronic conditions and high quality preventive and chronic disease care, and establish a web-based interactive prescription monitoring program to monitor prescribing and dispensing of schedule II, III, IV, and V substances;
- requiring the Office of Insurance Commissioner to report on opportunities to reduce key health care administrative costs for the state;
- designing a reinsurance program for individuals and small groups, for 2008 legislation;
- requiring all insurance carriers and state employee programs to offer enrollees an opportunity to extend coverage for unmarried dependents up to age 25;
- establishing a 24/7 nurse hotline for persons receiving health coverage through DSHS and HCA; and
- modifying benefits in the Washington State Health Insurance Program (WSHIP), formerly the “high-risk pool”, to make them more consistent with benefits in the private, individual market.
House Bill 1569 – Reforming the health care system
Prime sponsor: Rep. Eileen Cody, RN (D-34, West Seattle)
Passed House 61-34, Senate 28-20, signed by Governor Gregoire
HB 1569 creates a new Washington Health Insurance Partnership (WHP), to build upon the small employer health insurance partnership bill program from last year, with the following details:
- Creates a WHP Board to work with HCA and the Office of Insurance Commissioner, to study and design a public-private partnership, to pool purchasing of the private sector small group health benefit plans;
- Creates a nine-member Health Insurance Partnership Board, appointed by the Governor, by June 2007, to include representatives from: two small employers; two employees of small employers including one low-wage employee; four health benefit specialists; and the HCA Administrator;
- An RFP will be issued by 1/1/08 to seek a private entity to operate the WHP;
- Eligibility for premium assistance will include employees of small businesses with family incomes below 200 percent of the federal poverty level;
- The WHP Board will study the risks and benefits of additional markets participating in the WHP, including association health plans, individual health insurance plans, the Washington State Health Insurance Pool, the Basic Health Plan, Public Employees' Benefits Board enrollees, and Public School Employees, by December 1, 2009;
- Insurance Commissioner will contract for an independent study of health benefit mandates, rating requirements, and insurance statutes and rules to determine the impact on premiums and individuals' health, by December 1, 2007;
- The WHP Board will designate the health plans eligible for premium subsidy, from plans available in the private small group market, approved by the Insurance Commissioner, including at least four plans, with multiple cost-sharing and deductible options, ranging from high deductible/catastrophic to comprehensive;
- The WHP Board will determine a mid-range plan that will be used as the benchmark for the premium subsidy, and the premium subsidy will be developed similar to the sliding scale used for Basic Health; and
- The WHP Board will determine minimum employee participation requirements and if there should be a minimum employer contribution, though employers will continue to determine employee eligibility and their contribution (above a minimum if established).
House Bill 1128 – 2007-09 operating budget
Prime Sponsor: Rep. Helen Sommers (D-36, Seattle)
Passed House 60-36, Senate 31-17, signed by Governor Gregoire
The 2007-09 operating budget passed by the Legislature includes several items of budget and policy of potential interest to social workers and the clients we serve:
- The state’s Basic Health Plan (BHP) provides coverage for low-income persons whose incomes are not low enough to qualify for Medicaid coverage. In 2001, the BHP’s enrollment was over 132,000, but was cut to 100,000 in order to save money in the state budget just a couple of years later. The BHP’s enrollment is currently 105,300, and the 2007-09 operating budget funded an expansion of 1200 new BHP slots in January 2008 and an additional 3000 in January 2009, bringing the BHP’s full enrollment to 109,500 at that time.
- A budget proviso authorizes a legislative work group and study related to access to coverage for lower-wage workers of employers with over 50 employees. It is similar to previous bills that had sought to hold accountable (and billable) those employers whose employees are covered by state health insurance programs (e.g. Medicaid and BHP) rather than employer-sponsored health plans. NASW will be involved in providing input to this work group and study.
- Additional funding for mental health services was also widespread and fairly generous:
- The health care pilot project for general assistance (GA-U) program clients in King and Pierce Counties received $3.4 million to include mental health services for these clients (whose #1 reason for eligibility for GA-U is mental health issues);
- $6.1 million was appropriated to cover other people not eligible or not on Medicaid;
- Funding for wages of community mental health workers was increased by $15.1 million in state funds ($24.5 million total); and
- Community mental health centers received $7.3 million in additional state funds ($11.9 million total) to attempt to keep up with the cost of inflation.
Senate Bill 5093 – Children’s health care expansion
Prime Sponsor: Sen. Chris Marr (D-6, Spokane)
Passed Senate 38-9, House 68-28, signed by Governor Gregoire
SB 5093 expands coverage for children in the state’s Children’s Health Insurance Program to 300% of the federal poverty level, providing eligibility for an additional 50,000 children under the age of 18. The budget provides $36.5 million in state funds ($66.2 million total) for this coverage expansion.
House Bill 1088 – Children’s mental health
Prime Sponsor: Rep. Mary Lou Dickerson (D-36, Seattle)
Passed House 94-4, Senate unanimously, signed by Governor Gregoire
HB 1088 provides policy changes and the budget provides $5.7 million in state funds ($8.7 million total) for improved mental health services for children under the age of 21, with an emphasis on early identification, intervention, and prevention, and with a greater reliance on evidence-based and promising practices. The expressed goal of the Legislature is to create, by 2012, a comprehensive and high-quality children's mental health system centered on evidence-based practices that will be encouraged and piloted by this legislation.
Senate Bill 5336 – Domestic partnerships
Prime Sponsor: Sen. Ed Murray (D-43, Seattle)
Passed Senate 28-19, House 63-35, signed by Governor Gregoire
SB 5336 creates a registry of domestic partners with the Secretary of State’s Office, comprised of same-sex couples or heterosexual couples with a partner over the age of 62. Those domestic partners registered will be granted rights currently provided only to legal spouses, including health care facility visitation rights, ability to grant informed consent for health care for a patient who is not competent, authority of health care providers to disclose information about a patient without the patient's authorization, inheritance rights when the domestic partner dies without a will, and administration of an estate if the domestic partner died without a will.
Senate Bill 5320 – Public guardianship
Prime Sponsor: Sen. Rosa Franklin (D-29, Tacoma)
Passed House and Senate unanimously, signed by Governor Gregoire
Guardianship is a legal process through which a guardian is given the power to make decisions for a person who is determined to be "incapacitated" and therefore unable to exercise his or her rights (particularly of a financial nature) or provide for his or her basic needs without the help of a guardian. SB 5320 creates two pilot projects (one rural, one urban) to recruit persons and organizations to exercise these functions on behalf of incapacitated individuals age 18 or older whose income does not exceed 200 percent of the federal poverty level or who are receiving long-term care through DSHS.
House Bill 1460 – Mental health parity for individual and small group health plans
Prime Sponsor: Rep. Shay Schual-Berke, MD (D-33, Normandy Park)
Passed House 75-22, Senate 41-3, signed by Governor Gregoire
In 2005, the Legislature passed a mental health parity bill requiring that coverage of mental health services be equal to coverage for other medical and surgical services, for commercial insurance policies covering more than 50 employees, and for the public employees and Basic Health programs offered by the Health Care Authority. HB 1460 expands that policy, effective January 1, 2008, to all insurance policies issued for all groups and individuals in Washington, including policies offered by the Washington State Health Insurance Pool (WSHIP), also known as the “high risk pool”.
House Bill 1020 – Regulating payday lending
Prime Sponsor: Rep. Sherry Appleton (D-23, Poulsbo)
Died in House Insurance, Financial Services & Consumer Protection Committee
HB 1020 would have increased the stringency of regulations and requirements on “payday lenders” who typically offer short-term, high-interest loans (up to $500 at up to 391% per year) to consumers who may be in urgent need of immediate funds, including limiting the number of such loans any consumer could obtain, extend repayment terms, and substantially reduce interest rates (to 36% per year).
House Bill 2112 / Senate Bill 5950 – Clarifying the definition of “social worker”
Prime Sponsors: Rep. Eric Pettigrew (D-37, Seattle), Sen. Ed Murray (D-43, Seattle)
Died in House Early Learning & Children’s Services Committee / Senate Human Services & Corrections Committee
This legislation would have clarified that only those persons with education and training from an accredited school of social work could use the title “social worker” for professional credentials and employment in Washington. Though this legislation did not pass, an interim “sunrise review” will be conducted by DOH, with input from impacted individuals and organizations. As the organization responsible for bringing this issue forward to the Legislature, NASW will continue to exercise a leadership role in this effort.
House Bill 1993 – Regulation of “registered counselors”
Prime Sponsor: Rep. Don Barlow (D-6, Spokane)
Died on Senate Floor Calendar
There was extensive consideration of legislation to limit or eliminate the current profession of “registered counselor”, including establishing educational and scope of practice requirements on the current 17,000 registered counselors and any future applicants for this or similar professional designations. New regulatory legislation did not pass, but a budget proviso (Section 222 of House Bill 1128) established a work group to work with DOH to draft new credentialing guidelines for registered counselors by the beginning of 2008, including education in risk assessment, ethics, professional standards, and deadlines for compliance.
House Bill 1456 – Providing backup for mental health professionals during home visits
Prime Sponsor: Rep. Tami Green (D-28, Tacoma)
Passed House and Senate unanimously, signed into law by Governor Gregoire
Designated mental health professionals (DMHPs) who perform initial evaluations and detentions pursuant to the involuntary commitment statutes and provide crisis outreach services for individuals with mental disorders, occasionally conduct such evaluations or services in the homes of individuals with mental disorders. This legislation responds to the recent death of one such DMHP on a home visit, and stipulates that DMHPs or other mental health crisis outreach workers will not be required to conduct home visits alone. Such workers will be provided with a communication device, any history of dangerousness or potential dangerousness on the client they are visiting, if available, and annual training on safety and violence prevention. The budget provides $3.7 million to cover the costs of additional staffing, equipment, and training.
House Bill 1201 – Extending Medicaid benefits for foster youth
Prime Sponsor: Rep. Mary Helen Roberts (D-21, Edmonds)
Passed House 93-1, Senate unanimously, signed into law by Governor Gregoire
Currently, any state benefits for foster youth end on their 18th birthday. HB 1201 extends eligibility for Medicaid for youth that were in foster care on their 18th birthday, up to age 21, irrespective of continuing placement in foster care.