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As I am sure you have all noticed, 2016 is an election year. The General Election is on November 8th and I have no idea which way the political winds will blow for the political parties in the state legislature this year because it is such a wild and crazy presidential election on the national level. Why should East Asian Medicine Practitioners care about the Political Landscape? Because politics impact legislation and bills that we support can live or die because of legislative battles over issues that have nothing to do with us!
The balance of power in both the Senate and the House are up for grabs this year as they are only separated by a few members. Currently the Republicans control the Senate and the Democrats control the House. All 98 seats in the House of Representative are up for election. And 26 out of the 49 seats in the Senate are up for election. Many long-term Senators retired this year and some are running for other offices. The Democratic Governor’s is also up for re-election. The legislature will look quite different in 2017 with so many new members so there will be lots of opportunities to educate new legislators about East Asian Medicine!
2017 is the 105-day long session of the legislature where they develop the two-year operating budget for the state that funds human services and education. Bills introduced in 2017 live for two years. Despite increased tax revenues from an improving economy, the legislature is still facing the McCleary Supreme Court Decision. This will have a big impact on the legislature next session since they put it off for another year last session.
The decision requires the state legislature to fully fund education under the state’s Constitution. So far the legislature has come up with about $5 billion more in funding, but that is still not to the satisfaction of the states Supreme Court. They are currently fining the state legislature $100,000 a day starting last fall, with over $37 million already set aside in an account that will be used for educational funding at some point. The courts want the state to come up with an additional $3-5 billion to fully fund education under the state’s constitution. As you can imagine, this is quite controversial because there is no way to come up with this kind of money unless tax revenues are considered or loop-holes are closed. This is a highly partisan battle which could lead to a rocky legislative session in 2017 and possibly several special sessions. Maybe this time next year we will still be in Special Session!
SHB 2448 East Asian Medicine Point Injection Therapy
Point Injection Therapy Rulemaking
SHB 2448 went into effect on June 9th, 2016. It required DOH, in consultation with East Asian Medicine Advisory Committee (EAMAC), to adopt rules to define and clarify Point Injection Therapy in WAC. DOH has been scheduling the East Asian Medicine Advisory committee meetings in conjunction with the PIT Rulemaking. DOH submitted their first draft of the PIT Rules on August 25th for review and to solicit comments. It appears that they based their draft on a combination models from other states who practice PIT such as Colorado and Florida and are suggesting 60 hours of training. WEAMA has some concerns about the draft and established a PIT Workgroup to review and submit comments to DOH. Comments were submitted back to DOH by the deadline on October 21st and are currently under review by DOH. We will know more about their response at the EAMAC Spokane meeting and rescheduled it for November 16th. Some of the issues under consideration are grandfathering for EAMPs who are already doing PIT and the number of hours of training that will be required.
We have been having discussion about how EAMPs can purchase homeopathic medicines. At this point we believe that sending the new legislation to wholesale companies who require documentation that it is in your scope of practice may be the best option. Apparently, that is not working for some folks. I recommend that we request the EAM Advisory Committee either write a statement or get the Pharmacy Board to sign off on allowing EAMPs to purchase homeopathic medicine. I am working with DOH and the Executive Director of the Pharmacy Board on this issue. I will also bring this issue up at the EAMAC meeting in Spokane.
Epinephrine Auto-injectors Rulemaking
DOH is also implementing Rules on SSB 6421 Authorizing Health Care Providers to prescribe Epinephrine Auto-injectors in the name of authorized entities. PIT has the possibility of an allergic response and having an epi-pen available would be appropriate.
State Agency Rulemaking
How many of you understand what “rulemaking” means? It is the process that an agency follows to develop, adopt, repeal or amend a rule. Rules are developed by state agencies to further define an RCW/Statute or help provide clarity if the underlying statute is broad or unclear. A rule is a regulation adopted by a state agency and codified in the Washington Administrative Code (WAC). The words “rule”, “standard”, “regulation”, and “WAC” are often used interchangeably. A requirement is not enforceable if not in statute or a rule. A statute is also defined as an RCW or law established by the state legislature.
Basic Rulemaking Process
CR 101 first stage of process which initiates the rulemaking. Agencies then go to the Stakeholder phase where they gather input from interested parties. Based on that input the begin drafting rules and analysis. Sometimes there are numerous stakeholder meetings depending upon how complex or contentious the proposed rules are. After there is a consensus or the department feels they have gathered enough information to move forward it goes to the CR 102 Public Hearing and Comments/Respond phase. The department may make minor changes based on testimony at this point, but typically move to the CR 103 Final Adoption phase. If there were major issues that came up during the CR 102, they may go back to public hearing and stakeholder work again to try to resolve the issue. Every state agency goes through this process which is required under the Administrative Procedures Act in Washington State.
East Asian Medicine Advisory Committee (EAMAC)
The EAMAC was established in legislation we passed last year, SHB 1045. This committee now reviews all issues related to EAMPs at DOH. They have also supported our efforts on Dry Needling with a letter opposing it during the PT Sunrise Review. Two meetings have been held so far. With the next on coming up in Spokane on November 16th. I would encourage all of our eastern WA practitioners to add if you can and participate in this opportunity to support your profession!
|April 29, 2016
- PIT Overview
- Demonstration and Discussion
|November 16, 2016
- PIT rulemaking, review draft and comments
- WEAMA Letter Opposing Advanced Registered Nurses (ARNPs) 300-hr Acupuncture training
|January 27, 2017
- Potential CR 102 or additional stakeholder meeting on PIT Rules
|April 28, 2017
SB 6374 Dry Needling for PTs
SB 6374 Allowing physical therapists to perform dry needling with 54 hours of training died in the Senate Health Care. This bill was the basis of the Sunrise Review with DOH. Here is a link to the Sunrise Review Process if you are not familiar with it. This is how a profession is supposed to expand their scope of practice. As an example, WEAMA went through one to expand your scope of practice in 2009: Acupuncture Scope of Practice, 2009 (PDF)
DOH Sunrise Review on Dry Needling
Senator Randi Becker, the Chair of the Senate Health Care committee requested that DOH initiate a Sunrise Review on PT Dry Needling after the legislative session. Here is a link to the DOH Sunrise Review website if you have not had the opportunity to see the information on the PT Sunrise Review that is under consideration: http://www.doh.wa.gov/AboutUs/ProgramsandServices/HealthSystemsQualityAssurance/SunriseReviews/PendingSunriseReviews
Around 100 people attended the public hearing from both sides of the issue. DOH had an overwhelming response during the public comment period with 609 pages. The reaponse was unprecedented according the staff. DOH released the Review Draft on 9/26/16 with the following recommendations:
DOH does not support the applicant’s proposal to add dry needling to the physical therapy scope of practice. The proposal as submitted does not meet the sunrise criteria for increasing a profession’s scope of practice. This is a major victory for EAMPs!
DOH was accepting rebuttal comments on the draft sunrise report until 5 p.m. October 10, 2016.
WEAMA submitted final comments that focused only on the content of the draft report. DOH will post the final report on the website above when it's been approved and submitted to the legislature, prior to the start of the 2017 legislative session.
L & I Acupuncture Literature Review
After 5 years of effort by WEAMA and many volunteer researchers within the organization, we presented a literature review entitled “Acupuncture for Low Back Pain: A Systematic Review of Randomized Controlled Trials” Lisa Taylor-Swanson and Jennifer Stone (WEAMA Review Team) Megan Gale Kingsley
Lisa Taylor-Swanson made the presentation to Gary Franklin, L & I Medical Director on October 3rd, 2016. Ash Goddard, WEAMA President, also made a presentation on Acupuncture as Alternative to Opioids. We invited Dr. Bowling, MD, a Medical Acupuncturist from Bellingham to speak to the requests of patients who should be receiving acupuncture.
WEAMA Meeting with L & I
HB 2383 (2016) Establish acupuncture as a treatment for injured workers
Last session an EAMP worked with Rep Chris Reykdal in Olympia to initiate HB 2383. The bill did not reflect our goal for EAMPs as “Approved Providers” with L & I. This bill made EAMPs “Attending Providers”. This would require managing patients, initiating an L & I claim and patient care, typically provided by primary care providers. This would require lots of paperwork from our providers!! A revised version of this bill could be WEAMA legislation in 2017 depending on the outcome of our request for rulemaking with L & I.
L & I Rulemaking or Legislation?
L & I is currently reviewing the literature review and will decide about adding EAMPs to the list of approved providers by mid-November. Rulemaking to become “Approved Providers” would allow EAMPs to provide acupuncture treatments and remove the acupuncture prohibitions in WAC.
We only need legislation if L & I refuse to do rulemaking to accept EAMPs as approved providers. A bill passing the legislature would require them to add acupuncture as an approved treatment with L & I. Rep Sells, Chair of House Labor Committee is interested in sponsoring bill if needed. We have a meeting set up with him during the fall legislative days in early December. We are waiting to hear back from L & I before Legislative Days which begin mid-November for the Senate and early December for the House.
Governor Inslee “Call to Action”
Ash Goddard and I attended the Governors Call to action Addressing the Opioid Epidemic in WA State on October 7th. We spoke to the panel about using Acupuncture as a first line therapy or in conjunction with Western Medicine. Many organizations starting to integrate acupuncture into practices. Harborview working with Bastyr, Seattle Children’s Hospital has an integrated program and the state Medicaid Program Medical Director spoke about a pilot project in Oregon for Low Back pain. I told her about our literature review.She would like to meet with us to discuss further!
Insurance Commissioner Mike Kreidler supports East Asian Medicine!
In 1985 The Olympian newspaper had picture showing Mike Kreidler getting an acupuncture treatment as your new law went into effect authorizing independent practice. Kreidler used to be Chair of the Health Care Committee and was an optometrist. He is up for re-election the year!
Office of the Insurance Commissioner Prior Authorization Rulemaking
This rulemaking is not a big help for EAMPs because prior authorization is not going away. OIC is trying to make it more streamlined. WEAMA has been represented at these stakeholder meetings and has commented on the drafts. Rules have been adopted which established timelines for insurer communication about approvals and requests for more information. Insurers must respond to urgent care requests within 48 hours and normal requests within 5 calendar days.
The prior authorization rules just finished its second stakeholder review. Several small changes have been proposed that affect communication methods, data collection, and timelines to submit information. SB 6511 established a OneHealthPort workgroup to streamline prior authorizations. No provider groups could access this workgroup, but provider groups may comment on draft proposals at stakeholders' meetings.
Nursing Care Quality Assurance Commission (NCQAC) Guidelines on ARNPs & Acupuncture
NCQAC has proposed guidelines for ARNPs to practice Acupuncture with 300 hours training. Fuji McPherson, ARNP, EAMP is the proponent of the request to NCQAC. WEAMA Position: Opposed, we have submitted comments to NCQAC for review. RCW 18.06.020 says in part, “A person may not practice... acupuncture if the person is not licensed under this chapter.” No safety studies on the practice of acupuncture by nurses with the abbreviated 300-hour training.
Legislation for RAP Back FBI Fingerprinting
DOH held an “Associations” meeting on September 26th in Tumwater to discuss their legislative agenda for the next year. In 2016 the Nursing Commission ran legislation to try and establish the RAP Back FBI Fingerprinting system to assist with an Interstate Compact for Nursing.
The Division of Health Systems Quality Assurance (HSQA) is now considering legislation to implement the RapBack program in Washington State for all health care practitioners. National and State organizations such as the ACLU and other groups have expressed concerns about this program due to privacy concerns.
RapBack is a Federal Bureau of Investigation (FBI) program that would allow the Washington State Patrol (WSP) to maintain fingerprints on all health care practitioner licensees and to notify the department when a licensee has a change in their criminal history. They will also check past criminal records and unsolved crimes. Finger printing would be required at license renewal at an estimated cost of $32 for a one-time fee.
Please respond to WEAMA Legislative Alerts. Your participation makes a big difference! Emails and phone calls to legislators were integral to our success this year in stopping dry needling by PTs and passing our PIT bill.
Do you know who your legislators are? East Asian Medicine gaining in credibility as health care providers!! Here is a link to find out who your legislators are: http://app.leg.wa.gov/DistrictFinder/ Enter your address and you two House of Representative and Senate legislators will appear!
Meet w/Your local legislators!
During the interim between legislative sessions is the best time to speak with your legislator before session starts. You get way more time to speak with them in your local communities. Don’t be intimidated. Call them for appointment to discuss issues impacting EAMPs. Their legislative assistants typically answer the phone and set up appointments or respond back to your phone messages. They will set up a meeting time in your local community to meet. You could even intive them to your office! We basically have two main talking points right now:
Dry Needling is Acupuncture and practitioners need to be licensed EAMPs to practice it.
L & I should cover Acupuncture treatments. It is a cost effective, non-pharmacological approach to pain treatment that can be an alternative to opioids.
And please remember, be respectful. Treat a legislator like you would want to be treated. Never argue with a legislator…agree to disagree! We cannot afford to burn bridges as you never know when we will need their support on an important vote.
WEAMA had over $6,000 WEAMA PAC Donations this year! WEAMA invests time and energy to educate legislators on EAMP issues. Campaigns are expensive and we need to keep legislators that support EAM in office. 2017 will have lots of new legislators so we constantly need to educate and re-educate legislators on our issues to be successful.
WEAMA’s Success depends on your Support and Participation!
The more WEAMA members, the louder your voice in the state legislature. The more $$ in your PAC, the more influence you will have electing legislators that support East Asian Medicine. Please get involved. You can make a difference!
WEAMA is working hard for you!
Join for less than $16/month or donate to WEAMA or WEAMA PAC today!