Prepared by Leslie Emerick, Lobbyist
Washington state’s 2018 legislative session started on Monday, January 8th. The week got off to a fast start with pre-filed bills that were introduce on day one and had public hearings all week. Since we have a biennial legislature, some bills from last session are moving forward from where the left off last session.
They will also be working on the Supplemental Operating budget this session. It’s a 60-day “short” session this year and they will also have to contend with the Supreme Court McCleary decision to improve the education budget by $1 billion, court ordered improvements to the mental health system, a debate over the Capital budget and more!
Democrats have a new majority in the state Senate. The party recently won a special election in the Redmond/Issaquah area, ending a half-decade of Republican control in the chamber. They already controlled the House and Governor’s Office. The win gives them total control of state government. Their lead is just one vote in the Senate, but they will still have considerably more sway to push through legislation and write a supplemental state budget than they had in past years.
The states Capital Budget funding construction projects statewide for schools, colleges and other state institutions has also been on hold due to the Hirst Decision in the Supreme Court. The Democrats may have a majority, but to sign bonds for the state they need 60 votes, so they will still have to negotiate with the Republicans to pay for the bonds.
Governor Jay Inslee has requested a “carbon tax” in his budget creating a plan to charge polluters as the centerpiece of an effort to increase state revenue for education and environmental issues, but he hasn’t offered details on the size and scope of the plan yet. The Olympian states that “Such a tax is unlikely to win the hearts and minds of many Republicans, who have objected to carbon taxes. Many say taxing carbon emissions would not provide enough help to the environment to justify the job losses they predict would result from the implementation of the tax.” Inslee has proposed using reserves to meet the McCleary court order, with a promise to refill state coffers with a carbon tax later on.
WEAMA Legislative Priorities
Support Acupuncture as an Alternative to Opioids
On January 15, WEAMA was invited to present to the Senate Health Care Committee as part of a panel on Alternatives to Opioids. Jason Taylor, WEAMA Board member presented to the committee and sharing the “Acupunctures Role in Solving the Opioid Epidemic” that was presented to Congress last fall. Jason did a fabulous job and can be seen on TVW: www.tvw.org/watch/?clientID=9375922947&eventID=2018011155&eventID=2018011155&startStreamAt=781&stopStreamAt=1091&autoStartStream=true
If you would like to see the entire presentation start at the beginning of the hearing on TVW:
WEAMA has been working on Acupuncture as an Alternative to Opioids for a number of years. We sent Governor Inslee the attached letter on September 26, 2017 and within a week had a meeting scheduled with Jason McGill, Governor’s Health Policy Staff and the Medical Directors from the Health Care Authority, Medicaid and the Department of Health to discuss how to integrate acupuncture into the Medicaid insurance program in WA State. A policy analyst was assigned to research the issue. Out of that discussion came a section in two bills (companion bills) that have been introduced by Governor Inslee to address opioid abuse:
WEAMA Supports Governor Inslee’s Opioid bills, HB 2489/SB 6150 Concerning opioid use disorder treatment, prevention, and related services.
Here is Curt Eschels, WEAMA Legislative Chair, testimony on SB 6150: www.tvw.org/watch/?clientID=9375922947&eventID=2018011155&eventID=2018011155&startStreamAt=4720&stopStreamAt=4798&autoStartStream=true
These bills have bi-partisan support. WEAMA is very supportive of Section 14 of the bill that starts a pilot project at the Health Care Authority and will be testifying in support of these two bills next week. It is essentially a pilot project to start using EAMPs and acupuncture treatment with Medicaid in WA State. The standards are very similar to L & I for evidence based medicine.
NEW SECTION. Sec. 14. A new section is added to chapter 74.09 RCW to read as follows: (1) By October 2018, the health care authority shall develop and recommend for coverage nonpharmacologic treatments for chronic noncancer pain and shall report to the governor and the appropriate committees of the legislature, including any requests for funding6necessary to implement the recommendations under this section. The recommendations must contain the following elements: (a) A list of chronic conditions for which nonpharmacologic treatments will be covered; (b) A list of which nonpharmacologic treatments will be covered for each chronic condition specified as eligible for coverage; (c) Recommendations as to the duration, amount, and type of treatment eligible for coverage by condition; (d) A financial model that is scalable based on the types of conditions covered and the amount of allowed services per condition; (e) Guidance on the type of providers eligible to provide these treatments; and (f) Recommendations regarding the need to add any provider types to the list of currently eligible medicaid provider types. (2) The health care authority shall ensure only treatments that are supported by evidence for the treatment of the specific chronic pain conditions listed will be eligible for coverage recommendations.
Support SB 6157 Prior Authorization
WEAMA has been working with the chiropractors and PTs on a prior authorization bill for about 3 years now. The bill states “A health carrier may not require prior authorization for an initial evaluation and management visit or an initial, and up to 12 consecutive treatment visits with a contracting provider in a new episode of care of chiropractic, physical therapy, occupational therapy, East Asian medicine, massage therapy, or speech and hearing therapies within the benefit limits of the health plan.” The bill has not been scheduled for a public hearing yet.
State Agency Regulatory Update
Acupuncture and ARNPs Medical Acupuncture Advisory Opinion with NCQAC
WEAMA is consulting with our attorney regarding our official position and will provide talking points soon. We wanted to make sure our membership was aware of this meeting in case you would like to attend in person. We will send out the talking points as soon as we get legal counsel on our options to repeal this decision. We also plan to contact the Governor’s Office in the near future with our concerns.
Background: Fujio McPherson, a former member of the EAMAC and a dual licensed EAMP and ARNP, submitted a proposal to the NCQAC to allow advanced registered nurse practitioners (ARNPs) in Washington state to be able to do “medical acupuncture” similar to what the medical doctors and osteopaths are allowed to do for 300 hours. He intends to teach this class to ARNPs. The NCQAC prepared an Advisory Opinion that supported Fujio’s request and passed it out of the Advanced Registered Nurses Advisory Committee. It then went to the NCQAC for approval.
NCQAC approved the Advanced Registered Nurse Practitioner (ARNP) Medical Acupuncture Advisory Opinion at their November 17th, 2018 meeting. WEAMA strongly protested the passage of this Advisory Opinion due to lack of clarity over how they would enforce it and training standards. Dr. Yang and Curt Eschels testified before the commission in opposition.
The East Asian Medicine Advisory Committee (EAMAC) also petitioned the NCQAC to begin agency rulemaking to insure adequate public review and input from stakeholders on ARNPs Practicing Medical Acupuncture. At the November 17th meeting the NCQAC denied the petition to provide rulemaking and approved the ARNP Advisory Opinion. The NCQAC sent a response back to the EAMAC denying their request for rulemaking. The last words in the response were, “they had sufficiently addressed the concerns raised by EAMAC”. WEAMA strongly disagrees.
WEAMA is concerned that the Advisory Opinion would seem to set a precedent for sharply reduced training for acupuncture by other professions. Furthermore, the opinion fails to specify any required content for acupuncture training. Not containing any substantive standards would seem to make the allowance arbitrary and leave the Commission without a sound basis to regulate nurse acupuncturists. The Opinion recommends a model “similar to the AAAOM model”, which has only vague qualitative attributes, but no quantitative standards.
WEAMA attended the NCQAC meeting on Friday, January 12th, 2018 with testimony by Curt Eschles and Dr. Yang with 12 Chinese acupuncturists introduced in the audience.
Open microphone is for public presentation of issues to the NCQAC. This is a very short comment period and any testimony should be 2-3 minutes.
We ask that you contact the Nursing Commission and submit written testimony or attend in person. Please ask that they submit your concerns into the NCQAC official record for the January 15, 2018 meeting. Send comments to: Deborah Carlson, MSN, RN, Associate Director of Nursing Practice firstname.lastname@example.org or email@example.com.
East Asian Medicine Advisory Committee at DOH
The East Asian Medicine Advisory Committee (EAMAC) requested rulemaking on the Advisory Opinion on ARNPs practicing Medical Acupuncture and submitted it to the NCQAC. As stated above, the request was denied by the NCQAC. We need further discussion about this with the EAMAC. Their next meeting is February 9, 2018 at the Department of Health. Creekside Two Center Point, Room 307, 20425 72nd Ave. S., Bldg 2, Ste. 310 Kent, WA.
Please support WEAMA’s PAC!
2018 is an election year and WEAMA has a Political Action Committee to make contributions to legislative campaigns for candidates that support East Asian Medicine and Acupuncture. WEAMA sends a lot of time educating state legislators about your issues and we need to help keep them in office. Political campaigns are expensive, and our PAC is an investment in your future legislative success. To donate go to: https://weama.info/WEAMA-PAC
In a democracy, “the squeaky wheel gets the grease.” There is power in numbers and your voice counts! WEAMA needs your support and involvement to advocate for your profession to either promote or stop regulations and bills that profoundly impact acupuncture and East Asian Medicine.