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End of Session report

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Supplemental Budget and Overview

The Washington State Legislature passed its supplemental 2023-25 operating budget on March 7th. This is a supplemental budget which means this budget provides updates to the 2023-25 biennial budget passed in 2023. This year’s budget adds an additional $2.1 billion in spending before June 30, 2025 to the $69.8 billion approved in the 2023 session for the biennium.

The focus for 2024 legislative session was behavioral health, housing and homelessness, climate, and transportation. With that, the final budget includes maintenance level increases for Medicaid, assistance for food for kids and seniors, K-12 enrollment caseloads, as well as money for increasing school staff salaries, behavioral health, electric school buses, utility customer rebates, more money for ferries, funds to combat substance abuse disorder and the opioid epidemic, special education, school construction, an increase to state childcare reimbursements, some funding set aside for housing and homelessness programs, and more.

It is worth noting that $249 million acquired from the Climate Commitment Act is spread around the budget. These are proceeds from sales of emission allowances to the state’s largest polluters. Because of a pending ballot initiative to erase the law, some of those dollars cannot be spent until January 2025 when voters’ decision is final. It is also worth noting that three of six initiatives to the legislature were heard by lawmakers and passed off the floor this session. The other three initiatives will go to the ballot this November for voters to decide and if turned down will have an impact on future budgets. Lastly, a number of legislators are leaving the legislature by either retiring or running for another office this election year and therefore we should expect to see some shifts before the next legislative session in 2025.

Supplemental Conference Budget – Operating

Healthcare budget items of interest

All dollars reflect General Fund – State operating funds and any additional noted in description.

Budget ItemAgencyDescriptionFinal Budget
Health Equity ZonesDOHFunding is provided to health equity zones for implementation projects identified within the zone. (General Fund-State; Climate Commitment Account-State)$304k
Credentialing TimelinesDOHFunding is provided for staffing to implement licensing process improvements, update web content for license applicants, develop web-based tutorials for license application, and research live chat technology. (Health Professions Account-State)$3.2m
Anesthesiologist AssistantsDOHFunding is provided to implement SB 5184 (Anesthesiologist assistants), which directs the Department to establish a new credential for anesthesiologist assistants. (Health Professions Account-State)$49k
Congenital cytomegalovirusDOHFunding is provided to implement SSB 5829 (Congenital cytomegalovirus), which directs the State Board of Health to consider adding the congenital cytomegalovirus screening to the mandatory screening panel and DOH to develop educational materials. (General Fund-State)$114k
Drug overdose preventionDOHFunding is provided to implement ESB 5906 (Drug overdose prevention) or E2SHB 1956 (Substance use prevention ed.), which direct DOH to implement an ongoing drug overdose prevention campaign for youth and adults. (Opioid Abatement Settlement Account-State)$2.6m
Crime victims/witnessesDOHFunding is provided to implement E2SSB 5937 (Crime victims/witnesses), which creates the Statewide Forensic Nurse Examiner Coordination program at DOH. (General Fund-State)$972k
Certificate of need assessmentDOHFunding is provided to conduct an analysis of the certificate of need program established under chapter 70.38 RCW and report findings and recommendations to the Governor and appropriate legislative committees by June 30, 2025. The Department must, at a minimum, consider other state approaches to certificate of need, impacts on access to care, cost control of health services, equity, and approaches to identifying health care service needs at the statewide and community levels. (General Fund-State)$500k
Medical Assistant EMT CertificationDOHFunding is provided to implement SSB 5940 (Medical assistant-EMT cert.), which directs the Department to establish a new credential for medical assistant-EMTs. (Health Professions Account-State)$29k
Hospital at home servicesDOHFunding is provided for implementation of SHB 2295 (Hospital at-home services), which requires DOH to adopt rules to add hospital at-home services to the services that a licensed acute care hospital may provide and establish related standards. (General Fund-Local)$161k
High-Potency Synthetic OpioidsDOHFunding is provided to implement E2SSB 6109 (Children and families), which includes child abuse or neglect resulting from a high-potency synthetic opioid in a list of what may establish the basis for a determination of imminent physical harm when a child is removed from a parent by court order, law enforcement, or a hospital, and also provides for various services to families impacted by high-potency synthetic opioids. (Opioid Abatement Settlement Account-State)$384k
HIV prophylaxisDOHFunding is provided to implement ESSB 6127 (HIV prophylaxis), which requires hospitals to adopt policies for dispensing post-exposure prophylaxis HIV drugs and prohibits health plans and Medicaid from imposing cost sharing or prior authorization requirements.$10k
Newborn screening for BCKDKDOHFunding is provided to implement SB 6234 (Newborn screening for BCKDK), which directs the State Board of Health to consider adding the branched-chain ketoacid dehydrogenase kinase deficiency screening to the mandatory newborn screening panel. (General Fund-State)$215k
Nurse anesthetist workforceDOHFunding is provided to implement ESSB 6286 (Nurse anesthetist workforce), which directs DOH to implement a preceptor grant program for certified registered nurse anesthetists to precept nurse anesthesia residents in health care settings. (General Fund-State)$162k
ARNP legal titleDOHFunding is provided for implementation of HB 2416 (ARNP legal title), which changes the name of "advanced registered nurse practitioner" to "advanced practice registered nurse." (Health Professions Account-State)$29k
Breastfeeding guidelines for SUDDOHFunding is provided for the promotion of evidence-based breastfeeding guidelines for individuals with a substance use disorder or on medication-assisted treatment for a substance use disorder, and adaptation of the guidelines for tribal communities. (General Fund-State)$40k
Community-Based Health AssessmentsDOHFunding is provided for DOH to provide grants to support community-based health assessments for overburdened or highly impacted communities, and to develop a process for a grant program for federally recognized tribes. (General Fund-State)$300k
Opioid Data Dashboards and SystemsDOHFunding is provided for enhanced opioid and fentanyl data dashboards and data systems, to provide a centralized place for local data-gathering efforts to be collected, analyzed, and used in larger collaborative efforts. (General Fund-State)$4m
Naloxone distributionDOHFunding is provided for the distribution of naloxone through DOH's Overdose Education and Naloxone Distribution program. (Opioid Abatement Settlement Account-State)$4m
EMS & Fire Dept Opioid PreventionDOHFunding is provided to provide increased support for first responders in opioid overdose prevention, including naloxone leave-behind programs, overdose response communications, and staffing costs for community-based paramedics serving as navigators. (Opioid Abatement Settlement Account-State)$400k
COVID-19 fundingDOHFederal Coronavirus State Fiscal Recovery Fund (CSFRF) funding is reduced and replaced with General Fund-State in FY 2024.$18.7m
Naloxone to First RespondersDOHFunding is provided to purchase a dedicated supply of naloxone for first responders across the state. (Opioid Abatement Settlement Account-State)$1.2m
Food as medicineDOHFunding is provided to supplement the Fruit & Vegetable Prescription Program, which provides "food as medicine" services as prescriptions for individuals experiencing food insecurity. (General Fund-State)$100k
Healthcare Workforce GapsDOHFunding is provided to support a community organization that specializes in building a health care workforce equipped to meet the needs of Black, people of color, indigenous, LGBTQIA+, and other marginalized communities and in addressing identified gaps through recruitment and training initiatives and research. (General Fund-State)$400k
Health disparities councilDOHFunding is provided for additional staff and contracted services for the Health Disparities Council. The additional staff will provide administrative support, conduct research, and perform community outreach.$1.2
LHJ Opioid campaignsDOHFunding is provided for DOH to administer grants to local health jurisdictions for opioid and fentanyl awareness, prevention, and education campaigns. (Opioid Abatement Settlement Account-State)$2m
Local Opioid prevention & supportsDOHsupport local health jurisdictions, community-based organizations, and tribes for opioidrelated harm reduction, care linkage, and prevention work. (General Fund-State)$400k
Naloxone in librariesDOHFunding is provided to maintain a supply of naloxone in public libraries for emergency response. (Opioid Abatement Settlement Account-State)$133k
Certificate of need assessmentDOHFunding is provided to conduct an analysis of the certificate of need program established under chapter 70.38 RCW and report findings and recommendations to the Governor and appropriate legislative committees by June 30, 2025. The Department must, at a minimum, consider other state approaches to certificate of need, impacts on access to care, cost control of health services, equity, and approaches to identifying health care service needs at the statewide and community levels. (General Fund-State)$500k
Hospital bed tracking toolDOHFunding is provided for DOH to align their plan to implement a real-time hospital bed tracking tool with WaTech's requirements under section 701 of the enacted 2023-25 budget. An updated plan is due to the Office of Financial Management and the Office of the Governor by September 1, 2024. (General Fund-State)$50k
Naloxone for high schools & collegeDOHFunding is provided for the purchase of naloxone and fentanyl test strips, for distribution to high schools and public institutions of higher education. (Opioid Abatement Settlement Account-State)$745k
Rural health workforceDOHFunding is provided for Area Health Education Centers to recruit, train, and retain health care professionals in rural and underserved urban areas at two new centers. (General Fund-State)$426k
School-based health centersDOHFunding is provided to increase access to health care in academic settings by expanding the school-based health center program through 5 additional grants of $100,000 each. (General Fund-State)$500k
Opioid harm reduction programsDOHFunding is provided to stabilize and expand community-based harm reduction programs that provide evidencebased interventions, care navigation, and services, such as prevention of bloodborne infections, increasing naloxone access, and connecting people to resources and services. (General Fund-State)$1.5m
WA Poison centerDOHFunding is provided for the Washington Poison Center to expand its capacity to combat the opioid epidemic, including managing increased call volumes, supporting the development of protocols and communications, providing education to medical professionals, and distributing naloxone to the public and public-serving professionals. (General Fund-State)$500k
Public health nurse pilotDCYFFunding is provided for a pilot program to provide support for child welfare workers from public health nurses. (Opioid Abatement Settlement Account-State)$1.3m

Labor budget items of interest

Budget ItemAgencyDescriptionFinal Budget
Protected classes equal payL&IFunding is provided to implement SHB 1905 (Equal pay/protected classes), which amends the Equal Pay and Opportunities Act to include members of a protected class. (Accident Account-State; Medical Aid Account-State)$783k
Temporary total disabilityL&IFunding is provided to implement HB 1927 (Temporary total disability), which reduces the number of days that a worker's temporary total disability must continue to receive industrial insurance compensation for the day of an injury and the three-day period following the injury. (Accident Account-State; Medical Aid Account-State)$404k
Healthcare employee overtimeL&IFunding is provided to implement SHB 2061 (Health employees/overtime), which amends the definition of employee for purposes of mandatory overtime. (Accident Account-State; Medical Aid Account-State)$257k
Worker wage recoverL&IFunding is provided to implement SHB 2097 (Worker wage recovery), which creates a work group to recommend strategies for employees to recover wages owed by employers. (Accident Account-State; Medical Aid AccountState)$302k
Paid sick leaveL&IFunding is provided to implement SB 5793 (Concerning paid sick leave) to allow employees or transportation network company drivers to use paid sick leave when their child's school or place of care is closed after the declaration of an emergency. (Accident Account-State; Medical Aid Account-State)$581k
PTSD Presumptive Claims StudyL&IFunding is provided for a study on other states' Post-Traumatic Stress Disorder (PTSD) presumptive claim workers' compensation policies and practices. (Accident Account-State; Medical Aid Account-State)$400k
Registered Nurses PTSD adjustmentL&IFunding and staffing are adjusted to match the amount needed to implement Chapter 370, Laws of 2023 (2SSB 5454), which addresses industrial insurance coverage for post-traumatic stress disorders (PTSD) affecting registered nurses. (Accident Account-State; Medical Aid Account-State)$70k
Crime victims/witnessesL&IFunding is provided to implement E2SSB 5937 (Crime victims/witnesses), which promotes victim-centered, trauma-informed responses in the legal system. (General Fund-State)$550k
Crime victims compensation benefitsL&IFunding is provided for the Crime Victims Compensation Program to reflect increased costs and updated federal funding projections. (General Fund-State; General Fund-Federal; Crime Victims Compensation Account-NonAppr)$5.4m
Surgical Smoke Evacuation SystemL&IFunding is transferred into the Surgical Smoke Evacuation Account to accommodate reimbursement requirements outlined in Chapter 129, Laws of 2022 (SHB 1779). (Surgical Smoke Evacuation Account-Non-Appr)$300k

SNOW budget items of interest

Budget ItemAgencyDescriptionFinal Budget
Substance use prevention educationOSPIFunding is provided for implementation of E2SHB 1956 (Substance use prevention ed.), which, among other provisions, requires OSPI to develop, periodically update, and make available school and classroom substance use prevention and awareness materials. (General Fund-State)$334k
Healthcare industry credential feesOSPIFunding is provided for the Office of the Superintendent of Public Instruction (OSPI) to subsidize the cost of health-care-based industry-recognized credentials required for employment for students enrolled in health care courses in skill centers and comprehensive high school programs. (General Fund-State)$375k
AED grantOSPIFunding is provided for grants to schools to install at least one semi-automatic external defibrilator. OSPI shall establish a grant program to assist schools to offset the costs of purchasing an Automatic External Defibrilator (AED) or to maintain or replace an AED. (General Fund-State)$150k
Update Opioid prevention standardsOSPIFunding is provided to the Office of the Superintendent of Public Instruction (OSPI) to work with educational service districts, the Health Care Authority, and the Department of Health to review and update materials for information sessions provided to students in grades 8–12. These sessions are designed to prevent the use of opioids, including fentanyl, specifically outlining the risks of death related to uneven dosages and pills that look like prescription drugs. (General Fund-State)$125k
Food insecurity supportOSPIFunding is provided for OSPI to contract with an organization that provides bags of food for students in Thurston County schools who are impacted by food insecurity and do not have adequate access to food in the evenings, on weekends, during holiday breaks, and during the summer months. (General Fund-State)$300k
Inclusionary professional developmentOSPIFunding is provided for OSPI to support professional development in inclusionary practices for classroom teachers in an effort to reduce student isolation and restraint. (General Fund-State)$5m
Initiative 2081 technical assistanceOSPIFunding is provided for OSPI to develop guidance and provide technical assistance to school districts on the implementation of Initiative 2081 (Parental rights/schools). (General Fund-State)$500k

Policy Priorities

ARNP Reimbursement Parity — DEAD

SB 5373 requires all health carriers to reimburse ARNPs & Physician Assistants at the same rate as physicians for providing the same service in the same service area. The bill started in the Senate Ways & Means Committee where it left off in the 2023 legislative session. Ultimately, it was not voted out the Ways & Means Committee by executive session and therefore died in committee. One of the concerns indicated was the potential costs to the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs which are state funded.

Standing Order for Medication for School Nurses — PASSED

HB 1608 creates statewide standing orders allowing school nurses to administer the emergency medication epinephrine or epinephrine injectors. The bill builds on existing law that provides standing orders for Narcan in school settings. The bill started in the House Committee on Education and was ultimately voted for unanimously in both the House and Senate. It was delivered to the Governor on March 4th and signed into law on March 14th. The bill takes effect 90 days after the adjournment of session.

Property Tax Cap — DEAD 

SB 5770 lifts the property tax cap ceiling from 1% to 3% allowing Counties the ability to raise revenue that is to pay for things like Public Health, law enforcement, parks and other services provided by the County. This bill picked up in the Senate Ways & Means committee where it left off in the 2023 legislative session. After the public hearing and executive action was taken to pass it out of Ways & Means, it was announced that House and Senate leadership and the Governor’s office would not be supporting the bill this session due to the contention and opposition surrounding the bill. It died there in Ways & Means and the issue of funding for Public Health, most notably in King County where it has been stated public health clinics would be closed if a funding source did not come to fruition, remains an outstanding issue. WSNA represents nurses at King County public health and a handful of other public health departments around the state.

Keep Our Care Act (KOCA) — DEAD

SB 5241 known as the Keep Our Care Act (KOCA), or ‘mergers and acquisitions bill’ adds oversight and transparency by the Office of the Attorney General to the mergers and acquisitions process of health care entities. It was in its fourth year in front of the legislature and made more progress in this session than it had in past sessions. This year it successfully made it out of the Senate by a floor vote of 28-21 and then moved over to the House. It passed both the House Civil Rights & Judiciary and Appropriations committees. A number of amendments were proposed to the bill by both sides of the aisle. After a large and ultimately successful push in opposition of the bill, it was determined that there was not enough support to see it voted off the House floor and was not brought to a vote and died.

Other Bills of Interest – Supported, Opposed or Concerns     

SB 5184 - Concerning licensure of anesthesiologist assistants (AAs). — PASSED

This bill creates a license for AAs and establishes a new health profession in the state. An AA is a person who is licensed by the Medical Commission to assist in developing and implementing anesthesia care plans for patients under the supervision of an anesthesiologist or group of anesthesiologists approved by the Commission to supervise. Supporters asserted this would help address workforce shortage issues, while the Washington Association of Nurse Anesthetists (WANA), WSNA and others argued it does not address the need as there are already licensed health care professionals equipped to help address the shortage, namely CRNAs, who can practice independently. This bill was ultimately passed into law despite our opposition and testimony against it.

SB 5940 - Creating a medical assistant-EMT (MA-EMT) certification. — PASSED

This bill creates a medical assistant-emergency medical technician certification. A MA-EMT is defined as a person who holds basic or advanced EMT certification, or a paramedic certification, and is certified by DOH to perform certain authorized functions as prescribed in the law, under the supervision of a health care practitioner. It states that any person with these qualifying certifications need no additional training or examination requirements if they are in good standing. Supporters of the bill asserted this would help address workforce shortage issues, namely in rural settings where people with these certifications who are looking for work might be able to address gaps. WSNA opposed this bill and testified against it citing that the level of training varies widely for EMTs, advanced EMTs, and paramedics and that this bill combining the varying level of training into one credential was not advisable. The scope of practice is concerning, in particular for nurses who would be tasked with supervising these MA-EMTs. This bill was ultimately passed into law despite our opposition and testimony against it.

HB 2295 - Concerning hospital at-home services. — PASSED

This bill requires Department of Health to adopt rules to add hospital at-home services to the services that a licensed acute care hospital may provide and establish standards for the operations of a hospital at-home program. It extends the current program authorized at the federal level set to expire at the end of 2024. Under this program, physicians may deem certain patients eligible to continue receiving care in their home by a physician or RN after being discharged if they meet criteria. It is intended to free up beds in facilities and is reported to have good patient outcomes. WSNA supported this bill.  It passed the Legislature unanimously and has been signed into law.

SB 6127 - Increasing Access to HIV Postexposure Prophylaxis (PEP) Drugs or Therapies. — PASSED

This bill requires hospitals to adopt policies dispensing post-exposure prophylaxis (PEP) human immunodeficiency virus drugs. It includes a directive to provide a 28-day supply of PEP drugs or therapies in their dispensing or deliver of PEP to the patient with the patient’s informed consent. WSNA supported this bill and worked with a SANE nurse in delivering testimony in support. This bill passed both the Senate and the House unanimously and has been signed into law.

SB 6286 – Addressing the anesthesia workforce shortage by reducing barriers and expanding educational opportunities to increase the supply of certified registered nurse anesthetists in WA. — PASSED

This bill establishes a grant program to incentivize certified registered nurse anesthetists to precept nurse anesthesia residents. It also directs the Center for Health Workforce Studies at the University of Washington to study the workforce shortages in anesthesia care in each facility providing anesthesia services. WSNA ultimately supported this bill. It passed both chambers and has been signed into law.

SB 6060 – Concerning the acceptance of electronic signatures by the public employment relations commission for new organizing petitions. — PASSED

This bill requires the Public Employment Relations Commission to accept electronic signatures for new organization petitions to form a new bargaining unit of unrepresented workers or to add unrepresented workers to an existing bargaining unit. WSNA supported this bill. This bill passed both the House and Senate and was signed into law.

HB 1893/ SB 5777 – Concerning unemployment insurance benefits for striking or lockout workers. — DEAD

This bill allows individuals unemployed due to a labor strike to receive up to four weeks of unemployment insurance (UI) benefits following a specified disqualification period and the waiting week, provided that the labor strike is not prohibited by federal or state law or court order. It removes the provision disqualifying an individual for UI benefits based on an employer-initiated lockout resulting from a strike against another employer in a multi-employer bargaining unit. This bill was part of the Washington State Labor Council’s (WSLC) legislative agenda this year and WSNA did support this bill throughout its journey in the state legislature by signing in support while in committee, signing onto letters of support to key legislators, participating in a rally on the Capitol steps, and other means of support as needed along the way. This bill passed the House, but ultimately died in the Senate as it did not have the support needed in the Senate to bring it to a vote on the floor. For more information on this bill or WSLC’s 2024 legislative agenda you may read here.

SB 5778HB 1940 – Protecting the rights of workers to refrain from attending meetings or listening to their employer's speech on political or religious matters. It is also known as “Employee Free Choice Act.” — PASSED

This bill, also part of the WSLC legislative agenda, prohibits an employer from taking adverse action against an employee for refusal to attend or participate in an employer-sponsored meeting or refusal to listen to speech, the primary purpose of which is to communicate the employer's opinion concerning religious or political matters. WSNA did support this bill. It passed both the House and Senate and was signed into law.