Overview

The Legislature reconvened in Olympia this January for the first “short” 60-day legislative session since the pandemic. Despite the quick timeline, the Legislature tackled a wide range of topics including housing supply and affordability, behavioral health accessibility, artificial intelligence, clean energy, and significant cost overruns for several transportation projects across the state. More than 1,100 new bills were introduced this year and over 1,000 eligible bills from 2023 carried over to this session. Supplemental budget proposals were also considered.
While Democrats continued to maintain control of the House and Senate by comfortable margins, many representatives and senators had their sights set on the 2024 election as they considered which bills to advance this session. A total of 379 bills passed the legislature during the 2024 session. For comparison, the average number of bills passed in a 60-day session is about 315.

Here are some areas of focus the legislature worked on this session that has potential impact on PAs:

  1. Behavioral Health
    Both chambers continued their work to make improvements to the State’s behavioral health system and build capacity for services. Legislation passed this year will: improve the 988 system; extend the 23-hour Behavioral Health Crisis Facility model to provide crisis services for youth; require health plans to authorize at least 14 days of inpatient treatment and then at least seven days after the next insurance review; and develop regionalized coordinated behavioral health crisis response plans across the state. All this legislation passed with strong bipartisan support. Additionally, the legislature created a temporary supportive-housing option to address young adults exiting inpatient mental health treatment. On the budget side, $245M was allocated in the supplemental budget for behavioral health capacity, rate increases, and outpatient and personal care programs. Substance use disorder and the rise of fentanyl use received bipartisan focus this year. The supplemental budget invests in access to treatment, education, awareness, outreach and prevention with $215M in additional funding. The Legislature also invested in capital projects, putting $82.7M in behavioral health community capacity grants to build behavioral health care facilities across Washington. Funds for Tribal behavioral health centers are also expanded for new projects being developed with Tribes and the federal government.
  2. Firearm Safety
    Substantial gun violence prevention policies have passed each of the past few sessions and 2024 was anticipated to be a relatively modest year for gun violence prevention efforts. Ultimately, the Legislature passed four bills on the topic, including a bill establishing a civil infraction for the failure to report a firearm as lost or stolen and a bill granting the WA State Patrol the authority to destroy crime guns and guns acquired through buy-back programs. The State also expanded the “sensitive places” where the open carry of firearms is prohibited to include zoos, aquariums, libraries and transit centers. Finally, the state passed a bill to create a robust code of conduct for licensed gun dealers.
  3. Healthcare
    Healthcare affordability, workforce shortages, and access to care were some of the key areas that lawmakers focused on this session. The Legislature supported the healthcare workforce by authorizing compacts for Social Workers and Physician Assistants, licensing a new profession of Anesthesiologist Assistants, and providing a certification pathway for Magnetic Resonance Imaging (MRI) Technologists. The state also considered many so-called “scope of practice” bills, ultimately only passing an expansion of scope for Physician Assistants, while scope expansions for Psychologists and Pharmacists were unsuccessful. Efforts to increase Medicaid rates for various providers were unsuccessful this year and are anticipated to return. The state also made advancements in telehealth, passing one bill that creates a uniform standard for creating an “established relationship” for the purposes of coverage for audio-only telemedicine services and another which allows out of state providers to provide telehealth services in Washington in certain circumstances. Some other areas of focus this session include Climate/Environment & Energy, Housing, Artificial Intelligence, Business & Employment, and Transportation. With the session now being over, focus of legislators across the state are shifting their focus to the 2024 elections. There are many lawmakers who will not return to the legislature and many more seeking other statewide offices. We also have four statewide seats open, including for Governor, Attorney General, Commissioner of Public Lands, and Insurance Commissioner.

More directly, the following are specific bills that had impact on PA practice in Washington:

Bill Highlights

Physician Assistant Collaborative Practice (PASSED): HB 2041, sponsored by Rep. Marcus Riccelli (D-Spokane) establishes PA collaborative practice for experienced PAs and makes the changes listed below. HB 2041 passed the House with a vote of 91-6 with Representatives Abbarno, Caldier, Dye, McEntire, Orcutt, and Walsh voting no. The bill passed the Senate unanimously. The Governor signed the bill on 3/13 with many WAPA representatives present. Proponents of the bill included WA Academy of Physician Assistants, Docs Who Care, ZoomCare, Providence, and others.

The bill was heavily negotiated with WSMAand the WA State Association for Justice and reflects a step forward for PAs in Washington. Most provisions of the bill take effect January 1, 2025. Section 9 takes effect June 6, 2024; Sections 19 and 27, which are contingent; and section 29, take effect July 1, 2026. The WA Medical Commission and WAPA will soon share information about how the bill will be implemented and what to expect.

  • The bill replaces the supervision model for experienced PAs with a collaboration model. In this model, PAs can interact with, consult with, or refer to a physician or other appropriate members of the health care team as indicated by the patient’s condition, the education, experience, and competencies of the physician assistant, and the standard of care. The bill authorizes collaborative practice for PAs who have over 4,000 hours of post-graduate clinical experience and 2,000 hours of specialty experience. PAs are supervised until that point.
  • A PA’s scope of practice mirrors their participating physician’s or the group of physicians that the PA is working with in that specialty area(s) or department. PAs who have 10 years or 20,000 hours of specialty experience can work outside the scope of their participating physician(s) if they continue to obtain CME in that specialty and they are working in a medically underserved or rural area. This expanded scope must be described in a collaboration agreement.
  • PAs will enter into collaboration agreements, which can be signed by a participating physician or the PA employer (such as a medical director). The agreement is kept at the practice site and doesn’t need to be sent to the WA Medical Commission unless requested.
  • The bill removes the physician to PA ratio. Employers can staff their teams as they deem appropriate, and physicians can collaborate with as many PAs as they would like.
  • The bill authorizes direct pay for PA-provided care. This is especially helpful for PAs who don’t have an employment relationship with their participating physician or when a PA needs to reassign their payments. The bill does not affect PA reimbursement rates.
  • The bill makes PAs legally responsible for their medical decisions. The bill removed physician liability for care provided by PAs. This addresses one of the main reasons we hear physicians are not opting to hire and work with PAs.

Physician Assistant Licensure Compact (PASSED): HB 1917 & SB 5815, sponsored by Rep. Mari Leavitt (D-University Place) and Sen. Ron Muzzall (R-Oak Harbor), establishes a Physician Assistant compact, easing the licensure process for PAs who move to other states or wish to practice in multiple states. HB 1917 passed the House and Senate unanimously and was signed by the Governor on 3/13. Proponents included WA Academy of Physician Assistants, Veterans Legislative Coalition, Association of WA Business, Department of Defense, and Council of State Governments. **Reimbursement Parity for PAs, ARNPs & Physicians (DIED):** SB 5373 & HB 1495 would require equal reimbursement for advanced registered nurse practitioners, physician assistants, and physicians. Before the 2024 legislative session started, this policy had more momentum than in prior sessions. However, several factors, including opposition from the Washington State Medical Association, prevented the bill from advancing. The Washington Academy of PAs and the ARNPs United of Washington plan to continue to support the policy in 2025.

Increasing the Licensure Fees that Support the Washington Physicians Health Program (PASSED): HB 1972 & SB 5822 raises surcharge fees for the Washington Physician Health Program (WPHP) for physicians, osteopathic physicians, podiatric physicians, dentists, and physician assistants from $50 to $70. The WPHP provides confidential and therapeutic services to many health care practitioners in the state of Washington. The WPHP requested legislative authorization to increase the surcharge to keep up with programmatic costs.

Preserving Coverage of Preventive Services without Cost Sharing (PASSED): HB 1957 modifies the requirement for health carriers to cover the same preventive services without cost sharing as required by federal law (Affordable Care Act) and Authorizes the Insurance Commissioner to adopt rules related to any future preventive services recommendations or guidelines. The bill applies to non-grandfathered health plans issued or renewed on or after 90 days following the end of 2024 session.

Harmonizing Language Relating to Reproductive Health Care Services and Gender-Affirming Treatment (PASSED): HB 1954 protects providers who make referrals, assist, or recommend care for reproductive health care services and gender-affirming treatment from professional discipline under the Uniform Disciplinary Act for providing this type of care.

Audio-only Telemedicine Services (PASSED): HB 1881 & SB 5821 changes the definition of “established relationship” for the purposes of audio-only telemedicine coverage to create a single definition for all services. An established relationship means the provider has access to sufficient health records to ensure safe, effective, and appropriate care services and: (1) the covered person has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system as the provider providing audio-only telemedicine; or (2) the covered person was referred to the provider providing audio-only telemedicine by another provider who has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine.

ULC Telehealth Act (PASSED): SB 5481 is a carryover bill from 2023 and creates a pathway to telehealth practice that aims to help address the provider shortage in the state. The bill allows for an out of state provider to provide telehealth services in WA, allows a provider to establish a patient relationship via telehealth and directs the Telemedicine Collaborative to review proposals to allow out of state telehealth providers to serve patients in this state. The bill was signed by the Governor on March 19, 2024, and will take effect June 6, 2024.

The following are bills that failed to pass this session, with some that are likely to return next session:

Medicaid Reimbursement Rates (DIED): HB 2476 & SB 6309 increases Medicaid reimbursement rates to Medicare levels through a covered lives assessment.

Affordability & Provider Contracting (DIED): HB 2066 & SB 5948 prohibits the use of some contractual provisions often used by providers, hospitals, health systems, and carriers.

Concerning Provider Contract Compensation (DIED): HB 1655 requires increases in provider compensation commensurate with increases in the consumer price index for contracts between a health carrier and a health care provider who is not employed or affiliated with a hospital.

Concerning Provider Contract Compensation (DIED): SB 6161 requires contracts between a health carrier and a provider to include an increase from the previous year based on the Consumer Price Index.

Concerning Licensure of Anesthesiologist Assistants (PASSED): SB 5184 establishes anesthesiologist assistants as a new health profession licensed by the WA Medical Commission who must practice medicine under the supervision of an anesthesiologist or group of anesthesiologists approved by the Washington Medical Commission. The bill was brought forward by the Washington Academy of Anesthesiologist Assistants and the Washington State Society of Anesthesiologists. The Washington Association of Nurse Anesthetists strongly opposed the legislation.

Prescriptive Authority for Pharmacists (DIED): HB 2116 & SB 6019 authorizes and requires the Pharmacy Quality Assurance Commission to adopt rules identifying the drugs and devices that a pharmacist may prescribe. HB 2116 was heard in the Health Care & Wellness Committee, but the bill sponsor noted this bill was intended to start a conversation about prescriptive authority.

Concerning Wellness Programs for Certain Health Care Professionals (DIED): HB 2122 & SB 6165 was brought forward by WSMA to improve employer sponsored wellness programs aimed at addressing issues like fatigue and burnout that have not risen to the level of substance abuse necessitating involvement in the Washington Physician Health Program. The bill ensures confidentiality for these programs to encourage providers to use them and address workforce challenges before they become more serious. HB 2122 passed out of the policy committee but did not pass the House. There were some concerns raised by trial attorneys and the bill may return next session with revisions.

Hospital Mergers & Acquisitions (DIED): SB 5241 & HB 1263 is intended to restrict and provide AG oversight and approval of potential mergers and acquisitions of hospitals following the acquisition of secular health care systems by Catholic-owned hospital systems in Washington State.