5 Things Washington: HCA budget “asks,” Universal Care Work Group, Sen. Lisa Murkowski

Registration is now open for the 2020 Washington State of Reform Health Policy Conference, a mere 12 weeks away. That seems like a long ways away – unless you’re part of the team working to line up over 110 speakers in a 6 week period! We’ll have the Topical Agenda out to you soon for your review. But, before then, if you have ideas for sessions, topics, or speakers, now is a good time to send those my way to see if we might get your perspective in the mix!



With help from Emily Boerger


1.  Q&A: Getting inter-operability in “Cures” to work

We recently covered two interesting happenings in data on the national level – the Blue Button 2.0 initiative and the 21st Century Cures Act. This week, we bring you a Q&A with Colt Courtright, Director of Corporate Data & Analytics at Premera Blue Cross, for an expansive dive into the details of an HHS proposed rule on inter-operability, and some of the challenges and innovations surrounding the topic.

From Courtright: “We will need a live system: payer to payer, payer to provider, payer to member, payer to third-party app. But no one has actually done it, so we all have more to learn and there’s still a lot of work to be done.”


2. Reviewing HCA budget “asks”

The Office of Financial Management has made available the state agency “Decision Packages” submitted for consideration in the 2020 supplemental budget. These packages are a set of “asks” made by agencies to the governor, who will release his final supplemental budget decisions in December.

In a letter to OFM, the Health Care Authority provides an overview of the “26 maintenance-level and 17 performance level initiatives” in their proposal. We review a number of the notable requests here. Top budget requests relate to behavioral health supports, PEBB/SEBB, and savings restoration.

3. Universal care work group meeting

Members of the Universal Health Care Work Group – established in 2019 through HB 1109 – held their first meeting at the end of September. The group weighed potential frameworks for reaching universal coverage, looked at other states’ reform efforts, and discussed potential strategies to increase the insured rate in the state.

Strategies include: insurance mandates, state-funded subsidies to lower cost of coverage in the individual market, and extending Medicaid coverage to presently ineligible groups such as undocumented immigrants. Reporter Michael Goldberg has a rundown of the meeting here.

4. Video: Murkowski talks impeachment

While we focus this newsletter on Washington State health policy, sometimes news from other states stands out. Since Alaska Senator Lisa Murkowski is sometimes viewed as “the Republican Senator from Washington,” and because of her central vote in the ACA repeal debate, I thought I’d flag notable commentary.

Last week, Senator Murkowski joined State of Reform in Anchorage to talk through her work on health care, her vote on the repeal of the ACA, and her thoughts on the impeachment process that has newly unfolded in the nation’s capital. They are worth watching, as they were some of the first comments on impeachment made by a sitting US senator in a public forum.

“I’m also trying to think to myself ‘If this set of facts were to be in front of me, and the president were President Hillary Clinton instead of President Donald Trump, would I be viewing this in a different way?’  Because if I do, that’s wrong. I shouldn’t view what is right and what is wrong based on the political affiliation of the individual that we are considering.”


5. Stark, anti-kickback rules released by CMS

Yesterday, CMS released two draft rules to update the Stark Law and Anti-Kickback Statute (AKS). I’ll be honest: I haven’t finished the over 700 pages yet – but, thankfully, Matt Lund from UW sent me the American Health Lawyers Association breakdown late last night. AHLA says the Stark rule includes a possible requirement to include cost-of-care information “at the point of referral.” That would create a major paradigm shift, where providers would now become mutually accountable to one another on pricing, not just to patients, if they want to receive referrals from one another.

AHLA says the AKS rule would create important new safe harbors, including contracts “aimed at improving quality and outcomes” and value based contracts with “substantial downside” or full financial risk. Importantly, it also aligns with CMS by saying any future payment model endorsed by CMS is automatically exempt.