The 2017 Legislative Session and Tricare Humana Contract

Spring 2017: Volume 73, Number 1

Director of Professional Affairs Report 2
The 2017 Legislative Session
& Tricare Humana contract

Lucy Homans, Ed.D.

The 2017 Legislative session will end (we hope) on April 23rd and the “opposite House” cutoff date is Wednesday, April 12th, meaning that all bills, excluding budget related bills, must have been passed by the second house by the end of the day. So now is a good moment to see which bills that WSPA has supported are still “alive” and hopefully headed to the Governor’s office for his signature into law.

As you all know by now, SB 5800, the duty to warn bill died in the House Judiciary committee having passed the Senate. However, WSPA is supporting a joint effort with all state provider associations to include a proviso in the 2017-19 budget (yet to be passed) to fund an analysis of the existing duty to warn/duty to protect requirements in Washington State (because now we have two distinct requirements – see the article by Stephen Feldman, JD, PhD), including financial impacts, impact on and implications for clinical practice, and an analysis of similar laws in other states. This study would occur between the end of the 2017 Session and the end of this year, with the intent of reintroducing legislation in 2018.

HB 1043 which will address protection of privacy of personal health information kept in the Office of the Insurance Commissioner is on the calendar for a vote by the Senate. So, cross fingers that by the time you are reading this it will be awaiting the governor’s signature.

HB 1340 which will update all chemical dependency language in all state laws to “substance use disorder” language, will remove all reference to the goal of treatment being abstinence, and will allow substance use disorder treatment providers to be reimbursed for services in both outpatient and inpatient settings is also in Senate Rules but not quite as far along as 1043. With only 48 hours left, this is of concern. This is an excellent bill.

HB 1713, the children’s mental health bill is waiting for a Senate floor vote, too.

SB 5436 the telemedicine bill allowing patients who receive services via telehealth services is waiting for the Governor’s signature! SB 5457, which would require parity for telehealth service reimbursements with in person services, is being held over until 2018.

Of course the big issue before the Legislature is K-12 funding to meet the terms of the McCleary state Supreme Court decision. Having avoided this matter for several years, the Legislature now has it’s proverbial back against the wall and must pass a budget that actually pays for public education. Stay tuned on this one.

WSPA members who are members of the Tricare provider panel probably know that at the end of February notice was publicized that as of later this year, MHN (a behavioral health subsidiary of Health Net) will take over the 3rd party administration of the Tricare program. MHN celebrated the acquisition of this contract by reducing mental health provider reimbursements upwards of 30%. They are such party animals.

Fortunately, I was notified of this matter while attending the Practice Leadership Conference. The WSPA member who contacted me manages a group practice located near more than one of our many Department of Defense bases, and who has treated hundreds of military families. Only Congress can address problems in the Tricare program. So, while we were on Capitol Hill lobbying our delegations we were able to notify senior health policy staff in both this WSPA member’s Congressional district and in Senator Patty Murray’s office of the MHN decision. Senator Murray sits on a veterans affairs committee in the Senate and has helped WSPA members in the past with Tricare messes.

Subsequently, we have heard from Directors of Professional Affairs and Executive Directors around the country that the reimbursement reduction is system wide. The WSPA psychologist had contacted MHN to see if he could negotiate a higher reimbursement rate for his group practice and was initially turned down (just FYI, it took him quite a while to just reach MHN staff by phone…).

However, as a result of our member’s willingness to work with the Washington State Congressional and Senate staff and as a result of the national uproar over the reimbursement reduction proposed by MHN, our colleague has been able to negotiate a higher reimbursement rate for his group. We also hear that MHN has nationally agreed to keep the rate at the current level. Had this not occurred, hundreds of military families would not have been able to access mental health services throughout most of Washington State.

So, what do we learn from this debacle & recovery? I would suggest that first; we learn that WSPA can act significantly and successfully on behalf of our members and your clients. Second, we learn that if you do not contact your trusty DPA, we cannot help you. Third, know that we owe a big debt to our fellow member who took the time to contact his Congressperson and Senator, get to the health policy staff person and who is both stubborn and persistent. My graduate school dissertation advisor once told me these are the two qualities that correlate most with finishing a doctorate. I value both and thank our colleague for all of his hard work.

So, need I repeat the mantra? I’d rather just leave you with my email address: Thank you!