June 30, as scheduled.

The intent of the legislation in 2015 was to give Washington physical therapists an opportunity to develop supervisors who were qualified to sign the attestations for the endorsement requirements. In 2015 when the legislation allowing manipulation passed, it was understood as part of an agreement that the out-of-state supervision component of the legislation would expire June 30, 2020. The agreement included four specific components of training. Only the supervision component is required to be accomplished in Washington State after the expiration. The physical therapy profession in Washington now has an adequate number of supervisors to meet the terms of the legislation (less than 300 endorsements of a possible 7000). Less than 5 percent have chosen to seek the spinal manipulation endorsement. There is no shortage of access to providers that perform spinal manipulation in Washington. Healthcare profession scopes of practice vary from state to state. Even chiropractic has different scopes of practice throughout the country—and Washington State is the most restrictive. Physical therapists practicing in Washington, whether from out-of-state or not, are still able to practice physical therapy without a spinal manipulation endorsement. This expiration does not stop physical therapists from participating in the compact, or from performing spinal manipulation – it simply requires the out-of-state physical therapist to perform spinal manipulation under the supervision of a Washington state supervisor until they quality for the endorsement, if they choose.

HB 2702 Introduced Allowing Chiropractors to Deliver Care to Adult Medicaid Patients Chiropractors are eligible Medicaid providers, but are limited to Apple Health for children (age 20 and younger). Washington Apple Health is the public health insurance program for eligible Washington residents. Washington Apple Health is also the name used in Washington State for Medicaid, the children’s health insurance program (CHIP), and state-only funded healthcare programs. Washington Apple Health is administered by the Washington State Health Care Authority.

In accordance with WAC 182-531-1050, Manipulative Therapy and evaluation and management (E&M) services are covered services for adult Medicaid recipients, but only when provided by an osteopathic physician licensed under chapter 18.57 RCW or a naturopathic physician licensed under chapter 18.36A RCW, and then only when it meets the criteria prescribed in the rule. Adult Medicaid covers ten manipulations per client, per calendar year. Rehabilitation services are not covered by naturopaths or osteopaths. Our proposal includes the following language in RCW 74.09:

Effective January 1, 2021, the authority shall require provider payment for manipulative therapy and associated evaluation and management services provided to enrollees by a chiropractor licensed under chapter 18.25 RCW to the same extent and under the same conditions that payment is available for osteopathic physicians licensed under chapter 18.57 and naturopaths licensed under chapter 18.36A RCW.

The biggest challenge to this legislation is that it will cost the state an additional $17 million dollars. Even with some cost offsets included in the number modeling, we have a hurdle to get over to convince legislators that this is a high priority when making their spending decisions.

Along with these four major bills, there is legislation (HB 2378) that combines the physician assistant (PA) statute with the osteopathic assistant statute to create one physician assistant title. However, in their effort to combine the laws they created language that would allow the PA to manipulate the spine when they were working under an osteopathic supervisor. The WSCA opposed that language and sought an amendment, which was accepted by the sponsor of the bill. The legislation is scheduled to be amended and moved out of committee while this issue of Plexus is being printed.

As you can see we are following our legislative agenda announced last fall and will work to support the growth of the chiropractic profession at every opportunity.

OTHER BILLS BEING TRACKED INCLUDE:

SHB 1082 Concerning the licensure and certification of massage therapists and reflexologists.

HB 1552 Concerning healthcare provider credentialing by health carriers. Prohibits a health carrier from requiring a healthcare provider to submit credentialing information in a format other than through the database selected under RCW 48.165.035. Decreases the amount of time in which a health carrier must make a determination approving or denying a credentialing application from a health care provider. Requires a health carrier that credentials a healthcare provider in its network to reimburse the healthcare provider for covered healthcare services provided to the carrier’s enrollees during the credentialing process.

HB 2294 Expanding the scope of assault in the third degree to include all healthcare providers.

HB 2457 Establishing the healthcare cost transparency board.

HB 2554 (SB 6400) Mitigating inequity in the health insurance market caused by health plans that exclude certain mandated benefits.

HB 2568 (SB 6404) Adopting prior authorization and appropriate use criteria in patient care.

HB 2577 (SB 6408) Adopting prior authorization and appropriate use criteria in patient care.

HB 2582 Concerning taxation of independent healthcare providers.

HB 2615 (SB 6413) Establishing the primary care collaborative.

HB 2616 (SB 6397) Concerning nonparticipating providers.

HB 2677 (SB 6395) Sharing health insurance information to improve the coordination of benefits between health insurers and the healthcare authority.

HB 2689 (SB 6440) Concerning industrial insurance medical examinations.

HB 2786 Establishing the opioid epidemic response advisory council

SSB 5097 Concerning the licensure and certification of massage therapists and reflexologists. Requires a licensed massage therapist or a certified reflexologist to have government-issued photo identification on his or her person or have it available for inspection by city, county, or state law enforcement or department of health personnel at all times he or she practices massage therapy or reflexology; and requires the photo identification to match the name on the massage therapy license or reflexology certification.

SB 5319 Requires a Medicaid payment for primary care services furnished by a nurse practitioner, a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine or provided by subspecialists within these primary specialties, on a fee-for-service basis as well as through managed healthcare systems, to be at a rate not less than one hundred percent of the payment rate that applies to those services and providers under Medicare.

SB 6055 Exempting healthcare and veterinary services from the business and occupation surcharge.

SB 6059 Exempting healthcare-related services from the business and occupation surcharge.

SB 6061 Requiring training standards in providing telemedicine services.

SB 6062 Non-insurance related primary care services

SB 6554 Exempting dietary supplements from sales and use tax.

• HB means House Bill-House bills start at number 1000 • SB means Senate Bill-Senate bills start at number 5000 • SSB means Substitute Senate Bill (amended in committee)

• E means Engrossed (amended on the floor of a chamber)

• a number prior to the E means the number of times a bill was amended on the floor of a chamber

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