title: RCW 74.09.871

text:
(1) Any agreement or contract by the authority to provide behavioral health services as defined under RCW 71.24.025 to persons eligible for benefits under medicaid, Title XIX of the social security act, and to persons not eligible for medicaid must include the following:
(a) Contractual provisions consistent with the intent expressed in RCW 71.24.015 and 71.36.005;
(b) Standards regarding the quality of services to be provided, including increased use of evidence-based, research-based, and promising practices, as defined in RCW 71.24.025;
(c) Accountability for the client outcomes established in RCW 71.24.435, 70.320.020, and 71.36.025 and performance measures linked to those outcomes;
(d) Standards requiring behavioral health administrative services organizations and managed care organizations to maintain a network of appropriate providers that is supported by written agreements sufficient to provide adequate access to all services covered under the contract with the authority and to protect essential behavioral health system infrastructure and capacity, including a continuum of substance use disorder services;
(e) Provisions to require that medically necessary substance use disorder and mental health treatment services be available to clients;
(f) Standards requiring the use of behavioral health service provider reimbursement methods that incentivize improved performance with respect to the client outcomes established in RCW 71.24.435 and 71.36.025, integration of behavioral health and primary care services at the clinical level, and improved care coordination for individuals with complex care needs;
(g) Standards related to the financial integrity of the contracting entity. This subsection does not limit the authority of the authority to take action under a contract upon finding that a contracting entity's financial status jeopardizes the contracting entity's ability to meet its contractual obligations;
(h) Mechanisms for monitoring performance under the contract and remedies for failure to substantially comply with the requirements of the contract including, but not limited to, financial deductions, termination of the contract, receivership, reprocurement of the contract, and injunctive remedies;
(i) Provisions to maintain the decision-making independence of designated crisis responders; and
(j) Provisions stating that public funds appropriated by the legislature may not be used to promote or deter, encourage, or discourage employees from exercising their rights under Title 29, chapter 7, subchapter II, United States Code or chapter 41.56 RCW.
(2) At least six months prior to releasing a medicaid integrated managed care procurement, but no later than January 1, 2025, the authority shall adopt statewide network adequacy standards that are assessed on a regional basis for the behavioral health provider networks maintained by managed care organizations pursuant to subsection (1)(d) of this section. The standards shall require a network that ensures access to appropriate and timely behavioral health services for the enrollees of the managed care organization who live within the regional service area. At a minimum, these standards must address each behavioral health services type covered by the medicaid integrated managed care contract. This includes, but is not limited to: Outpatient, inpatient, and residential levels of care for adults and youth with a mental health disorder; outpatient, inpatient, and residential levels of care for adults and youth with a substance use disorder; crisis and stabilization services; providers of medication for opioid use disorders; specialty care; other facility-based services; and other providers as determined by the authority through this process. The authority shall apply the standards regionally and shall incorporate behavioral health system needs and considerations as follows:
(a) Include a process for an annual review of the network adequacy standards;
(b) Provide for participation from counties and behavioral health providers in both initial development and subsequent updates;
(c) Account for the regional service area's population; prevalence of behavioral health conditions; types of minimum behavioral health services and service capacity offered by providers in the regional service area; number and geographic proximity of providers in the regional service area; an assessment of the needs or gaps in the region; and availability of culturally specific services and providers in the regional service area to address the needs of communities that experience cultural barriers to health care including but not limited to communities of color and the LGBTQ+ community;
(d) Include a structure for monitoring compliance with provider network standards and timely access to the services;
(e) Consider how statewide services, such as residential treatment facilities, are utilized cross-regionally; and
(f) Consider how the standards would impact requirements for behavioral health administrative service organizations.
(3) Before releasing a medicaid integrated managed care procurement, the authority shall identify options that minimize provider administrative burden, including the potential to limit the number of managed care organizations that operate in a regional service area.
(4) The following factors must be given significant weight in any medicaid integrated managed care procurement process under this section:
(a) Demonstrated commitment and experience in serving low-income populations;
(b) Demonstrated commitment and experience serving persons who have mental illness, substance use disorders, or co-occurring disorders;
(c) Demonstrated commitment to and experience with partnerships with county and municipal criminal justice systems, housing services, and other critical support services necessary to achieve the outcomes established in RCW 71.24.435, 70.320.020, and 71.36.025;
(d) The ability to provide for the crisis service needs of medicaid enrollees, consistent with the degree to which such services are funded;
(e) Recognition that meeting enrollees' physical and behavioral health care needs is a shared responsibility of contracted behavioral health administrative services organizations, managed care organizations, service providers, the state, and communities;
(f) Consideration of past and current performance and participation in other state or federal behavioral health programs as a contractor;
(g) The ability to meet requirements established by the authority;
(h) The extent to which a managed care organization's approach to contracting simplifies billing and contracting burdens for community behavioral health provider agencies, which may include but is not limited to a delegation arrangement with a provider network that leverages local, federal, or philanthropic funding to enhance the effectiveness of medicaid-funded integrated care services and promote medicaid clients' access to a system of services that addresses additional social support services and social determinants of health as defined in RCW 43.20.025;
(i) Demonstrated prior national or in-state experience with a full continuum of behavioral health services that are substantially similar to the behavioral health services covered under the Washington medicaid state plan, including evidence through past and current data on performance, quality, and outcomes;
(j) Demonstrated commitment by managed care organizations to the use of alternative pricing and payment structures between a managed care organization and its behavioral health services providers, including provider networks described in subsection (b) of this section, and between a managed care organization and a behavioral administrative service organization, in any of their agreements or contracts under this section, which may include but are not limited to:
(i) Value-based purchasing efforts consistent with the authority's value-based purchasing strategy, such as capitated payment arrangements, comprehensive population-based payment arrangements, or case rate arrangements; or
(ii) Payment methods that secure a sufficient amount of ready and available capacity for levels of care that require staffing 24 hours per day, 365 days per year, to serve anyone in the regional service area with a demonstrated need for the service at all times, regardless of fluctuating utilization; and
(k) The accessibility of peer services, as demonstrated in the application through a required comprehensive analysis of access to peer services in the managed care organization's network. The analysis must evaluate the availability of certified peer counselors and peer support specialists certified under chapter 18.420 RCW who are:
(i) Adults in recovery from a mental health condition;
(ii) Adults in recovery from a substance use disorder;
(iii) Youth and young adults in recovery from a mental condition;
(iv) Youth and young adults in recovery from a substance use disorder; and
(v) The parent or legal guardian of a youth who is receiving or has received behavioral health services.
(5) The authority may use existing cross-system outcome data such as the outcomes and related measures under subsection (4)(c) of this section and chapter 338, Laws of 2013, to determine that the alternative pricing and payment structures referenced in subsection (4)(j) of this section have advanced community behavioral health system outcomes more effectively than a fee-for-service model may have been expected to deliver.
(6)(a) The authority shall urge managed care organizations to establish, continue, or expand delegation arrangements with a provider network that exists on July 23, 2023, and that leverages local, federal, or philanthropic funding to enhance the effectiveness of medicaid-funded integrated care services and promote medicaid clients' access to a system of services that addresses additional social support services and social determinants of health as defined in RCW 43.20.025. Such delegation arrangements must meet the requirements of the integrated managed care contract and the national committee for quality assurance accreditation standards.
(b) The authority shall recognize and support, and may not limit or restrict, a delegation arrangement that a managed care organization and a provider network described in (a) of this subsection have agreed upon, provided such arrangement meets the requirements of the integrated managed care contract and the national committee for quality assurance accreditation standards. The authority may periodically review such arrangements for effectiveness according to the requirements of the integrated managed care contract and the national committee for quality assurance accreditation standards.
(c) Managed care organizations and the authority may evaluate whether to establish or support future delegation arrangements with any additional provider networks that may be created after July 23, 2023, based on the requirements of the integrated managed care contract and the national committee for quality assurance accreditation standards.
(7) The authority shall expand the types of behavioral health crisis services that can be funded with medicaid to the maximum extent allowable under federal law, including seeking approval from the centers for medicare and medicaid services for amendments to the medicaid state plan or medicaid state directed payments that support the 24 hours per day, 365 days per year capacity of the crisis delivery system when necessary to achieve this expansion.
(8) The authority shall, in consultation with managed care organizations, review reports and recommendations of the involuntary treatment act work group established pursuant to section 103, chapter 302, Laws of 2020 and develop a plan for adding contract provisions that increase managed care organizations' accountability when their enrollees require long-term involuntary inpatient behavioral health treatment and shall explore opportunities to maximize medicaid funding as appropriate.
(9) In recognition of the value of community input and consistent with past procurement practices, the authority shall include county and behavioral health provider representatives in the development of any medicaid integrated managed care procurement process. This shall include, at a minimum, two representatives identified by the association of county human services and two representatives identified by the Washington council for behavioral health to participate in the review and development of procurement documents.
(10) For purposes of purchasing behavioral health services and medical care services for persons eligible for benefits under medicaid, Title XIX of the social security act and for persons not eligible for medicaid, the authority must use regional service areas. The regional service areas must be established by the authority as provided in RCW 74.09.870.
(11) Consideration must be given to using multiple-biennia contracting periods.
(12) Each behavioral health administrative services organization operating pursuant to a contract issued under this section shall serve clients within its regional service area who meet the authority's eligibility criteria for mental health and substance use disorder services within available resources.
[ 2025 c 360 s 1; 2023 c 292 s 2; 2019 c 325 s 4006; 2018 c 201 s 2007; 2014 c 225 s 3. Formerly RCW 43.20A.894.]
Notes:
Findings—Intent—2023 c 292: "(1) The legislature finds that:
(a) Medicaid enrollees in Washington are challenged with accessing needed behavioral health care. According to the Washington state department of social and health services, as of 2021, among medicaid enrollees with an identified mental health need, only 50 percent of adults and 66 percent of youth received treatment, while among medicaid enrollees with an identified substance use disorder need, only 37 percent of adults and 23 percent of youth received treatment. Furthermore, the national council for mental wellbeing's 2022 access to care survey found that 43 percent of adults in the United States who say they need mental health or substance use care did not receive that care, and they face numerous barriers to receiving needed treatment. Lack of necessary care can cause behavioral health conditions to deteriorate and crises to escalate, driving increasing use of intensive services such as inpatient care and involuntary treatment. As a result, the behavioral health system is reaching a crisis point in communities across the state.
(b) As of December 2022, 1,953,153 Washington residents rely on apple health managed care organizations to provide for their physical and behavioral health needs. During the integration of physical and behavioral health care pursuant to chapter 225, Laws of 2014, the health care authority most recently procured managed care services in 2018 and selected five managed care organizations to serve as Washington's apple health plans to provide for the physical and behavioral health care needs of medicaid enrollees. The health care authority has begun considering when to conduct a new procurement for managed care organizations, including an allowance for possible new entrants that do not currently serve Washington's medicaid population.
(c) Medicaid managed care procurement presents a need and an opportunity for the state to reset expectations for managed care organizations related to behavioral health services to ensure that Washington residents are being served by qualified and experienced health plans that can deliver on the access to care and quality of care that residents need and deserve. (2) It is the intent of the legislature to seize this opportunity to address ongoing challenges Washington's medicaid enrollees face in accessing behavioral health care. The legislature intends to establish robust new standards defining the levels of medicaid-funded behavioral health service capacity and resources that are adequate to meet medicaid enrollees' treatment needs; to ensure that managed care organizations that serve Washington's medicaid enrollees have a track record of success in delivering a broad range of behavioral health care services to safety net populations; and to advance payment structures and provider network delivery models that improve equitable access, promote integration of care, and deliver on outcomes.
(3) The legislature finds that increased access to behavioral health services for American Indians and Alaska Natives, children in foster care, and the aged, blind, and disabled through the preservation and enhancement of the fee-for-service system is also critical to reducing health disparities among these vulnerable populations. The legislature also intends to increase access to timely and robust behavioral health services for American Indians and Alaska Natives, children in foster care, and the aged, blind, and disabled, in the fee-for-service system they access." [ 2023 c 292 s 1.]
Effective date—2019 c 325: See note following RCW 71.24.011.
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.

catchline: Behavioral health services—Contracting process.


doc_type: statute

jurisdiction: wa

title: RCW 74.09.875

text:
(1) In the provision of reproductive health care services through programs under this chapter, the authority, managed care plans, and providers that administer or deliver such services may not discriminate in the delivery of a service provided through a program of the authority based on the covered person's gender identity or expression.
(2) The authority and any managed care plans delivering or administering services purchased or contracted for by the authority, may not issue automatic initial denials of coverage for reproductive health care services that are ordinarily or exclusively available to individuals of one gender, based on the fact that the individual's gender assigned at birth, gender identity, or gender otherwise recorded in one or more government-issued documents, is different from the one to which such health services are ordinarily or exclusively available.
(3) Denials as described in subsection (2) of this section are prohibited discrimination under chapter 49.60 RCW.
(4) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
(a) "Gender expression" means a person's gender-related appearance and behavior, whether or not stereotypically associated with the person's gender assigned at birth.
(b) "Gender identity" means a person's internal sense of the person's own gender, regardless of the person's gender assigned at birth.
(c) "Reproductive health care services" means any medical services or treatments, including pharmaceutical and preventive care service or treatments, directly involved in the reproductive system and its processes, functions, and organs involved in reproduction, in all stages of life. Reproductive health care services does not include infertility treatment.
(d) "Reproductive system" includes, but is not limited to: Genitals, gonads, the uterus, ovaries, fallopian tubes, and breasts.
(5) This section must not be construed to authorize discrimination on the basis of a covered person's gender identity or expression in the administration of any other medical assistance programs administered by the authority.
[ 2019 c 399 s 2.]
Notes:
Effective dates—2019 c 399 ss 2 and 3: "(1) Section 2 of this act takes effect January 1, 2020.
(2) Section 3 of this act takes effect January 1, 2021." [ 2019 c 399 s 9.]
Findings—2019 c 399: "The legislature finds and declares:
(1) It is the public policy of this state to provide the maximum access to reproductive health care and reproductive health care coverage for all people in Washington state.
(2) In 2018, the legislature passed Substitute Senate Bill No. 6219. Along with reproductive health care coverage requirements, the bill mandated a literature review of barriers to reproductive health care. As documented by the report submitted to the legislature on January 1, 2019, young people, immigrants, people living in rural communities, transgender and gender nonconforming people, and people of color still face significant barriers to getting the reproductive health care they need.
(3) Washingtonians who are transgender and gender nonconforming have important reproductive health care needs as well. These needs go unmet when, in the process of seeking care, transgender and gender nonconforming people are stigmatized or are denied critical health services because of their gender identity or expression.
(4) The literature review mandated by Substitute Senate Bill No. 6219 found that, "[a]ccording to 2015 U.S. Transgender Survey data, thirty-two percent of transgender respondents in Washington State reported that in the previous year they did not see a doctor when needed because they could not afford it."
(5) Existing state law should be enhanced to ensure greater coverage of and timely access to reproductive health care for the benefit of all Washingtonians, regardless of gender identity or expression.
(6) Because stigma is also a key barrier to access to reproductive health care, all Washingtonians, regardless of gender identity, should be free from discrimination in the provision of health care services, health care plan coverage, and in access to publicly funded health coverage.
(7) All people should have access to robust reproductive health services to maintain and improve their reproductive health." [ 2019 c 399 s 1.]
Short title—2019 c 399: "This act may be known and cited as the reproductive health care access for all act." [ 2019 c 399 s 8.]
Recommendations—Preexposure and postexposure prophylaxis financial support awareness—2019 c 399: See note following RCW 48.43.072.

license: public-domain-government-work

rule_set: Revised Code of Washington

catchline: Reproductive health care services—Prohibited discrimination.

code: rcw

unit: section

court: Washington State Legislature


title: RCW 74.09.880

text:
To improve health outcomes and address health inequities, the authority shall evaluate incentive approaches and recommend funding options to increase the collection of Z codes on individual medicaid claims, in accordance with standard billing guidance and regulations.
[ 2022 c 215 s 5.]
Notes:
Finding—Intent—2022 c 215: See note following RCW 70.320.020.

catchline: Z code collection—Incentives and funding.


title: RCW 74.09.885

text:
The definitions in this section apply throughout RCW 74.09.886 and 74.09.888 unless the context clearly requires otherwise.
(1) "Community support services" means active search and promotion of access to, and choice of, appropriate, safe, and affordable housing and ongoing supports to assure ongoing successful tenancy. The term includes, but is not limited to, services to medical assistance clients who are homeless or at risk of becoming homeless through outreach, engagement, and coordination of services with shelter and housing. The term includes benefits offered through the foundational community supports program established pursuant to the authority's federal waiver, entitled "medicaid transformation project," as amended and reauthorized.
(2) "Community support services provider" means a local entity that contracts with a coordinating entity to provide community support services. A community support services provider may also separately perform the functions of a housing provider.
(3) "Coordinating entity" means one or more organizations, including medicaid managed care organizations, under contract with the authority to coordinate community support services as required under RCW 74.09.886 and 74.09.888. There may only be one coordinating entity per regional service area.
(4) "Department" means the department of commerce.
(5) "Homeless person" has the same meaning as in RCW 43.185C.010.
(6) "Housing provider" means a public or private organization that supplies permanent supportive housing units consistent with RCW 36.70A.030 to meet the housing needs of homeless persons. A housing provider may supply permanent supportive housing in a site-based or scattered site arrangement using a variety of public, private, philanthropic, or tenant-based sources of funds to cover operating costs or rent. A housing provider may also perform the functions of a community support services provider.
(7) "Office" means the office of apple health and homes created in RCW 43.330.181.
(8) "Program" means the apple health and homes program established in RCW 74.09.886.
(9) "Permanent supportive housing" has the same meaning as in RCW 36.70A.030.
[ 2022 c 216 s 2.]
Notes:
Findings—Intent—2022 c 216: "(1) The legislature finds that:
(a) The epidemic of homelessness apparent in communities throughout Washington is creating immense suffering. It is threatening the health of homeless families and individuals, sapping their human potential, eroding public confidence, and undermining the shared values that have driven our state's prosperity, including public safety and access to public streets, parks, and facilities;
(b) In seeking to identify the causes of this epidemic, a large proportion of those unsheltered also suffer from serious behavioral health or physical health conditions that will inevitably grow worse without timely and effective health care;
(c) Housing is an indispensable element of effective health care. Stable housing is a prerequisite to addressing behavioral health needs and lack of housing is a precursor to poor health outcomes;
(d) A home, health care, and wellness are fundamental for Washington residents;
(e) Reducing homelessness is a priority of the people of Washington state and that reducing homelessness through policy alignment and reform lessens fiscal impact to the state and improves the economic vitality of our businesses;
(f) The impact of this epidemic is falling most heavily on those communities that already suffer the most serious health disparities: Black, indigenous, people of color, and historically marginalized and underserved communities. It is a moral imperative to shelter chronically homeless populations; and
(g) Washington state has many of the tools needed to address this challenge, including a network of safety net health and behavioral health care providers in both urban and rural areas, an effective system of health care coverage through apple health, and excellent public and nonprofit affordable housing providers. Yet far too many homeless families and individuals are going without the housing and health care resources they need because these tools have yet to be combined in an effective way across the state.
(2) It is the intent of the legislature to treat chronic homelessness as a medical condition and that the apple health and homes act address the needs of chronically homeless populations by pairing a health care problem with a health care solution." [ 2022 c 216 s 1.]
Short title—2022 c 216: "This act may be known and cited as the apple health and homes act." [ 2022 c 216 s 10.]

catchline: Apple health and homes program—Definitions.


title: RCW 74.09.886

text:
(1) Subject to the availability of amounts appropriated for this specific purpose, the apple health and homes program is established to provide a permanent supportive housing benefit and a community support services benefit through a network of community support services providers for persons assessed with specific health needs and risk factors.
(a) The program shall operate through the collaboration of the department, the authority, the department of social and health services, local governments, the coordinating entity or entities, community support services providers, local housing providers, local health care entities, and community-based organizations in contact with potentially eligible individuals, to assure seamless integration of community support services, stable housing, and health care services.
(b) The entities operating the program shall coordinate resources, technical assistance, and capacity building efforts to help match eligible individuals with community support services, health care, including behavioral health care and long-term care services, and stable housing.
(2) To be eligible for community support services and permanent supportive housing under subsection (3) of this section, a person must:
(a) Be 18 years of age or older;
(b)(i) Be enrolled in a medical assistance program under this chapter and eligible for community support services;
(ii)(A) Have a countable income that is at or below 133 percent of the federal poverty level, adjusted for family size, and determined annually by the federal department of health and human services; and
(B) Not be eligible for categorically needy medical assistance, as defined in the social security Title XIX state plan; or
(iii) Be assessed as likely eligible for, but not yet enrolled in, a medical assistance program under this chapter due to the severity of behavioral health symptom acuity level which creates barriers to accessing and receiving conventional services;
(c) Have been assessed:
(i) By a licensed behavioral health agency to have a behavioral health need which is defined as meeting one or both of the following criteria:
(A) Having mental health needs, including a need for improvement, stabilization, or prevention of deterioration of functioning resulting from the presence of a mental illness; or
(B) Having substance use disorder needs indicating the need for outpatient substance use disorder treatment which may be determined by an assessment using the American society of addiction medicine criteria or a similar assessment tool approved by the authority;
(ii) By the department of social and health services as needing either assistance with at least three activities of daily living or hands-on assistance with at least one activity of daily living and have the preliminary determination confirmed by the department of social and health services through an in-person assessment conducted by the department of social and health services; or
(iii) To be a homeless person with a long-continuing or indefinite physical condition requiring improvement, stabilization, or prevention of deterioration of functioning, including the ability to live independently without support; and
(d) Have at least one of the following risk factors:
(i)(A) Be a homeless person at the time of the eligibility determination for the program and have been homeless for 12 months prior to the eligibility determination; or
(B) Have been a homeless person on at least four separate occasions in the three years prior to the eligibility determination for the program, as long as the combined occasions equal at least 12 months;
(ii) Have a history of frequent or lengthy institutional contact, including contact at institutional care facilities such as jails, substance use disorder or mental health treatment facilities, hospitals, or skilled nursing facilities; or
(iii) Have a history of frequent stays at adult residential care facilities or residential treatment facilities.
(3) Once a coordinating entity verifies that a person has met the eligibility criteria established in subsection (2) of this section, it must connect the eligible person with a community support services provider. The community support services provider must:
(a) Deliver pretenancy support services to determine the person's specific housing needs and assist the person in identifying permanent supportive housing options that are appropriate and safe for the person;
(b) Fully incorporate the eligible person's available community support services into the case management services provided by the community support services provider; and
(c) Deliver ongoing tenancy-sustaining services to support the person in maintaining successful tenancy.
(4) Housing options offered to eligible participants may vary, subject to the availability of housing and funding.
(5) The community support services benefit must be sustained or renewed in accordance with the eligibility standards in subsection (2) of this section, except that the standards related to homelessness shall be replaced with an assessment of the person's likelihood to become homeless in the event that the community support services benefit is terminated. The coordinating entity must adopt procedures to conduct community support services benefit renewals, according to authority standards.
[ 2022 c 216 s 3.]
Notes:
Findings—Intent—Short title—2022 c 216: See notes following RCW 74.09.885.

catchline: Apple health and homes program—Establishment—Eligibility—Services.


title: RCW 74.09.888

text:
(1) To establish and administer RCW 74.09.886, the authority shall:
(a)(i) Establish or amend a contract with a coordinating entity to:
(A) Assure the availability of access to eligibility determinations services for community support services benefits and permanent supportive housing benefits;
(B) Verify that persons meet the eligibility standards of RCW 74.09.886(2);
(C) Coordinate enrollment in medical assistance programs for persons who meet the eligibility standards of RCW 74.09.886(2), except for actual enrollment in a medical assistance program under this chapter; and
(D) Coordinate with a network of community support services providers to arrange with local housing providers for the placement of an eligible person in permanent supportive housing appropriate to the person's needs and assure that community support services are provided to the person by a community support services provider.
(ii) The primary role of the coordinating entity or entities is administrative and operational, while the authority shall establish the general policy parameters for the work of the coordinating entity or entities.
(iii) In selecting the coordinating entity or entities, the authority shall: Choose one or more organizations that are capable of coordinating access to both community support services and permanent supportive housing services to eligible persons under RCW 74.09.886; and select no more than one coordinating entity per region which is served by medicaid managed care organizations;
(b) Report to the office for the ongoing monitoring of the program; and
(c) Adopt any rules necessary to implement the program.
(2) The authority shall establish a work group to provide feedback to the agency on its foundational community supports program as it aligns with the work of the housing benefit. The work group may include representatives of state agencies, behavioral health administrative services organizations, the coordinating entity or entities, and contracted agencies providing foundational community supports services. Topics may include, but are not limited to, best practices in eligibility screening processes and case rate billing for foundational community supports housing, regional cost differentials, costs consistent with specialized needs, improved data access and data sharing with foundational community supports providers, and requirements related to the use of a common practice tool among community support services providers to integrate social determinants of health into service delivery. The authority, in consultation with foundational community supports providers and their stakeholders, shall engage each region on case management tools and programs, evaluate effectiveness, and inform the appropriate committees of the legislature on the use of case management tools. Case management shall also be a regular item of engagement in the work group. The authority shall convene the work group at least once each quarter and may expand upon, but not duplicate, existing work groups or advisory councils at the authority or other state agencies.
(3) To support the goals of the program and the goals of other statewide initiatives to identify and address social needs, including efforts within the 1115 waiver renewal to advance health equity and health-related supports, the authority shall work with the office and the department of social and health services to research, identify, and implement statewide universal measures to identify and consider social determinants of health domains, including housing, food security, transportation, financial strain, and interpersonal safety. The authority shall select an accredited or nationally vetted tool, including criteria for prioritization, for the community support services provider to use when making determinations about housing options and other support services to offer individuals eligible for the program. This screening and prioritization process may not exclude clients transitioning from inpatient or other behavioral health residential treatment settings. The authority shall inform the governor and the appropriate committees of the legislature on progress to this end.
(4)(a) The authority and the department may seek and accept funds from private and federal sources to support the purposes of the program.
(b) The authority shall seek approval from the federal department of health and human services to:
(i) Receive federal matching funds for administrative costs and services provided under the program to persons enrolled in medicaid;
(ii) Align the eligibility and benefit standards of the foundational community supports program established pursuant to the waiver, entitled "medicaid transformation project" and initially approved November 2017, between the authority and the federal centers for medicare and medicaid services, as amended and reauthorized, with the standards of the program, including extending the duration of the benefits under the foundational community supports program to not less than 12 months; and
(iii) Implement a medical and psychiatric respite care benefit for certain persons enrolled in medicaid.
(5)(a) By December 1, 2022, the authority and the office shall report to the governor and the legislature on preparedness for the first year of program implementation, including the estimated enrollment, estimated program costs, estimated supportive housing unit availability, funding availability for the program from all sources, efforts to improve billing and administrative burdens for foundational community supports providers, efforts to streamline continuity of care and system connection for persons who are potentially eligible for foundational community supports, and any statutory or budgetary needs to successfully implement the first year of the program.
(b) By December 1, 2023, the authority and the office shall report to the governor and the legislature on the progress of the first year of program implementation and preparedness for the second year of program implementation.
(c) By December 1, 2024, the authority and the office shall report to the governor and the legislature on the progress of the first two years of program implementation and preparedness for ongoing housing acquisition and development.
(d) By December 1, 2026, the authority and the office shall report to the governor and the legislature on the full implementation of the program, including the number of persons served by the program, available permanent supportive housing units, estimated unmet demand for the program, ongoing funding requirements for the program, and funding availability for the program from all sources. Beginning December 1, 2027, the authority and the office shall provide annual updates to the governor and the legislature on the status of the program.
[ 2022 c 216 s 4.]
Notes:
Findings—Intent—Short title—2022 c 216: See notes following RCW 74.09.885.

catchline: Apple health and homes program—Authority duties—Funding—Reports to legislature.


title: RCW 74.09.890

text:
(1) The authority shall provide administrative oversight for all funds received under the medical assistance program, as codified in Title XIX of the federal social security act, the state children's health insurance program, as codified in Title XXI of the federal social security act, and any other federal medicaid funding to ensure that:
(a) All funds are spent according to federal and state laws and regulations;
(b) Delivery of services aligns with federal statutes and regulations;
(c) Corrective action plans are put in place if expenditures or services do not align with federal requirements; and
(d) Sound fiscal stewardship of medicaid funding in all agencies where medicaid funding is provided.
(2) The authority shall develop a strategic plan and performance measures for medicaid program integrity. The strategic plan must include stated strategic goals, agreed-upon objectives, performance measures, and a system to monitor progress and hold responsible parties accountable. In developing the strategic plan, the authority shall create a management information and reporting strategy with performance measures and management reports.
(3) The authority shall oversee the medicaid program resources of any state agency expending medicaid funding, including but not limited to:
(a) Regularly reviewing delegated work;
(b) Jointly reviewing required reports on terminated or sanctioned providers, compliance data, and application data;
(c) Requiring assurances that operational functions have been implemented;
(d) Reviewing audits performed on the sister state agency; and
(e) Assisting with risk assessments, setting goals, and developing policies and procedures.
(4) The authority shall develop and maintain a single, statewide medicaid fraud and abuse prevention plan consistent with the national medicaid fraud and abuse initiative or current federal best practice as recognized by the centers for medicare and medicaid services.
(5) The authority must follow best practices for identifying improper medicaid spending when implementing its program integrity activities, including but not limited to:
(a) Conducting risk assessments or evaluating leads with established risk factors;
(b) Relying on data analytics to generate leads;
(c) Conducting a preliminary review of incoming leads, which includes analyzing data about the lead and may include reviewing records such as billing histories;
(d) Determining the credibility of all allegations of potential fraud prior to referral to the state's medicaid fraud control unit;
(e) Analyzing all leads under review by the state's managed care organizations;
(f) Working with federally recognized experts that help state integrity programs improve their data analytics and identify potential fraud across medicare and medicaid such as unified program integrity contractors; and
(g) Maintaining a current fraud and abuse detection system.
[ 2023 c 439 s 3.]
Notes:
Intent—Finding—2023 c 439: See note following RCW 74.04.050.

catchline: Medicaid program integrity—Administrative oversight—Strategic plan—Best practices.


title: RCW 74.09.892

text:
(1) Beginning January 1, 2024, the authority's contracts with managed care organizations must clearly detail each party's requirements for maintaining program integrity and the consequences the managed care organizations face if they do not meet the requirements. The contract must ensure the penalties are adequate to ensure compliance.
(2) The authority shall follow leading program integrity practices as recommended by the centers for medicare and medicaid services, including but not limited to:
(a) Monthly reporting and quarterly meetings with managed care organizations to discuss program integrity issues and findings as well as trends in fraud and other improper payments;
(b) Financial penalties for failure to fulfill program integrity requirements, including liquidated damages and sanctions;
(c) Directly auditing providers and:
(i) Recovering overpayments from the providers; or
(ii) Assessing liquidated damages against the managed care organizations;
(d) Ensuring recoveries and liquidated damages resulting from overpayments are properly accounted for and applied to managed care encounters to ensure accurate future rate setting; and
(e) Ensuring all contracts with managed care organizations are updated as appropriate to reflect program integrity requirements.
[ 2023 c 439 s 4.]
Notes:
Intent—Finding—2023 c 439: See note following RCW 74.04.050.

catchline: Medicaid program integrity—Managed care organizations—Contracts—Best practices.


title: RCW 74.09.895

text:
(1) The legislature finds medicaid enrollees are entitled to timely access to postacute care services when apple health managed care organizations have determined such services are medically necessary for quality of care and health outcomes.
(2) In order to facilitate more access to postacute care services, the authority shall establish and adopt network adequacy standards for postacute care services by no later than January 1, 2028. Network adequacy standards development must include nursing homes licensed under chapter 18.51 RCW and inpatient rehabilitation facilities licensed under chapter 70.41 RCW.
(a) Network adequacy standards for nursing homes must take into consideration the Washington medicaid principle of keeping care local to an enrollee's community and any geographic adequacy threshold should not be broader than the regional service area a managed care organization is contracted to serve. The authority may narrow the geographic standards during development. These standards must also consider:
(i) Provider availability in a regional service area;
(ii) Timeliness of care, which is defined as the reasonable amount of time in which patients can receive access to postacute care based on their medical needs; and
(iii) Any other network adequacy standard required to maintain compliance with federal medicaid regulations.
(b) Network adequacy standards for inpatient rehabilitation facilities must take into consideration the Washington medicaid principle of keep care local to an enrollee's community and the geographic adequacy threshold must not be narrower than the regional service area a managed care organization is contracted to serve and must take into consideration patient referral and practice patterns. The authority may narrow the geographic standards during development. These standards must also consider:
(i) Provider availability in a regional service area;
(ii) Timeliness of care, which is defined as the reasonable amount of time in which patients can receive access to postacute care based on their medical needs; and
(iii) Any other network adequacy standard required to maintain compliance with federal medicaid regulations.
(3) As part of the development of network adequacy standards, the authority shall obtain stakeholder feedback.
(a) Stakeholders must include hospitals, nursing homes, managed care organizations, and any associations representing members of these groups. If the authority chooses to include additional provider types in developing postacute care network standards, it must include representatives from those facility types in the stakeholder feedback process.
(b) Feedback must be obtained at least three times, including:
(i) For initial criteria used to develop standards;
(ii) To review draft standards; and
(iii) To review final standards prior to publication and inclusion in the managed care contract.
(4) Network adequacy standards for postacute care services do not alter the ability of a facility to determine whether the facility can meet the needs of a prospective resident through available staffing and reasonable accommodations.
[ 2026 c 206 s 1.]

catchline: Network adequacy standards for postacute care services.


title: RCW 74.09.900

text:
All the provisions of Title 74 RCW, not otherwise inconsistent herewith, shall apply to the provisions of this chapter.
[ 1959 c 26 s 74.09.900. Prior: 1955 c 273 s 22.]

catchline: Other laws applicable.


title: RCW 74.09.920

text:
For the purposes of this chapter, the terms spouse, marriage, marital, husband, wife, widow, widower, next of kin, and family shall be interpreted as applying equally to state registered domestic partnerships or individuals in state registered domestic partnerships as well as to marital relationships and married persons, and references to dissolution of marriage shall apply equally to state registered domestic partnerships that have been terminated, dissolved, or invalidated, to the extent that such interpretation does not conflict with federal law. Where necessary to implement chapter 521, Laws of 2009, gender-specific terms such as husband and wife used in any statute, rule, or other law shall be construed to be gender neutral, and applicable to individuals in state registered domestic partnerships.
[ 2009 c 521 s 175.]
Notes:
Effective dates—2009 c 521 ss 5-8, 79, 87-103, 107, 151, 165, 166, 173-175, and 190-192: See note following RCW 2.10.900.

catchline: Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.


title: RCW 74.09A.005

text:
The legislature finds that:
(1) Simplification in the administration of payment of health benefits is important for the state, providers, and health insurers;
(2) The state, providers, and health insurers should take advantage of all opportunities to streamline operations through automation and the use of common computer standards;
(3) It is in the best interests of the state, providers, and health insurers to identify all third parties that are obligated to cover the cost of health care coverage of joint beneficiaries; and
(4) Health insurers, as a condition of doing business in Washington, must increase their effort to share information with the authority and accept the authority's timely claims consistent with 42 U.S.C. 1396a(a)(25).
Therefore, the legislature declares that to improve the coordination of benefits between the health care authority and health insurers to ensure that medical insurance benefits are properly utilized, a transfer of information between the authority and health insurers should be instituted, and the process for submitting requests for information and claims should be simplified.
[ 2011 1st sp.s. c 15 s 117; 2007 c 179 s 1; 1993 c 10 s 1.]
Notes:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
Effective date—2007 c 179: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 2007." [ 2007 c 179 s 5.]

catchline: Findings.


title: RCW 74.09A.010

text:
For the purposes of this chapter:
(1) "Authority" means the Washington state health care authority.
(2) "Computerized" means online or batch processing with standardized format via magnetic tape output.
(3) "Health insurance coverage" includes any policy, contract, or agreement under which health care items or services are provided, arranged, reimbursed, or paid for by a health insurer.
(4) "Health insurer" means any party that is, by statute, policy, contract, or agreement, legally responsible for payment of a claim for a health care item or service, including, but not limited to, a commercial insurance company providing disability insurance under chapter 48.20 or 48.21 RCW, a health care service contractor providing health care coverage under chapter 48.44 RCW, a health maintenance organization providing comprehensive health care services under chapter 48.46 RCW, an employer or union self-insured plan, any private insurer, a group health plan, a service benefit plan, a managed care organization, a pharmacy benefit manager, and a third party administrator.
(5) "Joint beneficiary" is an individual who has health insurance coverage and is a recipient of public assistance benefits under chapter 74.09 RCW.
[ 2011 1st sp.s. c 15 s 118; 2007 c 179 s 2; 1993 c 10 s 2.]
Notes:
Reviser's note: The definitions in this section have been alphabetized pursuant to RCW 1.08.015(2)(k).
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
Effective date—2007 c 179: See note following RCW 74.09A.005.

catchline: Definitions.


title: RCW 74.09A.020

text:
(1) Health insurers shall share all beneficiary eligibility and coverage information with the authority for the purpose of identifying joint beneficiaries. The authority shall use this information to identify joint beneficiaries. The authority shall use this information to improve accuracy and currency of health insurance coverage and to promote improved coordination of benefits.
(2) To the maximum extent possible, necessary data elements and a compatible database shall be developed by affected health insurers and the authority. The authority shall establish a representative group of health insurers and state agency representatives to develop necessary technical and file specifications to promote a standardized database. The database shall include elements essential to the authority and its population's health insurance coverage information.
(3) If the state and health insurers enter into other agreements regarding the use of common computer standards, the database identified in this section shall be replaced by the new common computer standards.
(4) The information provided will be of sufficient detail to promote reliable and accurate benefit coordination and identification of individuals who are also eligible for authority programs.
(5) The frequency of updates will be mutually agreed to by each health insurer and the authority based on frequency of change and operational limitations.
(6) The health insurers and the authority shall safeguard and properly use the information to protect records as provided by law, including but not limited to chapters 42.48, 74.09, 74.04, 70.02, and 42.56 RCW, and 42 U.S.C. Sec. 1396a and 42 C.F.R. Sec. 43 et seq. The purpose of this exchange of information is to improve coordination and administration of benefits and ensure that medical insurance benefits are properly utilized.
(7) The authority shall target implementation of this section to those health insurers with the highest probability of joint beneficiaries.
[ 2020 c 183 s 1; 2011 1st sp.s. c 15 s 119; 2007 c 179 s 3; 2005 c 274 s 350; 1993 c 10 s 3.]
Notes:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
Effective date—2007 c 179: See note following RCW 74.09A.005.

catchline: Eligibility and coverage information—Provision to health insurers.


title: RCW 74.09A.030

text:
Health insurers, as a condition of doing business in Washington, must:
(1) Provide, with respect to individuals who are eligible for, or are provided, medical assistance under chapter 74.09 RCW, upon the request of the authority, information to determine during what period the individual or their spouses or their dependents may be, or may have been, covered by a health insurer and the nature of coverage that is or was provided by the health insurer, including the name, address, and identifying number of the plan, in a manner prescribed by the authority;
(2) Accept the authority's right to recovery and the assignment to the authority of any right of an individual or other entity to payment from the party for an item or service for which payment has been made under chapter 74.09 RCW;
(3) Respond to any inquiry by the authority regarding a claim for payment for any health care item or service that is submitted not later than three years after the date of the provision of such health care item or service;
(4) Agree not to deny a claim submitted by the authority solely on the basis of the date of submission of the claim, the type or format of the claim form, or a failure to present proper documentation at the point-of-sale that is the basis of the claim, if:
(a) The claim is submitted by the authority within the three-year period beginning on the date the item or service was furnished; and
(b) Any action by the authority to enforce its rights with respect to such claim is commenced within six years of the authority's submission of such claim; and
(5) Agree that the prevailing party in any legal action to enforce this section receives reasonable attorneys' fees as well as related collection fees and costs incurred in the enforcement of this section.
[ 2011 1st sp.s. c 15 s 120; 2007 c 179 s 4.]
Notes:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
Effective date—2007 c 179: See note following RCW 74.09A.005.

catchline: Duties of health insurers—Providing information—Payments—Claims—Costs and fees.


title: RCW 74.09A.900

text:
For the purposes of this chapter, the terms spouse, marriage, marital, husband, wife, widow, widower, next of kin, and family shall be interpreted as applying equally to state registered domestic partnerships or individuals in state registered domestic partnerships as well as to marital relationships and married persons, and references to dissolution of marriage shall apply equally to state registered domestic partnerships that have been terminated, dissolved, or invalidated, to the extent that such interpretation does not conflict with federal law. Where necessary to implement chapter 521, Laws of 2009, gender-specific terms such as husband and wife used in any statute, rule, or other law shall be construed to be gender neutral, and applicable to individuals in state registered domestic partnerships.
[ 2009 c 521 s 176.]


title: RCW 74.12.010

text:
For the purposes of the administration of temporary assistance for needy families, the term "dependent child" means any child in need under the age of eighteen years who is living with a relative as specified under federal temporary assistance for needy families program requirements, in a place of residence maintained by one or more of such relatives as his or her or their homes. The term a "dependent child" shall, notwithstanding the foregoing, also include a child who would meet such requirements except for his or her removal from the home of a relative specified above as a result of a judicial determination that continuation therein would be contrary to the welfare of such child, for whose placement and care the state department of social and health services or the county office is responsible, and who has been placed in a licensed or approved child care institution or foster home as a result of such determination and who: (1) Was receiving an aid to families with dependent children grant for the month in which court proceedings leading to such determination were initiated; or (2) would have received aid to families with dependent children for such month if application had been made therefor; or (3) in the case of a child who had been living with a specified relative within six months prior to the month in which such proceedings were initiated, would have received aid to families with dependent children for such month if in such month he or she had been living with such a relative and application had been made therefor, as authorized by the social security act.
"Temporary assistance for needy families" means money payments, services, and remedial care with respect to a dependent child or dependent children and the needy parent or relative with whom the child lives.
[ 2013 c 23 s 204; 1999 c 120 s 1; 1997 c 59 s 16; 1992 c 136 s 2; 1983 1st ex.s. c 41 s 40; 1981 1st ex.s. c 6 s 23; 1981 c 8 s 21; 1979 c 141 s 350; 1973 2nd ex.s. c 31 s 1; 1969 ex.s. c 173 s 13; 1965 ex.s. c 37 s 1; 1963 c 228 s 18; 1961 c 265 s 1; 1959 c 26 s 74.12.010. Prior: 1957 c 63 s 10; 1953 c 174 s 24; 1941 c 242 s 1; 1937 c 114 s 1; Rem. Supp. 1941 s 9992-101.]
Notes:
Severability—1983 1st ex.s. c 41: See note following RCW 26.09.060.
Effective date—Severability—1981 1st ex.s. c 6: See notes following RCW 74.04.005.


title: RCW 74.12.030

text:
In addition to meeting the eligibility requirements of RCW 74.08.025, as now or hereafter amended, an applicant for temporary assistance for needy families must be a needy child who is a resident of the state of Washington.
[ 1997 c 59 s 17; 1971 ex.s. c 169 s 6; 1963 c 228 s 19; 1959 c 26 s 74.12.030. Prior: 1953 c 174 s 23; 1941 c 242 s 2; 1937 c 114 s 4; Rem. Supp. 1941 s 9992-104.]

catchline: Eligibility.


title: RCW 74.12.035

text:
(1) Children over eighteen years of age and under nineteen years of age who are full-time students reasonably expected to complete a program of secondary school, or the equivalent level of vocational or technical training, before reaching nineteen years of age are eligible to receive temporary assistance for needy families: PROVIDED HOWEVER, That if such students do not successfully complete such program before reaching nineteen years of age, the assistance rendered under this subsection during such period shall not be a debt due the state.
(2) Children with disabilities who are eighteen years of age and under twenty-one years of age and who are full-time students whose education is being provided in accordance with RCW 28A.155.020 are eligible to receive temporary assistance for needy families benefits.
(3) The department is authorized to grant exceptions to the eligibility restrictions for children eighteen years of age and under twenty-one years of age under subsections (1) and (2) of this section only when it determines by reasonable, objective criteria that such exceptions are likely to enable the children to complete their high school education, high school equivalency certificate as provided in RCW 28B.50.536, or vocational education.
[ 2013 c 39 s 29; 1999 c 120 s 2; 1997 c 59 s 18; 1985 c 335 s 1; 1981 2nd ex.s. c 10 s 3.]
Notes:
State consolidated standards of need: RCW 74.04.770.


title: RCW 74.12.240

text:
The department is authorized to provide such social and related services as are reasonably necessary to encourage the care of dependent children in their own homes or in the homes of relatives, to help maintain and strengthen family life and to help such parents or relatives to attain maximum self-support and personal independence consistent with the maintenance of continuing parental care and protection. In the provision of such services, maximum utilization of other agencies providing similar or related services shall be effected.
[ 1959 c 26 s 74.12.240. Prior: 1957 c 63 s 8.]

catchline: Services provided to help attain maximum self-support and independence of parents and relatives.


title: RCW 74.12.250

text:
If the department, after investigation, finds that any applicant for assistance under this chapter or any recipient of funds under this chapter would not use, or is not utilizing, the grant adequately for the needs of his or her child or children or would dissipate the grant or is dissipating such grant, or would be or is unable to manage adequately the funds paid on behalf of said child and that to provide or continue payments to the applicant or recipient would be contrary to the welfare of the child, the department may make such payments to another individual who is interested in or concerned with the welfare of such child and relative: PROVIDED, That the department shall provide such counseling and other services as are available and necessary to develop greater ability on the part of the relative to manage funds in such manner as to protect the welfare of the family. Periodic review of each case shall be made by the department to determine if said relative is able to resume management of the assistance grant. If after a reasonable period of time the payments to the relative cannot be resumed, the department may request the attorney general to file a petition in the superior court for the appointment of a guardian for the child or children. Such petition shall set forth the facts warranting such appointment. Notice of the hearing on such petition shall be served upon the recipient and the department not less than ten days before the date set for such hearing. Such petition may be filed with the clerk of [the] superior court and all process issued and served without payment of costs. If upon the hearing of such petition the court is satisfied that it is for the best interest of the child or children, and all parties concerned, that a guardian be appointed, he or she shall order the appointment, and may require the guardian to render to the court a detailed itemized account of expenditures of such assistance payments at such time as the court may deem advisable.
It is the intention of this section that the guardianship herein provided for shall be a special and limited guardianship solely for the purpose of safeguarding the assistance grants made to dependent children. Such guardianship shall terminate upon the termination of such assistance grant, or sooner on order of the court, upon good cause shown.
[ 2013 c 23 s 205; 1997 c 58 s 506; 1963 c 228 s 21; 1961 c 206 s 1.]
Notes:
Short title—Part headings, captions, table of contents not law—Exemptions and waivers from federal law—Conflict with federal requirements—Severability—1997 c 58: See RCW 74.08A.900 through 74.08A.904.

catchline: Payment of grant to another—Limited guardianship.


title: RCW 74.12.255

text:
(1) The department shall determine, after consideration of all relevant factors and in consultation with the applicant, the most appropriate living situation for applicants under eighteen years of age, unmarried, and either pregnant or having a dependent child or children in the applicant's care. An appropriate living situation shall include a place of residence that is maintained by the applicant's parents, parent, legal guardian, or other adult relative as their or his or her own home and that the department finds would provide an appropriate supportive living arrangement. It also includes a living situation maintained by an agency that is licensed under chapter 74.15 RCW that the department finds would provide an appropriate supportive living arrangement. Grant assistance shall not be provided under this chapter if the applicant does not reside in the most appropriate living situation, as determined by the department.
(2) An unmarried minor parent or pregnant minor applicant residing in the most appropriate living situation, as provided under subsection (1) of this section, is presumed to be unable to manage adequately the funds paid to the minor or on behalf of the dependent child or children and, unless the minor provides sufficient evidence to rebut the presumption, shall be subject to the protective payee requirements provided for under RCW 74.12.250 and 74.08.280.
(3) The department shall consider any statements or opinions by either parent of the unmarried minor parent or pregnant minor applicant as to an appropriate living situation for the minor and his or her children, whether in the parental home or other situation. If the parents or a parent of the minor request, they or he or she shall be entitled to a hearing in juvenile court regarding designation of the parental home or other relative placement as the most appropriate living situation for the pregnant or parenting minor.
The department shall provide the parents or parent with the opportunity to make a showing that the parental home, or home of the other relative placement, is the most appropriate living situation. It shall be presumed in any administrative or judicial proceeding conducted under this subsection that the parental home or other relative placement requested by the parents or parent is the most appropriate living situation. This presumption is rebuttable.
(4) In cases in which the minor is unmarried and unemployed, the department shall, as part of the determination of the appropriate living situation, make an affirmative effort to provide current and positive information about adoption including referral to community-based organizations for counseling and provide information about the manner in which adoption works, its benefits for unmarried, unemployed minor parents and their children, and the meaning and availability of open adoption.
(5) For the purposes of this section, "most appropriate living situation" shall not include a living situation including an adult male who fathered the qualifying child and is found to meet the elements of rape of a child as set forth in RCW 9A.44.079.
[ 1997 c 58 s 501; 1994 c 299 s 33.]
Notes:
Short title—Part headings, captions, table of contents not law—Exemptions and waivers from federal law—Conflict with federal requirements—Severability—1997 c 58: See RCW 74.08A.900 through 74.08A.904.
Intent—Finding—Severability—Conflict with federal requirements—1994 c 299: See notes following RCW 74.12.400.
Benefits for pregnant minors: RCW 74.04.0052.

catchline: Teen applicants' living situation—Criteria—Presumption—Protective payee—Adoption referral.


title: RCW 74.12.260

text:
Temporary assistance for needy families grants shall be made to persons specified in RCW 74.12.010 as amended or such others as the federal department of health, education and welfare shall recognize for the sole purposes of giving benefits to the children whose needs are included in the grant paid to such persons. The recipient of each temporary assistance for needy families grant shall be and hereby is required to present reasonable proof to the department of social and health services as often as may be required by the department that all funds received in the form of a temporary assistance for needy families grant for the children represented in the grant are being spent for the benefit of the children.
[ 1997 c 59 s 21; 1979 c 141 s 351; 1963 c 228 s 22.]

catchline: Persons to whom grants shall be made—Proof of use for benefit of children.


title: RCW 74.12.280

text:
The department is hereby authorized to adopt rules that will provide for coordination between the services provided pursuant to chapter 74.13 RCW and the services provided under the temporary assistance for needy families program in order to provide welfare and related services which will best promote the welfare of such children and their families and conform with the provisions of Public Law 87-543 (HR 10606).
[ 1997 c 59 s 22; 1983 c 3 s 191; 1963 c 228 s 24.]

catchline: Rules for coordination of services.


title: RCW 74.12.290

text:
The department of social and health services shall, during the initial and any subsequent determination of eligibility, evaluate the suitability of the home in which the dependent child lives, consideration to be given to physical care and supervision provided in the home; social, educational, and the moral atmosphere of the home as compared with the standards of the community; the child's physical and mental health and emotional security, special needs occasioned by the child's physical disabilities or illnesses, if any; the extent to which desirable factors outweigh the undesirable in the home; and the apparent possibility for improving undesirable conditions in the home.
[ 2020 c 274 s 60; 1979 c 141 s 352; 1963 c 228 s 25.]

catchline: Suitability of home—Evaluation.


title: RCW 74.12.300

text:
If the home in which the child lives is found to be unsuitable, but there is reason to believe that elimination of the undesirable conditions can be effected, and the child is otherwise eligible for aid, a grant shall be initiated or continued for such time as the state department of social and health services and the family require to remedy the conditions.
[ 1979 c 141 s 353; 1963 c 228 s 26.]

catchline: Grant during period required to eliminate undesirable conditions.


title: RCW 74.12.310

text:
When intensive efforts over a reasonable period have failed to improve the home conditions, the department shall determine if any other relatives specified by the social security act are maintaining a suitable home and are willing to take the care and custody of the child in their home. Upon an affirmative finding the department shall, if the parents or relatives with whom the child is living consent, take the necessary steps for placement of the child with such other relatives, but if the parents or relatives with whom the child lives refuse their consent to the placement then the department shall file a petition in the juvenile court for a decree adjudging the home unsuitable and placing the dependent child with such other relatives.
[ 1963 c 228 s 27.]

catchline: Placement of child with other relatives.


title: RCW 74.12.320

text:
If a diligent search reveals no other relatives as specified in the social security act maintaining a suitable home and willing to take custody of the child, then the department may file a petition in the appropriate juvenile court for placement of the child pursuant to the provisions of chapter 13.04 RCW.
[ 1963 c 228 s 28.]

catchline: Placement of child pursuant to chapter 13.04 RCW.


title: RCW 74.12.330

text:
Notwithstanding the provisions of this chapter a child otherwise eligible for aid shall not be denied such assistance where a relative as specified in the social security act is unavailable or refuses to accept custody and the juvenile court fails to enter an order removing the child from the custody of the parent, relative or guardian then having custody.
[ 1963 c 228 s 29.]

catchline: Assistance not to be denied for want of relative or court order.


title: RCW 74.12.340

text:
(1) The department is authorized to adopt rules governing the provision of day care as a part of child welfare services when the secretary determines that a need exists for such day care and that it is in the best interests of the child, the parents, or the custodial parent and in determining the need for such day care priority shall be given to geographical areas having the greatest need for such care and to members of low-income groups in the population. If the family is financially able to pay part or all of the costs of such care, fees shall be imposed and paid according to the financial ability of the family.
(2) This section does not affect the authority of the department of children, youth, and families to adopt rules governing child day care and early learning programs.
[ 2018 c 58 s 7; 2006 c 265 s 208; 1973 1st ex.s. c 154 s 111; 1963 c 228 s 30.]
Notes:
Effective date—2018 c 58: See note following RCW 28A.655.080.
Effective date—2006 c 265: See RCW 43.216.902.
Severability—1973 1st ex.s. c 154: See note following RCW 2.12.030.
Child welfare services: Chapter 74.13 RCW.

catchline: Day care.


title: RCW 74.12.350

text:
The department of social and health services is hereby authorized to promulgate rules and regulations in conformity with the provisions of Public Law 87-543 to allow all or any portion of a dependent child's earned or other income to be set aside for the identifiable future needs of the dependent child which will make possible the realization of the child's maximum potential as an independent and useful citizen.
The transfer into, or accumulation of, a child's income or resources in an irrevocable trust account is hereby allowed. The amount allowable is four thousand dollars. The department will provide income assistance recipients with clear and simple information on how to set up educational accounts, including how to assure that the accounts comply with federal law by being adequately earmarked for future educational use, and are irrevocable.
[ 1994 c 299 s 31; 1979 c 141 s 354; 1963 c 226 s 1.]
Notes:
Intent—Finding—Severability—Conflict with federal requirements—1994 c 299: See notes following RCW 74.12.400.

catchline: Child's income set aside for future needs—Irrevocable trusts—Educational accounts.


title: RCW 74.12.361

text:
The department shall actively develop mechanisms for the income assistance program, the medical assistance program, and the community services administration to facilitate the enrollment in the federal supplemental security income program of disabled persons currently part of assistance units receiving temporary assistance for needy families benefits.
[ 1997 c 59 s 23; 1994 c 299 s 35.]
Notes:
Intent—Finding—Severability—Conflict with federal requirements—1994 c 299: See notes following RCW 74.12.400.

catchline: Supplemental security income program—Enrollment of disabled persons.


title: RCW 74.12.400

text:
The department shall train financial services and social work staff who provide direct service to recipients of temporary assistance for needy families to:
(1) Effectively communicate the transitional nature of temporary assistance for needy families and the expectation that recipients will enter employment;
(2) Actively refer clients to the job opportunities and basic skills program;
(3) Provide social services needed to overcome obstacles to employability; and
(4) Provide family planning information and assistance, including alternatives to abortion, which shall be conducted in consultation with the department of health.
[ 1997 c 59 s 24; 1994 c 299 s 2.]
Notes:
Intent—1994 c 299: "The legislature finds that lengthy stays on welfare, lack of access to vocational education and training, the inadequate emphasis on employment by the social welfare system, and teen pregnancy are obstacles to achieving economic independence. Therefore, the legislature intends that:
(1) Income and employment assistance programs emphasize the temporary nature of welfare and set goals of responsibility, work, and independence;
(2) State institutions take an active role in preventing pregnancy in young teens;
(3) Family planning assistance be readily available to welfare recipients;
(4) Support enforcement be more effective and the level of responsibility of noncustodial parents be significantly increased; and
(5) Job search, job skills training, and vocational education resources are to be used in the most cost-effective manner possible." [ 1994 c 299 s 1.]
Finding—1994 c 299: "The legislature finds that the reliable receipt of child support payments by custodial parents is essential to maintaining economic self-sufficiency. It is the intent of the legislature to ensure that child support payments received by custodial parents when such support is owed are retained by those parents regardless of future claims made against such payments." [ 1994 c 299 s 17.]
Severability—1994 c 299: "If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected." [ 1994 c 299 s 40.]
Conflict with federal requirements—1994 c 299: "If any part of this act is found to be in conflict with federal requirements that are a prescribed condition to the allocation of federal funds to the state, the conflicting part of this act is inoperative solely to the extent of the conflict and with respect to the agencies directly affected, and this finding does not affect the operation of the remainder of this act in its application to the agencies concerned. The rules under this act shall meet federal requirements that are a necessary condition to the receipt of federal funds by the state." [ 1994 c 299 s 41.]

catchline: Reduce reliance on aid—Work and job training—Family planning—Staff training.


title: RCW 74.12.410

text:
(1) At the time of application or reassessment under this chapter the department shall offer or contract for family planning information and assistance, including alternatives to abortion, and any other available locally based unintended pregnancy prevention programs, to prospective and current recipients of temporary assistance for needy families.
(2) The department shall work in cooperation with the superintendent of public instruction to reduce the rate of abortions and unintended pregnancies in Washington state.
[ 2009 c 303 s 2; 1997 c 58 s 601; 1994 c 299 s 3.]
Notes:
Short title—Part headings, captions, table of contents not law—Exemptions and waivers from federal law—Conflict with federal requirements—Severability—1997 c 58: See RCW 74.08A.900 through 74.08A.904.
Intent—Finding—Severability—Conflict with federal requirements—1994 c 299: See notes following RCW 74.12.400.

catchline: Family planning information—Cooperation with the superintendent of public instruction.


title: RCW 74.12.450

text:
(1) Whenever the department receives an application for assistance on behalf of a child under this chapter and an employee of the department has reason to believe that the child has suffered abuse or neglect, the employee shall cause a report to be made as provided under chapter 26.44 RCW.
(2) Whenever the department approves an application for assistance on behalf of a child under this chapter, the department shall make a reasonable effort to determine whether the child is living with a parent of the child. Whenever the child is living in the home of a relative other than a parent of the child, the department shall make reasonable efforts to notify the parent with whom the child has most recently resided that an application for assistance on behalf of the child has been approved by the department and shall advise the parent of his or her rights under this section, RCW 74.12.460, and *sections 4 and 5 of this act, unless good cause exists not to do so based on a substantiated claim that the parent has abused or neglected the child.
(3) Upon written request of the parent, the department shall notify the parent of the address and location of the child, unless there is a current investigation or pending case involving abuse or neglect by the parent under chapter 13.34 RCW.
(4) The department shall notify and advise the parent of the provisions of the family reconciliation act under chapter 13.32A RCW.
[ 1995 c 401 s 2.]
Notes:
*Reviser's note: Sections 4 and 5 of this act were vetoed by the governor.
Severability—1995 c 401: "If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected." [ 1995 c 401 s 7.]

catchline: Application for assistance—Report on suspected child abuse or neglect—Notice to parent about application, location of child, and family reconciliation act.


title: RCW 74.12.460

text:
The department shall make reasonable efforts to notify the parent under RCW 74.12.450(2) as soon as reasonably possible, but no later than seven days after approval of the application by the department.
[ 1995 c 401 s 3.]
Notes:
Severability—1995 c 401: See note following RCW 74.12.450.

catchline: Notice to parent—Required within seven days of approval of application.


title: RCW 74.12.470

text:
(1) Subject to funds appropriated for this specific purpose, to assist with child-related necessities such as diapers, the department may make additional monthly payments to recipients with children under the age of three who are otherwise eligible for and receiving temporary assistance for needy families.
(2) The department shall set the benefit amounts in rule in accordance with available funds appropriated for this purpose.
(3) The department shall make reasonable efforts to ensure timely communication to families of the new subsidy at implementation and as the diaper subsidy eligibility changes.
[ 2022 c 100 s 2.]
Notes:
Findings—Intent—2022 c 100: "(1) The legislature finds that diapers are a necessity for every infant. Additionally, the majority of early child care programs require an adequate supply of diapers for child attendance, but, with the exception of early head start, do not provide diapers to families in need.
(2) The legislature further finds that families unable to afford an adequate supply of diapers may provide less frequent diaper changes to their child to maximize their supply of diapers. The failure to provide adequate diaper changes is associated with an increased rate of diaper dermatitis and urinary tract infection. Further, there are links between diaper need and increased parenting stress. Children whose parents manifest high levels of stress or depression are at greater risk of social, emotional, and behavioral problems.
(3) Therefore, the legislature intends to reduce parenting stress and increase parenting sense of competency by directing the department of social and health services to provide a monthly diaper subsidy to families with children under three who are otherwise eligible for temporary assistance for needy families, thereby improving parenting quality and overall child outcomes." [ 2022 c 100 s 1.]
Effective date—2022 c 100: "This act takes effect November 1, 2023." [ 2022 c 100 s 4.]

catchline: Monthly diaper subsidy—Rules—Outreach.


title: RCW 74.12.900

text:
The revisions to the temporary assistance for needy families program and job opportunities and basic skills training program shall be implemented by the department of social and health services on a statewide basis.
[ 1997 c 59 s 28; 1994 c 299 s 12.]
Notes:
Intent—Finding—Severability—Conflict with federal requirements—1994 c 299: See notes following RCW 74.12.400.

catchline: Welfare reform implementation—1994 c 299.


title: RCW 74.12A.020

text:
The department shall provide grants to community action agencies or other local nonprofit organizations to provide job opportunities and basic skills training program participants with transitional support services, one-to-one assistance, case management, and job retention services.
[ 1997 c 58 s 327; 1993 c 312 s 8.]
Notes:
Short title—Part headings, captions, table of contents not law—Exemptions and waivers from federal law—Conflict with federal requirements—Severability—1997 c 58: See RCW 74.08A.900 through 74.08A.904.
Findings—Intent—1993 c 312: "The legislature finds that:
(1) Public assistance is intended to be a temporary financial relief program, recognizing that families can be confronted with a financial crisis at any time in life. Successful public assistance programs depend on the availability of adequate resources to assist individuals deemed eligible for the benefits of such a program. In this way, eligible families are given sufficient assistance to reenter productive employment in a minimal time period.
(2) The current public assistance system requires a reduction in grant standards when income is received. In most cases, family income is limited to levels substantially below the standard of need. This is a strong disincentive to work. To remove this disincentive, the legislature intends to allow families to retain a greater percentage of income before it results in the reduction or termination of benefits;
(3) Employment, training, and education services provided to employable recipients of public assistance are effective tools in achieving economic self-sufficiency. Support services that are targeted to the specific needs of the individual offer the best hope of achieving economic self-sufficiency in a cost-effective manner;
(4) State welfare-to-work programs, which move individuals from dependence to economic independence, must be operated cooperatively and collaboratively between state agencies and programs. They also must include public assistance recipients as active partners in self-sufficiency planning activities. Participants in economic independence programs and services will benefit from the concepts of personal empowerment, self-motivation, and self-esteem;
(5) Many barriers to economic independence are found in federal statutes and rules, and provide states with limited options for restructuring existing programs in order to create incentives for employment over continued dependence;
(6) The legislature finds that the personal and societal costs of teenage childbearing are substantial. Teen parents are less likely to finish high school and more likely to depend upon public assistance than women who delay childbearing until adulthood; and
(7) The legislature intends that an effort be made to ensure that each teenage parent who is a public assistance recipient live in a setting that increases the likelihood that the teen parent will complete high school and achieve economic independence." [ 1993 c 312 s 1.]
Emergency—1993 c 312: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions." [ 1993 c 312 s 19.]
Implementation program design—1993 c 312: "The department of social and health services shall design a program for implementation involving recipients of aid to families with dependent children. A goal of this program is to develop a system that segments the aid to families with dependent children recipient population and identifies subgroups, matches services to the needs of the subgroup, and prioritizes available services. The department shall specify the services to be offered in each population segment. The general focus of the services offered shall be on job training, workforce preparedness, and job retention.
The program shall be designed for statewide implementation on July 1, 1994. A proposal for implementation may include phasing certain components over time or geographic area. The department shall submit this program to the appropriate committees of the senate and house of representatives by December 1, 1993." [ 1993 c 312 s 9.]

catchline: Job support services—Grants to community action agencies or nonprofit organizations.


title: RCW 74.13.010

text:
The purpose of this chapter is to safeguard, protect, and contribute to the welfare of the children of the state, through a comprehensive and coordinated program of child welfare services provided by both the department and agencies providing for: Social services and facilities for children who require guidance, care, control, protection, treatment, or rehabilitation; setting of standards for social services and facilities for children; cooperation with public and voluntary agencies, organizations, and citizen groups in the development and coordination of programs and activities in behalf of children; and promotion of community conditions and resources that help parents to discharge their responsibilities for the care, development, and well-being of their children.
[ 2018 c 284 s 34; 2009 c 520 s 49; 1965 c 30 s 2.]

catchline: Declaration of purpose.


title: RCW 74.13.013

text:
The legislature finds that accreditation of children's services by an independent entity can significantly improve the quality of services provided to children and families. Accreditation involves an ongoing commitment to meeting nationally recognized standards of practice in child welfare and holds organizations accountable for achieving improved outcomes for children.
Accreditation is a structured process designed to facilitate organizational change and improvement within individual local offices. Standards require improved case management, documentation, internal case management practices, and accountability. Accreditation requires the establishment of clear communication with biological parents, foster and adoptive parents, providers, the courts, and members of the community.
[ 2001 c 265 s 1.]

catchline: Finding—Accreditation of children's services.