title: RCW 74.09.010

text:
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Authority" means the Washington state health care authority.
(2) "Bidirectional integration" means integrating behavioral health services into primary care settings and integrating primary care services into behavioral health settings.
(3) "Children's health program" means the health care services program provided to children under eighteen years of age and in households with incomes at or below the federal poverty level as annually defined by the federal department of health and human services as adjusted for family size, and who are not otherwise eligible for medical assistance or the limited casualty program for the medically needy.
(4) "Chronic care management" means the health care management within a health home of persons identified with, or at high risk for, one or more chronic conditions. Effective chronic care management:
(a) Actively assists patients to acquire self-care skills to improve functioning and health outcomes, and slow the progression of disease or disability;
(b) Employs evidence-based clinical practices;
(c) Coordinates care across health care settings and providers, including tracking referrals;
(d) Provides ready access to behavioral health services that are, to the extent possible, integrated with primary care; and
(e) Uses appropriate community resources to support individual patients and families in managing chronic conditions.
(5) "Chronic condition" means a prolonged condition and includes, but is not limited to:
(a) A mental health condition;
(b) A substance use disorder;
(c) Asthma;
(d) Diabetes;
(e) Heart disease; and
(f) Being overweight, as evidenced by a body mass index over twenty-five.
(6) "County" means the board of county commissioners, county council, county executive, or tribal jurisdiction, or its designee.
(7) "Department" means the department of social and health services.
(8) "Department of health" means the Washington state department of health created pursuant to RCW 43.70.020.
(9) "Director" means the director of the Washington state health care authority.
(10) "Full benefit dual eligible beneficiary" means an individual who, for any month: Has coverage for the month under a medicare prescription drug plan or medicare advantage plan with part D coverage; and is determined eligible by the state for full medicaid benefits for the month under any eligibility category in the state's medicaid plan or a section 1115 demonstration waiver that provides pharmacy benefits.
(11) "Health home" or "primary care health home" means coordinated health care provided by a licensed primary care provider coordinating all medical care services, and a multidisciplinary health care team comprised of clinical and nonclinical staff. The term "coordinating all medical care services" shall not be construed to require prior authorization by a primary care provider in order for a patient to receive treatment for covered services by an optometrist licensed under chapter 18.53 RCW. Primary care health home services shall include those services defined as health home services in 42 U.S.C. Sec. 1396w-4 and, in addition, may include, but are not limited to:
(a) Comprehensive care management including, but not limited to, chronic care treatment and management;
(b) Extended hours of service;
(c) Multiple ways for patients to communicate with the team, including electronically and by phone;
(d) Education of patients on self-care, prevention, and health promotion, including the use of patient decision aids;
(e) Coordinating and assuring smooth transitions and follow-up from inpatient to other settings;
(f) Individual and family support including authorized representatives;
(g) The use of information technology to link services, track tests, generate patient registries, and provide clinical data; and
(h) Ongoing performance reporting and quality improvement.
(12) "Limited casualty program" means the medical care program provided to medically needy persons as defined under Title XIX of the federal social security act, and to medically indigent persons who are without income or resources sufficient to secure necessary medical services.
(13) "Managed care organization" means any health care organization, including health care providers, insurers, health care service contractors, health maintenance organizations, health insuring organizations, or any other entity or combination thereof, that provides directly or by contract health care services covered under this chapter and rendered by licensed providers, on a prepaid capitated basis and that meets the requirements of section 1903(m)(1)(A) of Title XIX of the federal social security act or federal demonstration waivers granted under section 1115(a) of Title XI of the federal social security act.
(14) "Medical assistance" means the federal aid medical care program provided to categorically needy persons as defined under Title XIX of the federal social security act.
(15) "Medical care services" means the limited scope of care financed by state funds and provided to persons who are not eligible for medicaid under RCW 74.09.510 and who are eligible for the aged, blind, or disabled assistance program authorized in RCW 74.62.030 or the essential needs and housing support program pursuant to RCW 74.04.805.
(16) "Multidisciplinary health care team" means an interdisciplinary team of health professionals which may include, but is not limited to, medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral and mental health providers including substance use disorder prevention and treatment providers, doctors of chiropractic, physical therapists, licensed complementary and alternative medicine practitioners, home care and other long-term care providers, and physicians' assistants.
(17) "Nursing home" means nursing home as defined in RCW 18.51.010.
(18) "Poverty" means the federal poverty level determined annually by the United States department of health and human services, or successor agency.
(19) "Primary care behavioral health" means a health care integration model in which behavioral health care is colocated, collaborative, and integrated within a primary care setting.
(20) "Primary care provider" means a general practice physician, family practitioner, internist, pediatrician, osteopathic physician, naturopath, physician assistant, and *advanced registered nurse practitioner licensed under Title 18 RCW.
(21) "Secretary" means the secretary of social and health services.
(22) "Whole-person care in behavioral health" means a health care integration model in which primary care services are integrated into a behavioral health setting either through colocation or community-based care management.
[ 2023 c 51 s 33; 2020 c 80 s 55; 2017 c 226 s 5; 2013 2nd sp.s. c 10 s 8. Prior: 2011 1st sp.s. c 15 s 2; 2011 c 316 s 2; prior: 2010 1st sp.s. c 8 s 28; 2007 c 3 s 2; 1990 c 296 s 6; 1987 c 406 s 11; 1981 1st ex.s. c 6 s 18; 1981 c 8 s 17; 1979 c 141 s 333; 1959 c 26 s 74.09.010; prior: 1955 c 273 s 2.]
Notes:
*Reviser's note: The term "advanced registered nurse practitioner" was changed to "advanced practice registered nurse" by 2024 c 239 s 1, effective June 30, 2027.
Effective date—2020 c 80 ss 12-59: See note following RCW 7.68.030.
Intent—2020 c 80: See note following RCW 18.71A.010.
Sustainable solutions for the integration of behavioral and physical health—2017 c 226: See note following RCW 74.09.497.
Effective date—2013 2nd sp.s. c 10: See note following RCW 74.62.030.
Effective date—2011 1st sp.s. c 15: "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, 2011." [ 2011 1st sp.s. c 15 s 130.]
Findings—Intent—2011 1st sp.s. c 15: "The legislature finds that:
(1) Washington state government must be organized to be efficient, cost-effective, and responsive to its residents;
(2) The cost of state purchased health care continues to grow at an unsustainable rate, now representing nearly one-third of the state's budget and hindering our ability to invest in other essential services such as education and public safety;
(3) Responsibility for state health care purchasing is currently spread over multiple agencies, but successful interagency collaboration on quality and cost initiatives has helped demonstrate the benefits to the state of centralized health care purchasing;
(4) Consolidating the majority of state health care purchasing into a single state agency will best position the state to work with others, including private sector purchasers, health insurance carriers, health care providers, and consumers to increase the quality and affordability of health care for all state residents;
(5) The development and implementation of uniform state policies for all state purchased health care is among the purposes for which the health care authority was originally created; and
(6) The state will be best able to take advantage of the opportunities and meet its obligations under the federal affordable care act, including establishment of a health benefit exchange and medicaid expansion, if primary responsibility for doing so rests with a single state agency.
The legislature therefore intends, where appropriate, to consolidate state health care purchasing within the health care authority, positioning the state to use its full purchasing power to get the greatest value for its money, and allowing other agencies to focus even more intently on their core missions." [ 2011 1st sp.s. c 15 s 1.]
Report—2011 1st sp.s. c 15: "(1) By December 10, 2011, the department of social and health services and the health care authority shall provide a preliminary report, and by December 1, 2012, provide a final implementation plan, to the governor and the legislature with recommendations regarding the role of the health care authority in the state's purchasing of mental health treatment, substance abuse treatment, and long-term care services, including services for those with developmental disabilities.
(2) The reports shall:
(a) Consider options for effectively coordinating the purchase and delivery of care for people who need long-term care, developmental disabilities, mental health, or chemical dependency services. Options considered may include, but are not limited to, transitioning purchase of these services from the department of social and health services to the health care authority, and strategies for the agencies to collaborate seamlessly while purchasing services separately; and
(b) Address the following components:
(i) Incentives to improve prevention efforts;
(ii) Service delivery approaches, including models for care management and care coordination and benefit design;
(iii) Rules to assure that those requiring long-term care services and supports receive that care in the least restrictive setting appropriate to their needs;
(iv) Systems to measure cost savings;
(v) Mechanisms to measure health outcomes and consumer satisfaction;
(vi) The designation of a single point of entry for financial and functional eligibility determinations for long-term care services; and
(vii) Process for collaboration with local governments.
(3) In developing these recommendations, the agencies shall:
(a) Consult with tribal governments and with interested stakeholders, including consumers, health care and other service providers, health insurance carriers, and local governments; and
(b) Cooperate with the joint select committee on health reform implementation established in House Concurrent Resolution No. 4404 and any of its advisory committees. The agencies shall strongly consider the guidance and input received from these forums in the development of its recommendations.
(4) The agencies shall submit a progress report to the governor and the legislature by November 15, 2013, that provides details on the agencies' progress on purchasing coordination to date." [ 2011 1st sp.s. c 15 s 116.]
Agency transfer—2011 1st sp.s. c 15: "(1) All powers, duties, and functions of the department of social and health services pertaining to the medical assistance program and the medicaid purchasing administration are transferred to the health care authority to the extent necessary to carry out the purposes of this act. All references to the secretary or the department of social and health services in the Revised Code of Washington shall be construed to mean the director or the health care authority when referring to the functions transferred in this section.
(2)(a) All reports, documents, surveys, books, records, files, papers, or written material in the possession of the department of social and health services pertaining to the powers, functions, and duties transferred shall be delivered to the custody of the health care authority. All cabinets, furniture, office equipment, motor vehicles, and other tangible property employed by the department of social and health services in carrying out the powers, functions, and duties transferred shall be made available to the health care authority. All funds, credits, or other assets held in connection with the powers, functions, and duties transferred shall be assigned to the health care authority.
(b) Any appropriations made to the department of social and health services for carrying out the powers, functions, and duties transferred shall, on July 1, 2011, be transferred and credited to the health care authority.
(c) Whenever any question arises as to the transfer of any personnel, funds, books, documents, records, papers, files, equipment, or other tangible property used or held in the exercise of the powers and the performance of the duties and functions transferred, the director of financial management shall make a determination as to the proper allocation and certify the same to the state agencies concerned.
(3) All employees of the medicaid purchasing administration at the department of social and health services are transferred to the jurisdiction of the health care authority. All employees classified under chapter 41.06 RCW, the state civil service law, are assigned to the health care authority to perform their usual duties upon the same terms as formerly, without any loss of rights, subject to any action that may be appropriate thereafter in accordance with the laws and rules governing state civil service.
(4) All rules and all pending business before the department of social and health services pertaining to the powers, functions, and duties transferred shall be continued and acted upon by the health care authority. All existing contracts and obligations shall remain in full force and shall be performed by the health care authority.
(5) The transfer of the powers, duties, functions, and personnel of the department of social and health services shall not affect the validity of any act performed before July 1, 2011.
(6) If apportionments of budgeted funds are required because of the transfers directed by this section, the director of financial management shall certify the apportionments to the agencies affected, the state auditor, and the state treasurer. Each of these shall make the appropriate transfer and adjustments in funds and appropriation accounts and equipment records in accordance with the certification.
(7) A nonsupervisory medicaid purchasing unit bargaining unit is created at the health care authority. All nonsupervisory civil service employees of the medicaid purchasing administration at the department of social and health services assigned to the health care authority under this section whose positions are within the existing bargaining unit description at the department of social and health services shall become a part of the nonsupervisory medicaid purchasing unit bargaining unit at the health care authority under the provisions of chapter 41.80 RCW. The exclusive bargaining representative of the existing bargaining unit at the department of social and health services is certified as the exclusive bargaining representative of the nonsupervisory medicaid purchasing unit bargaining unit at the health care authority without the necessity of an election.
(8) A supervisory medicaid purchasing unit bargaining unit is created at the health care authority. All supervisory civil service employees of the medicaid purchasing administration at the department of social and health services assigned to the health care authority under this section whose positions are within the existing bargaining unit description at the department of social and health services shall become a part of the supervisory medicaid purchasing unit bargaining unit at the health care authority under the provisions of chapter 41.80 RCW. The exclusive bargaining representative of the existing bargaining unit at the department of social and health services is certified as the exclusive bargaining representative of the supervisory medicaid purchasing unit bargaining unit at the health care authority without the necessity of an election.
(9) The bargaining units of employees created under this section are appropriate units under the provisions of chapter 41.80 RCW. However, nothing contained in this section shall be construed to alter the authority of the public employment relations commission under the provisions of chapter 41.80 RCW to amend or modify the bargaining units.
(10) Positions from the department of social and health services central administration are transferred to the jurisdiction of the health care authority. Employees classified under chapter 41.06 RCW, the state civil service law, are assigned to the health care authority to perform their usual duties upon the same terms as formerly, without any loss of rights, subject to any action that may be appropriate thereafter in accordance with the laws and rules governing state civil service.
(11) All classified employees of the department of social and health services central administration assigned to the health care authority under subsection (10) of this section whose positions are within an existing bargaining unit description at the health care authority shall become a part of the existing bargaining unit at the health care authority and shall be considered an appropriate inclusion or modification of the existing bargaining unit under the provisions of chapter 41.80 RCW." [ 2011 1st sp.s. c 15 s 124.]
References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: "The code reviser shall note wherever "administrator" is used or referred to in the Revised Code of Washington as the head of the health care authority that the title of the agency head has been changed to "director." The code reviser shall prepare legislation for the 2012 regular session that changes all statutory references to "administrator" of the health care authority to "director" of the health care authority." [ 2011 1st sp.s. c 15 s 125.]
Findings—Intent—Short title—Effective date—2010 1st sp.s. c 8: See notes following RCW 74.04.225.
Effective date—1990 c 296: "This act shall take effect July 1, 1990." [ 1990 c 296 s 9.]
Effective date—Severability—1981 1st ex.s. c 6: See notes following RCW 74.04.005.
PDF
RCW 74.09.010
Definitions. (Effective June 30, 2027.)
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Authority" means the Washington state health care authority.
(2) "Bidirectional integration" means integrating behavioral health services into primary care settings and integrating primary care services into behavioral health settings.
(3) "Children's health program" means the health care services program provided to children under eighteen years of age and in households with incomes at or below the federal poverty level as annually defined by the federal department of health and human services as adjusted for family size, and who are not otherwise eligible for medical assistance or the limited casualty program for the medically needy.
(4) "Chronic care management" means the health care management within a health home of persons identified with, or at high risk for, one or more chronic conditions. Effective chronic care management:
(a) Actively assists patients to acquire self-care skills to improve functioning and health outcomes, and slow the progression of disease or disability;
(b) Employs evidence-based clinical practices;
(c) Coordinates care across health care settings and providers, including tracking referrals;
(d) Provides ready access to behavioral health services that are, to the extent possible, integrated with primary care; and
(e) Uses appropriate community resources to support individual patients and families in managing chronic conditions.
(5) "Chronic condition" means a prolonged condition and includes, but is not limited to:
(a) A mental health condition;
(b) A substance use disorder;
(c) Asthma;
(d) Diabetes;
(e) Heart disease; and
(f) Being overweight, as evidenced by a body mass index over twenty-five.
(6) "County" means the board of county commissioners, county council, county executive, or tribal jurisdiction, or its designee.
(7) "Department" means the department of social and health services.
(8) "Department of health" means the Washington state department of health created pursuant to RCW 43.70.020.
(9) "Director" means the director of the Washington state health care authority.
(10) "Full benefit dual eligible beneficiary" means an individual who, for any month: Has coverage for the month under a medicare prescription drug plan or medicare advantage plan with part D coverage; and is determined eligible by the state for full medicaid benefits for the month under any eligibility category in the state's medicaid plan or a section 1115 demonstration waiver that provides pharmacy benefits.
(11) "Health home" or "primary care health home" means coordinated health care provided by a licensed primary care provider coordinating all medical care services, and a multidisciplinary health care team comprised of clinical and nonclinical staff. The term "coordinating all medical care services" shall not be construed to require prior authorization by a primary care provider in order for a patient to receive treatment for covered services by an optometrist licensed under chapter 18.53 RCW. Primary care health home services shall include those services defined as health home services in 42 U.S.C. Sec. 1396w-4 and, in addition, may include, but are not limited to:
(a) Comprehensive care management including, but not limited to, chronic care treatment and management;
(b) Extended hours of service;
(c) Multiple ways for patients to communicate with the team, including electronically and by phone;
(d) Education of patients on self-care, prevention, and health promotion, including the use of patient decision aids;
(e) Coordinating and assuring smooth transitions and follow-up from inpatient to other settings;
(f) Individual and family support including authorized representatives;
(g) The use of information technology to link services, track tests, generate patient registries, and provide clinical data; and
(h) Ongoing performance reporting and quality improvement.
(12) "Limited casualty program" means the medical care program provided to medically needy persons as defined under Title XIX of the federal social security act, and to medically indigent persons who are without income or resources sufficient to secure necessary medical services.
(13) "Managed care organization" means any health care organization, including health care providers, insurers, health care service contractors, health maintenance organizations, health insuring organizations, or any other entity or combination thereof, that provides directly or by contract health care services covered under this chapter and rendered by licensed providers, on a prepaid capitated basis and that meets the requirements of section 1903(m)(1)(A) of Title XIX of the federal social security act or federal demonstration waivers granted under section 1115(a) of Title XI of the federal social security act.
(14) "Medical assistance" means the federal aid medical care program provided to categorically needy persons as defined under Title XIX of the federal social security act.
(15) "Medical care services" means the limited scope of care financed by state funds and provided to persons who are not eligible for medicaid under RCW 74.09.510 and who are eligible for the aged, blind, or disabled assistance program authorized in RCW 74.62.030 or the essential needs and housing support program pursuant to RCW 74.04.805.
(16) "Multidisciplinary health care team" means an interdisciplinary team of health professionals which may include, but is not limited to, medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral and mental health providers including substance use disorder prevention and treatment providers, doctors of chiropractic, physical therapists, licensed complementary and alternative medicine practitioners, home care and other long-term care providers, and physicians' assistants.
(17) "Nursing home" means nursing home as defined in RCW 18.51.010.
(18) "Poverty" means the federal poverty level determined annually by the United States department of health and human services, or successor agency.
(19) "Primary care behavioral health" means a health care integration model in which behavioral health care is colocated, collaborative, and integrated within a primary care setting.
(20) "Primary care provider" means a general practice physician, family practitioner, internist, pediatrician, osteopathic physician, naturopath, physician assistant, and advanced practice registered nurse licensed under Title 18 RCW.
(21) "Secretary" means the secretary of social and health services.
(22) "Whole-person care in behavioral health" means a health care integration model in which primary care services are integrated into a behavioral health setting either through colocation or community-based care management.
[ 2025 c 58 s 5167; 2023 c 51 s 33; 2020 c 80 s 55; 2017 c 226 s 5; 2013 2nd sp.s. c 10 s 8. Prior: 2011 1st sp.s. c 15 s 2; 2011 c 316 s 2; prior: 2010 1st sp.s. c 8 s 28; 2007 c 3 s 2; 1990 c 296 s 6; 1987 c 406 s 11; 1981 1st ex.s. c 6 s 18; 1981 c 8 s 17; 1979 c 141 s 333; 1959 c 26 s 74.09.010; prior: 1955 c 273 s 2.]
Notes:
Effective date—2025 c 58 ss 5058-5170: See note following RCW 7.68.030.
Explanatory note—2025 c 58: See note following RCW 1.16.050.
Effective date—2020 c 80 ss 12-59: See note following RCW 7.68.030.
Intent—2020 c 80: See note following RCW 18.71A.010.
Sustainable solutions for the integration of behavioral and physical health—2017 c 226: See note following RCW 74.09.497.
Effective date—2013 2nd sp.s. c 10: See note following RCW 74.62.030.
Effective date—2011 1st sp.s. c 15: "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, 2011." [ 2011 1st sp.s. c 15 s 130.]
Findings—Intent—2011 1st sp.s. c 15: "The legislature finds that:
(1) Washington state government must be organized to be efficient, cost-effective, and responsive to its residents;
(2) The cost of state purchased health care continues to grow at an unsustainable rate, now representing nearly one-third of the state's budget and hindering our ability to invest in other essential services such as education and public safety;
(3) Responsibility for state health care purchasing is currently spread over multiple agencies, but successful interagency collaboration on quality and cost initiatives has helped demonstrate the benefits to the state of centralized health care purchasing;
(4) Consolidating the majority of state health care purchasing into a single state agency will best position the state to work with others, including private sector purchasers, health insurance carriers, health care providers, and consumers to increase the quality and affordability of health care for all state residents;
(5) The development and implementation of uniform state policies for all state purchased health care is among the purposes for which the health care authority was originally created; and
(6) The state will be best able to take advantage of the opportunities and meet its obligations under the federal affordable care act, including establishment of a health benefit exchange and medicaid expansion, if primary responsibility for doing so rests with a single state agency.
The legislature therefore intends, where appropriate, to consolidate state health care purchasing within the health care authority, positioning the state to use its full purchasing power to get the greatest value for its money, and allowing other agencies to focus even more intently on their core missions." [ 2011 1st sp.s. c 15 s 1.]
Report—2011 1st sp.s. c 15: "(1) By December 10, 2011, the department of social and health services and the health care authority shall provide a preliminary report, and by December 1, 2012, provide a final implementation plan, to the governor and the legislature with recommendations regarding the role of the health care authority in the state's purchasing of mental health treatment, substance abuse treatment, and long-term care services, including services for those with developmental disabilities.
(2) The reports shall:
(a) Consider options for effectively coordinating the purchase and delivery of care for people who need long-term care, developmental disabilities, mental health, or chemical dependency services. Options considered may include, but are not limited to, transitioning purchase of these services from the department of social and health services to the health care authority, and strategies for the agencies to collaborate seamlessly while purchasing services separately; and
(b) Address the following components:
(i) Incentives to improve prevention efforts;
(ii) Service delivery approaches, including models for care management and care coordination and benefit design;
(iii) Rules to assure that those requiring long-term care services and supports receive that care in the least restrictive setting appropriate to their needs;
(iv) Systems to measure cost savings;
(v) Mechanisms to measure health outcomes and consumer satisfaction;
(vi) The designation of a single point of entry for financial and functional eligibility determinations for long-term care services; and
(vii) Process for collaboration with local governments.
(3) In developing these recommendations, the agencies shall:
(a) Consult with tribal governments and with interested stakeholders, including consumers, health care and other service providers, health insurance carriers, and local governments; and
(b) Cooperate with the joint select committee on health reform implementation established in House Concurrent Resolution No. 4404 and any of its advisory committees. The agencies shall strongly consider the guidance and input received from these forums in the development of its recommendations.
(4) The agencies shall submit a progress report to the governor and the legislature by November 15, 2013, that provides details on the agencies' progress on purchasing coordination to date." [ 2011 1st sp.s. c 15 s 116.]
Agency transfer—2011 1st sp.s. c 15: "(1) All powers, duties, and functions of the department of social and health services pertaining to the medical assistance program and the medicaid purchasing administration are transferred to the health care authority to the extent necessary to carry out the purposes of this act. All references to the secretary or the department of social and health services in the Revised Code of Washington shall be construed to mean the director or the health care authority when referring to the functions transferred in this section.
(2)(a) All reports, documents, surveys, books, records, files, papers, or written material in the possession of the department of social and health services pertaining to the powers, functions, and duties transferred shall be delivered to the custody of the health care authority. All cabinets, furniture, office equipment, motor vehicles, and other tangible property employed by the department of social and health services in carrying out the powers, functions, and duties transferred shall be made available to the health care authority. All funds, credits, or other assets held in connection with the powers, functions, and duties transferred shall be assigned to the health care authority.
(b) Any appropriations made to the department of social and health services for carrying out the powers, functions, and duties transferred shall, on July 1, 2011, be transferred and credited to the health care authority.
(c) Whenever any question arises as to the transfer of any personnel, funds, books, documents, records, papers, files, equipment, or other tangible property used or held in the exercise of the powers and the performance of the duties and functions transferred, the director of financial management shall make a determination as to the proper allocation and certify the same to the state agencies concerned.
(3) All employees of the medicaid purchasing administration at the department of social and health services are transferred to the jurisdiction of the health care authority. All employees classified under chapter 41.06 RCW, the state civil service law, are assigned to the health care authority to perform their usual duties upon the same terms as formerly, without any loss of rights, subject to any action that may be appropriate thereafter in accordance with the laws and rules governing state civil service.
(4) All rules and all pending business before the department of social and health services pertaining to the powers, functions, and duties transferred shall be continued and acted upon by the health care authority. All existing contracts and obligations shall remain in full force and shall be performed by the health care authority.
(5) The transfer of the powers, duties, functions, and personnel of the department of social and health services shall not affect the validity of any act performed before July 1, 2011.
(6) If apportionments of budgeted funds are required because of the transfers directed by this section, the director of financial management shall certify the apportionments to the agencies affected, the state auditor, and the state treasurer. Each of these shall make the appropriate transfer and adjustments in funds and appropriation accounts and equipment records in accordance with the certification.
(7) A nonsupervisory medicaid purchasing unit bargaining unit is created at the health care authority. All nonsupervisory civil service employees of the medicaid purchasing administration at the department of social and health services assigned to the health care authority under this section whose positions are within the existing bargaining unit description at the department of social and health services shall become a part of the nonsupervisory medicaid purchasing unit bargaining unit at the health care authority under the provisions of chapter 41.80 RCW. The exclusive bargaining representative of the existing bargaining unit at the department of social and health services is certified as the exclusive bargaining representative of the nonsupervisory medicaid purchasing unit bargaining unit at the health care authority without the necessity of an election.
(8) A supervisory medicaid purchasing unit bargaining unit is created at the health care authority. All supervisory civil service employees of the medicaid purchasing administration at the department of social and health services assigned to the health care authority under this section whose positions are within the existing bargaining unit description at the department of social and health services shall become a part of the supervisory medicaid purchasing unit bargaining unit at the health care authority under the provisions of chapter 41.80 RCW. The exclusive bargaining representative of the existing bargaining unit at the department of social and health services is certified as the exclusive bargaining representative of the supervisory medicaid purchasing unit bargaining unit at the health care authority without the necessity of an election.
(9) The bargaining units of employees created under this section are appropriate units under the provisions of chapter 41.80 RCW. However, nothing contained in this section shall be construed to alter the authority of the public employment relations commission under the provisions of chapter 41.80 RCW to amend or modify the bargaining units.
(10) Positions from the department of social and health services central administration are transferred to the jurisdiction of the health care authority. Employees classified under chapter 41.06 RCW, the state civil service law, are assigned to the health care authority to perform their usual duties upon the same terms as formerly, without any loss of rights, subject to any action that may be appropriate thereafter in accordance with the laws and rules governing state civil service.
(11) All classified employees of the department of social and health services central administration assigned to the health care authority under subsection (10) of this section whose positions are within an existing bargaining unit description at the health care authority shall become a part of the existing bargaining unit at the health care authority and shall be considered an appropriate inclusion or modification of the existing bargaining unit under the provisions of chapter 41.80 RCW." [ 2011 1st sp.s. c 15 s 124.]
References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: "The code reviser shall note wherever "administrator" is used or referred to in the Revised Code of Washington as the head of the health care authority that the title of the agency head has been changed to "director." The code reviser shall prepare legislation for the 2012 regular session that changes all statutory references to "administrator" of the health care authority to "director" of the health care authority." [ 2011 1st sp.s. c 15 s 125.]
Findings—Intent—Short title—Effective date—2010 1st sp.s. c 8: See notes following RCW 74.04.225.
Effective date—1990 c 296: "This act shall take effect July 1, 1990." [ 1990 c 296 s 9.]
Effective date—Severability—1981 1st ex.s. c 6: See notes following RCW 74.04.005.

catchline: Definitions. (Effective until June 30, 2027.)


doc_type: statute

jurisdiction: wa

title: RCW 74.09.015

text:
To the extent that sufficient funding is provided specifically for this purpose, the authority shall provide all persons receiving services under this chapter with access to a twenty-four hour, seven day a week nurse hotline. The authority shall determine the most appropriate way to provide the nurse hotline under RCW 41.05.037 and this section, which may include use of the 211 system established in chapter 43.211 RCW.
[ 2011 1st sp.s. c 15 s 122; 2007 c 259 s 16.]
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.
Subheadings not law—2007 c 259: See note following RCW 7.70.060.

license: public-domain-government-work

rule_set: Revised Code of Washington

catchline: Nurse hotline, when funded.

code: rcw

unit: section

court: Washington State Legislature


title: RCW 74.09.035

text:
(1) To the extent of available funds, medical care services may be provided to:
(a) Victims of human trafficking, as defined in RCW 74.04.005, who are not eligible for medicaid under RCW 74.09.510, section 1902(a)(10)(A)(i)(VIII) of the social security act, or apple health for kids under RCW 74.09.470, who otherwise qualify for state family assistance programs under RCW 74.04.820;
(b) Persons eligible for the aged, blind, or disabled assistance program authorized in RCW 74.62.030 and who are not eligible for medicaid under RCW 74.09.510; and
(c) Persons eligible for essential needs and housing support under RCW 74.04.805 and who are not eligible for medicaid under RCW 74.09.510.
(2) Enrollment in medical care services may not result in expenditures that exceed the amount that has been appropriated in the operating budget. If it appears that continued enrollment will result in expenditures exceeding the appropriated level for a particular fiscal year, the department may freeze new enrollment and establish a waiting list of persons who may receive benefits only when sufficient funds are available.
(3) Determination of the amount, scope, and duration of medical care services shall be limited to coverage as defined by the authority, except that adult dental, and routine foot care shall not be included unless there is a specific appropriation for these services.
(4) The authority shall enter into performance-based contracts with one or more managed health care systems for the provision of medical care services under this section. The contract must provide for integrated delivery of medical and mental health services.
(5) The authority shall establish standards of assistance and resource and income exemptions, which may include deductibles and coinsurance provisions. In addition, the authority may include a prohibition against the voluntary assignment of property or cash for the purpose of qualifying for assistance.
(6) Eligibility for medical care services shall commence with the date of eligibility for the aged, blind, or disabled assistance program provided under RCW 74.62.030 or the date of eligibility for the essential needs and housing support program under RCW 74.04.805.
(7) To the extent possible, the authority must coordinate with the department of social and health services, food assistance programs for legal immigrants, state family assistance programs, and refugee cash assistance programs.
[ 2020 c 136 s 4; 2013 2nd sp.s. c 10 s 7. Prior: 2011 1st sp.s. c 36 s 6; 2011 1st sp.s. c 15 s 3; 2011 c 284 s 3; prior: 2010 1st sp.s. c 8 s 29; 2010 c 94 s 22; 1987 c 406 s 12; 1985 c 5 s 1; 1983 1st ex.s. c 43 s 2; 1982 1st ex.s. c 19 s 3; 1981 1st ex.s. c 6 s 19.]
Notes:
Effective date—2020 c 136: See note following RCW 74.04.005.
Effective date—2013 2nd sp.s. c 10: See note following RCW 74.62.030.
Effective date—2011 1st sp.s. c 36 s 6: "Section 6 of 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 22, 2011." [ 2011 1st sp.s. c 36 s 39.]
Findings—Intent—2011 1st sp.s. c 36: See RCW 74.62.005.
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.
Implementation—2010 1st sp.s. c 8 ss 1-10 and 29: See note following RCW 74.04.225.
Findings—Intent—Short title—Effective date—2010 1st sp.s. c 8: See notes following RCW 74.04.225.
Purpose—2010 c 94: See note following RCW 44.04.280.
Effective date—1983 1st ex.s. c 43: See note following RCW 74.09.700.
Effective date—1982 1st ex.s. c 19: "This act is necessary for the immediate preservation of the public peace, health, and safety, the support of the state government and its existing public institutions, and shall take effect April 1, 1982 [April 3, 1982]." [ 1982 1st ex.s. c 19 s 6.]
Effective date—Severability—1981 1st ex.s. c 6: See notes following RCW 74.04.005.

catchline: Medical care services—Eligibility, standards—Limits.


title: RCW 74.09.037

text:
Any card issued by the authority or a managed health care system to a person receiving services under this chapter, that must be presented to providers for purposes of claims processing, may not display an identification number that includes more than a four-digit portion of the person's complete social security number.
[ 2011 1st sp.s. c 15 s 4; 2004 c 115 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.

catchline: Identification card—Social security number restriction.


title: RCW 74.09.050

text:
(1) The director shall appoint such professional personnel and other assistants and employees, including professional medical screeners, as may be reasonably necessary to carry out the provisions of this chapter or other applicable law. The medical screeners shall be supervised by one or more physicians who shall be appointed by the director or his or her designee. The director shall appoint a medical director who is licensed under chapter 18.57 or 18.71 RCW.
(2) Whenever the director's authority is not specifically limited by law, he or she has complete charge and supervisory powers over the authority. The director is authorized to create such administrative structures as deemed appropriate, except as otherwise specified by law. The director has the power to employ such assistants and personnel as may be necessary for the general administration of the authority. Except as elsewhere specified, such employment must be in accordance with the rules of the state civil service law, chapter 41.06 RCW.
[ 2018 c 201 s 7004; 2011 1st sp.s. c 15 s 5; 2000 c 5 s 15; 1979 c 141 s 335; 1959 c 26 s 74.09.050. Prior: 1955 c 273 s 6.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
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.
Intent—Purpose—2000 c 5: See RCW 48.43.500.
Application—Short title—Captions not law—Construction—Severability—Application to contracts—Effective dates—2000 c 5: See notes following RCW 48.43.500.

catchline: Director's powers and duties—Personnel—Medical screeners—Medical director.


title: RCW 74.09.053

text:
(1) Beginning in November 2012, the department of social and health services, in coordination with the health care authority, shall by November 15th of each year report to the legislature:
(a) The number of medical assistance recipients who: (i) Upon enrollment or recertification had reported being employed, and beginning with the 2008 report, the month and year they reported being hired; or (ii) upon enrollment or recertification had reported being the dependent of someone who was employed, and beginning with the 2008 report, the month and year they reported the employed person was hired. For recipients identified under (a)(i) and (ii) of this subsection, the department shall report the basis for their medical assistance eligibility, including but not limited to family medical coverage, transitional medical assistance, children's medical coverage, aged coverage, or coverage for individuals with disabilities; member months; and the total cost to the state for these recipients, expressed as general fund-state and general fund-federal dollars. The information shall be reported by employer size for employers having more than fifty employees as recipients or with dependents as recipients. This information shall be provided for the preceding January and June of that year.
(b) The following aggregated information: (i) The number of employees who are recipients or with dependents as recipients by private and governmental employers; (ii) the number of employees who are recipients or with dependents as recipients by employer size for employers with fifty or fewer employees, fifty-one to one hundred employees, one hundred one to one thousand employees, one thousand one to five thousand employees and more than five thousand employees; and (iii) the number of employees who are recipients or with dependents as recipients by industry type.
(2) For each aggregated classification, the report will include the number of hours worked, the number of department of social and health services covered lives, and the total cost to the state for these recipients. This information shall be for each quarter of the preceding year.
[ 2023 c 51 s 34. Prior: 2009 c 568 s 6; 2009 c 479 s 62; 2006 c 264 s 2.]
Notes:
Effective date—2009 c 479: See note following RCW 2.56.030.

catchline: Annual reporting requirement.


title: RCW 74.09.055

text:
The authority is authorized to establish copayment, deductible, or coinsurance, or other cost-sharing requirements for recipients of any medical programs defined in RCW 74.09.010 or other applicable law, except that premiums shall not be imposed on children in households at or below two hundred percent of the federal poverty level.
[ 2018 c 201 s 7005; 2011 1st sp.s. c 15 s 6; 2006 c 24 s 1; 2003 1st sp.s. c 14 s 1; 1993 c 492 s 231; 1982 c 201 s 19.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
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—2003 1st sp.s. c 14: "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, 2003." [ 2003 1st sp.s. c 14 s 2.]
Findings—Intent—1993 c 492: See notes following RCW 43.20.050.
Short title—Savings—Reservation of legislative power—Effective dates—1993 c 492: See RCW 43.72.910 through 43.72.915.

catchline: Copayment, deductible, coinsurance, other cost-sharing requirements authorized.


title: RCW 74.09.075

text:
The department or authority, as appropriate, shall provide (1) for evaluation of employability when a person is applying for public assistance representing a medical condition as a basis for need, and (2) for medical reports to be used in the evaluation of total and permanent disability. It shall further provide for medical consultation and assistance in determining the need for special diets, housekeeper and attendant services, and other requirements as found necessary because of the medical condition under the rules promulgated by the secretary or director.
[ 2011 1st sp.s. c 15 s 7; 1979 c 141 s 337; 1967 ex.s. c 30 s 2.]
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.

catchline: Employability and disability evaluation—Medical condition—Medical reports—Medical consultations and assistance.


title: RCW 74.09.080

text:
In carrying out the administrative responsibility of this chapter or other applicable law, the department or authority, as appropriate:
(1) May contract with an individual or a group, may utilize existing local state public assistance offices, or establish separate welfare medical care offices on a county or multicounty unit basis as found necessary; and
(2) Shall determine both financial and functional eligibility for persons applying for long-term care services under chapter 74.39 or 74.39A RCW as a unified process in a single long-term care organizational unit.
[ 2018 c 201 s 7006; 2011 1st sp.s. c 15 s 8; 1979 c 141 s 338; 1959 c 26 s 74.09.080. Prior: 1955 c 273 s 9.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
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.

catchline: Methods of performing administrative responsibilities.


title: RCW 74.09.120

text:
(1) The department shall purchase nursing home care by contract and payment for the care shall be in accordance with the provisions of chapter 74.46 RCW and rules adopted by the department. No payment shall be made to a nursing home which does not permit inspection by the authority and the department of every part of its premises and an examination of all records, including financial records, methods of administration, general and special dietary programs, the disbursement of drugs and methods of supply, and any other records the authority or the department deems relevant to the regulation of nursing home operations, enforcement of standards for resident care, and payment for nursing home services.
(2) The department may purchase nursing home care by contract in veterans' homes operated by the state department of veterans affairs and payment for the care shall be in accordance with the provisions of chapter 74.46 RCW and rules adopted by the department under the authority of RCW 74.46.800.
(3) The department may purchase care in institutions for persons with intellectual disabilities, also known as intermediate care facilities for persons with intellectual disabilities. The department shall establish rules for reasonable accounting and reimbursement systems for such care. Institutions for persons with intellectual disabilities include licensed nursing homes, public institutions, licensed assisted living facilities with fifteen beds or less, and hospital facilities certified as intermediate care facilities for persons with intellectual disabilities under the federal medicaid program to provide health, habilitative, or rehabilitative services and twenty-four hour supervision for persons with intellectual disabilities or related conditions and includes in the program "active treatment" as federally defined.
(4) The department may purchase care in institutions for mental diseases by contract. The department shall establish rules for reasonable accounting and reimbursement systems for such care. Institutions for mental diseases are certified under the federal medicaid program and primarily engaged in providing diagnosis, treatment, or care to persons with mental diseases, including medical attention, nursing care, and related services.
(5) Both the department and the authority may each purchase all other services provided under this chapter or other applicable law by contract or at rates established by the department or the authority respectively.
[ 2018 c 201 s 7007; 2012 c 10 s 60; 2011 1st sp.s. c 15 s 9; 2010 c 94 s 23; 1998 c 322 s 45; 1993 sp.s. c 3 s 8; 1992 c 8 s 1; 1989 c 372 s 15; 1983 1st ex.s. c 67 s 44; 1981 2nd ex.s. c 11 s 6; 1981 1st ex.s. c 2 s 11; (1980 c 177 s 84 repealed by 1983 1st ex.s. c 67 s 48); 1975 1st ex.s. c 213 s 1; 1967 ex.s. c 30 s 1; 1959 c 26 s 74.09.120. Prior: 1955 c 273 s 13.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
Application—2012 c 10: See note following RCW 18.20.010.
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.
Purpose—2010 c 94: See note following RCW 44.04.280.
Effective date—1993 sp.s. c 3: See note following RCW 72.36.140.
Findings—1993 sp.s. c 3: See RCW 72.36.1601.
Effective dates—1983 1st ex.s. c 67: See note following RCW 74.46.475.
Severability—Effective dates—1981 1st ex.s. c 2: See notes following RCW 18.51.010.
Conflict with federal requirements and this section: RCW 74.46.840.

catchline: Purchases of services, care, supplies—Nursing homes—Veterans' homes—Institutions for persons with intellectual disabilities—Institutions for mental diseases.


title: RCW 74.09.150

text:
All personnel employed in the administration of the medical care program shall be covered by the existing merit system under the Washington personnel resources board.
[ 1993 c 281 s 66; 1959 c 26 s 74.09.150. Prior: 1955 c 273 s 16.]
Notes:
Effective date—1993 c 281: See note following RCW 41.06.022.

catchline: Personnel to be under existing merit system.


title: RCW 74.09.160

text:
Each vendor or group who has a contract and is rendering service to eligible persons as defined in this chapter or other applicable law shall submit such charges as agreed upon between the department or authority, as appropriate, and the individual or group no later than twelve months from the date of service. If the final charges are not presented within the twelve-month period, they shall not be a charge against the state. Said twelve-month period may also be extended by regulation, but only if required by applicable federal law or regulation, and to no more than the extension of time so required.
[ 2018 c 201 s 7008; 2011 1st sp.s. c 15 s 10; 1991 c 103 s 1; 1980 c 32 s 11; 1979 ex.s. c 81 s 1; 1973 1st ex.s. c 48 s 1; 1959 c 26 s 74.09.160. Prior: 1955 c 273 s 17.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
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.

catchline: Presentment of charges by contractors.


title: RCW 74.09.171

text:
(1) The legislature finds that the authority and the department purchase or contract for the delivery of medicaid programs through contracts with providers and managed care organizations under this chapter, contractors providing behavioral health services under chapters 71.24 and 71.34 RCW, and contractors providing long-term care services under chapter 74.39A RCW.
(2) The authority and department must collaborate and seek opportunities to expand access to care for enrollees in the medicaid programs identified in subsection (1) of this section living in border communities that may require contractual agreements with providers across the state border when care is appropriate, available, and cost-effective.
(3) All authority and department contracts for medicaid services issued or renewed after July 1, 2014, must include provisions that allow for care to be accessed cross-border ensuring timely access to necessary care, including inpatient and outpatient services. The contracts must include reciprocal arrangements that allow Washington, Oregon, and Idaho border residents to access care when care is appropriate, available, and cost-effective.
[ 2023 c 51 s 35; 2014 c 39 s 1.]
Notes:

catchline: Contracts for medicaid services—Border communities.


title: RCW 74.09.180

text:
(1) The provisions of this chapter shall not apply to recipients whose personal injuries are occasioned by negligence or wrong of another: PROVIDED, HOWEVER, That the director may furnish assistance, under the provisions of this chapter, for the results of injuries to or illness of a recipient, and the authority shall thereby be subrogated to the recipient's rights against the recovery had from any tort feasor or the tort feasor's insurer, or both, and shall have a lien thereupon to the extent of the value of the assistance furnished by the authority. To secure reimbursement for assistance provided under this section, the authority may pursue its remedies under RCW 41.05A.070.
(2) The rights and remedies provided to the authority in this section to secure reimbursement for assistance, including the authority's lien and subrogation rights, may be delegated to a *managed health care system by contract entered into pursuant to RCW 74.09.522. A *managed health care system may enforce all rights and remedies delegated to it by the authority to secure and recover assistance provided under a *managed health care system consistent with its agreement with the authority.
[ 2011 1st sp.s. c 15 s 11; 1997 c 236 s 1; 1990 c 100 s 2; 1987 c 283 s 14; 1979 ex.s. c 171 s 14; 1971 ex.s. c 306 s 1; 1969 ex.s. c 173 s 8; 1959 c 26 s 74.09.180. Prior: 1955 c 273 s 19.]
Notes:
*Reviser's note: RCW 74.09.522 was amended by 2023 c 51 s 43, removing the definition of "managed health care system" and changing "managed health care system" to "managed care organization."
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.
Application—1990 c 100 ss 2, 4, 7(1), 8(2): See note following RCW 43.20B.060.
Severability—Savings—1987 c 283: See notes following RCW 43.20A.020.
Severability—1979 ex.s. c 171: See note following RCW 74.20.300.

catchline: Chapter does not apply if another party is liable—Exception—Subrogation—Lien—Reimbursement—Delegation of lien and subrogation rights.


title: RCW 74.09.185

text:
To the extent that payment for covered expenses has been made under medical assistance for health care items or services furnished to an individual, in any case where a third party has a legal liability to make payments, the state is considered to have acquired the rights of the individual to payment by any other party for those health care items or services. Recovery pursuant to the subrogation rights, assignment, or enforcement of the lien granted to the authority by this section shall not be reduced, prorated, or applied to only a portion of a judgment, award, or settlement, except as provided in RCW 41.05A.060 and 41.05A.070. The doctrine of equitable subrogation shall not apply to defeat, reduce, or prorate recovery by the authority as to its assignment, lien, or subrogation rights.
[ 2011 1st sp.s. c 15 s 12; 1995 c 34 s 6.]
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.

catchline: Third party has legal liability to make payments—State acquires rights—Lien—Equitable subrogation does not apply.


title: RCW 74.09.190

text:
Nothing in this chapter shall be construed as empowering the secretary or director to compel any recipient of public assistance and a medical indigent person to undergo any physical examination, surgical operation, or accept any form of medical treatment contrary to the wishes of said person who relies on or is treated by prayer or spiritual means in accordance with the creed and tenets of any well recognized church or religious denomination.
[ 2011 1st sp.s. c 15 s 13; 1979 c 141 s 342; 1959 c 26 s 74.09.190. Prior: 1955 c 273 s 23.]
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.

catchline: Religious beliefs—Construction of chapter.


title: RCW 74.09.195

text:
(1) Audits of the records of health care providers performed under this chapter are subject to the following:
(a) The authority must provide at least thirty calendar days' notice before scheduling any on-site audit, unless there is evidence of danger to public health and safety or fraudulent activities;
(b) The authority must make a good faith effort to establish a mutually agreed upon time and date for the on-site audit;
(c) The authority must allow providers, at their request, to submit records requested as a result of an audit in electronic format, including compact disc, digital versatile disc, or other electronic formats deemed appropriate by the authority, or by facsimile transmission;
(d) The authority shall make reasonable efforts to avoid reviewing claims that are currently being audited by the authority, that have already been audited by the authority, or that are currently being audited by another governmental entity;
(e) A finding of overpayment to a provider in a program operated or administered by the authority may not be based on extrapolation unless there is a determination of sustained high level of payment error involving the provider or when documented educational intervention has failed to correct the level of payment error. Any finding that is based upon extrapolation, and the related sampling, must be established to be statistically fair and reasonable in order to be valid. The sampling methodology used must be validated by a statistician or person with equivalent experience as having a confidence level of ninety-five percent or greater;
(f) The authority must provide a detailed explanation in writing to a provider for any adverse determination that would result in partial or full recoupment of a payment to the provider. The written notification shall, at a minimum, include the following: (i) The reason for the adverse determination; (ii) the specific criteria on which the adverse determination was based; (iii) an explanation of the provider's appeal rights; and (iv) if applicable, the appropriate procedure to submit a claims adjustment in accordance with subsection (3) of this section;
(g) The authority may not recoup overpayments until all informal and formal appeals processes have been completed;
(h) The authority must offer a provider with an adverse determination the option of repaying the amount owed according to a negotiated repayment plan of up to twelve months;
(i) The authority must produce a preliminary report or draft audit findings within one hundred twenty days from the receipt of all requested information as identified in writing by the authority; and
(j) In the event that the authority seeks to recoup funds from a provider who is no longer a contractor with the medical assistance program, the authority must provide a description of the claim, including the patient name, date of service, and procedure. A provider is not required to obtain a court order to receive such information.
(2) Any contractor that conducts audits of the medical assistance program on behalf of the authority must comply with the requirements in this subsection and must:
(a) In any appeal by a health care provider, employ or contract with a medical or dental professional who practices within the same specialty, is board certified, and experienced in the treatment, billing, and coding procedures used by the provider being audited to make findings and determinations;
(b) Compile, on an annual basis, metrics specified by the authority. The authority shall publish the metrics on its website. The metrics must, at a minimum, include:
(i) The number and type of claims reviewed;
(ii) The number of records requested;
(iii) The number of overpayments and underpayments identified by the contractor;
(iv) The aggregate dollar amount associated with identified overpayments and underpayments;
(v) The duration of audits from initiation until time of completion;
(vi) The number of adverse determinations and the overturn rates of those determinations at each stage of the informal and formal appeal process;
(vii) The number of informal and formal appeals filed by providers categorized by disposition status;
(viii) The contractor's compensation structure and dollar amount of compensation; and
(ix) A copy of the authority's contract with the contractor.
(3) The authority shall develop and implement a procedure by which an improper payment identified by an audit may be resubmitted as a claims adjustment.
(4) The authority shall provide educational and training programs annually for providers. The training topics must include a summary of audit results, a description of common issues, problems and mistakes identified through audits and reviews, and opportunities for improvement.
[ 2017 c 242 s 1.]

catchline: Audits of health care providers by the authority—Requirements—Procedure.


title: RCW 74.09.200

text:
The legislature finds and declares it to be in the public interest and for the protection of the health and welfare of the residents of the state of Washington that a proper regulatory and inspection program be instituted in connection with the providing of medical, dental, and other health services to recipients of public assistance and medically indigent persons. In order to effectively accomplish such purpose and to assure that the recipient of such services receives such services as are paid for by the state of Washington, the acceptance by the recipient of such services, and by practitioners of reimbursement for performing such services, shall authorize the secretary or director, to inspect and audit all records in connection with the providing of such services.
[ 2011 1st sp.s. c 15 s 14; 1979 ex.s. c 152 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.

catchline: Audits and investigations—Legislative declaration—State authority.


title: RCW 74.09.210

text:
(1) No person, firm, corporation, partnership, association, agency, institution, or other legal entity, but not including an individual public assistance recipient of health care, shall, on behalf of himself or herself or others, obtain or attempt to obtain benefits or payments under this chapter or other applicable law in a greater amount than that to which entitled by means of:
(a) A willful false statement;
(b) By willful misrepresentation, or by concealment of any material facts; or
(c) By other fraudulent scheme or device, including, but not limited to:
(i) Billing for services, drugs, supplies, or equipment that were unfurnished, of lower quality, or a substitution or misrepresentation of items billed; or
(ii) Repeated billing for purportedly covered items, which were not in fact so covered.
(2) Any person or entity knowingly violating any of the provisions of subsection (1) of this section shall be liable for repayment of any excess benefits or payments received, plus interest at the rate and in the manner provided in RCW 43.20B.695. Such person or other entity shall further, in addition to any other penalties provided by law, be subject to civil penalties. The director or the attorney general may assess civil penalties in an amount not to exceed three times the amount of such excess benefits or payments: PROVIDED, That these civil penalties shall not apply to any acts or omissions occurring prior to September 1, 1979. RCW 43.20A.215 governs notice of a civil fine assessed by the director and provides the right to an adjudicative proceeding.
(3) A criminal action need not be brought against a person for that person to be civilly liable under this section.
(4) In all administrative proceedings under this section, service, adjudicative proceedings, and judicial review of such determinations shall be in accordance with chapter 34.05 RCW, the administrative procedure act.
(5) Civil penalties shall be deposited upon their receipt into the medicaid fraud penalty account established in RCW 74.09.215.
(6) The attorney general may contract with private attorneys and local governments in bringing actions under this section as necessary.
[ 2018 c 201 s 7009; 2013 c 23 s 202; 2012 c 241 s 102; 2011 1st sp.s. c 15 s 15; 1989 c 175 s 146; 1987 c 283 s 7; 1979 ex.s. c 152 s 2.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
Intent—Finding—2012 c 241: See note following RCW 74.66.010.
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—1989 c 175: See note following RCW 34.05.010.
Severability—Savings—1987 c 283: See notes following RCW 43.20A.020.

catchline: Fraudulent practices—Penalties.


title: RCW 74.09.215

text:
The medicaid fraud penalty account is created in the state treasury. All receipts from civil penalties collected under RCW 74.09.210, all receipts received under judgments or settlements that originated under a filing under the federal false claims act, all receipts from fines received pursuant to RCW 43.71C.090, and all receipts received under judgments or settlements that originated under the state medicaid fraud false claims act, chapter 74.66 RCW, must be deposited into the account. Moneys in the account may be spent only after appropriation and must be used only for medicaid services, fraud detection and prevention activities, recovery of improper payments, for other medicaid fraud enforcement activities, and the prescription monitoring program established in chapter 70.225 RCW.
[ 2023 c 51 s 36; 2019 c 334 s 14. Prior: 2013 2nd sp.s. c 4 s 1902; 2013 2nd sp.s. c 4 s 997; 2013 2nd sp.s. c 4 s 995; 2013 c 36 s 3; 2012 c 241 s 103.]
Notes:
Effective dates—2013 2nd sp.s. c 4: See note following RCW 2.68.020.
Findings—2013 c 36: See note following RCW 70.225.020.
Intent—Finding—2012 c 241: See note following RCW 74.66.010.

catchline: Medicaid fraud penalty account.


title: RCW 74.09.220

text:
Any person, firm, corporation, partnership, association, agency, institution or other legal entity, but not including an individual public assistance recipient of health care, that, without intent to violate this chapter or other applicable law, obtains benefits or payments under this code to which such person or entity is not entitled, or in a greater amount than that to which entitled, shall be liable for (1) any excess benefits or payments received, and (2) interest calculated at the rate and in the manner provided in RCW 43.20B.695 or 41.05A.220. Whenever a penalty is due under RCW 74.09.210 or interest is due under RCW 43.20B.695 or 41.05A.220, such penalty or interest shall not be reimbursable by the state as an allowable cost under any of the provisions of this chapter or other applicable law.
[ 2023 c 51 s 37; 2018 c 201 s 7010; 1987 c 283 s 8; 1979 ex.s. c 152 s 3.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
Severability—Savings—1987 c 283: See notes following RCW 43.20A.020.

catchline: Liability for receipt of excess payments.


title: RCW 74.09.230

text:
Any person, including any corporation, that
(1) knowingly makes or causes to be made any false statement or representation of a material fact in any application for any payment under any medical care program authorized under this chapter or other applicable law, or
(2) at any time knowingly makes or causes to be made any false statement or representation of a material fact for use in determining rights to such payment, or knowingly falsifies, conceals, or covers up by any trick, scheme, or device a material fact in connection with such application or payment, or
(3) having knowledge of the occurrence of any event affecting (a) the initial or continued right to any payment, or (b) the initial or continued right to any such payment of any other individual in whose behalf he or she has applied for or is receiving such payment, conceals or fails to disclose such event with an intent fraudulently to secure such payment either in a greater amount or quantity than is due or when no such payment is authorized,
shall be guilty of a class C felony: PROVIDED, That the fine, if imposed, shall not be in an amount more than twenty-five thousand dollars, except as authorized by RCW 9A.20.030.
[ 2018 c 201 s 7011; 2013 c 23 s 203; 1979 ex.s. c 152 s 4.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.

catchline: False statements, fraud—Penalties.


title: RCW 74.09.240

text:
(1) Any person, including any corporation, that solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind
(a) in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under this chapter or other applicable law, or
(b) in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any goods, facility, service, or item for which payment may be made in whole or in part under this chapter or other applicable law,
shall be guilty of a class C felony; however, the fine, if imposed, shall not be in an amount more than twenty-five thousand dollars, except as authorized by RCW 9A.20.030.
(2) Any person, including any corporation, that offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person
(a) to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made, in whole or in part, under this chapter or other applicable law, or
(b) to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any goods, facility, service, or item for which payment may be made in whole or in part under this chapter or other applicable law,
shall be guilty of a class C felony; however, the fine, if imposed, shall not be in an amount more than twenty-five thousand dollars, except as authorized by RCW 9A.20.030.
(3)(a) Except as provided in 42 U.S.C. 1395 nn, physicians are prohibited from self-referring any client eligible under this chapter for the following designated health services to a facility in which the physician or an immediate family member has a financial relationship:
(i) Clinical laboratory services;
(ii) Physical therapy services;
(iii) Occupational therapy services;
(iv) Radiology including magnetic resonance imaging, computerized axial tomography, and ultrasound services;
(v) Durable medical equipment and supplies;
(vi) Parenteral and enteral nutrients equipment and supplies;
(vii) Prosthetics, orthotics, and prosthetic devices;
(viii) Home health services;
(ix) Outpatient prescription drugs;
(x) Inpatient and outpatient hospital services;
(xi) Radiation therapy services and supplies.
(b) For purposes of this subsection, "financial relationship" means the relationship between a physician and an entity that includes either:
(i) An ownership or investment interest; or
(ii) A compensation arrangement.
For purposes of this subsection, "compensation arrangement" means an arrangement involving remuneration between a physician, or an immediate family member of a physician, and an entity.
(c) The department or authority, as appropriate, is authorized to adopt by rule amendments to 42 U.S.C. 1395 nn enacted after July 23, 1995.
(d) This section shall not apply in any case covered by a general exception specified in 42 U.S.C. Sec. 1395 nn.
(4) Subsections (1) and (2) of this section shall not apply to:
(a) A discount or other reduction in price obtained by a provider of services or other entity under this chapter or other applicable law if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity under this chapter or other applicable law; and
(b) Any amount paid by an employer to an employee (who has a bona fide employment relationship with such employer) for employment in the provision of covered items or services.
(5) Subsections (1) and (2) of this section, if applicable to the conduct involved, shall supersede the criminal provisions of chapter 19.68 RCW, but shall not preclude administrative proceedings authorized by chapter 19.68 RCW.
[ 2018 c 201 s 7012; 2011 1st sp.s. c 15 s 16; 1995 c 319 s 1; 1979 ex.s. c 152 s 5.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
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.


title: RCW 74.09.250

text:
Any person, including any corporation, that knowingly makes or causes to be made, or induces or seeks to induce the making of, any false statement or representation of a material fact with respect to the conditions or operations of any institution or facility in order that such institution or facility may qualify (either upon initial certification or upon recertification) as a hospital, nursing facility, or home health agency, shall be guilty of a class C felony: PROVIDED, That the fine, if imposed, shall not be in an amount more than five thousand dollars.
[ 1991 sp.s. c 8 s 6; 1979 ex.s. c 152 s 6.]
Notes:
Effective date—1991 sp.s. c 8: See note following RCW 18.51.050.

catchline: False statements regarding institutions, facilities—Penalties.


title: RCW 74.09.260

text:
Any person, including any corporation, that knowingly:
(1) Charges, for any service provided to a patient under any medical care plan authorized under this chapter or other applicable law, money or other consideration at a rate in excess of the rates established by the department or authority, as appropriate; or
(2) Charges, solicits, accepts, or receives, in addition to any amount otherwise required to be paid under such plan, any gift, money, donation, or other consideration (other than a charitable, religious, or philanthropic contribution from an organization or from a person unrelated to the patient):
(a) As a precondition of admitting a patient to a hospital or nursing facility; or
(b) As a requirement for the patient's continued stay in such facility,
when the cost of the services provided therein to the patient is paid for, in whole or in part, under such plan, shall be guilty of a class C felony: PROVIDED, That the fine, if imposed, shall not be in an amount more than twenty-five thousand dollars, except as authorized by RCW 9A.20.030.
[ 2018 c 201 s 7013; 2011 1st sp.s. c 15 s 17; 1991 sp.s. c 8 s 7; 1979 ex.s. c 152 s 7.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
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—1991 sp.s. c 8: See note following RCW 18.51.050.

catchline: Excessive charges, payments—Penalties.


title: RCW 74.09.270

text:
(1) Any person having any patient trust funds in his or her possession, custody, or control, who, knowing that he or she is violating any statute, regulation, or agreement, deliberately fails to deposit, transfer, or maintain said funds in a separate, designated, trust bank account as required by such statute, regulation, or agreement shall be guilty of a gross misdemeanor and shall be punished by imprisonment for up to three hundred sixty-four days in the county jail, or by a fine of not more than ten thousand dollars or as authorized by RCW 9A.20.030, or by both such fine and imprisonment.
(2) "Patient trust funds" are funds received by any health care facility which belong to patients and are required by any state or federal statute, regulation, or by agreement to be kept in a separate trust bank account for the benefit of such patients.
(3) This section shall not be construed to prevent a prosecution for theft.
[ 2011 c 96 s 54; 1979 ex.s. c 152 s 8.]
Notes:
Findings—Intent—2011 c 96: See note following RCW 9A.20.021.

catchline: Failure to maintain trust funds in separate account—Penalties.


title: RCW 74.09.280

text:
The secretary or director may by rule require that any application, statement, or form filled out by suppliers of medical care under this chapter or other applicable law shall contain or be verified by a written statement that it is made under the penalties of perjury and such declaration shall be in lieu of any oath otherwise required, and each such paper shall in such event so state. The making or subscribing of any such papers or forms containing any false or misleading information may be prosecuted and punished under chapter 9A.72 RCW.
[ 2018 c 201 s 7014; 2011 1st sp.s. c 15 s 18; 1979 ex.s. c 152 s 9.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
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.

catchline: False verification of written statements—Penalties.


title: RCW 74.09.290

text:
The secretary or director shall have the authority to:
(1) Conduct audits and investigations of providers of medical and other services furnished pursuant to this chapter or other applicable law, except that the Washington medical commission shall generally serve in an advisory capacity to the secretary or director in the conduct of audits or investigations of physicians. Any overpayment discovered as a result of an audit of a provider under this authority shall be offset by any underpayments discovered in that same audit sample. In order to determine the provider's actual, usual, customary, or prevailing charges, the secretary or director may examine such random representative records as necessary to show accounts billed and accounts received except that in the conduct of such examinations, patient names, other than public assistance applicants or recipients, shall not be noted, copied, or otherwise made available to the department or authority. In order to verify costs incurred by the department or authority for treatment of public assistance applicants or recipients, the secretary or director may examine patient records or portions thereof in connection with services to such applicants or recipients rendered by a health care provider, notwithstanding the provisions of RCW 5.60.060, 18.53.200, 18.83.110, or any other statute which may make or purport to make such records privileged or confidential: PROVIDED, That no original patient records shall be removed from the premises of the health care provider, and that the disclosure of any records or information by the department or the authority is prohibited and shall be punishable as a class C felony according to chapter 9A.20 RCW, unless such disclosure is directly connected to the official purpose for which the records or information were obtained: PROVIDED FURTHER, That the disclosure of patient information as required under this section shall not subject any physician or other health services provider to any liability for breach of any confidential relationship between the provider and the patient, but no evidence resulting from such disclosure may be used in any civil, administrative, or criminal proceeding against the patient unless a waiver of the applicable evidentiary privilege is obtained: PROVIDED FURTHER, That the secretary or director shall destroy all copies of patient medical records in their possession upon completion of the audit, investigation or proceedings;
(2) Approve or deny applications to participate as a provider of services furnished pursuant to this chapter or other applicable law;
(3) Terminate or suspend eligibility to participate as a provider of services furnished pursuant to this chapter or other applicable law; and
(4) Adopt, promulgate, amend, and repeal administrative rules, in accordance with the administrative procedure act, chapter 34.05 RCW, to carry out the policies and purposes of this section and RCW 74.09.200 through 74.09.280.
[ 2019 c 55 s 19; 2018 c 201 s 7015; 2011 1st sp.s. c 15 s 19; 1994 sp.s. c 9 s 749; 1990 c 100 s 5; 1983 1st ex.s. c 41 s 23; 1979 ex.s. c 152 s 10.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
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.
Severability—Headings and captions not law—Effective date—1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.
Severability—1983 1st ex.s. c 41: See note following RCW 26.09.060.

catchline: Audits and investigations of providers—Patient records—Penalties.


title: RCW 74.09.295

text:
It is permissible to provide to a correctional institution, as defined in RCW 9.94.049, with the fact, place, and date of an involuntary commitment and the fact and date of discharge or release of a person who has been involuntarily committed under chapter 71.05 or 71.34 RCW, without a person's consent, in the course of the implementation and use of the department's postinstitutional medical assistance system supporting the expedited medical determinations and medical suspensions as provided in RCW 74.09.555. Disclosure under this section is mandatory for the purposes of the health insurance portability and accountability act.
[ 2011 c 305 s 2.]
Notes:
Findings—2011 c 305: "The legislature finds that effective collaboration and communication between mental health and chemical dependency treatment providers and service delivery systems and law enforcement and criminal justice agencies is important to both the care of persons with mental disorders and chemical dependency and public safety. The legislature also finds that many state and local efforts in recent years have worked to address improved treatment of persons with mental disorders, chemical dependency disorders, or co-occurring mental and substance abuse disorders who are confined in a correctional institution and to improve communication and collaboration among the agencies, institutions, and professionals who are responsible for the care or custody of those persons. While numerous laws have been enacted to clarify the appropriate sharing of information between those agencies, institutions, and professionals, the legislature finds further clarification will continue to aide [aid] and improve the care of those persons and augment public safety." [ 2011 c 305 s 1.]

catchline: Disclosure of involuntary commitment information.


title: RCW 74.09.300

text:
Whenever the secretary or director imposes a civil penalty under RCW 74.09.210, or terminates or suspends a provider's eligibility under RCW 74.09.290, he or she shall, if the provider is licensed pursuant to Titles 18, 70, or 71 RCW, give written notice of such imposition, termination, or suspension to the appropriate licensing agency or disciplinary board.
[ 2011 1st sp.s. c 15 s 20; 1979 ex.s. c 152 s 11.]
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.

catchline: Department to report penalties to appropriate licensing agency or disciplinary board.


title: RCW 74.09.315

text:
(1) For the purposes of this section:
(a) "Employer" means any person, firm, corporation, partnership, association, agency, institution, or other legal entity.
(b) "Whistleblower" means an employee of an employer that obtains or attempts to obtain benefits or payments under this chapter or other applicable law in violation of RCW 74.09.210, who in good faith reports a violation of RCW 74.09.210 to the authority.
(c) "Workplace reprisal or retaliatory action" includes, but is not limited to: Denial of adequate staff to fulfill duties; frequent staff changes; frequent and undesirable office changes; refusal to assign meaningful work; unwarranted and unsubstantiated report of misconduct under Title 18 RCW; unwarranted and unsubstantiated letters of reprimand or unsatisfactory performance evaluations; demotion; reduction in pay; denial of promotion; suspension; dismissal; denial of employment; a supervisor or superior behaving in or encouraging coworkers to behave in a hostile manner toward the whistleblower; or a change in the physical location of the employee's workplace or a change in the basic nature of the employee's job, if either are in opposition to the employee's expressed wish.
(2) A whistleblower who has been subjected to workplace reprisal or retaliatory action has the remedies provided under chapter 49.60 RCW. RCW 4.24.500 through 4.24.520, providing certain protection to persons who communicate to government agencies, apply to complaints made under this section. The identity of a whistleblower who complains, in good faith, to the authority about a suspected violation of RCW 74.09.210 may remain confidential if requested. The identity of the whistleblower must subsequently remain confidential unless the authority determines that the complaint was not made in good faith.
(3) This section does not prohibit an employer from exercising its authority to terminate, suspend, or discipline an employee who engages in workplace reprisal or retaliatory action against a whistleblower. The protections provided to whistleblowers under this chapter do not prevent an employer from: (a) Terminating, suspending, or disciplining a whistleblower for other lawful purposes; or (b) reducing the hours of employment or terminating employment as a result of the demonstrated inability to meet payroll requirements. The authority shall determine if the employer cannot meet payroll in cases where a whistleblower has been terminated or had hours of employment reduced due to the inability of a facility to meet payroll.
(4) The authority shall adopt rules to implement procedures for filing, investigation, and resolution of whistleblower complaints that are integrated with complaint procedures under this chapter. The authority shall adopt rules designed to discourage whistleblower complaints made in bad faith or for retaliatory purposes.
[ 2018 c 201 s 7016; 2012 c 241 s 104.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
Intent—Finding—2012 c 241: See note following RCW 74.66.010.

catchline: Whistleblowers—Workplace reprisal or retaliatory action.