title: RCW 74.09.515

text:
(1) The authority shall adopt rules and policies providing that when youth who were enrolled in a medical assistance program immediately prior to confinement are released from confinement, their medical assistance coverage will be fully reinstated on the day of their release, subject to any expedited review of their continued eligibility for medical assistance coverage that is required under federal or state law.
(2) The authority, in collaboration with the department, county juvenile court administrators, managed care organizations, the department of children, youth, and families, and behavioral health administrative services organizations, shall establish procedures for coordination among field offices, juvenile rehabilitation institutions, and county juvenile courts that result in prompt reinstatement of eligibility and speedy eligibility determinations for youth who are likely to be eligible for medical assistance services upon release from confinement. Procedures developed under this subsection must address:
(a) Mechanisms for receiving medical assistance services' applications on behalf of confined youth in anticipation of their release from confinement;
(b) Expeditious review of applications filed by or on behalf of confined youth and, to the extent practicable, completion of the review before the youth is released; and
(c) Mechanisms for providing medical assistance services' identity cards to youth eligible for medical assistance services immediately upon their release from confinement.
(3) For purposes of this section, "confined" or "confinement" means detained in a juvenile rehabilitation facility operated by or under contract with the department of children, youth, and families, or detained in a juvenile detention facility operated under chapter 13.04 RCW.
(4) The authority shall adopt standardized statewide screening and application practices and forms designed to facilitate the application of a confined youth who is likely to be eligible for a medical assistance program.
[ 2019 c 325 s 4003; 2014 c 225 s 100; 2011 1st sp.s. c 15 s 26; 2007 c 359 s 8.]
Notes:
Effective date—2019 c 325: See note following RCW 71.24.011.
Effective date—2014 c 225: See note following RCW 71.24.016.
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.
Captions not law—2007 c 359: See note following RCW 71.36.005.

catchline: Medical assistance—Coverage for youth released from confinement.


doc_type: statute

jurisdiction: wa

title: RCW 74.09.520

text:
(1) The term "medical assistance" may include the following care and services subject to rules adopted by the authority or department: (a) Inpatient hospital services; (b) outpatient hospital services; (c) other laboratory and X-ray services; (d) nursing facility services; (e) physicians' services, which shall include prescribed medication and instruction on birth control devices; (f) medical care, or any other type of remedial care as may be established by the secretary or director; (g) home health care services; (h) private duty nursing services; (i) dental services; (j) physical and occupational therapy and related services; (k) prescribed drugs, dentures, and prosthetic devices; and eyeglasses prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the individual may select; (l) personal care services, as provided in this section; (m) hospice services; (n) other diagnostic, screening, preventive, and rehabilitative services; and (o) like services when furnished to a child by a school district in a manner consistent with the requirements of this chapter. For the purposes of this section, neither the authority nor the department may cut off any prescription medications, oxygen supplies, respiratory services, or other life-sustaining medical services or supplies.
"Medical assistance," notwithstanding any other provision of law, shall not include routine foot care, or dental services delivered by any health care provider, that are not mandated by Title XIX of the social security act unless there is a specific appropriation for these services.
(2) The department shall adopt, amend, or rescind such administrative rules as are necessary to ensure that Title XIX personal care services are provided to eligible persons in conformance with federal regulations.
(a) These administrative rules shall include financial eligibility indexed according to the requirements of the social security act providing for medicaid eligibility.
(b) The rules shall require clients be assessed as having a medical condition requiring assistance with personal care tasks. Plans of care for clients requiring health-related consultation for assessment and service planning may be reviewed by a nurse.
(c) The department shall determine by rule which clients have a health-related assessment or service planning need requiring registered nurse consultation or review. This definition may include clients that meet indicators or protocols for review, consultation, or visit.
(3) The department shall design and implement a means to assess the level of functional disability of persons eligible for personal care services under this section. The personal care services benefit shall be provided to the extent funding is available according to the assessed level of functional disability. Any reductions in services made necessary for funding reasons should be accomplished in a manner that assures that priority for maintaining services is given to persons with the greatest need as determined by the assessment of functional disability.
(4) Effective July 1, 1989, the authority shall offer hospice services in accordance with available funds.
(5) For Title XIX personal care services administered by the department, the department shall contract with area agencies on aging or may contract with a federally recognized Indian tribe under RCW 74.39A.090(3):
(a) To provide case management services to individuals receiving Title XIX personal care services in their own home; and
(b) To reassess and reauthorize Title XIX personal care services or other home and community services as defined in RCW 74.39A.009 in home or in other settings for individuals consistent with the intent of this section:
(i) Who have been initially authorized by the department to receive Title XIX personal care services or other home and community services as defined in RCW 74.39A.009; and
(ii) Who, at the time of reassessment and reauthorization, are receiving such services in their own home.
(6) In the event that an area agency on aging or federally recognized Indian tribe is unwilling to enter into or satisfactorily fulfill a contract or an individual consumer's need for case management services will be met through an alternative delivery system, the department is authorized to:
(a) Obtain the services through competitive bid; and
(b) Provide the services directly until a qualified contractor can be found.
(7) Subject to the availability of amounts appropriated for this specific purpose, the authority may offer medicare part D prescription drug copayment coverage to full benefit dual eligible beneficiaries.
(8) Effective January 1, 2016, the authority shall require universal screening and provider payment for autism and developmental delays as recommended by the bright futures guidelines of the American academy of pediatrics, as they existed on August 27, 2015. This requirement is subject to the availability of funds.
(9) Subject to the availability of amounts appropriated for this specific purpose, effective January 1, 2018, the authority shall require provider payment for annual depression screening for youth ages twelve through eighteen as recommended by the bright futures guidelines of the American academy of pediatrics, as they existed on January 1, 2017. Providers may include, but are not limited to, primary care providers, public health nurses, and other providers in a clinical setting. This requirement is subject to the availability of funds appropriated for this specific purpose.
(10) Subject to the availability of amounts appropriated for this specific purpose, effective January 1, 2018, the authority shall require provider payment for maternal depression screening for mothers of children ages birth to six months. This requirement is subject to the availability of funds appropriated for this specific purpose.
(11) Subject to the availability of amounts appropriated for this specific purpose, the authority shall:
(a) Allow otherwise eligible reimbursement for the following related to mental health assessment and diagnosis of children from birth through five years of age:
(i) Up to five sessions for purposes of intake and assessment, if necessary;
(ii) Assessments in home or community settings, including reimbursement for provider travel; and
(b) Require providers to use the current version of the DC:0-5 diagnostic classification system for mental health assessment and diagnosis of children from birth through five years of age.
(12) Effective January 1, 2024, the authority shall require coverage for noninvasive preventive colorectal cancer screening tests assigned either a grade of A or grade of B by the United States preventive services task force and shall require coverage for colonoscopies performed as a result of a positive result from such a test.
(13)(a) The authority shall require or provide payment to the hospital for any day of a hospital stay in which an adult or child patient enrolled in medical assistance, including home and community services or with a medicaid managed care organization, under this chapter:
(i) Does not meet the criteria for acute inpatient level of care as defined by the authority;
(ii) Meets the criteria for discharge, as defined by the authority or department, to any appropriate placement including, but not limited to:
(A) A nursing home licensed under chapter 18.51 RCW;
(B) An assisted living facility licensed under chapter 18.20 RCW;
(C) An adult family home licensed under chapter 70.128 RCW; or
(D) A setting in which residential services are provided or funded by the developmental disabilities administration of the department, including supported living as defined in RCW 71A.10.020; and
(iii) Is not discharged from the hospital because placement in the appropriate location described in (a)(ii) of this subsection is not available.
(b) Pharmacy services and pharmaceuticals shall be billed by and paid to the hospital separately.
(c) The requirements of this subsection do not alter requirements for billing or payment for inpatient care.
(d) The authority shall adopt, amend, or rescind such administrative rules as necessary to facilitate calculation and payment of the amounts described in this subsection, including for clients of medicaid managed care organizations.
(e) The authority shall adopt rules requiring medicaid managed care organizations to establish specific and uniform administrative and review processes for payment under this subsection.
(f) For patients meeting the criteria in (a)(ii)(A) of this subsection, hospitals must utilize swing beds or skilled nursing beds to the extent the services are available within their facility and the associated reimbursement methodology prior to the billing under the methodology in (a) of this subsection, if the hospital determines that such swing bed or skilled nursing bed placement is appropriate for the patient's care needs, the patient is appropriate for the existing patient mix, and appropriate staffing is available.
[ 2025 c 367 s 1. Prior: 2023 c 315 s 1; 2023 c 299 s 1; 2022 c 255 s 4; 2021 c 126 s 2; 2017 c 202 s 4; 2015 1st sp.s. c 8 s 2; 2011 1st sp.s. c 15 s 27; 2007 c 3 s 1; 2004 c 141 s 2; 2003 c 279 s 1; 1998 c 245 s 145; 1995 1st sp.s. c 18 s 39; 1994 c 21 s 4; prior: 1993 c 149 s 10; 1993 c 57 s 1; 1991 sp.s. c 8 s 9; prior: 1991 c 233 s 1; 1991 c 119 s 1; prior: 1990 c 33 s 594; 1990 c 25 s 1; prior: 1989 c 427 s 10; 1989 c 400 s 3; 1985 c 5 s 3; 1982 1st ex.s. c 19 s 4; 1981 1st ex.s. c 6 s 21; 1981 c 8 s 20; 1979 c 141 s 344; 1969 ex.s. c 173 s 11; 1967 ex.s. c 30 s 5.]
Notes:
Findings—Intent—2017 c 202: See note following RCW 74.09.495.
Findings—2015 1st sp.s. c 8: "(1) The bright futures guidelines issued by the American academy of pediatrics outline recommended well-child visit schedules and universal screening of children for autism and developmental delays. Private health plans established after March 2010 are required to comply with the bright futures guidelines as the standard for preventive services. The federal law does not require medicaid programs to follow the guidelines; however, thirty states completely cover the bright futures guidelines, six states cover all but one well-child screen, and six additional states cover all but developmental and autism screens as part of their medicaid programs.
(2) The 2012 Washington state legislature directed the Washington state institute for public policy to assess the costs and benefits of implementing the guidelines. The research indicates that fewer than half of children with developmental delays are identified before starting school and roughly half of children with autism spectrum disorder are diagnosed only after entering school, by which time significant delays may have occurred and opportunities for treatment may have been missed. Adopting the universal screening guidelines improves early diagnosis and enables early intervention with appropriate therapies and services. The annual cost to society for caring for children with autism or developmental delays can be significant, including cost of services, special education, informal care, and lost productivity. Early intervention and access to appropriate therapies mitigate long-term societal costs and improve the health and opportunity for the child.
(3) The more adverse experiences a child has, such as the burden of family economic hardship and social bias, the greater the likelihood of developmental delays and later health problems. Over forty-six percent of Washington's children have medicaid apple health for kids and have a much greater likelihood of reporting poor to very poor health compared to children who have commercial insurance. Disparities also exist in the diagnosis and initiation of treatment services for children of color. Research shows that children of color are diagnosed later and begin receiving early intervention services later. This health equity gap can be addressed by identifying and supporting children early through universal screening.
(4) Primary care providers currently see ninety-nine percent of children between birth and three years of age and are uniquely situated to access nearly all children with universal screening." [ 2015 1st sp.s. c 8 s 1.]
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.
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
Conflict with federal requirements—Effective date—1994 c 21: See notes following RCW 43.20B.080.
Conflict with federal requirements—Severability—Effective dates—1993 c 149: See notes following RCW 28A.150.390.
Effective date—1991 sp.s. c 8: See note following RCW 18.51.050.
Purpose—Statutory references—Severability—1990 c 33: See RCW 28A.900.100 through 28A.900.102.
Intent—1989 c 400: See note following RCW 28A.150.390.
Effective date—1982 1st ex.s. c 19: See note following RCW 74.09.035.
Effective date—Severability—1981 1st ex.s. c 6: See notes following RCW 74.04.005.
Legislative confirmation of effect of 1994 c 21: RCW 43.20B.090.

license: public-domain-government-work

rule_set: Revised Code of Washington

catchline: Medical assistance—Care and services included—Funding limitations.

code: rcw

unit: section

court: Washington State Legislature


title: RCW 74.09.522

text:
(1) For the purposes of this section, "nonparticipating provider" means a person, health care provider, practitioner, facility, or entity, acting within their scope of practice, that does not have a written contract to participate in a managed care organization's provider network, but provides health care services to enrollees of programs authorized under this chapter or other applicable law whose health care services are provided by the managed care organization.
(2) The authority shall enter into agreements with managed care organizations to provide health care services to recipients of medicaid under the following conditions:
(a) Agreements shall be made for at least thirty thousand recipients statewide;
(b) Agreements in at least one county shall include enrollment of all recipients of programs as allowed for in the approved state plan amendment or federal waiver for Washington state's medicaid program;
(c) To the extent that this provision is consistent with section 1903(m) 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, recipients shall have a choice of systems in which to enroll and shall have the right to terminate their enrollment in a system: PROVIDED, That the authority may limit recipient termination of enrollment without cause to the first month of a period of enrollment, which period shall not exceed twelve months: AND PROVIDED FURTHER, That the authority shall not restrict a recipient's right to terminate enrollment in a system for good cause as established by the authority by rule;
(d) To the extent that this provision is consistent with section 1903(m) of Title XIX of the federal social security act, participating managed care organizations shall not enroll a disproportionate number of medical assistance recipients within the total numbers of persons served by the managed care organizations, except as authorized by the authority under federal demonstration waivers granted under section 1115(a) of Title XI of the federal social security act;
(e)(i) In negotiating with managed care organizations the authority shall adopt a uniform procedure to enter into contractual arrangements, including:
(A) Standards regarding the quality of services to be provided;
(B) The financial integrity of the responding system;
(C) Provider reimbursement methods that incentivize chronic care management within health homes, including comprehensive medication management services for patients with multiple chronic conditions consistent with the findings and goals established in RCW 74.09.5223;
(D) Provider reimbursement methods that reward health homes that, by using chronic care management, reduce emergency department and inpatient use;
(E) Promoting provider participation in the program of training and technical assistance regarding care of people with chronic conditions described in RCW 43.70.533, including allocation of funds to support provider participation in the training, unless the managed care organization is an integrated health delivery system that has programs in place for chronic care management;
(F) Provider reimbursement methods within the medical billing processes that incentivize pharmacists or other qualified providers licensed in Washington state to provide comprehensive medication management services consistent with the findings and goals established in RCW 74.09.5223;
(G) Evaluation and reporting on the impact of comprehensive medication management services on patient clinical outcomes and total health care costs, including reductions in emergency department utilization, hospitalization, and drug costs; and
(H) Established consistent processes to incentivize integration of behavioral health services in the primary care setting, promoting care that is integrated, collaborative, colocated, and preventive.
(ii)(A) Health home services contracted for under this subsection may be prioritized to enrollees with complex, high cost, or multiple chronic conditions.
(B) Contracts that include the items in (e)(i)(C) through (G) of this subsection must not exceed the rates that would be paid in the absence of these provisions;
(f) The authority shall seek waivers from federal requirements as necessary to implement this chapter;
(g) The authority shall, wherever possible, enter into prepaid capitation contracts that include inpatient care. However, if this is not possible or feasible, the authority may enter into prepaid capitation contracts that do not include inpatient care;
(h) The authority shall define those circumstances under which a managed care organization is responsible for out-of-plan services and assure that recipients shall not be charged for such services;
(i) Nothing in this section prevents the authority from entering into similar agreements for other groups of people eligible to receive services under this chapter; and
(j) The authority must consult with the federal center for medicare and medicaid innovation and seek funding opportunities to support health homes.
(3) The authority shall ensure that publicly supported community health centers and providers in rural areas, who show serious intent and apparent capability to participate as managed care organizations are seriously considered as contractors. The authority shall coordinate its managed care activities with activities under chapter 70.47 RCW.
(4) The authority shall work jointly with the state of Oregon and other states in this geographical region in order to develop recommendations to be presented to the appropriate federal agencies and the United States congress for improving health care of the poor, while controlling related costs.
(5) The legislature finds that competition in the managed health care marketplace is enhanced, in the long term, by the existence of a large number of managed care organization options for medicaid clients. In a managed care delivery system, whose goal is to focus on prevention, primary care, and improved enrollee health status, continuity in care relationships is of substantial importance, and disruption to clients and health care providers should be minimized. To help ensure these goals are met, the following principles shall guide the authority in its healthy options managed health care purchasing efforts:
(a) All managed care organizations should have an opportunity to contract with the authority to the extent that minimum contracting requirements defined by the authority are met, at payment rates that enable the authority to operate as far below appropriated spending levels as possible, consistent with the principles established in this section.
(b) Managed care organizations should compete for the award of contracts and assignment of medicaid beneficiaries who do not voluntarily select a contracting system, based upon:
(i) Demonstrated commitment to or experience in serving low-income populations;
(ii) Quality of services provided to enrollees;
(iii) Accessibility, including appropriate utilization, of services offered to enrollees;
(iv) Demonstrated capability to perform contracted services, including ability to supply an adequate provider network;
(v) Payment rates; and
(vi) The ability to meet other specifically defined contract requirements established by the authority, including consideration of past and current performance and participation in other state or federal health programs as a contractor.
(c) Consideration should be given to using multiple year contracting periods.
(d) Quality, accessibility, and demonstrated commitment to serving low-income populations shall be given significant weight in the contracting, evaluation, and assignment process.
(e) All contractors that are regulated health carriers must meet state minimum net worth requirements as defined in applicable state laws. The authority shall adopt rules establishing the minimum net worth requirements for contractors that are not regulated health carriers. This subsection does not limit the authority of the Washington state health care authority to take action under a contract upon finding that a contractor's financial status seriously jeopardizes the contractor's ability to meet its contract obligations.
(f) Procedures for resolution of disputes between the authority and contract bidders or the authority and contracting carriers related to the award of, or failure to award, a managed care contract must be clearly set out in the procurement document.
(6) The authority may apply the principles set forth in subsection (5) of this section to its managed health care purchasing efforts on behalf of clients receiving supplemental security income benefits to the extent appropriate.
(7) Any contract with a managed care organization to provide services to medical assistance enrollees shall require that managed care organizations offer contracts to mental health providers and substance use disorder treatment providers to provide access to primary care services integrated into behavioral health clinical settings, for individuals with behavioral health and medical comorbidities.
(8) Managed care organization contracts effective on or after April 1, 2016, shall serve geographic areas that correspond to the regional service areas established in RCW 74.09.870.
(9) A managed care organization shall pay a nonparticipating provider that provides a service covered under this chapter or other applicable law to the organization's enrollee no more than the lowest amount paid for that service under the managed care organization's contracts with similar providers in the state if the managed care organization has made good faith efforts to contract with the nonparticipating provider.
(10) For services covered under this chapter or other applicable law to medical assistance or medical care services enrollees, nonparticipating providers must accept as payment in full the amount paid by the managed care organization under subsection (9) of this section in addition to any deductible, coinsurance, or copayment that is due from the enrollee for the service provided. An enrollee is not liable to any nonparticipating provider for covered services, except for amounts due for any deductible, coinsurance, or copayment under the terms and conditions set forth in the managed care organization contract to provide services under this section.
(11) Pursuant to federal managed care access standards, 42 C.F.R. Sec. 438, managed care organizations must maintain a network of appropriate providers that is supported by written agreements sufficient to provide adequate access to all services covered under the contract with the authority, including hospital-based physician services. The authority will monitor and periodically report on the proportion of services provided by contracted providers and nonparticipating providers, by county, for each managed care organization to ensure that managed health care systems are meeting network adequacy requirements. No later than January 1st of each year, the authority will review and report its findings to the appropriate policy and fiscal committees of the legislature for the preceding state fiscal year.
(12) Managed care organization contracts or amendments effective on or after July 1, 2028, shall be required to meet network adequacy requirements established under this chapter for postacute care services, including nursing homes licensed under chapter 18.51 RCW, inpatient rehabilitation facilities licensed under chapter 70.41 RCW, and any other postacute care services the authority determines necessary to increase access to a full continuum of care for medicaid enrollees. The adequacy requirements included in this subsection shall be incorporated into monitoring and reporting requirements under subsection (11) of this section.
(13) Payments under RCW 74.60.130 are exempt from this section.
[ 2026 c 206 s 2; 2023 c 51 s 43; 2020 c 260 s 1; 2019 c 325 s 4004; 2018 c 201 s 7017; 2015 c 256 s 1; 2014 c 225 s 55; 2013 2nd sp.s. c 17 s 13; 2013 c 261 s 2. Prior: 2011 1st sp.s. c 15 s 29; 2011 1st sp.s. c 9 s 2; 2011 c 316 s 4; prior: 1997 c 59 s 15; 1997 c 34 s 1; 1989 c 260 s 2; 1987 1st ex.s. c 5 s 21; 1986 c 303 s 2.]
Notes:
Effective date—2019 c 325: See note following RCW 71.24.011.
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
Effective date—2013 2nd sp.s. c 17: See note following RCW 74.60.005.
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.
Findings—Intent—2011 1st sp.s. c 9: See note following RCW 70.47.020.
Effective date—1997 c 34: "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 immediately [April 16, 1997]." [ 1997 c 34 s 3.]
Legislative findings—Intent—1986 c 303: "(1) The legislature finds that:
(a) Good health care for indigent persons is of importance to the state;
(b) To ensure the availability of a good level of health care, efforts must be made to encourage cost consciousness on the part of providers and consumers, while maintaining medical assistance recipients within the mainstream of health care delivery;
(c) Managed health care systems have been found to be effective in controlling costs while providing good health care services;
(d) By enrolling medical assistance recipients within managed health care systems, the state's goal is to ensure that medical assistance recipients receive at least the same quality of care they currently receive.
(2) It is the intent of the legislature to develop and implement new strategies that promote the use of managed health care systems for medical assistance recipients by establishing prepaid capitated programs for both inpatient and outpatient services." [ 1986 c 303 s 1.]

catchline: Medical assistance—Agreements with managed care organizations for provision of services to medicaid recipients—Principles to be applied in purchasing managed health care.


title: RCW 74.09.5222

text:
(1) The authority shall submit a section 1115 demonstration waiver request to the federal department of health and human services to expand and revise the medical assistance program as codified in Title XIX of the federal social security act. The waiver request should be designed to ensure the broadest federal financial participation under Title XIX and XXI of the federal social security act. To the extent permitted under federal law, the waiver request should include the following components:
(a) Establishment of a single eligibility standard for low-income persons, including expansion of categorical eligibility to include childless adults. The authority shall request that the single eligibility standard be phased in such that incremental steps are taken to cover additional low-income parents and individuals over time, with the goal of offering coverage to persons with household income at or below two hundred percent of the federal poverty level;
(b) Establishment of a single seamless application and eligibility determination system for all state low-income medical programs included in the waiver. Applications may be electronic and may include an electronic signature for verification and authentication. Eligibility determinations should maximize federal financing where possible;
(c) The delivery of all low-income coverage programs as a single program, with a common core benefit package that may be similar to the basic health benefit package or an alternative benefit package approved by the secretary of the federal department of health and human services, including the option of supplemental coverage for select categorical groups, such as children, and individuals who are aged, blind, and disabled;
(d) A program design to include creative and innovative approaches such as: Coverage for preventive services with incentives to use appropriate preventive care; enhanced medical home reimbursement and bundled payment methodologies; cost-sharing options; use of care management and care coordination programs to improve coordination of medical and behavioral health services; application of an innovative predictive risk model to better target care management services; and mandatory enrollment in managed care, as may be necessary;
(e) The ability to impose enrollment limits or benefit design changes for eligibility groups that were not eligible under the Title XIX state plan in effect on the date of submission of the waiver application;
(f) A premium assistance program whereby employers can participate in coverage options for employees and dependents of employees otherwise eligible under the waiver. The waiver should make every effort to maximize enrollment in employer-sponsored health insurance when it is cost-effective for the state to do so, and the purchase is consistent with the requirements of Titles XIX and XXI of the federal social security act. To the extent allowable under federal law, the authority shall require enrollment in available employer-sponsored coverage as a condition of eligibility for coverage under the waiver; and
(g) The ability to share savings that might accrue to the federal medicare program, Title XVIII of the federal social security act, from improved care management for persons who are eligible for both medicare and medicaid. Through the waiver application process, the authority shall determine whether the state could serve, directly or by contract, as a medicare special needs plan for persons eligible for both medicare and medicaid.
(2) The authority shall hold ongoing stakeholder discussions as it is developing the waiver request, and provide opportunities for public review and comment as the request is being developed.
(3) The authority shall identify statutory changes that may be necessary to ensure successful and timely implementation of the waiver request as submitted to the federal department of health and human services as the apple health program for adults.
(4) The legislature must authorize implementation of any waiver approved by the federal department of health and human services under this section.
[ 2011 1st sp.s. c 15 s 30; 2009 c 545 s 4.]
Notes:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
Findings—2009 c 545: See note following RCW 43.06.155.

catchline: Medical assistance—Section 1115 demonstration waiver request.


title: RCW 74.09.5223

text:
The legislature finds that chronic care management, including comprehensive medication management services, provided by licensed pharmacists and qualified providers is a critical component of a collaborative, multidisciplinary, inter-professional approach to the treatment of chronic diseases for targeted individuals, to improve the quality of care and reduce overall cost in the treatment of such diseases.
[ 2013 c 261 s 1.]

catchline: Findings—Chronic care management.


title: RCW 74.09.5225

text:
(1) Payments for recipients eligible for medical assistance programs under this chapter for services provided by hospitals, regardless of the beneficiary's managed care enrollment status, shall be made based on allowable costs incurred during the year, when services are provided by a rural hospital certified by the centers for medicare and medicaid services as a critical access hospital, unless the critical access hospital is participating in the Washington rural health access preservation pilot described in subsection (2)(c) of this section. Any additional payments made by the authority for the healthy options program shall be no more than the additional amounts per service paid under this section for other medical assistance programs.
(2)(a) Beginning on July 24, 2005, except as provided in (b) and (c) of this subsection, a moratorium shall be placed on additional hospital participation in critical access hospital payments under this section. However, rural hospitals that applied for certification to the centers for medicare and medicaid services prior to January 1, 2005, but have not yet completed the process or have not yet been approved for certification, remain eligible for medical assistance payments under this section.
(b) A critical access hospital designated by the centers for medicare and medicaid services is eligible for payment under subsection (1) of this section if the hospital is located on an island operating within a public hospital district in Skagit county.
(c)(i) The purpose of the Washington rural health access preservation pilot is to develop an alternative service and payment system to the critical access hospital authorized under section 1820 of the social security act to sustain essential services in rural communities.
(ii) For the purposes of state law, any rural hospital approved by the department of health for participation in critical access hospital payments under this section that participates in the Washington rural health access preservation pilot identified by the state office of rural health and ceases to participate in critical access hospital payments may renew participation in critical access hospital associated payment methodologies under this section at any time.
(iii) The Washington rural health access preservation pilot is subject to the following requirements:
(A) In the pilot formation or development, the department of health, health care authority, and Washington state hospital association will identify goals for the pilot project before any hospital joins the pilot project;
(B) Participation in the pilot is optional and no hospital may be required to join the pilot;
(C) Before a hospital enters the pilot program, the health care authority must provide information to the hospital regarding how the hospital could end its participation in the pilot if the pilot is not working in its community;
(D) Payments for services delivered by public health care service districts participating in the Washington rural health access preservation pilot to recipients eligible for medical assistance programs under this chapter must be based on an alternative, value-based payment methodology established by the authority. Subject to the availability of amounts appropriated for this specific purpose, the payment methodology must provide sufficient funding to sustain essential services in the areas served, including but not limited to emergency and primary care services. The methodology must adjust payment amounts based on measures of quality and value, rather than volume. As part of the pilot, the health care authority shall encourage additional payers to use the adopted payment methodology for services delivered by the pilot participants to individuals insured by those payers;
(E) The department of health, health care authority, and Washington state hospital association will report interim progress to the legislature no later than December 1, 2018, and will report on the results of the pilot no later than six months following the conclusion of the pilot. The reports will describe any policy changes identified during the course of the pilot that would support small critical access hospitals; and
(F) Funds appropriated for the Washington rural health access preservation pilot will be used to help participating hospitals transition to a new payment methodology and will not extend beyond the anticipated three-year pilot period.
(3)(a) Beginning January 1, 2015, payments for recipients eligible for medical assistance programs under this chapter for services provided by a hospital, regardless of the beneficiary's managed care enrollment status, shall be increased to one hundred twenty-five percent of the hospital's fee-for-service rates, when services are provided by a rural hospital that:
(i) Was certified by the centers for medicare and medicaid services as a sole community hospital as of January 1, 2013;
(ii) Had a level III adult trauma service designation from the department of health as of January 1, 2014;
(iii) Had less than one hundred fifty acute care licensed beds in fiscal year 2011; and
(iv) Is owned and operated by the state or a political subdivision.
(b) The enhanced payment rates under this subsection shall be considered the hospital's medicaid payment rate for purposes of any other state or private programs that pay hospitals according to medicaid payment rates.
(c) Hospitals participating in the certified public expenditures program may not receive the increased reimbursement rates provided in this subsection (3) for inpatient services.
(4) Payments for recipients eligible for medical assistance programs under this chapter for services provided by a rural hospital designated by the federal centers for medicare and medicaid services as a rural emergency hospital, regardless of the managed care enrollment status of the beneficiary, are subject to appropriation.
[ 2026 c 112 s 1; 2026 c 84 s 1; (2023 c 443 s 2 expired January 1, 2024); 2017 c 198 s 1; 2016 sp.s. c 31 s 2; 2014 c 57 s 2; 2011 1st sp.s. c 15 s 31; 2005 c 383 s 1; 2001 2nd sp.s. c 2 s 2.]
Notes:
Reviser's note: This section was amended by 2026 c 84 s 1 and by 2026 c 112 s 1, each without reference to the other. Both amendments are incorporated in the publication of this section under RCW 1.12.025(2). For rule of construction, see RCW 1.12.025(1).
Finding—Intent—2016 sp.s. c 31: "The legislature finds that small critical access hospitals provide essential services to their communities. The legislature recognizes the need to offer small critical access hospitals the opportunity to pilot different delivery and payment models than may be currently allowed under the critical access hospital program. The legislature also intends to allow these participating hospitals to return to the critical access hospital program if they so choose." [ 2016 sp.s. c 31 s 1.]
Findings—2014 c 57: "The legislature finds that promoting a financially viable health care system in all parts of the state is a critical interest. The federal centers for medicare and medicaid services has recognized the crucial role hospitals play in providing care in rural areas by creating the sole community hospital program, which allows certain small rural hospitals to receive enhanced payments for medicare services. The legislature further finds that creating a similar reimbursement system for the state's medicaid program for sole community hospitals will promote the long-term financial viability of the rural health care system in those communities." [ 2014 c 57 s 1.]
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.
Findings—2001 2nd sp.s. c 2: "The legislature finds that promoting a financially viable health care system in all parts of the state is a paramount interest. The health care financing administration has recognized the crucial role that hospitals play in providing care in rural areas by creating the critical access hospital program to allow small, rural hospitals that qualify to receive reasonable cost-based reimbursement for medicare services. The legislature further finds that creating a similar reimbursement system for the state's medical assistance programs in small, rural hospitals that qualify will help assure the long-term financial viability of the rural health system in those communities." [ 2001 2nd sp.s. c 2 s 1.]

catchline: Medical assistance—Payments for services provided by rural hospitals—Participation in Washington rural health access preservation pilot.


title: RCW 74.09.5226

text:
Beginning January 1, 2027, any rural hospital that is located on a federally recognized Indian reservation shall be eligible for payments for recipients eligible for medical assistance programs under this chapter for services provided by that rural hospital, regardless of the managed care enrollment status of the beneficiary, that are made at 150 percent of the fee-for-service rate for inpatient and outpatient hospital services, when those services are provided by that rural hospital, not including any beds in the psychiatric unit.
[ 2026 c 124 s 1.]
Notes:
Expiration date—2026 c 124 s 1: "Section 1 of the [this] act expires January 1, 2029." [ 2026 c 124 s 2.]

catchline: Medical assistance—Rural hospitals located on federally recognized Indian reservations. (Effective until January 1, 2029.)


title: RCW 74.09.5228

text:
By January 1, 2025, the authority shall submit a state plan amendment to the federal centers for medicare and medicaid services to allow medicaid-eligible children with medically complex conditions to voluntarily enroll in a health home as provided in section 3 of the medicaid services investment and accountability act of 2019 (P.L. 116-16).
[ 2024 c 177 s 2.]
Notes:
Findings—Intent—2024 c 177: "(1) The legislature finds that:
(a) Children with medical complexity deserve coordinated and effective care delivered in a high quality setting. Families should be able to focus solely on their child's needs and not waste precious time fighting a fragmented care system or the complexities of medicaid;
(b) In 2019, the federal government adopted the advancing care for exceptional kids act to address these concerns. This law created a new health home model that will coordinate prompt care for children with medically complex conditions, develop an individualized, comprehensive, pediatric, family-centered care plan, coordinate access to subspecialized care, and coordinate appropriate care with out-of-state providers; and
(c) The federal law provides health homes with a higher federal matching rate, making this proposal beneficial to Washington's children with medical complexities while also being financially prudent.
(2) The legislature, therefore, intends to actively support these medically complex children by taking the steps necessary to implement health homes in Washington." [ 2024 c 177 s 1.]

catchline: Primary care health homes—Children with medically complex conditions.


title: RCW 74.09.5229

text:
The legislature finds that:
(1) Health care costs are growing rapidly, exceeding the consumer price index year after year. Consequently, state health programs are capturing a growing share of the state budget, even as state revenues have declined. Sustaining these critical health programs will require actions to effectively contain health care cost increases in the future; and
(2) The primary care health home model has been demonstrated to successfully constrain costs, while improving quality of care. Chronic care management, occurring within a primary care health home, has been shown to be especially effective at reducing costs and improving quality. However, broad adoption of these models has been impeded by a fee-for-service system that reimburses volume of services and does not adequately support important primary care health home services, such as case management and patient outreach. Furthermore, successful implementation will require a broad adoption effort by private and public payers, in coordination with providers.
Therefore the legislature intends to promote the adoption of primary care health homes for children and adults and, within them, advance the practice of chronic care management to improve health outcomes and reduce unnecessary costs. To facilitate the best coordination and patient care, primary care health homes are encouraged to collaborate with other providers currently outside the medical insurance model. Successful chronic care management for persons receiving long-term care services in addition to medical care will require close coordination between primary care providers, long-term care workers, and other long-term care service providers, including area agencies on aging. Primary care providers also should consider oral health coordination through collaboration with dental providers and, when possible, delivery of oral health prevention services. The legislature also intends that the methods and approach of the primary care health home become part of basic primary care medical education.
[ 2011 c 316 s 1.]

catchline: Primary care health homes—Chronic care management—Findings—Intent.


title: RCW 74.09.523

text:
(1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
(a) "PACE" means the program of all-inclusive care for the elderly, a managed care medicare/medicaid program authorized under sections 1894, 1905(a), and 1934 of the social security act and administered by the department.
(b) "PACE program agreement" means an agreement between a PACE organization, the health care financing administration, and the department.
(2) A PACE program may operate in the state only in accordance with a PACE program agreement with the department.
(3) A PACE program shall at the time of entering into the initial PACE program agreement, and at each renewal thereof, demonstrate cash reserves to cover expenses in the event of insolvency.
(a) The cash reserves at a minimum shall equal the sum of:
(i) One month's total capitation revenue; and
(ii) One month's average payment to subcontractors.
(b) The program may demonstrate cash reserves to cover expenses of insolvency with one or more of the following: Reasonable and sufficient net worth, insolvency insurance, or parental guarantees.
(4) A PACE program must provide full disclosure regarding the terms of enrollment and the option to disenroll at any time to all persons who seek to participate or who are participants in the program.
(5) The department must establish rules to authorize long-term care clients enrolled in a PACE program to elect to continue their enrollment in a PACE program regardless of improved status related to functional criteria for nursing facility level of care, consistent with 42 C.F.R. Sec. 460.160(b) (2013).
(6) The department must develop and implement a coordinated plan to provide education about PACE program site operations under this section. The plan must include:
(a) A strategy to assure that case managers and other staff with responsibilities related to eligibility determinations discuss the option and potential benefits of participating in a PACE program with all eligible long-term care clients;
(b) Requirements that all clients eligible for placement in the community options program entry system waiver program that are age fifty-five or over and reside in a PACE service area be referred to the PACE provider for evaluation. The department's plan must assure that referrals are conducted in a manner that is consistent with federal requirements of Title XIX of the federal social security act; and
(c) Requirements for additional and ongoing training for case managers and other staff with responsibilities related to eligibility determinations in those counties in which a PACE program is operating. The training must include instruction in recognizing the benefits of continued enrollment in a PACE program for those clients who have experienced improved status related to functional criteria for nursing facility level of care.
(7) The department must identify a private entity that operates PACE program sites in Washington to provide the training required under subsection (6) of this section at no cost to the state.
[ 2013 c 258 s 1; 2001 c 191 s 2.]
Notes:
Finding—2001 c 191: "The legislature finds that PACE programs provide essential care to the frail elderly in the state of Washington. PACE serves to enhance the quality of life and autonomy for frail, older adults, maximize the dignity of and respect for older adults, enable frail and older adults to live in their homes and their community as long as medically possible, and preserve and support the older adult's family unit." [ 2001 c 191 s 1.]
Effective date—2001 c 191: "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 immediately [May 7, 2001]." [ 2001 c 191 s 4.]

catchline: PACE program—Definitions—Requirements.


title: RCW 74.09.530

text:
(1)(a) The authority is designated as the single state agency for purposes of Title XIX of the federal social security act.
(b) The amount and nature of medical assistance and the determination of eligibility of recipients for medical assistance shall be the responsibility of the authority.
(c) The authority shall establish reasonable standards of assistance and resource and income exemptions which shall be consistent with the provisions of the social security act and federal regulations for determining eligibility of individuals for medical assistance and the extent of such assistance to the extent that funds are available from the state and federal government. The authority shall not consider resources in determining continuing eligibility for recipients eligible under section 1931 of the social security act.
(d) The authority is authorized to collaborate with other state or local agencies and nonprofit organizations in carrying out its duties under this chapter or other applicable law and, to the extent appropriate, may enter into agreements with such other entities.
(2) Individuals eligible for medical assistance under RCW 74.09.510(3) shall be transitioned into coverage under that subsection immediately upon their termination from coverage under RCW 74.09.510(2)(a). The authority shall use income eligibility standards and eligibility determinations applicable to children placed in foster care. The authority shall provide information regarding basic health plan enrollment and shall offer assistance with the application and enrollment process to individuals covered under RCW 74.09.510(3) who are approaching their twenty-first birthday.
[ 2018 c 201 s 7018; 2011 1st sp.s. c 15 s 32; 2007 c 315 s 2; 2000 c 218 s 2; 1979 c 141 s 345; 1967 ex.s. c 30 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.
Conflict with federal requirements—2007 c 315: See note following RCW 74.09.510.

catchline: Medical assistance—Powers and duties of authority.


title: RCW 74.09.540

text:
(1) It is the intent of the legislature to remove barriers to employment for individuals with disabilities by providing medical assistance to working individuals with disabilities through a buy-in program in accordance with section 1902(a)(10)(A)(ii) of the social security act and eligibility and cost-sharing requirements established by the authority.
(2) The authority shall establish cost-sharing requirements for the buy-in program in accordance with federal law and any conditions or limitations specified in the omnibus appropriations act. The authority shall establish and modify eligibility and cost-sharing requirements in order to administer the program within available funds. The authority may consider a person's income when establishing cost-sharing requirements. The authority may not establish eligibility restrictions for the buy-in program based upon a person's income or maximum age. The authority shall make every effort to coordinate benefits with employer-sponsored coverage available to the working individuals with disabilities receiving benefits under this chapter or other applicable law.
(3) The authority shall seek federal approval to exclude resources accumulated in a separate account that results from earnings during an individual's enrollment in the buy-in program when determining the individual's subsequent eligibility for another medical assistance program.
[ 2019 c 70 s 1; 2018 c 201 s 7019; 2011 1st sp.s. c 15 s 33; 2001 2nd sp.s. c 15 s 2.]
Notes:
Effective date—2019 c 70: "This act takes effect January 1, 2020." [ 2019 c 70 s 2.]
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.
Findings—Intent—2001 2nd sp.s. c 15: "The legislature finds that individuals with disabilities face many barriers and disincentives to employment. Individuals with disabilities are often unable to obtain health insurance that provides the services and supports necessary to allow them to live independently and enter or rejoin the workforce. The legislature finds that there is a compelling public interest in eliminating barriers to work by continuing needed health care coverage for individuals with disabilities who enter and maintain employment.
The legislature intends to strengthen the state's policy of supporting individuals with disabilities in leading fully productive lives by supporting the implementation of the federal ticket to work and work incentives improvement act of 1999, Public Law 106-170. This shall include improving incentives to work by continuing coverage for health care and support services, by seeking federal funding for innovative programs, and by exploring options which provide individuals with disabilities a choice in receiving services needed to obtain and maintain employment." [ 2001 2nd sp.s. c 15 s 1.]

catchline: Medical assistance—Working individuals with disabilities—Intent.


title: RCW 74.09.545

text:
(1) An agreement between spouses transferring or assigning rights to future income from one spouse to the other shall be invalid for purposes of determining eligibility for medical assistance or the limited casualty program for the medically needy, but this subsection does not affect agreements between spouses transferring or assigning resources, and income produced by transferred or assigned resources shall continue to be recognized as the separate income of the transferee; and
(2) In determining eligibility for medical assistance or the limited casualty program for the medically needy for a married person in need of institutional care, or care under home and community-based waivers as defined in Title XIX of the Social Security Act, if the community income received in the name of the nonapplicant spouse exceeds the community income received in the name of the applicant spouse, the applicant's interest in that excess shall be considered unavailable to the applicant.
[ 1986 c 220 s 1.]

catchline: Medical assistance or limited casualty program—Eligibility—Agreements between spouses to transfer future income—Community income.


title: RCW 74.09.555

text:
(1) The authority shall adopt rules and policies providing that when persons who were enrolled in medical assistance immediately prior to confinement, or who become enrolled in medical assistance in suspense status during the period of confinement, are released from confinement, their medical assistance coverage shall be fully reinstated no later than at the moment of their release, subject to any expedited review of their continued eligibility for medical assistance coverage that is required under federal or state law. The authority may reinstate medical assistance prior to the day of release provided that no federal funds are expended for any purpose that is not authorized by the state's agreements with the federal government.
(2) The authority, in collaboration with the Washington association of sheriffs and police chiefs, the department of corrections, the department of children, youth, and families, managed care organizations, and behavioral health administrative services organizations, shall establish procedures for coordination between the authority and department field offices, institutions for mental disease, correctional facilities, as defined in RCW 72.09.015 and 70.48.020, and institutions or facilities operated by the department of children, youth, and families, that result in prompt reinstatement of eligibility and speedy eligibility determinations for medical assistance services upon release from confinement. Procedures developed under this subsection must address:
(a) Mechanisms for receiving medical assistance services applications on behalf of confined persons in anticipation of their release from confinement;
(b) Expeditious review of applications filed by or on behalf of confined persons and, to the extent practicable, completion of the review before the person is released;
(c) Mechanisms for providing medical assistance services identity cards to persons eligible for medical assistance services before their release from confinement;
(d) Coordination with the federal social security administration, through interagency agreements or otherwise, to expedite processing of applications for federal supplemental security income or social security disability benefits, including federal acceptance of applications on behalf of confined persons; and
(e) Assuring that notification of the person's release date, current location, and other appropriate information is provided to the person's managed care organization before the person's scheduled release from confinement, or as soon as practicable thereafter.
(3) Where medical or psychiatric examinations during a person's confinement indicate that the person is disabled, the correctional facility, institution for mental diseases, or institution or facility operated by the department of children, youth, and families, shall provide the authority with that information for purposes of making medical assistance eligibility and enrollment determinations prior to the person's release from confinement. The authority shall, to the maximum extent permitted by federal law, use the examination in making its determination whether the person is disabled and eligible for medical assistance.
(4) For purposes of this section, "confined" or "confinement" means incarcerated in a correctional facility, as defined in RCW 72.09.015 and 70.48.020, held in an institution or facility operated by the department of children, youth, and families, or admitted to an institute for mental disease, as defined in 42 C.F.R. part 435, Sec. 1009 on July 24, 2005.
(5) The economic services administration within the department shall adopt standardized statewide screening and application practices and forms designed to facilitate the application of a confined person for medicaid.
[ 2025 c 12 s 3; 2021 c 243 s 3; 2019 c 325 s 4005; 2014 c 225 s 102. Prior: 2011 1st sp.s. c 36 s 32; 2011 1st sp.s. c 15 s 34; 2010 1st sp.s. c 8 s 30; 2005 c 503 s 12.]
Notes:
Finding—Conflict with federal requirements—2025 c 12: See notes following RCW 74.09.670.
Findings—2021 c 243: See note following RCW 74.09.670.
Effective date—2019 c 325: See note following RCW 71.24.011.
Effective date—2014 c 225: See note following RCW 71.24.016.
Findings—Intent—2011 1st sp.s. c 36: See RCW 74.62.005.
Effective date—2011 1st sp.s. c 36: See note following 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.
Findings—Intent—Short title—Effective date—2010 1st sp.s. c 8: See notes following RCW 74.04.225.
Correction of references—Savings—Severability—2005 c 503: See notes following RCW 71.24.015.

catchline: Medical assistance—Reinstatement upon release from confinement—Expedited eligibility determinations.


title: RCW 74.09.557

text:
(1) The authority shall establish a separate recognition for individually configured, complex rehabilitation technology products and services for complex needs patients with the medical assistance program. This separate recognition shall:
(a) Establish a budget and services category separate from other categories, such as durable medical equipment and supplies;
(b) Take into consideration the customized nature of complex rehabilitation technology and the broad range of services necessary to meet the unique medical and functional needs of people with complex medical needs; and
(c) Establish standards for the purchase of complex rehabilitation technology exclusively from qualified complex rehabilitation technology suppliers.
(2) The authority shall require complex needs patients receiving complex rehabilitation technology to be evaluated by:
(a) A licensed health care provider who performs specialty evaluations within his or her scope of practice, including a physical therapist licensed under chapter 18.74 RCW and an occupational therapist licensed under chapter 18.59 RCW, and has no financial relationship with the qualified complex rehabilitation technology supplier; and
(b) A qualified complex rehabilitation technology professional, as identified in subsection (3)(d)(iii) of this section.
(3) As used in this section:
(a) "Complex needs patient" means an individual with a diagnosis or medical condition that results in significant physical or functional needs and capacities. "Complex needs patient" does not negate the requirement that an individual meet medical necessity requirements under authority rules to qualify for receiving a complex rehabilitation product.
(b) "Complex rehabilitation technology" means wheelchairs and seating systems classified as durable medical equipment within the medicare program as of January 1, 2013, that:
(i) Are individually configured for individuals to meet their specific and unique medical, physical, and functional needs and capacities for basic activities of daily living and instrumental activities of daily living identified as medically necessary to prevent hospitalization or institutionalization of a complex needs patient;
(ii) Are primarily used to serve a medical purpose and generally not useful to a person in the absence of an illness or injury; and
(iii) Require certain services to allow for appropriate design, configuration, and use of such item, including patient evaluation and equipment fitting and configuration.
(c) "Individually configured" means a device has a combination of features, adjustments, or modifications specific to a complex needs patient that a qualified complex rehabilitation technology supplier provides by measuring, fitting, programming, adjusting, or adapting the device as appropriate so that the device is consistent with an assessment or evaluation of the complex needs patient by a health care professional and consistent with the complex needs patient's medical condition, physical and functional needs and capacities, body size, period of need, and intended use.
(d) "Qualified complex rehabilitation technology supplier" means a company or entity that:
(i) Is accredited by a recognized accrediting organization as a supplier of complex rehabilitation technology;
(ii) Meets the supplier and quality standards established for durable medical equipment suppliers under the medicare program;
(iii) For each site that it operates, employs at least one complex rehabilitation technology professional, who has been certified by the rehabilitation engineering and assistive technology society of North America as an assistive technology professional, to analyze the needs and capacities of complex needs patients, assist in selecting appropriate covered complex rehabilitation technology items for such needs and capacities, and provide training in the use of the selected covered complex rehabilitation technology items;
(iv) Has the complex rehabilitation technology professional physically present for the evaluation and determination of the appropriate individually configured complex rehabilitation technologies for the complex needs patient;
(v) Provides service and repairs by qualified technicians for all complex rehabilitation technology products it sells; and
(vi) Provides written information to the complex needs patient at the time of delivery about how the individual may receive service and repair.
[ 2013 c 178 s 2.]
Notes:
Intent—2013 c 178: "The legislature intends to:
(1) Protect access for complex needs patients to important technology and supporting services;
(2) Establish and improve safeguards relating to the delivery and provision of medically necessary complex rehabilitation technology; and
(3) Provide supports for complex needs patients to stay in the home or community setting, prevent institutionalization, and prevent hospitalizations and other costly secondary complications." [ 2013 c 178 s 1.]
Effective date—2013 c 178: "This act takes effect January 1, 2014." [ 2013 c 178 s 3.]

catchline: Medical assistance—Complex rehabilitation technology products.


title: RCW 74.09.559

text:
(1) The authority shall establish appropriate billing codes for hospitals and psychiatric hospitals that administer long-acting injectable buprenorphine on an outpatient basis to use for billing patients enrolled in a medical assistance program.
(2) Upon initiation or renewal of a contract with the authority to administer a medicaid managed care plan, a managed care organization must reimburse a hospital or psychiatric hospital that bills for the administration of long-acting injectable buprenorphine on an outpatient basis as a separate reimbursable expense.
(3) Beginning January 1, 2025, for individuals enrolled in a medical assistance program that is not a medicaid managed care plan, the authority must reimburse a hospital or psychiatric hospital that bills for the administration of long-acting injectable buprenorphine on an outpatient basis administered as a separate reimbursable expense.
(4) Reimbursements provided under this section must be separate from any bundled payment for outpatient hospital or emergency department services.
[ 2024 c 366 s 18.]
Notes:
Findings—Intent—2024 c 366: See note following RCW 71.24.847.

catchline: Long-acting injectable buprenorphine—Billing codes—Reimbursement.


title: RCW 74.09.565

text:
(1) An agreement between spouses transferring or assigning rights to future income from one spouse to the other shall be invalid for purposes of determining eligibility for medical assistance or the limited casualty program for the medically needy, but this subsection does not affect agreements between spouses transferring or assigning resources, and income produced by transferred or assigned resources shall continue to be recognized as the separate income of the transferee.
(2) In determining eligibility for medical assistance or the limited casualty program for the medically needy for a married person in need of institutional care, or care under home and community-based waivers as defined in Title XIX of the social security act, if the community income received in the name of the nonapplicant spouse exceeds the community income received in the name of the applicant spouse, the applicant's interest in that excess shall be considered unavailable to the applicant.
(3) The department or authority, as appropriate, shall adopt rules consistent with the provisions of section 1924 of the social security act entitled "Treatment of Income and Resources for Certain Institutionalized Spouses," in determining the allocation of income between an institutionalized and community spouse.
(4) The department or authority, as appropriate, shall establish the monthly maintenance needs allowance for the community spouse up to the maximum amount allowed by state appropriation or within available funds and permitted in section 1924 of the social security act. The total monthly needs allowance shall not exceed one thousand five hundred dollars, subject to adjustment provided in section 1924 of the social security act.
[ 2011 1st sp.s. c 15 s 35; 1989 c 87 s 4.]
Notes:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
Captions not law—1989 c 87: "Section captions, as found in sections 4 through 8 of this act, constitute no part of the law." [ 1989 c 87 s 10.]
Effective dates—1989 c 87: See note following RCW 74.09.510.

catchline: Medical assistance for institutionalized persons—Treatment of income between spouses.


title: RCW 74.09.575

text:
(1) The department or authority, as appropriate, shall promulgate rules consistent with the treatment of resources provisions of section 1924 of the social security act in determining the allocation of resources between the institutionalized and community spouse.
(2) In the interest of supporting the community spouse the department or authority, as appropriate, shall allow the maximum resource allowance amount permissible under the social security act for the community spouse for persons institutionalized before August 1, 2003.
(3) For persons institutionalized on or after August 1, 2003, the department or authority, as appropriate, in the interest of supporting the community spouse, shall allow up to a maximum of forty thousand dollars in resources for the community spouse. For the fiscal biennium beginning July 1, 2005, and each fiscal biennium thereafter, the maximum resource allowance amount for the community spouse shall be adjusted for economic trends and conditions by increasing the amount allowable by the consumer price index as published by the federal bureau of labor statistics. However, in no case shall the amount allowable exceed the maximum resource allowance permissible under the social security act.
[ 2011 1st sp.s. c 15 s 36; 2003 1st sp.s. c 28 s 1; 1989 c 87 s 5.]
Notes:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
Effective date—2003 1st sp.s. c 28: "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 28 s 2.]
Effective dates—1989 c 87: See note following RCW 74.09.510.
Captions not law—1989 c 87: See note following RCW 74.09.565.

catchline: Medical assistance for institutionalized persons—Treatment of resources.


title: RCW 74.09.585

text:
(1) The department or authority, as appropriate, shall establish standards consistent with section 1917 of the social security act in determining the period of ineligibility for medical assistance due to the transfer of resources.
(2) There shall be no penalty imposed for the transfer of assets that are excluded in a determination of the individual's eligibility for medicaid to the extent such assets are protected by the long-term care insurance policy or contract pursuant to chapter 48.85 RCW.
(3) The department or authority, as appropriate, may waive a period of ineligibility if the department or authority determines that denial of eligibility would work an undue hardship.
[ 2011 1st sp.s. c 15 s 37; 1995 1st sp.s. c 18 s 81; 1989 c 87 s 7.]
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.
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
Effective dates—1989 c 87: See note following RCW 74.09.510.
Captions not law—1989 c 87: See note following RCW 74.09.565.

catchline: Medical assistance for institutionalized persons—Period of ineligibility for transfer of resources.


title: RCW 74.09.595

text:
The department or authority, as appropriate, shall in compliance with section 1924 of the social security act adopt procedures which provide due process for institutionalized or community spouses who request a fair hearing as to the valuation of resources, the amount of the community spouse resource allowance, or the monthly maintenance needs allowance.
[ 2011 1st sp.s. c 15 s 38; 1989 c 87 s 8.]
Notes:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
Effective dates—1989 c 87: See note following RCW 74.09.510.
Captions not law—1989 c 87: See note following RCW 74.09.565.

catchline: Medical assistance for institutionalized persons—Due process procedures.


title: RCW 74.09.597

text:
The following must be medicare providers in order to be paid under the medicaid program: Providers of durable medical equipment and related supplies and providers of medical supplies and related services.
[ 2012 c 241 s 105.]
Notes:
Intent—Finding—2012 c 241: See note following RCW 74.66.010.

catchline: Medical assistance—Durable medical equipment and medical supplies—Providers.


title: RCW 74.09.600

text:
Nothing in this chapter shall preclude the state auditor from conducting post audit examinations of public funds pursuant to RCW 43.09.330 or other applicable law.
[ 1977 ex.s. c 260 s 6.]
Notes:
Severability—1977 ex.s. c 260: "If any provision of this act, or its application to any person or circumstance is held invalid, the remainder of the act, or the application of the provision to other persons or circumstances is not affected." [ 1977 ex.s. c 260 s 8.]

catchline: Post audit examinations by state auditor.


title: RCW 74.09.605

text:
The authority shall incorporate the expected outcomes and criteria to measure the performance of service coordination organizations as provided in chapter 70.320 RCW into contracts with managed care organizations that provide services to clients under this chapter.
[ 2013 c 320 s 7.]

catchline: Incorporation of outcomes/criteria into contracts with managed care organizations.


title: RCW 74.09.611

text:
(1) If sufficient funds are made available as provided in subsection (2) of this section the authority, in collaboration with the Washington state hospital association, shall design a system of hospital quality incentive payments for noncritical access hospitals. The system must be based upon the following principles:
(a) Evidence-based treatment and processes must be used to improve health care outcomes for hospital patients;
(b) Effective purchasing strategies to improve the quality of health care services should involve the use of common quality improvement measures by public and private health care purchasers, while recognizing that some measures may not be appropriate for application to specialty pediatric, psychiatric, or rehabilitation hospitals;
(c) Quality measures chosen for the system should be consistent with the standards that have been developed by national quality improvement organizations, such as the national quality forum, the federal centers for medicare and medicaid services, or the federal agency for healthcare research and quality. New reporting burdens to hospitals should be minimized by giving priority to measures hospitals are currently required to report to governmental agencies, such as the hospital compare measures collected by the federal centers for medicare and medicaid services;
(d) Benchmarks for each quality improvement measure should be set at levels that are feasible for hospitals to achieve, yet represent real improvements in quality and performance for a majority of hospitals in Washington state; and
(e) Hospital performance and incentive payments should be designed in a manner such that all noncritical access hospitals are able to receive the incentive payments if performance is at or above the benchmark score set in the system established under this section.
(2) If hospital safety net assessment funds under RCW 74.60.020 are made available, such funds must be used to support an additional one percent increase in inpatient hospital rates for noncritical access hospitals that:
(a) Meet the quality incentive benchmarks established under this section; and
(b) Participate in Washington state hospital association collaboratives related to the benchmarks in order to improve care and promote sharing of best practices with other hospitals.
(3) Funds directed from any other lawful source may also be used to support the purposes of this section.
[ 2013 2nd sp.s. c 17 s 18.]
Notes:
Effective date—2013 2nd sp.s. c 17: See note following RCW 74.60.005.

catchline: Hospital quality incentive payments—Noncritical access hospitals.


title: RCW 74.09.630

text:
Until the opioid overdose reversal medication bulk purchasing and distribution program established in RCW 70.14.170 is operational:
(1) All medicaid managed care organizations must reimburse a hospital or behavioral health agency for dispensing or distributing opioid overdose reversal medication to a covered person under RCW 70.41.485 and 71.24.594.
(2) If the person is not enrolled in a medicaid managed care organization and does not have any other available insurance coverage, the authority must reimburse a hospital, behavioral health agency, or pharmacy for dispensing or distributing opioid overdose reversal medication under RCW 70.41.485 and 71.24.594.
[ 2023 c 51 s 44; 2021 c 273 s 5.]
Notes:
Findings—Intent—2021 c 273: See note following RCW 70.41.480.

catchline: Opioid overdose reversal medications—Reimbursement.


title: RCW 74.09.632

text:
(1) The authority, in consultation with the department of health, the office of the insurance commissioner, and the addictions, drug, and alcohol institute at the University of Washington, shall provide technical assistance to hospitals and licensed or certified , behavioral health agencies to assist these entities, practitioners, and providers in complying with RCW 70.41.485 and 71.24.594. The technical assistance provided to behavioral health agencies must include:
(a) Training nonmedical providers on distributing and providing client education and directions for use of opioid overdose reversal medication;
(b) Providing written guidance for billing for opioid overdose reversal medication; and
(c) Analyzing the cost of additional behavioral health agency staff time to carry out the activities in RCW 71.24.594, and providing written guidance no later than January 1, 2022, for funding and billing direct service activities related to assisting clients to obtain opioid overdose reversal medication.
(2) The authority shall develop written materials in all relevant languages for each hospital and applicable licensed or certified behavioral health agency to comply with RCW 70.41.485 and 71.24.594, including directions for the use of opioid overdose reversal medication, and provide them to all hospitals and behavioral health agencies by January 1, 2022.
[ 2021 c 273 s 6.]
Notes:
Findings—Intent—2021 c 273: See note following RCW 70.41.480.

catchline: Opioid overdose reversal medications—Technical assistance—Written materials.


title: RCW 74.09.634

text:
(1) All medicaid contracted managed health care organizations must participate in the opioid overdose reversal medication bulk purchasing and distribution program established in RCW 70.14.170 once the program is operational.
(2) The health care authority must participate in the opioid overdose reversal medication bulk purchasing and distribution program established in RCW 70.14.170 once the program is operational for purposes of individuals enrolled in medical assistance under this chapter that are not enrolled in a managed care organization and are uninsured individuals.
[ 2023 c 51 s 45; 2021 c 273 s 12.]
Notes:
Rules—2021 c 273 ss 7-12: See note following RCW 70.14.170.
Findings—Intent—2021 c 273: See note following RCW 70.41.480.

catchline: Opioid overdose reversal medications—Bulk purchasing and distribution program.


title: RCW 74.09.640

text:
(1) In order to support prevention of potential opioid use disorders, the authority must develop and recommend for coverage nonpharmacologic treatments for acute, subacute, and chronic noncancer pain and must report to the governor and the appropriate committees of the legislature, including any requests for funding necessary to implement the recommendations under this section. The recommendations must contain the following elements:
(a) A list of which nonpharmacologic treatments will be covered;
(b) Recommendations as to the duration, amount, and type of treatment eligible for coverage;
(c) Guidance on the type of providers eligible to provide these treatments; and
(d) Recommendations regarding the need to add any provider types to the list of currently eligible medicaid provider types.
(2) The authority must ensure only treatments that are evidence-based for the treatment of the specific acute, subacute, and chronic pain conditions will be eligible for coverage recommendations.
[ 2019 c 314 s 35.]
Notes:
Declaration—2019 c 314: See note following RCW 18.22.810.

catchline: Opioid use disorder—Nonpharmacologic treatments.


title: RCW 74.09.645

text:
All medicaid contracted managed care organizations shall provide coverage without prior authorization of at least one federal food and drug administration approved product for the treatment of opioid use disorder in the drug classes opioid agonists, opioid antagonists, and opioid partial agonists.
[ 2023 c 51 s 46; 2019 c 314 s 38.]
Notes:
Declaration—2019 c 314: See note following RCW 18.22.810.

catchline: Opioid use disorder—Coverage without prior authorization.


title: RCW 74.09.650

text:
(1) To the extent funds are appropriated specifically for this purpose, and subject to any conditions placed on appropriations made for this purpose, the authority shall design a medicaid prescription drug assistance program. Neither the benefits of, nor eligibility for, the program is considered to be an entitlement.
(2) The authority shall request any federal waiver necessary to implement this program. Consistent with federal waiver conditions, the department may charge enrollment fees, premiums, or point-of-service cost-sharing to program enrollees.
(3) Eligibility for this program is limited to persons:
(a) Who are eligible for medicare or age sixty-five and older;
(b) Whose family income does not exceed two hundred percent of the federal poverty level as adjusted for family size and determined annually by the federal department of health and human services;
(c) Who lack insurance that provides prescription drug coverage; and
(d) Who are not otherwise eligible under Title XIX of the federal social security act.
(4) The authority shall use a cost-effective prescription drug benefit design. Consistent with federal waiver conditions, this benefit design may be different than the benefit design offered under the medical assistance program. The benefit design may include a deductible benefit that provides coverage when enrollees incur higher prescription drug costs as defined by the department. The authority also may offer more than one benefit design.
(5) The authority shall limit enrollment of persons who qualify for the program so as to prevent an overexpenditure of appropriations for this program or to assure necessary compliance with federal waiver budget neutrality requirements. The authority may not reduce existing medical assistance program eligibility or benefits to assure compliance with federal waiver budget neutrality requirements.
(6) Premiums paid by medicaid enrollees not in the medicaid prescription drug assistance program may not be used to finance the medicaid prescription drug assistance program.
(7) This program will be terminated within twelve months after implementation of a prescription drug benefit under Title XVIII of the federal social security act.
[ 2023 c 51 s 47; 2003 1st sp.s. c 29 s 2.]
Notes:
Finding—Intent—2003 1st sp.s. c 29: "The legislature finds that prescription drugs are an effective and important part of efforts to maintain and improve the health of Washington state residents. However, their increased cost and utilization is straining the resources of many state health care programs, and is particularly hard on low-income elderly people who lack insurance coverage for such drugs. Furthermore, inappropriate use of prescription drugs can result in unnecessary expenditures and lead to serious health consequences. It is therefore the intent of the legislature to support the establishment by the state of an evidence-based prescription drug program that identifies preferred drugs, develop programs to provide prescription drugs at an affordable price to those in need, and increase public awareness regarding their safe and cost-effective use." [ 2003 1st sp.s. c 29 s 1.]
Severability—2003 1st sp.s. c 29: "If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected." [ 2003 1st sp.s. c 29 s 14.]
Conflict with federal requirements—2003 1st sp.s. c 29: "If any part of this act is found to be in conflict with federal requirements that are a prescribed condition to the allocation of federal funds to the state, the conflicting part of this act is inoperative solely to the extent of the conflict and with respect to the agencies directly affected, and this finding does not affect the operation of the remainder of this act in its application to the agencies concerned. Rules adopted under this act must meet federal requirements that are a necessary condition to the receipt of federal funds by the state." [ 2003 1st sp.s. c 29 s 15.]
Effective date—2003 1st sp.s. c 29: "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 immediately [June 26, 2003]." [ 2003 1st sp.s. c 29 s 16.]

catchline: Prescription drug assistance program.


title: RCW 74.09.653

text:
A committee or council required by federal law, within the health care authority, that makes policy recommendations regarding reimbursement for drugs under the requirements of federal law or regulations is subject to chapter 42.30 RCW.
[ 2023 c 51 s 48; 2011 1st sp.s. c 15 s 60; 1997 c 430 s 2. Formerly RCW 43.20A.365.]
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: Drug reimbursement policy recommendations.


title: RCW 74.09.655

text:
The authority shall provide coverage under this chapter for smoking cessation counseling services, as well as prescription and nonprescription agents when used to promote smoking cessation, so long as such agents otherwise meet the definition of "covered outpatient drug" in 42 U.S.C. Sec. 1396r-8(k). However, the authority may initiate an individualized inquiry and determine and implement by rule appropriate coverage limitations as may be required to encourage the use of effective, evidence-based services and prescription and nonprescription agents.
[ 2023 c 51 s 49; 2011 1st sp.s. c 15 s 39; 2008 c 245 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: Smoking cessation assistance.


title: RCW 74.09.657

text:
The legislature finds that:
(1) Over half of all births in Washington state are covered by public programs;
(2) Research has demonstrated that children of unintended pregnancies receive less prenatal care and are at higher risk for premature birth, low birth weight, neurological disorders, and poor academic performance;
(3) In Washington state, over 50 percent of unintended pregnancies occur in women age 25 years and older;
(4) Washington state's take charge program has been successful in helping women avoid unintended pregnancies; however, when the caseload declined due to federally mandated changes, the rate of unintended pregnancies increased dramatically;
(5) Expanding family planning services to cover women to 260 percent of the federal poverty level would align that program's eligibility standard with income eligibility for publicly funded maternity care service; and
(6) Such an expansion would reduce unintended pregnancies and associated costs to the state.
[ 2023 c 51 s 50; 2011 1st sp.s. c 41 s 1.]
Notes:
Funding reduction—2011 1st sp.s. c 41: "Upon implementation of the expansion directed in RCW 74.09.659, the office of financial management shall reduce general fund—state allotments for the medical assistance program by one million five hundred thousand dollars for fiscal year 2012 and by two million three hundred fifty thousand dollars for fiscal year 2013. The amounts reduced from allotments shall be placed in reserve status and remain unexpended." [ 2011 1st sp.s. c 41 s 3.]

catchline: Findings—Family planning services expansion.


title: RCW 74.09.658

text:
(1) The home health program shall require registered nurse oversight and intervention, as appropriate. In-person contact between a home health care registered nurse and a patient is not required under the state's medical assistance program for home health services that are: (a) Delivered with the assistance of telemedicine and (b) otherwise eligible for reimbursement as a medically necessary skilled home health nursing visit under the program.
(2) The department or authority, as appropriate, in consultation with home health care service providers shall develop reimbursement rules and, in rule, define the requirements that must be met for a reimbursable skilled nursing visit when services are rendered without a face-to-face visit and are assisted by telemedicine.
(3)(a) The department or authority, as appropriate, shall establish the reimbursement rate for skilled home health nursing services delivered with the assistance of telemedicine that meet the requirements of a reimbursable visit as defined by the department or authority, as appropriate.
(b) Reimbursement is not provided for purchase or lease of telemedicine equipment.
(4) Any home health agency licensed under chapter 70.127 RCW and eligible for reimbursement under the medical programs authorized under this chapter may be reimbursed for services under this section if the service meets the requirements for a reimbursable skilled nursing visit.
(5) Nothing in this section shall be construed to alter the scope of practice of any home health care services provider or authorizes the delivery of home health care services in a setting or manner not otherwise authorized by law.
(6) The use of telemedicine is not intended to replace registered nurse health care visits when necessary.
(7) For the purposes of this section, "telemedicine" means the use of telemonitoring to enhance the delivery of certain home health medical services through:
(a) The provision of certain education related to health care services using audio, video, or data communication instead of a face-to-face visit; or
(b) The collection of clinical data and the transmission of such data between a patient at a distant location and the home health provider through electronic processing technologies. Objective clinical data that may be transmitted includes, but is not limited to, weight, blood pressure, pulse, respirations, blood glucose, and pulse oximetry.
[ 2011 1st sp.s. c 15 s 40; 2009 c 326 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: Home health—Reimbursement—Telemedicine.


title: RCW 74.09.659

text:
(1) The authority shall continue to submit applications for the family planning waiver program.
(2) The authority shall submit a request to the federal department of health and human services to amend the current family planning waiver program as follows:
(a) Provide coverage for sexually transmitted disease testing and treatment; and
(b) Return to the eligibility standards used in 2005 including, but not limited to, citizenship determination based on declaration or matching with federal social security databases, insurance eligibility standards comparable to 2005, and confidential service availability for minors and survivors of domestic and sexual violence.
[ 2023 c 51 s 51. Prior: 2011 1st sp.s. c 41 s 2; 2011 1st sp.s. c 15 s 41; 2009 c 545 s 5.]
Notes:
Funding reduction—2011 1st sp.s. c 41: See note following RCW 74.09.657.
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.
Findings—2009 c 545: See note following RCW 43.06.155.

catchline: Family planning waiver program request.


title: RCW 74.09.660

text:
Each of the state's area agencies on aging shall implement a program intended to inform and train persons sixty-five years of age and older in the safe and appropriate use of prescription and nonprescription medications. To further this purpose, the department shall award development grants averaging up to twenty-five thousand dollars to each of the agencies upon a showing that:
(1) The agency has the ability to effectively administer such a program, including an understanding of the relevant issues and appropriate outreach and follow-up;
(2) The agency can bring resources to the program in addition to those funded by the grant; and
(3) The program will be a collaborative effort between the agency and other health care programs and providers in the location to be served, including doctors, pharmacists, and long-term care providers.
[ 2003 1st sp.s. c 29 s 8.]
Notes:
Finding—Intent—Severability—Conflict with federal requirements—Effective date—2003 1st sp.s. c 29: See notes following RCW 74.09.650.

catchline: Prescription drug education for seniors—Grant qualifications.


title: RCW 74.09.665

text:
(1) The authority and all medicaid contracted managed care organizations shall provide coverage without prior authorization for the drugs that comprise at least one regimen recommended by the centers for disease control and prevention for human immunodeficiency virus postexposure prophylaxis.
(2) Notwithstanding the coverage requirements of this section, the authority or a medicaid contracted managed care organization shall reimburse a hospital that bills for a 28-day supply of any human immunodeficiency virus postexposure prophylaxis drugs or therapies dispensed or delivered to a patient in the emergency department for take-home use, pursuant to RCW 70.41.495, as a separate reimbursable expense. This reimbursable expense is separate from any bundled payment for emergency department services.
[ 2024 c 251 s 4.]
Notes:
Effective date—2024 c 251: See note following RCW 70.41.495.

catchline: Human immunodeficiency virus postexposure prophylaxis drugs—Coverage—Reimbursement.


title: RCW 74.09.667

text:
(1) The authority shall provide coverage under this chapter for all federal food and drug administration approved HIV antiviral drugs without prior authorization or step therapy. This coverage must be provided to apple health clients enrolled in both fee-for-service and managed care programs.
(2) Upon initiation or renewal of a contract with the authority to administer a medicaid managed care plan, a managed health care system shall provide coverage without prior authorization or step therapy for all federal food and drug administration approved HIV antiviral drugs.
[ 2025 c 11 s 1.]

catchline: Human immunodeficiency virus antiviral drugs—Coverage.