The bill seeks to enhance the Medicaid payment system for nursing facilities in Washington State by introducing a "patient-driven payment method" that categorizes skilled nursing facility patients into payment groups based on specific data-driven characteristics. It mandates the development of a new case mix adjustment method, informed by data from the Centers for Medicare and Medicaid Services, with a phased implementation plan that requires reporting to the governor and legislative committees. Additionally, the bill modifies definitions and provisions related to case mix classifications, establishing default case mix groups for residents who die or are discharged before their initial assessment is completed.

Furthermore, the bill replaces the previous method of calculating case mix weights, which relied on nursing staff time measurements and wage ratios, with finalized case mix weights published by the Centers for Medicare and Medicaid Services. It specifies the calculation of average case mix indexes for each Medicaid nursing facility, clarifying that the facility average case mix index will exclude default cases while the Medicaid average case mix index will include them. The bill establishes a timeline for using resident assessment data to calculate these indexes and mandates semiannual updates to nursing facilities' direct care component rates based on the Medicaid average case mix index, ensuring fair compensation for the care provided.

Statutes affected:
Original Bill: 74.46.485, 74.46.496, 74.46.501
Substitute Bill: 74.46.485, 74.46.496, 74.46.501
Bill as Passed Legislature: 74.46.485, 74.46.496, 74.46.501
Session Law: 74.46.485, 74.46.496, 74.46.501