The bill aims to enhance patient access to timely and medically necessary postacute care by establishing network adequacy standards for skilled nursing facilities and rehabilitation hospitals within managed care contracts for medical assistance programs in Washington State. A new section is added to chapter 74.09 RCW, mandating the authority to develop and adopt these standards by January 1, 2027. The standards will consider factors such as provider availability, timeliness of care, and compliance with federal Medicaid regulations, while also ensuring that care remains local to the enrollee's community. Stakeholder feedback will be solicited throughout the development process, involving hospitals, skilled nursing facilities, managed care organizations, and other relevant associations.

Additionally, the bill amends RCW 74.09.522 to require that managed care organization contracts or amendments effective on or after July 1, 2027, must meet the established network adequacy requirements for postacute care services. This includes skilled nursing facilities and rehabilitation hospitals, as well as any other necessary postacute care services determined by the authority. The adequacy requirements will be integrated into existing monitoring and reporting obligations to ensure compliance and improve access to a full continuum of care for Medicaid enrollees.

Statutes affected:
Original Bill: 74.09.522
Substitute Bill: 74.09.522