Bill > SB5124

This bill aims to improve patient access to postacute care services for Medicaid enrollees by establishing network adequacy standards for skilled nursing facilities and rehabilitation hospitals. The Washington State Health Care Authority is required to develop these standards by January 1, 2027, with input from various stakeholders including hospitals, skilled nursing facilities, and managed care organizations. The standards will focus on keeping care local to an enrollee's community, considering provider availability in regional service areas, and ensuring timely access to care based on medical needs. The bill emphasizes the importance of maintaining compliance with federal Medicaid regulations while developing these standards. Key provisions include requiring at least three rounds of stakeholder feedback during the standards development process and ensuring that the new network adequacy requirements will be incorporated into managed care organization contracts starting July 1, 2027. Importantly, the bill does not alter a facility's ability to determine whether it can meet a prospective resident's needs through available staffing and reasonable accommodations, maintaining flexibility for individual care providers while working to improve overall access to postacute care services.

Budget and Finance, Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=5124&Year=2025&Initiative=false