AN ACT Relating to increasing 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;
Summary
SB 5124 would require Washington’s health care authority to establish network adequacy standards for postacute care services used by Medicaid managed care enrollees, with a focus on skilled nursing facilities and inpatient rehabilitation hospitals. The bill states that Medicaid enrollees are entitled to timely access to medically necessary postacute care when managed care organizations determine such care is needed for quality and health outcomes. It directs the agency to adopt standards by a specified deadline and to consider provider availability, timeliness of care, geographic access, and federal Medicaid requirements.
The bill also requires the health care authority to gather stakeholder input from hospitals, skilled nursing facilities, managed care organizations, and relevant associations when developing the standards, with at least three rounds of feedback: initial criteria, draft standards, and final standards before publication and inclusion in managed care contracts. It further requires annual monitoring and reporting to the Legislature on network adequacy for postacute care, including the proportion of services delivered by contracted versus nonparticipating providers. The measure also reinforces that managed care contracts must maintain adequate provider networks and may include additional postacute care providers as needed to improve access across the full continuum of care.
Impact
The bill would amend Washington’s Medicaid managed care statutes and add a new section to chapter 74.09 RCW to create explicit network adequacy requirements for postacute care. It would affect the Health Care Authority’s contracting, oversight, and reporting duties, and would require managed care organizations to meet new access standards for skilled nursing facilities, rehabilitation hospitals, and other postacute services. The bill also ties these standards to federal Medicaid managed care rules and allows the agency to seek waivers or use federal funding opportunities as needed to implement the changes.
Sentiment
The recorded votes show strong and consistent support for the bill, with unanimous or near-unanimous committee and floor approvals in both chambers. The Senate Health & Long-Term Care Committee advanced the bill unanimously, and subsequent Senate and House floor votes were also unanimous. The bill was also reported out of House policy and fiscal committees without recorded opposition, suggesting broad agreement with the goal of improving access to postacute care for Medicaid enrollees.
Contention
There is little visible opposition in the available record, but the bill’s main policy tensions are implicit rather than explicit. The most likely points of concern are the administrative burden on the Health Care Authority, the ability of managed care organizations to meet new network standards in rural or provider-scarce areas, and the potential cost implications of requiring broader postacute networks. The bill attempts to address these issues by allowing the agency to narrow geographic standards during development, considering provider availability and timeliness, and requiring stakeholder feedback from providers and managed care plans.
AN ACT Relating to improving access to appropriate mental health and substance use disorder services by updating Washington's mental health parity law and ensuring coverage of medically necessary care;
Ensures Medicaid spending results in real access to medical care by increasing transparency in Medicaid managed care network adequacy reviews and safeguarding continuity of care in light of recent major provider network withdrawals.