reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.220 - Liability for receipt of excess payments.

RCW 74.09.220
Liability for receipt of excess payments.
Any person, firm, corporation, partnership, association, agency, institution or other legal entity, but not including an individual public assistance recipient of health care, that, without intent to violate this chapter or other applicable law, obtains benefits or payments under this code to which such person or entity is not entitled, or in a greater amount than that to which entitled, shall be liable for (1) any excess benefits or payments received, and (2) interest calculated at the rate and in the manner provided in RCW 43.20B.695 or 41.05A.220. Whenever a penalty is due under RCW 74.09.210 or interest is due under RCW 43.20B.695 or 41.05A.220, such penalty or interest shall not be reimbursable by the state as an allowable cost under any of the provisions of this chapter or other applicable law.
[ 2023 c 51 § 37; 2018 c 201 § 7010; 1987 c 283 § 8; 1979 ex.s. c 152 § 3.]
NOTES:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
Severability—Savings—1987 c 283: See notes following RCW 43.20A.020.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.230 - False statements, fraud—Penalties.

RCW 74.09.230
False statements, fraud—Penalties.
Any person, including any corporation, that
(1) knowingly makes or causes to be made any false statement or representation of a material fact in any application for any payment under any medical care program authorized under this chapter or other applicable law, or
(2) at any time knowingly makes or causes to be made any false statement or representation of a material fact for use in determining rights to such payment, or knowingly falsifies, conceals, or covers up by any trick, scheme, or device a material fact in connection with such application or payment, or
(3) having knowledge of the occurrence of any event affecting (a) the initial or continued right to any payment, or (b) the initial or continued right to any such payment of any other individual in whose behalf he or she has applied for or is receiving such payment, conceals or fails to disclose such event with an intent fraudulently to secure such payment either in a greater amount or quantity than is due or when no such payment is authorized,
shall be guilty of a class C felony: PROVIDED, That the fine, if imposed, shall not be in an amount more than twenty-five thousand dollars, except as authorized by RCW 9A.20.030.
[ 2018 c 201 § 7011; 2013 c 23 § 203; 1979 ex.s. c 152 § 4.]
NOTES:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.250 - False statements regarding institutions, facilities—Penalties.

RCW 74.09.250
False statements regarding institutions, facilities—Penalties.
Any person, including any corporation, that knowingly makes or causes to be made, or induces or seeks to induce the making of, any false statement or representation of a material fact with respect to the conditions or operations of any institution or facility in order that such institution or facility may qualify (either upon initial certification or upon recertification) as a hospital, nursing facility, or home health agency, shall be guilty of a class C felony: PROVIDED, That the fine, if imposed, shall not be in an amount more than five thousand dollars.
[ 1991 sp.s. c 8 § 6; 1979 ex.s. c 152 § 6.]
NOTES:
Effective date—1991 sp.s. c 8: See note following RCW 18.51.050.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.260 - Excessive charges, payments—Penalties.

RCW 74.09.260
Excessive charges, payments—Penalties.
Any person, including any corporation, that knowingly:
(1) Charges, for any service provided to a patient under any medical care plan authorized under this chapter or other applicable law, money or other consideration at a rate in excess of the rates established by the department or authority, as appropriate; or
(2) Charges, solicits, accepts, or receives, in addition to any amount otherwise required to be paid under such plan, any gift, money, donation, or other consideration (other than a charitable, religious, or philanthropic contribution from an organization or from a person unrelated to the patient):
(a) As a precondition of admitting a patient to a hospital or nursing facility; or
(b) As a requirement for the patient's continued stay in such facility,
when the cost of the services provided therein to the patient is paid for, in whole or in part, under such plan, shall be guilty of a class C felony: PROVIDED, That the fine, if imposed, shall not be in an amount more than twenty-five thousand dollars, except as authorized by RCW 9A.20.030.
[ 2018 c 201 § 7013; 2011 1st sp.s. c 15 § 17; 1991 sp.s. c 8 § 7; 1979 ex.s. c 152 § 7.]
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.
Effective date—1991 sp.s. c 8: See note following RCW 18.51.050.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.270 - Failure to maintain trust funds in separate account—Penalties.

RCW 74.09.270
Failure to maintain trust funds in separate account—Penalties.
(1) Any person having any patient trust funds in his or her possession, custody, or control, who, knowing that he or she is violating any statute, regulation, or agreement, deliberately fails to deposit, transfer, or maintain said funds in a separate, designated, trust bank account as required by such statute, regulation, or agreement shall be guilty of a gross misdemeanor and shall be punished by imprisonment for up to three hundred sixty-four days in the county jail, or by a fine of not more than ten thousand dollars or as authorized by RCW 9A.20.030, or by both such fine and imprisonment.
(2) "Patient trust funds" are funds received by any health care facility which belong to patients and are required by any state or federal statute, regulation, or by agreement to be kept in a separate trust bank account for the benefit of such patients.
(3) This section shall not be construed to prevent a prosecution for theft.
[ 2011 c 96 § 54; 1979 ex.s. c 152 § 8.]
NOTES:
Findings—Intent—2011 c 96: See note following RCW 9A.20.021.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.280 - False verification of written statements—Penalties.

RCW 74.09.280
False verification of written statements—Penalties.
The secretary or director may by rule require that any application, statement, or form filled out by suppliers of medical care under this chapter or other applicable law shall contain or be verified by a written statement that it is made under the penalties of perjury and such declaration shall be in lieu of any oath otherwise required, and each such paper shall in such event so state. The making or subscribing of any such papers or forms containing any false or misleading information may be prosecuted and punished under chapter 9A.72 RCW.
[ 2018 c 201 § 7014; 2011 1st sp.s. c 15 § 18; 1979 ex.s. c 152 § 9.]
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.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.295 - Disclosure of involuntary commitment information.

RCW 74.09.295
Disclosure of involuntary commitment information.
It is permissible to provide to a correctional institution, as defined in RCW 9.94.049, with the fact, place, and date of an involuntary commitment and the fact and date of discharge or release of a person who has been involuntarily committed under chapter 71.05 or 71.34 RCW, without a person's consent, in the course of the implementation and use of the department's postinstitutional medical assistance system supporting the expedited medical determinations and medical suspensions as provided in RCW 74.09.555. Disclosure under this section is mandatory for the purposes of the health insurance portability and accountability act.
[ 2011 c 305 § 2.]
NOTES:
Findings—2011 c 305: "The legislature finds that effective collaboration and communication between mental health and chemical dependency treatment providers and service delivery systems and law enforcement and criminal justice agencies is important to both the care of persons with mental disorders and chemical dependency and public safety. The legislature also finds that many state and local efforts in recent years have worked to address improved treatment of persons with mental disorders, chemical dependency disorders, or co-occurring mental and substance abuse disorders who are confined in a correctional institution and to improve communication and collaboration among the agencies, institutions, and professionals who are responsible for the care or custody of those persons. While numerous laws have been enacted to clarify the appropriate sharing of information between those agencies, institutions, and professionals, the legislature finds further clarification will continue to aide [aid] and improve the care of those persons and augment public safety." [ 2011 c 305 § 1.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.300 - Department to report penalties to appropriate licensing agency or disciplinary board.

RCW 74.09.300
Department to report penalties to appropriate licensing agency or disciplinary board.
Whenever the secretary or director imposes a civil penalty under RCW 74.09.210, or terminates or suspends a provider's eligibility under RCW 74.09.290, he or she shall, if the provider is licensed pursuant to Titles 18, 70, or 71 RCW, give written notice of such imposition, termination, or suspension to the appropriate licensing agency or disciplinary board.
[ 2011 1st sp.s. c 15 § 20; 1979 ex.s. c 152 § 11.]
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.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.327 - Audio-only telemedicine—Fee-for-service reimbursement.

RCW 74.09.327
Audio-only telemedicine—Fee-for-service reimbursement.
(1) The authority shall adopt rules regarding medicaid fee-for-service reimbursement for services delivered through audio-only telemedicine. Except as provided in subsection (2) of this section, the rules must establish a manner of reimbursement for audio-only telemedicine that is consistent with RCW 74.09.325.
(2) The rules shall require rural health clinics to be reimbursed for audio-only telemedicine at the rural health clinic encounter rate.
(3)(a) For purposes of this section, "audio-only telemedicine" means the delivery of health care services through the use of audio-only technology, permitting real-time communication between a patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.
(b) For purposes of this section only, "audio-only telemedicine" does not include:
(i) The use of facsimile or email; or
(ii) The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.
[ 2021 c 157 § 6.]
NOTES:
Conflict with federal requirements—2021 c 157: "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. Nothing in this act alters the requirement for the health care authority to report potential fraud to the medicaid fraud control division of the Washington attorney general's office under 42 C.F.R. 455.21." [ 2021 c 157 § 10.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.330 - Reimbursement methodology for ambulance services—Transport of a medical assistance enrollee to a mental health facility or chemical dependency program.

RCW 74.09.330
Reimbursement methodology for ambulance services—Transport of a medical assistance enrollee to a mental health facility or chemical dependency program.
The authority shall develop a reimbursement methodology for ambulance services when transporting a medical assistance enrollee to a mental health facility or chemical dependency program in accordance with the applicable alternative facility procedures adopted under RCW 70.168.100.
[ 2015 c 157 § 6.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.335 - Reimbursement of health care services provided by fire departments—Adoption of standards.

RCW 74.09.335
Reimbursement of health care services provided by fire departments—Adoption of standards.
The authority shall adopt standards for the reimbursement of health care services provided to eligible clients by fire departments pursuant to a community assistance referral and education services program under RCW 35.21.930. The standards must allow payment for covered health care services provided to individuals whose medical needs do not require ambulance transport to an emergency department.
[ 2017 c 273 § 1.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.340 - Personal needs allowance, adjusted.

RCW 74.09.340
Personal needs allowance, adjusted.
(1) Except as provided in RCW 72.36.160, beginning July 1, 2023, the personal needs allowance for clients being served in medical institutions and in residential settings is $100.
(2) Beginning January 1, 2024, and each year thereafter, the personal needs allowance for clients being served in medical institutions and in residential settings shall:
(a) Be adjusted for economic trends and conditions by increasing the allowance by the percentage cost-of-living adjustment for old-age, survivors, and disability social security benefits as published by the federal social security administration; and
(b) Not exceed the maximum personal needs allowance permissible under the federal social security act.
(3) Unless subject to a separate determination of a monthly maintenance needs allowance for a community spouse by authority rule, beginning July 1, 2022, the personal needs allowance for a client receiving home and community-based waiver services authorized by home and community services while living at home shall:
(a) Be adjusted to an amount that is no less than 300 percent of the federal benefit rate; and
(b) Not exceed the maximum personal needs allowance permissible under the federal social security act.
[ 2023 c 201 § 1; 2022 c 164 § 1; 2018 c 137 § 1; 2017 c 270 § 2.]
NOTES:
Findings—Intent—2017 c 270: "(1) The legislature finds that through the medicaid program, state and federal government fund long-term care, mental health, and medical services for many elderly persons and people with disabilities, both in institutions and in community alternatives. The legislature also finds that a significant portion of these individuals' social security benefits is retained by the state to assist with the cost of their care. The legislature intends that these individuals retain for their own use a reasonable and modest personal needs allowance which may be used to purchase clothing, postage, barber services, travel, and other personal items not covered by their care setting, in order to promote their autonomy and personal dignity.
(2) It is the intent of the legislature to adjust the personal needs allowance annually to reflect cost-of-living adjustments to federal social security benefits for medicaid-eligible residents in institutions and community-based residential settings receiving long-term care, developmental disabilities, or mental health services." [ 2017 c 270 § 1.]
Effective date—2017 c 270: "Section 2 of 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, 2017." [ 2017 c 270 § 3.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.390 - Access to baby and child dentistry program—Coverage for eligible children—Authority's duties—Report to legislature.

RCW 74.09.390
Access to baby and child dentistry program—Coverage for eligible children—Authority's duties—Report to legislature.
(1) Subject to the availability of amounts appropriated for this specific purpose, the authority shall expand the access to baby and child dentistry (ABCD) program to include eligible children as clients.
(2) Once enrolled in the program, eligible children must be covered until their thirteenth birthday.
(3) Eligible children enrolled in the program shall receive all services and benefits received by program clients.
(4) The authority shall pay enhanced fees for program services provided to eligible children enrolled in the program to dentists, primary care providers, and dental hygienists certified to provide program services. To receive certification to provide program services to eligible children, a dentist, primary care provider, or dental hygienist must:
(a) Be licensed under Title 18 RCW; and
(b) Complete a course on treating eligible children as defined by the authority in rule.
(5) On or before December 15, 2020, and on or before December 15, 2021, the authority, in consultation with any organizations administering the program, shall provide a report, in compliance with RCW 43.01.036, to the health care and fiscal committees of the legislature, to include:
(a) The number of dentists, primary care providers, and dental hygienists participating in the program; and
(b) The number of eligible children who received treatment through the program.
(6) For purposes of this section:
(a) "Eligible children" means all individuals who meet clinical criteria established by the authority, who are under the age of thirteen with a disability attributable to intellectual disability, cerebral palsy, epilepsy, autism, or another neurological condition closely related to an intellectual disability or that requires treatment similar to that required for persons with intellectual disabilities, which has continued or can be expected to continue indefinitely, and which constitutes a substantial limitation to such individual, who are eligible for one of the following medical assistance programs:
(i) Categorically needy program;
(ii) Limited casualty program-medically needy program;
(iii) Children's health program; or
(iv) State children's health insurance program.
(b) "Program" means the access to baby and child dentistry program as established by WAC 182-535-1245 or successor rule.
[ 2020 c 242 § 1; 2018 c 156 § 1.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.395 - Access to baby and child dentistry program—Outreach and engagement—Stakeholder collaboration.

RCW 74.09.395
Access to baby and child dentistry program—Outreach and engagement—Stakeholder collaboration.
(1) The authority, in consultation with the office of equity, created in chapter 332, Laws of 2020, shall work with the statewide managing partner of the access to baby and child dentistry program to develop a local access to baby and child dentistry program fund allocation formula, key deliverables, and target metrics for increased outreach and provider engagement and support with the goal of reducing racial and ethnic disparities.
(2) The authority, in consultation with the office of equity, created in chapter 332, Laws of 2020, shall collaborate with stakeholders to monitor progress toward the goals articulated in subsection (1) of this section and provide support to local access to baby and child dentistry programs and providers.
[ 2020 c 293 § 2.]
NOTES:
Intent—2020 c 293: "The legislature recognizes that oral disease is the most common childhood chronic disease, yet is almost entirely preventable, impacting school readiness, future employability, and overall well-being and quality of life. The access to baby and child dentistry program has made Washington a leader in oral health care access across the nation, providing greater levels of access and utilization for medicaid eligible children under six years old. The legislature further recognizes that the access to baby and child dentistry program connects children to a dental home in their communities, enabling children to get off to a healthy start. While the state has made great strides, children of color continue to experience higher rates of tooth decay than their peers and children under the age of two are not accessing care at the same rate as older children. Therefore, it is the legislature's intent to expand on the program investments the state has already made to provide additional outreach and support to eligible families and providers, increase very young children's access to care, and further reduce racial and ethnic disparities in access to care and oral health outcomes." [ 2020 c 293 § 1.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.460 - Children's affordable health coverage—Findings—Intent.

RCW 74.09.460
Children's affordable health coverage—Findings—Intent.
(1) The legislature finds that parents have a responsibility to:
(a) Enroll their children in affordable health coverage;
(b) Ensure that their children receive appropriate well-child preventive care;
(c) Link their child with a medical home; and
(d) Understand and act upon the health benefits of good nutrition and physical activity.
(2) The legislature intends that the programs and outreach and education efforts established in RCW 74.09.470(6), as well as partnerships with the public and private sectors, provide the support and information needed by parents to meet the responsibilities set forth in this section.
[ 2007 c 5 § 3.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.4701 - Apple health for kids—Unemployment compensation.

RCW 74.09.4701
Apple health for kids—Unemployment compensation.
For apple health for kids, the department shall not count the twenty-five dollar increase paid as part of an individual's weekly benefit amount when determining family income, eligibility, and payment levels.
[ 2023 c 51 § 41; 2011 c 4 § 19.]
NOTES:
Effective date—2011 c 4 §§ 1-6 and 16-21: See note following RCW 50.20.120.
Conflict with federal requirements—2011 c 4: See note following RCW 50.29.021.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.475 - Newborn delivery services to medical assistance clients—Policies and procedures—Reporting.

RCW 74.09.475
Newborn delivery services to medical assistance clients—Policies and procedures—Reporting.
(1) Effective January 1, 2018, the authority shall require that all health care facilities that provide newborn delivery services to medical assistance clients establish policies and procedures to provide:
(a) Skin-to-skin placement of the newborn on the mother's chest immediately following birth to promote the initiation of breastfeeding, except as otherwise indicated by authority guidelines; and
(b) Room-in practices in which a newborn and a mother share the same room for the duration of their postdelivery stay at the facility, except as otherwise indicated by authority guidelines.
(2) The authority shall provide guidelines for hospitals to use when establishing policies and procedures for services under subsection (1) of this section, including circumstances in which providing the services is not appropriate.
(3) The authority shall require managed care organizations to report on the frequency with which each facility they contract with is able to adhere to the policies and procedures and the most common reasons for nonadherence. The authority shall include a summary of this information in the biennial report required under RCW 74.09.480(3).
[ 2017 c 294 § 2.]
NOTES:
Findings—2017 c 294: "(1) The legislature finds that the state has an interest in assuring that children are given the opportunity to have a healthy start in life. Because approximately half of all births in Washington state are funded by state resources, and over eight hundred thousand children in Washington state are enrolled in the apple health program, the state is in a unique position to make a difference in the health of children in Washington.
(2) The legislature also finds that there may be gaps in programs that could greatly benefit children. Where programs may benefit children in their early stages of development, the state must assure they receive these benefits. Where children are not receiving services because the public is unaware of the services, opportunities for outreach must be explored.
(3) The legislature additionally finds that several hospitals have begun adopting the best practices of the baby-friendly hospital initiative. The state can use its resources to encourage hospitals to adopt some of the most critical components by incorporating the standards into medicaid contracts.
(4) The legislature further finds that providing children with a healthy start also requires promoting healthy pregnancies. In one national survey, pregnant workers said they needed more frequent breaks while pregnant. Prenatal care is also critical for positive birth outcomes, and pregnant women have cited the need for flexibility in their work schedule for the purposes of attending doctor visits. Reasonable accommodations for pregnant women in the workplace can go a long way to promoting healthy pregnancies without producing an undue hardship on employers." [ 2017 c 294 § 1.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.480 - Performance measures—Provider rate increases—Report.

RCW 74.09.480
Performance measures—Provider rate increases—Report.
(1) The authority, in collaboration with the department of health, department of social and health services, health carriers, local public health jurisdictions, children's health care providers including pediatricians, family practitioners, advanced registered nurse practitioners, certified nurse midwives, and pediatric subspecialists, community and migrant health centers, parents, and other purchasers, shall establish a concise set of explicit performance measures that can indicate whether children enrolled in the program are receiving health care through an established and effective medical home, and whether the overall health of enrolled children is improving. Such indicators may include, but are not limited to:
(a) Childhood immunization rates;
(b) Well child care utilization rates, including the use of behavioral and oral health screening, and validated, structured developmental screens using tools, that are consistent with nationally accepted pediatric guidelines and recommended administration schedule, once funding is specifically appropriated for this purpose;
(c) Care management for children with chronic illnesses;
(d) Emergency room utilization;
(e) Visual acuity and eye health;
(f) Preventive oral health service utilization; and
(g) Children's mental health status. In defining these measures the authority shall be guided by the measures provided in RCW 71.36.025.
Performance measures and targets for each performance measure must be established and monitored each biennium, with a goal of achieving measurable, improved health outcomes for the children of Washington state each biennium.
(2) Beginning in calendar year 2009, targeted provider rate increases shall be linked to quality improvement measures established under this section. The authority, in conjunction with those groups identified in subsection (1) of this section, shall develop parameters for determining criteria for increased payment, alternative payment methodologies, or other incentives for those practices and health plans that incorporate evidence-based practice and achieve sustained improvement with respect to the measures.
(3) The department shall provide a report to the governor and the legislature related to provider performance on these measures, as well as the information collected under RCW 74.09.475, beginning in September 2010 for 2007 through 2009 and the authority shall provide the report biennially thereafter.
[ 2023 c 51 § 42; 2017 c 294 § 4; 2011 1st sp.s. c 15 § 22; 2009 c 463 § 4; 2007 c 5 § 4.]
NOTES:
Findings—2017 c 294: See note following RCW 74.09.475.
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—2009 c 463: See notes following RCW 74.09.470.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.490 - Children's mental health—Improving medication management and care coordination.

RCW 74.09.490
Children's mental health—Improving medication management and care coordination.
(1) The authority, in consultation with the evidence-based practice institute established in RCW 71.24.061, shall develop and implement policies to improve prescribing practices for treatment of emotional or behavioral disturbances in children, improve the quality of children's mental health therapy through increased use of evidence-based and research-based practices and reduced variation in practice, improve communication and care coordination between primary care and mental health providers, and prioritize care in the family home or care which integrates the family where out-of-home placement is required.
(2) The authority shall identify those children with emotional or behavioral disturbances who may be at high risk due to off-label use of prescription medication, use of multiple medications, high medication dosage, or lack of coordination among multiple prescribing providers, and establish one or more mechanisms to evaluate the appropriateness of the medication these children are using, including but not limited to obtaining second opinions from experts in child psychiatry.
(3) The authority shall review the psychotropic medications of all children under five and establish one or more mechanisms to evaluate the appropriateness of the medication these children are using, including but not limited to obtaining second opinions from experts in child psychiatry.
(4) Within existing funds, the authority shall require a second opinion review from an expert in psychiatry for all prescriptions of one or more antipsychotic medications of all children under eighteen years of age in the foster care system. Thirty days of a prescription medication may be dispensed pending the second opinion review. The second opinion feedback must include discussion of the psychosocial interventions that have been or will be offered to the child and caretaker if appropriate in order to address the behavioral issues brought to the attention of the prescribing physician.
(5) The authority shall track prescriptive practices with respect to psychotropic medications with the goal of reducing the use of medication.
(6) The authority shall promote the appropriate use of cognitive behavioral therapies and other treatments which are empirically supported or evidence-based, in addition to or in the place of prescription medication where appropriate and such interventions are available.
[ 2015 c 283 § 2; 2011 1st sp.s. c 15 § 23; 2007 c 359 § 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.
Captions not law—2007 c 359: See note following RCW 71.36.005.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.500 - Medical assistance—Established.

RCW 74.09.500
Medical assistance—Established.
There is hereby established a new program of federal-aid assistance to be known as medical assistance to be administered by the authority. The authority is authorized to comply with the federal requirements for the medical assistance program provided in the social security act and particularly Title XIX of Public Law (89-97), as amended, in order to secure federal matching funds for such program.
[ 2011 1st sp.s. c 15 § 24; 1979 c 141 § 343; 1967 ex.s. c 30 § 3.]
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.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.515 - Medical assistance—Coverage for youth released from confinement.

RCW 74.09.515
Medical assistance—Coverage for youth released from confinement.
(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 § 4003; 2014 c 225 § 100; 2011 1st sp.s. c 15 § 26; 2007 c 359 § 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.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.5223 - Findings—Chronic care management.

RCW 74.09.5223
Findings—Chronic care management.
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 § 1.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.5229 - Primary care health homes—Chronic care management—Findings—Intent.

RCW 74.09.5229
Primary care health homes—Chronic care management—Findings—Intent.
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 § 1.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.530 - Medical assistance—Powers and duties of authority.

RCW 74.09.530
Medical assistance—Powers and duties of authority.
(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 § 7018; 2011 1st sp.s. c 15 § 32; 2007 c 315 § 2; 2000 c 218 § 2; 1979 c 141 § 345; 1967 ex.s. c 30 § 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.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.545 - Medical assistance or limited casualty program—Eligibility—Agreements between spouses to transfer future income—Community income.

RCW 74.09.545
Medical assistance or limited casualty program—Eligibility—Agreements between spouses to transfer future income—Community income.
(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 § 1.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.565 - Medical assistance for institutionalized persons—Treatment of income between spouses.

RCW 74.09.565
Medical assistance for institutionalized persons—Treatment of income between spouses.
(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 § 35; 1989 c 87 § 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 § 10.]
Effective dates—1989 c 87: See note following RCW 74.09.510.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.575 - Medical assistance for institutionalized persons—Treatment of resources.

RCW 74.09.575
Medical assistance for institutionalized persons—Treatment of resources.
(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 § 36; 2003 1st sp.s. c 28 § 1; 1989 c 87 § 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 § 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.