reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.585 - Medical assistance for institutionalized persons—Period of ineligibility for transfer of resources.

RCW 74.09.585
Medical assistance for institutionalized persons—Period of ineligibility for transfer of resources.
(1) The department or authority, as appropriate, shall establish standards consistent with section 1917 of the social security act in determining the period of ineligibility for medical assistance due to the transfer of resources.
(2) There shall be no penalty imposed for the transfer of assets that are excluded in a determination of the individual's eligibility for medicaid to the extent such assets are protected by the long-term care insurance policy or contract pursuant to chapter 48.85 RCW.
(3) The department or authority, as appropriate, may waive a period of ineligibility if the department or authority determines that denial of eligibility would work an undue hardship.
[ 2011 1st sp.s. c 15 § 37; 1995 1st sp.s. c 18 § 81; 1989 c 87 § 7.]
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.
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
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.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.595 - Medical assistance for institutionalized persons—Due process procedures.

RCW 74.09.595
Medical assistance for institutionalized persons—Due process procedures.
The department or authority, as appropriate, shall in compliance with section 1924 of the social security act adopt procedures which provide due process for institutionalized or community spouses who request a fair hearing as to the valuation of resources, the amount of the community spouse resource allowance, or the monthly maintenance needs allowance.
[ 2011 1st sp.s. c 15 § 38; 1989 c 87 § 8.]
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 dates—1989 c 87: See note following RCW 74.09.510.
Captions not law—1989 c 87: See note following RCW 74.09.565.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.597 - Medical assistance—Durable medical equipment and medical supplies—Providers.

RCW 74.09.597
Medical assistance—Durable medical equipment and medical supplies—Providers.
The following must be medicare providers in order to be paid under the medicaid program: Providers of durable medical equipment and related supplies and providers of medical supplies and related services.
[ 2012 c 241 § 105.]
NOTES:
Intent—Finding—2012 c 241: See note following RCW 74.66.010.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.600 - Post audit examinations by state auditor.

RCW 74.09.600
Post audit examinations by state auditor.
Nothing in this chapter shall preclude the state auditor from conducting post audit examinations of public funds pursuant to RCW 43.09.330 or other applicable law.
[ 1977 ex.s. c 260 § 6.]
NOTES:
Severability—1977 ex.s. c 260: "If any provision of this act, or its application to any person or circumstance is held invalid, the remainder of the act, or the application of the provision to other persons or circumstances is not affected." [ 1977 ex.s. c 260 § 8.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.605 - Incorporation of outcomes/criteria into contracts with managed care organizations.

RCW 74.09.605
Incorporation of outcomes/criteria into contracts with managed care organizations.
The authority shall incorporate the expected outcomes and criteria to measure the performance of service coordination organizations as provided in chapter 70.320 RCW into contracts with managed care organizations that provide services to clients under this chapter.
[ 2013 c 320 § 7.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.611 - Hospital quality incentive payments—Noncritical access hospitals.

RCW 74.09.611
Hospital quality incentive payments—Noncritical access hospitals.
(1) If sufficient funds are made available as provided in subsection (2) of this section the authority, in collaboration with the Washington state hospital association, shall design a system of hospital quality incentive payments for noncritical access hospitals. The system must be based upon the following principles:
(a) Evidence-based treatment and processes must be used to improve health care outcomes for hospital patients;
(b) Effective purchasing strategies to improve the quality of health care services should involve the use of common quality improvement measures by public and private health care purchasers, while recognizing that some measures may not be appropriate for application to specialty pediatric, psychiatric, or rehabilitation hospitals;
(c) Quality measures chosen for the system should be consistent with the standards that have been developed by national quality improvement organizations, such as the national quality forum, the federal centers for medicare and medicaid services, or the federal agency for healthcare research and quality. New reporting burdens to hospitals should be minimized by giving priority to measures hospitals are currently required to report to governmental agencies, such as the hospital compare measures collected by the federal centers for medicare and medicaid services;
(d) Benchmarks for each quality improvement measure should be set at levels that are feasible for hospitals to achieve, yet represent real improvements in quality and performance for a majority of hospitals in Washington state; and
(e) Hospital performance and incentive payments should be designed in a manner such that all noncritical access hospitals are able to receive the incentive payments if performance is at or above the benchmark score set in the system established under this section.
(2) If hospital safety net assessment funds under RCW 74.60.020 are made available, such funds must be used to support an additional one percent increase in inpatient hospital rates for noncritical access hospitals that:
(a) Meet the quality incentive benchmarks established under this section; and
(b) Participate in Washington state hospital association collaboratives related to the benchmarks in order to improve care and promote sharing of best practices with other hospitals.
(3) Funds directed from any other lawful source may also be used to support the purposes of this section.
[ 2013 2nd sp.s. c 17 § 18.]
NOTES:
Effective date—2013 2nd sp.s. c 17: See note following RCW 74.60.005.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.630 - Opioid overdose reversal medications—Reimbursement.

RCW 74.09.630
Opioid overdose reversal medications—Reimbursement.
Until the opioid overdose reversal medication bulk purchasing and distribution program established in RCW 70.14.170 is operational:
(1) All medicaid managed care organizations must reimburse a hospital or behavioral health agency for dispensing or distributing opioid overdose reversal medication to a covered person under RCW 70.41.485 and 71.24.594.
(2) If the person is not enrolled in a medicaid managed care organization and does not have any other available insurance coverage, the authority must reimburse a hospital, behavioral health agency, or pharmacy for dispensing or distributing opioid overdose reversal medication under RCW 70.41.485 and 71.24.594.
[ 2023 c 51 § 44; 2021 c 273 § 5.]
NOTES:
Findings—Intent—2021 c 273: See note following RCW 70.41.480.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.632 - Opioid overdose reversal medications—Technical assistance—Written materials.

RCW 74.09.632
Opioid overdose reversal medications—Technical assistance—Written materials.
(1) The authority, in consultation with the department of health, the office of the insurance commissioner, and the addictions, drug, and alcohol institute at the University of Washington, shall provide technical assistance to hospitals and licensed or certified , behavioral health agencies to assist these entities, practitioners, and providers in complying with RCW 70.41.485 and 71.24.594. The technical assistance provided to behavioral health agencies must include:
(a) Training nonmedical providers on distributing and providing client education and directions for use of opioid overdose reversal medication;
(b) Providing written guidance for billing for opioid overdose reversal medication; and
(c) Analyzing the cost of additional behavioral health agency staff time to carry out the activities in RCW 71.24.594, and providing written guidance no later than January 1, 2022, for funding and billing direct service activities related to assisting clients to obtain opioid overdose reversal medication.
(2) The authority shall develop written materials in all relevant languages for each hospital and applicable licensed or certified behavioral health agency to comply with RCW 70.41.485 and 71.24.594, including directions for the use of opioid overdose reversal medication, and provide them to all hospitals and behavioral health agencies by January 1, 2022.
[ 2021 c 273 § 6.]
NOTES:
Findings—Intent—2021 c 273: See note following RCW 70.41.480.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.634 - Opioid overdose reversal medications—Bulk purchasing and distribution program.

RCW 74.09.634
Opioid overdose reversal medications—Bulk purchasing and distribution program.
(1) All medicaid contracted managed health care organizations must participate in the opioid overdose reversal medication bulk purchasing and distribution program established in RCW 70.14.170 once the program is operational.
(2) The health care authority must participate in the opioid overdose reversal medication bulk purchasing and distribution program established in RCW 70.14.170 once the program is operational for purposes of individuals enrolled in medical assistance under this chapter that are not enrolled in a managed care organization and are uninsured individuals.
[ 2023 c 51 § 45; 2021 c 273 § 12.]
NOTES:
Rules—2021 c 273 §§ 7-12: See note following RCW 70.14.170.
Findings—Intent—2021 c 273: See note following RCW 70.41.480.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.640 - Opioid use disorder—Nonpharmacologic treatments.

RCW 74.09.640
Opioid use disorder—Nonpharmacologic treatments.
(1) In order to support prevention of potential opioid use disorders, the authority must develop and recommend for coverage nonpharmacologic treatments for acute, subacute, and chronic noncancer pain and must report to the governor and the appropriate committees of the legislature, including any requests for funding necessary to implement the recommendations under this section. The recommendations must contain the following elements:
(a) A list of which nonpharmacologic treatments will be covered;
(b) Recommendations as to the duration, amount, and type of treatment eligible for coverage;
(c) Guidance on the type of providers eligible to provide these treatments; and
(d) Recommendations regarding the need to add any provider types to the list of currently eligible medicaid provider types.
(2) The authority must ensure only treatments that are evidence-based for the treatment of the specific acute, subacute, and chronic pain conditions will be eligible for coverage recommendations.
[ 2019 c 314 § 35.]
NOTES:
Declaration—2019 c 314: See note following RCW 18.22.810.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.645 - Opioid use disorder—Coverage without prior authorization.

RCW 74.09.645
Opioid use disorder—Coverage without prior authorization.
All medicaid contracted managed care organizations shall provide coverage without prior authorization of at least one federal food and drug administration approved product for the treatment of opioid use disorder in the drug classes opioid agonists, opioid antagonists, and opioid partial agonists.
[ 2023 c 51 § 46; 2019 c 314 § 38.]
NOTES:
Declaration—2019 c 314: See note following RCW 18.22.810.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.653 - Drug reimbursement policy recommendations.

RCW 74.09.653
Drug reimbursement policy recommendations.
A committee or council required by federal law, within the health care authority, that makes policy recommendations regarding reimbursement for drugs under the requirements of federal law or regulations is subject to chapter 42.30 RCW.
[ 2023 c 51 § 48; 2011 1st sp.s. c 15 § 60; 1997 c 430 § 2. Formerly RCW 43.20A.365.]
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. › 74.09.655 - Smoking cessation assistance.

RCW 74.09.655
Smoking cessation assistance.
The authority shall provide coverage under this chapter for smoking cessation counseling services, as well as prescription and nonprescription agents when used to promote smoking cessation, so long as such agents otherwise meet the definition of "covered outpatient drug" in 42 U.S.C. Sec. 1396r-8(k). However, the authority may initiate an individualized inquiry and determine and implement by rule appropriate coverage limitations as may be required to encourage the use of effective, evidence-based services and prescription and nonprescription agents.
[ 2023 c 51 § 49; 2011 1st sp.s. c 15 § 39; 2008 c 245 § 1.]
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. › 74.09.657 - Findings—Family planning services expansion.

RCW 74.09.657
Findings—Family planning services expansion.
The legislature finds that:
(1) Over half of all births in Washington state are covered by public programs;
(2) Research has demonstrated that children of unintended pregnancies receive less prenatal care and are at higher risk for premature birth, low birth weight, neurological disorders, and poor academic performance;
(3) In Washington state, over 50 percent of unintended pregnancies occur in women age 25 years and older;
(4) Washington state's take charge program has been successful in helping women avoid unintended pregnancies; however, when the caseload declined due to federally mandated changes, the rate of unintended pregnancies increased dramatically;
(5) Expanding family planning services to cover women to 260 percent of the federal poverty level would align that program's eligibility standard with income eligibility for publicly funded maternity care service; and
(6) Such an expansion would reduce unintended pregnancies and associated costs to the state.
[ 2023 c 51 § 50; 2011 1st sp.s. c 41 § 1.]
NOTES:
Funding reduction—2011 1st sp.s. c 41: "Upon implementation of the expansion directed in RCW 74.09.659, the office of financial management shall reduce general fund—state allotments for the medical assistance program by one million five hundred thousand dollars for fiscal year 2012 and by two million three hundred fifty thousand dollars for fiscal year 2013. The amounts reduced from allotments shall be placed in reserve status and remain unexpended." [ 2011 1st sp.s. c 41 § 3.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.658 - Home health—Reimbursement—Telemedicine.

RCW 74.09.658
Home health—Reimbursement—Telemedicine.
(1) The home health program shall require registered nurse oversight and intervention, as appropriate. In-person contact between a home health care registered nurse and a patient is not required under the state's medical assistance program for home health services that are: (a) Delivered with the assistance of telemedicine and (b) otherwise eligible for reimbursement as a medically necessary skilled home health nursing visit under the program.
(2) The department or authority, as appropriate, in consultation with home health care service providers shall develop reimbursement rules and, in rule, define the requirements that must be met for a reimbursable skilled nursing visit when services are rendered without a face-to-face visit and are assisted by telemedicine.
(3)(a) The department or authority, as appropriate, shall establish the reimbursement rate for skilled home health nursing services delivered with the assistance of telemedicine that meet the requirements of a reimbursable visit as defined by the department or authority, as appropriate.
(b) Reimbursement is not provided for purchase or lease of telemedicine equipment.
(4) Any home health agency licensed under chapter 70.127 RCW and eligible for reimbursement under the medical programs authorized under this chapter may be reimbursed for services under this section if the service meets the requirements for a reimbursable skilled nursing visit.
(5) Nothing in this section shall be construed to alter the scope of practice of any home health care services provider or authorizes the delivery of home health care services in a setting or manner not otherwise authorized by law.
(6) The use of telemedicine is not intended to replace registered nurse health care visits when necessary.
(7) For the purposes of this section, "telemedicine" means the use of telemonitoring to enhance the delivery of certain home health medical services through:
(a) The provision of certain education related to health care services using audio, video, or data communication instead of a face-to-face visit; or
(b) The collection of clinical data and the transmission of such data between a patient at a distant location and the home health provider through electronic processing technologies. Objective clinical data that may be transmitted includes, but is not limited to, weight, blood pressure, pulse, respirations, blood glucose, and pulse oximetry.
[ 2011 1st sp.s. c 15 § 40; 2009 c 326 § 1.]
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. › 74.09.659 - Family planning waiver program request.

RCW 74.09.659
Family planning waiver program request.
(1) The authority shall continue to submit applications for the family planning waiver program.
(2) The authority shall submit a request to the federal department of health and human services to amend the current family planning waiver program as follows:
(a) Provide coverage for sexually transmitted disease testing and treatment; and
(b) Return to the eligibility standards used in 2005 including, but not limited to, citizenship determination based on declaration or matching with federal social security databases, insurance eligibility standards comparable to 2005, and confidential service availability for minors and survivors of domestic and sexual violence.
[ 2023 c 51 § 51. Prior: 2011 1st sp.s. c 41 § 2; 2011 1st sp.s. c 15 § 41; 2009 c 545 § 5.]
NOTES:
Funding reduction—2011 1st sp.s. c 41: See note following RCW 74.09.657.
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—2009 c 545: See note following RCW 43.06.155.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.660 - Prescription drug education for seniors—Grant qualifications.

RCW 74.09.660
Prescription drug education for seniors—Grant qualifications.
Each of the state's area agencies on aging shall implement a program intended to inform and train persons sixty-five years of age and older in the safe and appropriate use of prescription and nonprescription medications. To further this purpose, the department shall award development grants averaging up to twenty-five thousand dollars to each of the agencies upon a showing that:
(1) The agency has the ability to effectively administer such a program, including an understanding of the relevant issues and appropriate outreach and follow-up;
(2) The agency can bring resources to the program in addition to those funded by the grant; and
(3) The program will be a collaborative effort between the agency and other health care programs and providers in the location to be served, including doctors, pharmacists, and long-term care providers.
[ 2003 1st sp.s. c 29 § 8.]
NOTES:
Finding—Intent—Severability—Conflict with federal requirements—Effective date—2003 1st sp.s. c 29: See notes following RCW 74.09.650.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.671 - Incarcerated persons—Local jails—Behavioral health services—Federal funding.

RCW 74.09.671
Incarcerated persons—Local jails—Behavioral health services—Federal funding.
The authority shall collaborate with the department, the Washington state association of counties, the Washington association of sheriffs and police chiefs, and accountable communities of health to improve population health and reduce avoidable use of intensive services and settings by requesting expenditure authority from the federal government to provide behavioral health services to persons who are incarcerated in local jails. The authority in consultation with its partners may narrow its submission to discrete programs or regions of the state as deemed advisable to effectively demonstrate the potential to achieve savings by integrating medical assistance across community and correctional settings.
[ 2016 c 154 § 4.]
NOTES:
Intent—2016 c 154: See note following RCW 74.09.670.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.672 - Inmates of a public institution—Exclusion from medicaid coverage—Work release and partial confinement programs.

RCW 74.09.672
Inmates of a public institution—Exclusion from medicaid coverage—Work release and partial confinement programs.
It is the understanding of the legislature that persons participating in a work release program or other partial confinement programs at the state, county, or city level which allow regular freedom during the day to pursue rehabilitative community activities such as participation in work, treatment, or medical care should not be considered "inmates of a public institution" for the purposes of exclusion from medicaid coverage under the social security act. The authority is instructed to obtain any permissions from the federal government necessary to confirm this understanding, and report back to the governor and relevant committees of the legislature.
[ 2016 c 154 § 5.]
NOTES:
Intent—2016 c 154: See note following RCW 74.09.670.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.675 - Gender-affirming care services—Prohibited discrimination.

RCW 74.09.675
Gender-affirming care services—Prohibited discrimination.
(1) In the provision of gender-affirming care services through programs under this chapter, the authority, managed care plans, and providers that administer or deliver such services may not discriminate in the delivery of a service provided through a program of the authority based on the covered person's gender identity or expression.
(2) Beginning January 1, 2022:
(a) The authority and any managed care plans delivering or administering services purchased or contracted for by the authority may not apply categorical cosmetic or blanket exclusions to gender-affirming treatment.
(b) Facial feminization surgeries and facial gender-affirming treatment, such as tracheal shaves, hair electrolysis, and other care such as mastectomies, breast reductions, breast implants, or any combination of gender-affirming procedures, including revisions to prior treatment, when prescribed as gender-affirming treatment, may not be excluded as cosmetic.
(c) The authority and managed care plans administering services purchased or contracted for by the authority may not issue an adverse benefit determination denying or limiting access to gender-affirming treatment, unless a health care provider with experience prescribing or delivering gender-affirming treatment has reviewed and confirmed the appropriateness of the adverse benefit determination.
(d) If the authority and managed care plans administering services purchased or contracted for by the authority do not have an adequate network for gender-affirming treatment, they shall ensure the delivery of timely and geographically accessible medically necessary gender-affirming treatment at no greater expense than if they had an in-network, geographically accessible provider available. This includes, but is not limited to, providing case management services to secure out-of-network gender-affirming treatment options that are available to the enrollee in a timely manner within their geographic region. The enrollee shall pay no more than the same cost sharing that the enrollee would pay for the same covered services received from an in-network provider.
(3) For the purposes of this section, "gender-affirming treatment" means a service or product that a health care provider, as defined in RCW 70.02.010, prescribes to an individual to support and affirm the individual's gender identity. Gender-affirming treatment includes, but is not limited to, treatment for gender dysphoria. Gender-affirming treatment can be prescribed to two spirit, transgender, nonbinary, and other gender diverse individuals.
(4) Nothing in this section may be construed to mandate coverage of a service that is not medically necessary.
(5) The authority shall adopt rules necessary to implement this section.
[ 2021 c 280 § 4.]
NOTES:
Short title—2021 c 280: See note following RCW 49.60.178.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.710 - Chronic care management programs—Medical homes—Definitions.

RCW 74.09.710
Chronic care management programs—Medical homes—Definitions.
(1) The authority, in collaboration with the department of health and the department of social and health services, shall:
(a) Design and implement medical homes for its aged, blind, and disabled clients in conjunction with chronic care management programs to improve health outcomes, access, and cost-effectiveness. Programs must be evidence based, facilitating the use of information technology to improve quality of care, must acknowledge the role of primary care providers and include financial and other supports to enable these providers to effectively carry out their role in chronic care management, and must improve coordination of primary, acute, and long-term care for those clients with multiple chronic conditions. The authority shall consider expansion of existing medical home and chronic care management programs and build on the Washington state collaborative initiative. The authority shall use best practices in identifying those clients best served under a chronic care management model using predictive modeling through claims or other health risk information; and
(b) Evaluate the effectiveness of current chronic care management efforts in the authority and the department, comparison to best practices, and recommendations for future efforts and organizational structure to improve chronic care management.
(2) For purposes of this section:
(a) "Medical home" means a site of care that provides comprehensive preventive and coordinated care centered on the patient needs and assures high quality, accessible, and efficient care.
(b) "Chronic care management" means the authority's program that provides care management and coordination activities for medical assistance clients determined to be at risk for high medical costs. "Chronic care management" provides education and training and/or coordination that assist program participants in improving self-management skills to improve health outcomes and reduce medical costs by educating clients to better utilize services.
[ 2011 1st sp.s. c 15 § 43; 2007 c 259 § 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.
Subheadings not law—2007 c 259: See note following RCW 7.70.060.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.715 - Access to dental care.

RCW 74.09.715
Access to dental care.
Within funds appropriated for this purpose, the authority shall establish two dental access projects to serve seniors and other adults who are categorically needy blind or disabled. The projects shall provide:
(1) Enhanced reimbursement rates for certified dentists for specific procedures, to begin no sooner than July 1, 2009;
(2) Reimbursement for trained medical providers for preventive oral health services, to begin no sooner than July 1, 2009;
(3) Training, development, and implementation through a partnership with the University of Washington school of dentistry;
(4) Local program coordination including outreach and case management; and
(5) An evaluation that measures the change in utilization rates and cost savings.
[ 2011 1st sp.s. c 15 § 44; 2008 c 146 § 13.]
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.
Findings—Intent—Severability—2008 c 146: See notes following RCW 74.41.040.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.717 - Dental health aide therapist services—Federal funding.

RCW 74.09.717
Dental health aide therapist services—Federal funding.
(1) It is the intent of the legislature to provide that dental health aide therapist services are eligible for medicaid funding in order to promote increased dental care access for persons served in settings operated by Indian tribes, tribal organizations, and urban Indian organizations.
(2) The health care authority is directed to coordinate with the centers for medicare and medicaid services to provide that dental health aide therapist services authorized in chapter 70.350 RCW are eligible for federal funding of up to one hundred percent.
[ 2017 c 5 § 8.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.725 - Prostate cancer screening.

RCW 74.09.725
Prostate cancer screening.
The authority shall provide coverage for prostate cancer screening under this chapter, provided that the screening is delivered upon the recommendation of the patient's physician, advanced registered nurse practitioner, or physician assistant.
[ 2011 1st sp.s. c 15 § 46; 2006 c 367 § 8.]
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. › 74.09.730 - Disproportionate share hospital adjustment.

RCW 74.09.730
Disproportionate share hospital adjustment.
(1) In establishing Title XIX payments for inpatient hospital services:
(a) To the extent funds are appropriated specifically for this purpose, and subject to any conditions placed on appropriations made for this purpose, the authority shall provide a disproportionate share hospital adjustment considering the following components:
(i) A low-income care component based on a hospital's medicaid utilization rate, its low-income utilization rate, its provision of obstetric services, and other factors authorized by federal law;
(ii) A medical indigency care component based on a hospital's services to persons who are medically indigent; and
(iii) A state-only component, to be paid from available state funds to hospitals that do not qualify for federal payments under (a)(ii) of this subsection, based on a hospital's services to persons who are medically indigent;
(b) The payment methodology for disproportionate share hospitals shall be specified by the authority in regulation.
(2) Nothing in this section shall be construed as a right or an entitlement by any hospital to any payment from the authority.
[ 2018 c 201 § 7020; 2011 1st sp.s. c 15 § 47; 2009 c 538 § 1; 1991 sp.s. c 9 § 8; 1989 c 260 § 1; 1987 1st ex.s. c 5 § 20.]
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 dates—1991 sp.s. c 9: See note following RCW 74.09.700.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.745 - Medicaid funding for home visiting services—Recommendations to legislature.

RCW 74.09.745
Medicaid funding for home visiting services—Recommendations to legislature.
(1) The authority shall collaborate with the department of children, youth, and families to identify opportunities to leverage medicaid funding for home visiting services.
(2) The authority must provide a set of recommendations relevant to subsection (1) of this section to the legislature by December 1, 2018, that builds upon the research and strategies developed in the Washington state home visiting and medicaid financing strategies report submitted by the authority to the department of early learning in August 2017.
[ 2018 c 175 § 4.]
NOTES:
Findings—Intent—2018 c 175: See note following RCW 74.09.495.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.748 - Regional service areas—Certain reimbursements required or allowed upon adoption of fully integrated managed health care system.

RCW 74.09.748
Regional service areas—Certain reimbursements required or allowed upon adoption of fully integrated managed health care system.
Upon adoption of a fully integrated managed health care system pursuant to chapter 71.24 RCW, regional service areas:
(1) Must allow reimbursement for time spent supervising persons working toward satisfying supervision requirements established for the relevant practice areas pursuant to RCW 18.225.090; and
(2) May allow reimbursement for services delivered through a partial hospitalization or intensive outpatient program as described in RCW 71.24.385.
[ 2018 c 175 § 8.]
NOTES:
Findings—Intent—2018 c 175: See note following RCW 74.09.495.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.760 - Short title—1989 1st ex.s. c 10.

RCW 74.09.760
Short title—1989 1st ex.s. c 10.
This act may be known and cited as the "maternity care access act of 1989."
[ 1989 1st ex.s. c 10 § 1.]
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.770 - Maternity care access system established.

RCW 74.09.770
Maternity care access system established.
(1) The legislature finds that Washington state and the nation as a whole have a high rate of infant illness and death compared with other industrialized nations. This is especially true for minority and low-income populations. Premature and low weight births have been directly linked to infant illness and death. The availability of adequate maternity care throughout the course of pregnancy has been identified as a major factor in reducing infant illness and death. Further, the investment in preventive health care programs, such as maternity care, contributes to the growth of a healthy and productive society and is a sound approach to health care cost containment. The legislature further finds that access to maternity care for low-income women in the state of Washington has declined significantly in recent years and has reached a crisis level.
(2) It is the purpose of this subchapter to provide, consistent with appropriated funds, maternity care necessary to ensure healthy birth outcomes for low-income families. To this end, a maternity care access system is established based on the following principles:
(a) The family is the fundamental unit in our society and should be supported through public policy.
(b) Access to maternity care for eligible persons to ensure healthy birth outcomes should be made readily available in an expeditious manner through a single service entry point.
(c) Unnecessary barriers to maternity care for eligible persons should be removed.
(d) Access to preventive and other health care services should be available for low-income children.
(e) Each woman should be encouraged to and assisted in making her own informed decisions about her maternity care.
(f) Unnecessary barriers to the provision of maternity care by qualified health professionals should be removed.
(g) The system should be sensitive to cultural differences among eligible persons.
(h) To the extent possible, decisions about the scope, content, and delivery of services should be made at the local level involving a broad representation of community interests.
(i) The maternity care access system should be evaluated at appropriate intervals to determine effectiveness and need for modification.
(j) Maternity care services should be delivered in a cost-effective manner.
[ 2011 1st sp.s. c 15 § 48; 1989 1st ex.s. c 10 § 2.]
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. › 74.09.780 - Reservation of legislative power.

RCW 74.09.780
Reservation of legislative power.
The legislature reserves the right to amend or repeal all or any part of this subchapter at any time and there shall be no vested private right of any kind against such amendment or repeal. All rights, privileges, or immunities conferred by this subchapter or any acts done pursuant thereto shall exist subject to the power of the legislature to amend or repeal this subchapter at any time.
[ 2018 c 201 § 7021; 1989 1st ex.s. c 10 § 3.]
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. › 74.09.790 - Definitions.

RCW 74.09.790
Definitions.
Unless the context clearly requires otherwise, the definitions in this section apply throughout RCW 74.09.760 through 74.09.820 and 74.09.510:
(1) "At-risk eligible person" means an eligible person determined by the authority to need special assistance in applying for and obtaining maternity care, including pregnant women who are substance abusers, pregnant and parenting adolescents, pregnant minority women, and other eligible persons who need special assistance in gaining access to the maternity care system.
(2) "Authority" means the Washington state health care authority.
(3) "County authority" means the board of county commissioners, county council, or county executive having the authority to participate in the maternity care access program or its designee. Two or more county authorities may enter into joint agreements to fulfill the requirements of this chapter.
(4) "Department" means the department of social and health services.
(5) "Eligible person" means a woman in need of maternity care or a child, who is eligible for medical assistance pursuant to this chapter or the prenatal care program administered by the authority.
(6) "Family planning services" means planning the number of one's children by use of contraceptive techniques.
(7) "Maternity care services" means inpatient and outpatient medical care, case management, and support services necessary during prenatal, delivery, and postpartum periods.
(8) "Support services" means, at least, public health nursing assessment and follow-up, health and childbirth education, psychological assessment and counseling, outreach services, nutritional assessment and counseling, needed vitamin and nonprescriptive drugs, transportation, family planning services, and child care. Support services may include alcohol and substance abuse treatment for pregnant women who are addicted or at risk of being addicted to alcohol or drugs to the extent funds are made available for that purpose.
[ 2011 1st sp.s. c 15 § 49; 1993 c 407 § 9; 1990 c 151 § 4; 1989 1st ex.s. c 10 § 4.]
NOTES:
Reviser's note: The definitions in this section have been alphabetized pursuant to RCW 1.08.015(2)(k).
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. › 74.09.800 - Maternity care access program established.

RCW 74.09.800
Maternity care access program established.
The authority shall, consistent with the state budget act, develop a maternity care access program designed to ensure healthy birth outcomes as follows:
(1) Provide maternity care services to low-income pregnant women and health care services to children in poverty to the maximum extent allowable under the medical assistance program, Title XIX of the federal social security act;
(2) Provide maternity care services to low-income women who are not eligible to receive such services under the medical assistance program, Title XIX of the federal social security act;
(3) Have the following procedures in place to improve access to maternity care services and eligibility determinations for pregnant women applying for maternity care services under the medical assistance program, Title XIX of the federal social security act:
(a) Use of a shortened and simplified application form;
(b) Outstationing authority staff to make eligibility determinations;
(c) Establishing local plans at the county and regional level, coordinated by the authority; and
(d) Conducting an interview for the purpose of determining medical assistance eligibility within five working days of the date of an application by a pregnant woman and making an eligibility determination within fifteen working days of the date of application by a pregnant woman;
(4) Establish a maternity care case management system that shall assist at-risk eligible persons with obtaining medical assistance benefits and receiving maternity care services, including transportation and child care services;
(5) Within available resources, establish appropriate reimbursement levels for maternity care providers;
(6) Implement a broad-based public education program that stresses the importance of obtaining maternity care early during pregnancy;
(7) Refer persons eligible for maternity care services under the program established by this section to persons, agencies, or organizations with maternity care service practices that primarily emphasize healthy birth outcomes;
(8) Provide family planning services including information about the synthetic progestin capsule implant form of contraception, for twelve months immediately following a pregnancy to women who were eligible for medical assistance under the maternity care access program during that pregnancy or who were eligible only for emergency labor and delivery services during that pregnancy; and
(9) Within available resources, provide family planning services to women who meet the financial eligibility requirements for services under subsections (1) and (2) of this section.
[ 2011 1st sp.s. c 15 § 50; 1993 c 407 § 10; 1989 1st ex.s. c 10 § 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.
2023 Revised Code of Washington › Title 74 - Public Assistance › Chapter 74.09 - Medical Care. › 74.09.810 - Alternative maternity care service delivery system established—Remedial action report.

RCW 74.09.810
Alternative maternity care service delivery system established—Remedial action report.
(1) The authority shall establish an alternative maternity care service delivery system, if it determines that a county or a group of counties is a maternity care distressed area. A maternity care distressed area shall be defined by the authority, in rule, as a county or a group of counties where eligible women are unable to obtain adequate maternity care. The authority shall include the following factors in its determination:
(a) Higher than average percentage of eligible persons in the distressed area who receive late or no prenatal care;
(b) Higher than average percentage of eligible persons in the distressed area who go out of the area to receive maternity care;
(c) Lower than average percentage of obstetrical care providers in the distressed area who provide care to eligible persons;
(d) Higher than average percentage of infants born to eligible persons per obstetrical care provider in the distressed area; and
(e) Higher than average percentage of infants that are of low birth weight, five and one-half pounds or two thousand five hundred grams, born to eligible persons in the distressed area.
(2) If the authority determines that a maternity care distressed area exists, it shall notify the relevant county authority. The county authority shall, within one hundred twenty days, submit a brief report to the authority recommending remedial action. The report shall be prepared in consultation with the authority and with the department's local community service offices, the local public health officer, community health clinics, health care providers, hospitals, the business community, labor representatives, and low-income advocates in the distressed area. A county authority may contract with a local nonprofit entity to develop the report. If the county authority is unwilling or unable to develop the report, it shall notify the authority within thirty days, and the authority shall develop the report for the distressed area.
(3) The authority shall review the report and use it, to the extent possible, in developing strategies to improve maternity care access in the distressed area. The authority may contract with or directly employ qualified maternity care health providers to provide maternity care services, if access to such providers in the distressed area is not possible by other means. In such cases, the authority is authorized to pay that portion of the health care providers' malpractice liability insurance that represents the percentage of maternity care provided to eligible persons by that provider through increased medical assistance payments.
[ 2011 1st sp.s. c 15 § 51; 1989 1st ex.s. c 10 § 6.]
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. › 74.09.820 - Maternity care provider's loan repayment program.

RCW 74.09.820
Maternity care provider's loan repayment program.
To the extent that federal matching funds are available, the authority or the department of health shall establish, in consultation with the health science programs of the state's colleges and universities, and community health clinics, a loan repayment program that will encourage maternity care providers to practice in medically underserved areas in exchange for repayment of part or all of their health education loans.
[ 2011 1st sp.s. c 15 § 52; 1989 1st ex.s. c 10 § 7.]
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.
Health professional scholarships: Chapter 28B.115 RCW.