wa-law.org > bill > 2025-26 > HB 2385 > Original Bill
By September 1, 2030, the authority shall submit any state plan amendments or waiver requests to the centers for medicare and medicaid services that are necessary to implement the medicaid access program established in RCW 74.76.050.
The assessment, collection, and disbursement of funds for this program shall be conditional upon:
Final approval by the centers for medicare and medicaid services of any state plan amendments or waiver requests that are necessary in order to implement the applicable sections of this chapter including, if necessary, waiver of the broad-based or uniformity requirements as specified under section 1903(w)(3)(E) of the federal social security act and 42 C.F.R. Sec. 433.68(e);
To the extent necessary, amendment of contracts between the authority and managed care organizations to implement this chapter; and
Certification by the office of financial management that appropriations have been adopted that fully support the rates established in RCW 74.76.030 for the upcoming fiscal year.
The medicaid access program is hereby created.
By January 1st of the second plan year after conditions of RCW 74.76.020 are met, professional services rates for anesthesia, diagnostics, intense outpatient, opioid treatment programs, emergency room, inpatient and outpatient surgery, inpatient visits, low-level behavioral health, maternity services, office and home visits, consults, office administered drugs, vision, and other physician services, for services that are not reimbursed at or above medicare rates as of December 31st of the prior year, must be increased uniformly across professional service categories by a percentage of corresponding medicare rates as of December 31st of the prior year, based on availability of funds in the account created in RCW 74.76.040 for rate increases from collections in the preceding plan year.
By January 1st of the third plan year after the conditions of RCW 74.76.020 are met, and annually thereafter, the rates for all services listed in subsection (2) of this section shall be adjusted using the most recently published medicare economic index available at the time rates are established for the plan year.
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Beginning January 1st of the third plan year after the conditions of RCW 74.76.020 are met and by January 1st in each of the two subsequent plan years, the authority shall study the impact of the professional services rate increases described in this section on medicaid access. The authority shall provide information to fiscal and health committees of the legislature whether these rate increases have increased access for medicaid enrollees, using metrics including but not limited to:
Increases in utilization of services from licensed health care providers;
Number of contracts with identifiable provider types enrolled to provide services to medicaid enrollees;
Patient access measures in the consumer assessment of healthcare providers and systems health plan surveys of managed care organizations; and
Other external quality review metrics.
The authority shall provide the information in a fashion that disaggregates managed care organizations and fee-for-service.
(1) This act expires if by January 1, 2027 2032, the federal centers for medicare and medicaid services does not provide final approval of the state plan amendment or waiver requests under section 2 of this act.