wa-law.org > bill > 2025-26 > SB 6094 > Original Bill
The legislature finds that thousands of infants are born in Washington state each year exposed to harmful substances including, but not limited to: Opiates and synthetic opioids such as heroin; methadone and fentanyl; methamphetamines; tobacco; marijuana; alcohol; morphine; buprenorphine; codeine; cocaine; and other substances. Prenatal substance exposure frequently results in infants suffering from neonatal abstinence syndrome and its accompanying withdrawal symptoms after birth. Consequently, the legislature finds that substance-exposed infants have unique medical and nonmedical needs and benefit from specialized health care that addresses, not only their unique withdrawal symptoms, but their bonding and attachment needs.
The legislature further finds that the pilot project which provides medical and nonmedical, nonpharmacologic care and wraparound support to infants and their families in a nurturing environment, demonstrated that its nonhospital treatment model promotes bonding and attachment between substance-exposed infants and their parents and caregivers. Of the 49 parents who have resided full time with their infants in the study of the pilot project, 88 percent are in recovery, in custody of their infant, and housed.
The legislature further finds that substance-exposed infants are currently being treated in neonatal intensive care unit hospital settings for extended periods of time resulting in a high systemic cost and a lessened opportunity for parental bonding compared to the structure and the therapeutic environment provided at significantly lower cost to the state by the pilot project.
The legislature further finds that it is in the interest of the state to keep substance-exposed infants with their parents who are also in recovery. Promoting bonding and attachment during the first few weeks of the life of an infant increases the chance that the infant will not go into the foster care system and results in further cost savings to the state.
The legislature, therefore, intends to encourage alternatives to continued hospitalization for substance-exposed infants, including the continuation and development of pediatric transitional care facilities through the creation of a bundled, sustainable funding model for pediatric transitional care facilities using a combination of existing federal and state resources.
By July 1, 2027, and within existing resources, the health care authority shall develop and submit a state plan amendment to the federal centers for medicare and medicaid services to allow for facility-based payments to residential pediatric recovery centers as provided in section 1007 of P.L. 115-271.
By January 1, 2027, and within existing resources, the health care authority shall submit a status report to the appropriate policy and fiscal committees of the legislature detailing the feasibility of an approval for a state plan amendment as outlined in subsection (1) of this section.
Until the state plan amendment submitted under subsection (1) of this section is approved and the bundled funding model detailed in section 3(1) of this act is implemented, and subject to amounts appropriated for this specific purpose, the health care authority shall provide grant funds to the facility that was the subject of the pilot project created in section 215(117), chapter 475, Laws of 2023 to ensure the availability of services to infants with a history of substance exposure. It is the intent of the legislature to appropriate funds from the opioid abatement settlement account for this purpose.
This section expires December 31, 2028.
Subject to amounts appropriated for this specific purpose, by July 1, 2027, the department of children, youth, and families, in coordination with the authority, shall develop and implement a bundled funding model for nonmedical maternal and child health programmatic services provided by residential pediatric recovery centers to infants born substance exposed and their families.
The bundled funding model established under this section shall support family centered nonmedical maternal and child health services that promote infant stabilization, caregiver capacity, and safe transition to the home environment. The department shall identify allowable service components, which may include, but are not limited to:
Caregiver coaching, education, and skill building related to infant care, feeding, soothing, safe sleep, and developmental support;
Dyadic services that promote bonding, attachment, and caregiver-infant interaction;
Family support services, including peer navigation, case management, and coordination with child welfare and community-based providers;
Respite, overnight accommodations, and on-site supports for caregivers while the infant is receiving services at a residential pediatric recovery center; and
Discharge and transition planning, including linkage to early intervention, home visiting, substance use disorder treatment, primary care, and community supports.
For the purposes of this section, "residential pediatric recovery center" means a health care facility licensed or certified by the department to provide pediatric transitional care services under this chapter that is able to provide medically necessary recovery services to infants affected by neonatal abstinence syndrome, neonatal opioid withdrawal syndrome, or prenatal substance exposure, as well as nonmedical treatment and wraparound support services for infants born substance exposed and their families.
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
"Department" means the department of health.
"Elopement" means any situation in which an admitted patient of a private establishment who is cognitively, physically, mentally, emotionally, and/or chemically impaired wanders, walks, runs away, escapes, or otherwise leaves a private establishment or the grounds of a private establishment prior to the patient's scheduled discharge unsupervised, unnoticed, and without the staff's knowledge.
"Private establishment," "establishment," and "institution" mean:
Every private or county or municipal hospital, including public hospital districts, homes, behavioral health hospitals, residential treatment facilities, or other places receiving or caring for any person with a behavioral health or substance use disorder; and
Beginning January 1, 2019, facilities providing pediatric transitional care services.
"Immediate jeopardy" means a situation in which the private establishment's noncompliance with one or more statutory or regulatory requirements has placed the health and safety of patients in its care at risk for serious injury, serious harm, serious impairment, or death.
"Pediatric transitional care services" means any medical and nonmedical treatment and wraparound support services for substance-exposed infants and one or more parents of the infant according to the requirements of this chapter and provided in an establishment licensed by the department.
"Behavioral health hospital" means an establishment caring for any person with mental illness or substance use disorder excluding acute care hospitals licensed under chapter 70.41 RCW, state psychiatric hospitals established under chapter 72.23 RCW, and residential treatment facilities as defined in this section.
"Residential treatment facility" means an establishment in which 24-hour on-site care is provided for the evaluation, stabilization, or treatment of residents for substance use, mental health, co-occurring disorders, or for substance-exposed infants and their parents.
"Secretary" means the secretary of the department of health.
"Technical assistance" means the provision of information on the state laws and rules applicable to the regulation of private establishments, the process to apply for a license, and methods and resources to avoid or address compliance problems. Technical assistance does not include assistance provided under chapter 43.05 RCW.
"Trained caregiver" means a noncredentialed, unlicensed person trained by the establishment providing pediatric transitional care services to provide hands-on care to substance-exposed infants. Caregivers may not provide medical care to infants and may only work under the supervision of an appropriate health care professional.
infants who:
a. Have been exposed to substances before birth;
b. Have been determined by the clinical director or medical director of the establishment to respond favorably developmentally to specialized care to assist bonding and attachment from 24-hour continuous residential care treatment services including nursing and infant care services as a result of prenatal substance exposure; and
c. Are referred to the establishment by the department of children, youth, and families, regional hospitals, and private parties.
An establishment providing pediatric transitional care services to substance-exposed infants and their parents shall:
Provide services including, but not limited to: Medication management for withdrawal of neonatal abstinence syndrome and neonatal opioid withdrawal syndrome; specialized feeding in collaboration with the early support for infants and toddlers program at the department of children, youth, and families; oxygen therapy; feeding tubes when necessary; wound care; and comorbid conditions that are managed in a nonacute setting;
Have capacity to provide room and board to one or both parents of an infant receiving treatment at the establishment; and
Provide wraparound services as described in section 3(3) of this act to one or both parents of an infant receiving treatment at the establishment regardless of whether the parent is residing at the establishment when the infant is receiving treatment.
After January 1, 2019, no person may operate or maintain an establishment that provides pediatric transitional care services without a license under this chapter.
The secretary must, in consultation with the department of children, youth, and families, adopt rules on pediatric transitional care services. The rules must:
Establish requirements for medical examinations and consultations which must be delivered by an appropriate health care professional;
Require twenty-four hour medical supervision for children receiving pediatric transitional services in accordance with the staffing ratios established under subsection (3) of this section;
Include staffing ratios that consider the number of registered nurses or licensed practical nurses employed by the establishment and the number of trained caregivers on duty at the establishment. These staffing ratios may not require more than:
One registered nurse to be on duty at all times;
One registered nurse or licensed practical nurse to eight infants; and
One trained caregiver to four infants;
Require establishments that provide pediatric transitional care services to prepare weekly plans specific to each infant in their care and in collaboration with the health care professional's standing orders. The health care professional may modify an infant's weekly plan without reexamining the infant if he or she determines the modification is in the best interest of the child. This modification may be communicated to the registered nurse on duty at the establishment who must then implement the modification. Weekly plans are to include short-term goals for each infant and outcomes must be included in reports required by the department;
Ensure that neonatal abstinence syndrome scoring is conducted by an appropriate health care professional;
Establish drug exposed infant developmental screening tests for establishments that provide pediatric transitional care services to administer according to a schedule established by the secretary;
Require the establishment to collaborate with the department of children, youth, and families to develop an individualized safety plan for each child and to meet other contractual requirements of the department of children, youth, and families to identify strategies to meet supervision needs, medical concerns, and family support needs;
Require, at a minimum, weekly assessments on each infant to determine whether the infant continues to benefit from receiving care or services;
Develop timelines for initial and ongoing parent-infant visits to nurture and help develop attachment and bonding between the child and parent, if the parents are not sharing a room with the infant at the facility and if such visits are possible. Timelines must be developed upon placement of the infant in the establishment providing pediatric transitional care services;
Determine how transportation for the infant will be provided, if needed;
Establish on-site training requirements for caregivers, volunteers, parents, foster parents, and relatives;
Establish background check requirements for caregivers, volunteers, employees, and any other person with unsupervised access to the infants under the care of the establishment;
Establish supportive family rules for the parent of an infant to stay at the facility while the infant is receiving care. Supportive family rules shall provide for:
Room and board for any parent who the establishment deems eligible for such services;
Access to and secure storage for medication-assisted treatment medications;
Training on infant cues to promote dyadic bonding and attachment;
Transportation to inpatient or outpatient substance use disorder services for the parents;
Training on safe sleep techniques;
Coordination between providers from the early support for infants and toddlers program of the department of children, youth, and families and parents to promote continuity of care;
Training on basic parental skills;
Care management services;
Peer support;
Supervised visitation services; and
Education on secondary exposure to opioids; and
Establish other requirements necessary to support the infant and the infant's family.
After referral by the department of children, youth, and families of an infant to an establishment approved to provide pediatric transitional care services, the department of children, youth, and families:
Retains primary responsibility for case management and must provide consultation to the establishment regarding all placements and permanency planning issues, including developing a parent-child visitation plan;
Must work with the department and the establishment to identify and implement evidence-based practices that address current and best medical practices and dyadic participation; and
Must work with the establishment to ensure medicaid-eligible services are so billed.