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74.09.010 | Definitions.(Effective until June 30, 2027.) | The definitions in this section apply throughout this chapter unless the context clearly requires otherwise. (1) "Authority" means the Washington state health care authority. (2) "Bidirectional integration" means integrating behavioral health services into primary care settings and integrating primary care services int... |
74.09.015 | Nurse hotline, when funded. | To the extent that sufficient funding is provided specifically for this purpose, the authority shall provide all persons receiving services under this chapter with access to a twenty-four hour, seven day a week nurse hotline. The authority shall determine the most appropriate way to provide the nurse hotline under RCW ... |
74.09.035 | Medical care services—Eligibility, standards—Limits. | (1) To the extent of available funds, medical care services may be provided to: (a) Victims of human trafficking, as defined in RCW 74.04.005 , who are not eligible for medicaid under RCW 74.09.510 , section 1902(a)(10)(A)(i)(VIII) of the social security act, or apple health for kids under RCW 74.09.470 , who otherwise... |
74.09.037 | Identification card—Social security number restriction. | Any card issued by the authority or a managed health care system to a person receiving services under this chapter, that must be presented to providers for purposes of claims processing, may not display an identification number that includes more than a four-digit portion of the person's complete social security number... |
74.09.050 | Director's powers and duties—Personnel—Medical screeners—Medical director. | (1) The director shall appoint such professional personnel and other assistants and employees, including professional medical screeners, as may be reasonably necessary to carry out the provisions of this chapter or other applicable law. The medical screeners shall be supervised by one or more physicians who shall be ap... |
74.09.053 | Annual reporting requirement. | (1) Beginning in November 2012, the department of social and health services, in coordination with the health care authority, shall by November 15th of each year report to the legislature: (a) The number of medical assistance recipients who: (i) Upon enrollment or recertification had reported being employed, and beginn... |
74.09.055 | Copayment, deductible, coinsurance, other cost-sharing requirements authorized. | The authority is authorized to establish copayment, deductible, or coinsurance, or other cost-sharing requirements for recipients of any medical programs defined in RCW 74.09.010 or other applicable law, except that premiums shall not be imposed on children in households at or below two hundred percent of the federal p... |
74.09.075 | Employability and disability evaluation—Medical condition—Medical reports—Medical consultations and assistance. | The department or authority, as appropriate, shall provide (1) for evaluation of employability when a person is applying for public assistance representing a medical condition as a basis for need, and (2) for medical reports to be used in the evaluation of total and permanent disability. It shall further provide for me... |
74.09.080 | Methods of performing administrative responsibilities. | In carrying out the administrative responsibility of this chapter or other applicable law, the department or authority, as appropriate: (1) May contract with an individual or a group, may utilize existing local state public assistance offices, or establish separate welfare medical care offices on a county or multicount... |
74.09.120 | Purchases of services, care, supplies—Nursing homes—Veterans' homes—Institutions for persons with intellectual disabilities—Institutions for mental diseases. | (1) The department shall purchase nursing home care by contract and payment for the care shall be in accordance with the provisions of chapter 74.46 RCW and rules adopted by the department. No payment shall be made to a nursing home which does not permit inspection by the authority and the department of every part of i... |
74.09.150 | Personnel to be under existing merit system. | All personnel employed in the administration of the medical care program shall be covered by the existing merit system under the Washington personnel resources board.
[ 1993 c 281 s 66 ; 1959 c 26 s 74.09.150 . Prior: 1955 c 273 s 16 .]
Effective date — 1993 c 281: See note following RCW 41.06.022 . |
74.09.160 | Presentment of charges by contractors. | Each vendor or group who has a contract and is rendering service to eligible persons as defined in this chapter or other applicable law shall submit such charges as agreed upon between the department or authority, as appropriate, and the individual or group no later than twelve months from the date of service. If the f... |
74.09.171 | Contracts for medicaid services—Border communities. | (1) The legislature finds that the authority and the department purchase or contract for the delivery of medicaid programs through contracts with providers and managed care organizations under this chapter, contractors providing behavioral health services under chapters 71.24 and 71.34 RCW, and contractors providing lo... |
74.09.180 | Chapter does not apply if another party is liable—Exception—Subrogation—Lien—Reimbursement—Delegation of lien and subrogation rights. | (1) The provisions of this chapter shall not apply to recipients whose personal injuries are occasioned by negligence or wrong of another: PROVIDED, HOWEVER, That the director may furnish assistance, under the provisions of this chapter, for the results of injuries to or illness of a recipient, and the authority shall ... |
74.09.185 | Third party has legal liability to make payments—State acquires rights—Lien—Equitable subrogation does not apply. | To the extent that payment for covered expenses has been made under medical assistance for health care items or services furnished to an individual, in any case where a third party has a legal liability to make payments, the state is considered to have acquired the rights of the individual to payment by any other party... |
74.09.190 | Religious beliefs—Construction of chapter. | Nothing in this chapter shall be construed as empowering the secretary or director to compel any recipient of public assistance and a medical indigent person to undergo any physical examination, surgical operation, or accept any form of medical treatment contrary to the wishes of said person who relies on or is treated... |
74.09.195 | Audits of health care providers by the authority—Requirements—Procedure. | (1) Audits of the records of health care providers performed under this chapter are subject to the following: (a) The authority must provide at least thirty calendar days' notice before scheduling any on-site audit, unless there is evidence of danger to public health and safety or fraudulent activities; (b) The authori... |
74.09.200 | Audits and investigations—Legislative declaration—State authority. | The legislature finds and declares it to be in the public interest and for the protection of the health and welfare of the residents of the state of Washington that a proper regulatory and inspection program be instituted in connection with the providing of medical, dental, and other health services to recipients of pu... |
74.09.210 | Fraudulent practices—Penalties. | (1) No person, firm, corporation, partnership, association, agency, institution, or other legal entity, but not including an individual public assistance recipient of health care, shall, on behalf of himself or herself or others, obtain or attempt to obtain benefits or payments under this chapter or other applicable la... |
74.09.215 | Medicaid fraud penalty account. | The medicaid fraud penalty account is created in the state treasury. All receipts from civil penalties collected under RCW 74.09.210 , all receipts received under judgments or settlements that originated under a filing under the federal false claims act, all receipts from fines received pursuant to RCW 43.71C.090 , and... |
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 entit... |
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 a... |
74.09.240 | Bribes, kickbacks, rebates—Self-referrals—Penalties. | (1) Any person, including any corporation, that solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind (a) in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service... |
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 (eith... |
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) Ch... |
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, regulati... |
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 o... |
74.09.290 | Audits and investigations of providers—Patient records—Penalties. | The secretary or director shall have the authority to: (1) Conduct audits and investigations of providers of medical and other services furnished pursuant to this chapter or other applicable law, except that the Washington medical commission shall generally serve in an advisory capacity to the secretary or director in ... |
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 ... |
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 appropr... |
74.09.315 | Whistleblowers—Workplace reprisal or retaliatory action. | (1) For the purposes of this section: (a) "Employer" means any person, firm, corporation, partnership, association, agency, institution, or other legal entity. (b) "Whistleblower" means an employee of an employer that obtains or attempts to obtain benefits or payments under this chapter or other applicable law in viola... |
74.09.325 | Reimbursement of a health care service provided through telemedicine or store and forward technology—Audio-only telemedicine. | (1)(a) All managed care organizations contracted with the authority for the medicaid program shall reimburse a provider for a health care service provided to a covered person through telemedicine or store and forward technology if: (i) The managed care organization in which the covered person is enrolled provides cover... |
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) Th... |
74.09.328 | Use of substitute providers—When permitted—Reimbursement requirements. | (1) In order to protect patients and ensure that they benefit from seamless quality care when contracted providers are absent from their practices or when there is a temporary vacancy in a position while a hospital, rural health clinic, or rural provider is recruiting to meet patient demand, hospitals, rural health cli... |
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 s 6 .] |
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 wh... |
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 ... |
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 c... |
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... |
74.09.402 | Children's health care—Findings—Intent. | (1) The legislature finds that: (a) Improving the health of children in Washington state is an investment in a productive and successful next generation. The health of children is critical to their success in school and throughout their lives; (b) Healthy children are ready to learn. In order to provide students with t... |
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 phy... |
74.09.470 | Children's affordable health coverage—Authority duties. | (1) Consistent with the goals established in RCW 74.09.402 , through the apple health for kids program authorized in this section, the authority shall provide affordable health care coverage to children under the age of nineteen who reside in Washington state and whose family income at the time of enrollment is not gre... |
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 s 41 ; 2011 c 4 s 19 .]
Effective date — 2011 c 4 ss 1-6 and 16-21: See note following RCW 50.20.12... |
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 initiat... |
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 pediatr... |
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 ... |
74.09.495 | Access to children's behavioral health services—Report to legislature. | (1) To better assure and understand issues related to network adequacy and access to services, the authority shall report to the appropriate committees of the legislature by December 1, 2017, and annually thereafter, on the status of access to behavioral health services for children from birth through age seventeen usi... |
74.09.4951 | Children and youth behavioral health work group—Advisory groups—Report to governor and legislature.(Expires December 30, 2029.) | *** CHANGE IN 2026 *** (SEE 2429-S2.SL ) ***
(1) The children and youth behavioral health work group is established to: (a) Identify barriers to and opportunities for accessing behavioral health services for children, youth, and young adults and their families; (b) Strengthen and build a coordinated systemic approach t... |
74.09.497 | Authority review of payment codes available to health plans and providers related to primary care and behavioral health—Requirements—Principles considered—Matrices—Reporting. | (1) By August 1, 2017, the authority must complete a review of payment codes available to health plans and providers related to primary care and behavioral health. The review must include adjustments to payment rules if needed to facilitate bidirectional integration. The review must involve stakeholders and include con... |
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 (... |
74.09.510 | Medical assistance—Eligibility. | Medical assistance may be provided in accordance with eligibility requirements established by the authority, as defined in the social security Title XIX state plan for mandatory categorically needy persons and: (1) Individuals who would be eligible for cash assistance except for their institutional status; (2) Individu... |
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 co... |
74.09.520 | Medical assistance—Care and services included—Funding limitations. | (1) The term "medical assistance" may include the following care and services subject to rules adopted by the authority or department: (a) Inpatient hospital services; (b) outpatient hospital services; (c) other laboratory and X-ray services; (d) nursing facility services; (e) physicians' services, which shall include ... |
74.09.522 | Medical assistance—Agreements with managed care organizations for provision of services to medicaid recipients—Principles to be applied in purchasing managed health care. | (1) For the purposes of this section, "nonparticipating provider" means a person, health care provider, practitioner, facility, or entity, acting within their scope of practice, that does not have a written contract to participate in a managed care organization's provider network, but provides health care services to e... |
74.09.5222 | Medical assistance—Section 1115 demonstration waiver request. | (1) The authority shall submit a section 1115 demonstration waiver request to the federal department of health and human services to expand and revise the medical assistance program as codified in Title XIX of the federal social security act. The waiver request should be designed to ensure the broadest federal financia... |
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, t... |
74.09.5225 | Medical assistance—Payments for services provided by rural hospitals—Participation in Washington rural health access preservation pilot. | *** CHANGE IN 2026 *** (SEE 6103.SL ) ***
*** CHANGE IN 2026 *** (SEE 5923-S.SL ) ***
(1) Payments for recipients eligible for medical assistance programs under this chapter for services provided by hospitals, regardless of the beneficiary's managed care enrollment status, shall be made based on allowable costs incurre... |
74.09.5228 | Primary care health homes—Children with medically complex conditions. | By January 1, 2025, the authority shall submit a state plan amendment to the federal centers for medicare and medicaid services to allow medicaid-eligible children with medically complex conditions to voluntarily enroll in a health home as provided in section 3 of the medicaid services investment and accountability act... |
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 effect... |
74.09.523 | PACE program—Definitions—Requirements. | (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise. (a) "PACE" means the program of all-inclusive care for the elderly, a managed care medicare/medicaid program authorized under sections 1894, 1905(a), and 1934 of the social security act and administered b... |
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 esta... |
74.09.540 | Medical assistance—Working individuals with disabilities—Intent. | (1) It is the intent of the legislature to remove barriers to employment for individuals with disabilities by providing medical assistance to working individuals with disabilities through a buy-in program in accordance with section 1902(a)(10)(A)(ii) of the social security act and eligibility and cost-sharing requireme... |
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 transfer... |
74.09.555 | Medical assistance—Reinstatement upon release from confinement—Expedited eligibility determinations. | (1) The authority shall adopt rules and policies providing that when persons who were enrolled in medical assistance immediately prior to confinement, or who become enrolled in medical assistance in suspense status during the period of confinement, are released from confinement, their medical assistance coverage shall ... |
74.09.557 | Medical assistance—Complex rehabilitation technology products. | (1) The authority shall establish a separate recognition for individually configured, complex rehabilitation technology products and services for complex needs patients with the medical assistance program. This separate recognition shall: (a) Establish a budget and services category separate from other categories, such... |
74.09.559 | Long-acting injectable buprenorphine—Billing codes—Reimbursement. | (1) The authority shall establish appropriate billing codes for hospitals and psychiatric hospitals that administer long-acting injectable buprenorphine on an outpatient basis to use for billing patients enrolled in a medical assistance program. (2) Upon initiation or renewal of a contract with the authority to adminis... |
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 transfer... |
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 t... |
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 d... |
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 m... |
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 s 105 .]
Intent — Finding — 2012 c 241: See note following RCW 74.66.010 . |
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 s 6 .]
Severability — 1977 ex.s. c 260: "If any provision of this act, or its application to any person or circumstance is held invalid, ... |
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 s 7 .] |
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: ... |
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 und... |
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, pr... |
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 ... |
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 ne... |
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 s 46 ; 20... |
74.09.650 | Prescription drug assistance program. | (1) 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 design a medicaid prescription drug assistance program. Neither the benefits of, nor eligibility for, the program is considered to be an entitlement. ... |
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 s 48 ; 2011 1st sp.s. c 15 s 60 ; 1997 c 430 s 2 . Formerly RCW 43.20A.3... |
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 autho... |
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... |
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 telemedi... |
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 an... |
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 ... |
74.09.665 | Human immunodeficiency virus postexposure prophylaxis drugs—Coverage—Reimbursement. | (1) The authority and all medicaid contracted managed care organizations shall provide coverage without prior authorization for the drugs that comprise at least one regimen recommended by the centers for disease control and prevention for human immunodeficiency virus postexposure prophylaxis. (2) Notwithstanding the co... |
74.09.667 | Human immunodeficiency virus antiviral drugs—Coverage. | (1) The authority shall provide coverage under this chapter for all federal food and drug administration approved HIV antiviral drugs without prior authorization or step therapy. This coverage must be provided to apple health clients enrolled in both fee-for-service and managed care programs. (2) Upon initiation or ren... |
74.09.670 | Medical assistance benefits—Incarcerated or committed persons—Suspension. | (1) Except as provided in subsection (2) of this section, when the authority receives information that a person enrolled in medical assistance is confined in a setting in which federal financial participation is disallowed by the state's agreements with the federal government, the authority shall suspend, rather than t... |
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 ... |
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 sho... |
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 identit... |
74.09.700 | Medical care—Limited casualty program. | (1) To the extent of available funds and subject to any conditions placed on appropriations made for this purpose, medical care may be provided under the limited casualty program to persons not eligible for medical assistance or medical care services who are medically needy as defined in the social security Title XIX s... |
74.09.705 | Family medicine workforce development account. | The family medicine workforce development account is created in the state treasury. All receipts from funding available for the family medicine residency network pursuant to RCW 74.60.090 and 70.112.060 and any other funds collected for the medicaid direct payment program established in chapter 376, Laws of 2024 must b... |
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. Pro... |
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 ... |
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 i... |
74.09.719 | Compact of free association islander dental care program. | (1) The COFA islander dental care program is established to provide dental services to COFA citizens who meet the requirements in subsection (2) of this section. The authority shall begin administering this program by January 1, 2020. (2) Subject to the availability of amounts appropriated for this specific purpose, th... |
74.09.725 | Prostate cancer screening.(Effective until June 30, 2027.) | 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 s 46 ; 2006 c 367 s 8 .]
*Reviser's note: The term "a... |
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... |
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