Massage therapy coverage

AN ACT Relating to providing coverage for massage therapy under 1
medical assistance plans; and reenacting and amending RCW 74.09.520.2
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:3
Sec. 1. RCW 74.09.520 and 2023 c 315 s 1 and 2023 c 299 s 1 are 4
each reenacted and amended to read as follows: 5
(1) The term "medical assistance" may include the following care 6
and services subject to rules adopted by the authority or department: 7
(a) Inpatient hospital services; (b) outpatient hospital services; 8
(c) other laboratory and X-ray services; (d) nursing facility 9
services; (e) physicians' services, which shall include prescribed 10
medication and instruction on birth control devices; (f) medical 11
care, or any other type of remedial care as may be established by the 12
secretary or director; (g) home health care services; (h) private 13
duty nursing services; (i) dental services; (j) physical and 14
occupational therapy and related services; (k) prescribed drugs, 15
dentures, and prosthetic devices; and eyeglasses prescribed by a 16
physician skilled in diseases of the eye or by an optometrist, 17
whichever the individual may select; (l) personal care services, as 18
provided in this section; (m) hospice services; (n) other diagnostic, 19
screening, preventive, and rehabilitative services; and (o) like 20
services when furnished to a child by a school district in a manner 21
S-0202.1
SENATE BILL 5507
State of Washington 69th Legislature 2025 Regular Session
By Senators Cleveland, Hasegawa, Saldaña, and Valdez
Read first time 01/27/25. Referred to Committee on Health & Long-
Term Care.
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consistent with the requirements of this chapter. For the purposes of 1
this section, neither the authority nor the department may cut off 2
any prescription medications, oxygen supplies, respiratory services, 3
or other life-sustaining medical services or supplies.4
"Medical assistance," notwithstanding any other provision of law, 5
shall not include routine foot care, or dental services delivered by 6
any health care provider, that are not mandated by Title XIX of the 7
social security act unless there is a specific appropriation for 8
these services. 9
(2) The department shall adopt, amend, or rescind such 10
administrative rules as are necessary to ensure that Title XIX 11
personal care services are provided to eligible persons in 12
conformance with federal regulations. 13
(a) These administrative rules shall include financial 14
eligibility indexed according to the requirements of the social 15
security act providing for medicaid eligibility. 16
(b) The rules shall require clients be assessed as having a 17
medical condition requiring assistance with personal care tasks. 18
Plans of care for clients requiring health-related consultation for 19
assessment and service planning may be reviewed by a nurse.20
(c) The department shall determine by rule which clients have a 21
health-related assessment or service planning need requiring 22
registered nurse consultation or review. This definition may include 23
clients that meet indicators or protocols for review, consultation, 24
or visit. 25
(3) The department shall design and implement a means to assess 26
the level of functional disability of persons eligible for personal 27
care services under this section. The personal care services benefit 28
shall be provided to the extent funding is available according to the 29
assessed level of functional disability. Any reductions in services 30
made necessary for funding reasons should be accomplished in a manner 31
that assures that priority for maintaining services is given to 32
persons with the greatest need as determined by the assessment of 33
functional disability. 34
(4) Effective July 1, 1989, the authority shall offer hospice 35
services in accordance with available funds. 36
(5) For Title XIX personal care services administered by the 37
department, the department shall contract with area agencies on aging 38
or may contract with a federally recognized Indian tribe under RCW 39
74.39A.090(3): 40
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(a) To provide case management services to individuals receiving 1
Title XIX personal care services in their own home; and2
(b) To reassess and reauthorize Title XIX personal care services 3
or other home and community services as defined in RCW 74.39A.009 in 4
home or in other settings for individuals consistent with the intent 5
of this section: 6
(i) Who have been initially authorized by the department to 7
receive Title XIX personal care services or other home and community 8
services as defined in RCW 74.39A.009; and 9
(ii) Who, at the time of reassessment and reauthorization, are 10
receiving such services in their own home. 11
(6) In the event that an area agency on aging or federally 12
recognized Indian tribe is unwilling to enter into or satisfactorily 13
fulfill a contract or an individual consumer's need for case 14
management services will be met through an alternative delivery 15
system, the department is authorized to: 16
(a) Obtain the services through competitive bid; and17
(b) Provide the services directly until a qualified contractor 18
can be found. 19
(7) Subject to the availability of amounts appropriated for this 20
specific purpose, the authority may offer medicare part D 21
prescription drug copayment coverage to full benefit dual eligible 22
beneficiaries. 23
(8) Effective January 1, 2016, the authority shall require 24
universal screening and provider payment for autism and developmental 25
delays as recommended by the bright futures guidelines of the 26
American academy of pediatrics, as they existed on August 27, 2015. 27
This requirement is subject to the availability of funds.28
(9) Subject to the availability of amounts appropriated for this 29
specific purpose, effective January 1, 2018, the authority shall 30
require provider payment for annual depression screening for youth 31
ages twelve through eighteen as recommended by the bright futures 32
guidelines of the American academy of pediatrics, as they existed on 33
January 1, 2017. Providers may include, but are not limited to, 34
primary care providers, public health nurses, and other providers in 35
a clinical setting. This requirement is subject to the availability 36
of funds appropriated for this specific purpose. 37
(10) Subject to the availability of amounts appropriated for this 38
specific purpose, effective January 1, 2018, the authority shall 39
require provider payment for maternal depression screening for 40
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mothers of children ages birth to six months. This requirement is 1
subject to the availability of funds appropriated for this specific 2
purpose. 3
(11) Subject to the availability of amounts appropriated for this 4
specific purpose, the authority shall: 5
(a) Allow otherwise eligible reimbursement for the following 6
related to mental health assessment and diagnosis of children from 7
birth through five years of age: 8
(i) Up to five sessions for purposes of intake and assessment, if 9
necessary; 10
(ii) Assessments in home or community settings, including 11
reimbursement for provider travel; and 12
(b) Require providers to use the current version of the DC:0-5 13
diagnostic classification system for mental health assessment and 14
diagnosis of children from birth through five years of age.15
(12) Effective January 1, 2024, the authority shall require 16
coverage for noninvasive preventive colorectal cancer screening tests 17
assigned either a grade of A or grade of B by the United States 18
preventive services task force and shall require coverage for 19
colonoscopies performed as a result of a positive result from such a 20
test. 21
(13)(a) The authority shall require or provide payment to the 22
hospital for any day of a hospital stay in which an adult or child 23
patient enrolled in medical assistance, including home and community 24
services or with a medicaid managed care organization, under this 25
chapter: 26
(i) Does not meet the criteria for acute inpatient level of care 27
as defined by the authority; 28
(ii) Meets the criteria for discharge, as defined by the 29
authority or department, to any appropriate placement including, but 30
not limited to: 31
(A) A nursing home licensed under chapter 18.51 RCW;32
(B) An assisted living facility licensed under chapter 18.20 RCW;33
(C) An adult family home licensed under chapter 70.128 RCW; or34
(D) A setting in which residential services are provided or 35
funded by the developmental disabilities administration of the 36
department, including supported living as defined in RCW 71A.10.020; 37
and 38
p. 4 SB 5507
(iii) Is not discharged from the hospital because placement in 1
the appropriate location described in (a)(ii) of this subsection is 2
not available. 3
(b) The authority shall adopt rules identifying which services 4
are included in the payment described in (a) of this subsection and 5
which services may be billed separately, including specific revenue 6
codes or services required on the inpatient claim. 7
(c) Allowable medically necessary services performed during a 8
stay described in (a) of this subsection shall be billed by and paid 9
to the hospital separately. Such services may include but are not 10
limited to hemodialysis, laboratory charges, and x-rays.11
(d) Pharmacy services and pharmaceuticals shall be billed by and 12
paid to the hospital separately. 13
(e) The requirements of this subsection do not alter requirements 14
for billing or payment for inpatient care. 15
(f) The authority shall adopt, amend, or rescind such 16
administrative rules as necessary to facilitate calculation and 17
payment of the amounts described in this subsection, including for 18
clients of medicaid managed care organizations. 19
(g) The authority shall adopt rules requiring medicaid managed 20
care organizations to establish specific and uniform administrative 21
and review processes for payment under this subsection.22
(h) For patients meeting the criteria in (a)(ii)(A) of this 23
subsection, hospitals must utilize swing beds or skilled nursing beds 24
to the extent the services are available within their facility and 25
the associated reimbursement methodology prior to the billing under 26
the methodology in (a) of this subsection, if the hospital determines 27
that such swing bed or skilled nursing bed placement is appropriate 28
for the patient's care needs, the patient is appropriate for the 29
existing patient mix, and appropriate staffing is available.30
(14) Beginning January 1, 2027, the authority shall provide 31
coverage for massage therapy performed by a licensed massage 32
therapist when medically necessary as a nonpharmacological 33
alternative for the treatment or management of pain and with a 34
referral from a provider authorized to order or refer items or 35
services.36
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