Hospitals in Skagit county

AN ACT Relating to critical access hospital designations in 1
Skagit county; and amending RCW 74.09.5225. 2
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:3
Sec. 1. RCW 74.09.5225 and 2017 c 198 s 1 are each amended to 4
read as follows: 5
(1) Payments for recipients eligible for medical assistance 6
programs under this chapter for services provided by hospitals, 7
regardless of the beneficiary's managed care enrollment status, shall 8
be made based on allowable costs incurred during the year, when 9
services are provided by a rural hospital certified by the centers 10
for medicare and medicaid services as a critical access hospital, 11
unless the critical access hospital is participating in the 12
Washington rural health access preservation pilot described in 13
subsection (2) (((b))) (c) of this section. Any additional payments 14
made by the authority for the healthy options program shall be no 15
more than the additional amounts per service paid under this section 16
for other medical assistance programs. 17
(2)(a) Beginning on July 24, 2005, except as provided in (b) and 18
(c) of this subsection, a moratorium shall be placed on additional 19
hospital participation in critical access hospital payments under 20
this section. However, rural hospitals that applied for certification 21
S-3614.3
SENATE BILL 5923
State of Washington 69th Legislature 2026 Regular Session
By Senators Muzzall, Lovelett, Nobles, and Shewmake
Prefiled 12/22/25. Read first time 01/12/26. Referred to Committee
on Ways & Means.
p. 1 SB 5923
to the centers for medicare and medicaid services prior to January 1, 1
2005, but have not yet completed the process or have not yet been 2
approved for certification, remain eligible for medical assistance 3
payments under this section. 4
(b) A hospital is eligible for payment under subsection (1) of 5
this section if the hospital: (i) Has been certified by the centers 6
for medicare and medicaid services as a critical access hospital on 7
or after January 1, 2026; and (ii) is located on an island operating 8
within a public hospital district in Skagit county.9
(c)(i) The purpose of the Washington rural health access 10
preservation pilot is to develop an alternative service and payment 11
system to the critical access hospital authorized under section 1820 12
of the social security act to sustain essential services in rural 13
communities. 14
(ii) For the purposes of state law, any rural hospital approved 15
by the department of health for participation in critical access 16
hospital payments under this section that participates in the 17
Washington rural health access preservation pilot identified by the 18
state office of rural health and ceases to participate in critical 19
access hospital payments may renew participation in critical access 20
hospital associated payment methodologies under this section at any 21
time. 22
(iii) The Washington rural health access preservation pilot is 23
subject to the following requirements: 24
(A) In the pilot formation or development, the department of 25
health, health care authority, and Washington state hospital 26
association will identify goals for the pilot project before any 27
hospital joins the pilot project; 28
(B) Participation in the pilot is optional and no hospital may be 29
required to join the pilot; 30
(C) Before a hospital enters the pilot program, the health care 31
authority must provide information to the hospital regarding how the 32
hospital could end its participation in the pilot if the pilot is not 33
working in its community; 34
(D) Payments for services delivered by public health care service 35
districts participating in the Washington rural health access 36
preservation pilot to recipients eligible for medical assistance 37
programs under this chapter must be based on an alternative, value-38
based payment methodology established by the authority. Subject to 39
the availability of amounts appropriated for this specific purpose, 40
p. 2 SB 5923
the payment methodology must provide sufficient funding to sustain 1
essential services in the areas served, including but not limited to 2
emergency and primary care services. The methodology must adjust 3
payment amounts based on measures of quality and value, rather than 4
volume. As part of the pilot, the health care authority shall 5
encourage additional payers to use the adopted payment methodology 6
for services delivered by the pilot participants to individuals 7
insured by those payers; 8
(E) The department of health, health care authority, and 9
Washington state hospital association will report interim progress to 10
the legislature no later than December 1, 2018, and will report on 11
the results of the pilot no later than six months following the 12
conclusion of the pilot. The reports will describe any policy changes 13
identified during the course of the pilot that would support small 14
critical access hospitals; and 15
(F) Funds appropriated for the Washington rural health access 16
preservation pilot will be used to help participating hospitals 17
transition to a new payment methodology and will not extend beyond 18
the anticipated three-year pilot period. 19
(3)(a) Beginning January 1, 2015, payments for recipients 20
eligible for medical assistance programs under this chapter for 21
services provided by a hospital, regardless of the beneficiary's 22
managed care enrollment status, shall be increased to one hundred 23
twenty-five percent of the hospital's fee-for-service rates, when 24
services are provided by a rural hospital that: 25
(i) Was certified by the centers for medicare and medicaid 26
services as a sole community hospital as of January 1, 2013;27
(ii) Had a level III adult trauma service designation from the 28
department of health as of January 1, 2014; 29
(iii) Had less than one hundred fifty acute care licensed beds in 30
fiscal year 2011; and 31
(iv) Is owned and operated by the state or a political 32
subdivision. 33
(b) The enhanced payment rates under this subsection shall be 34
considered the hospital's medicaid payment rate for purposes of any 35
other state or private programs that pay hospitals according to 36
medicaid payment rates. 37
p. 3 SB 5923
(c) Hospitals participating in the certified public expenditures 1
program may not receive the increased reimbursement rates provided in 2
this subsection (3) for inpatient services. 3
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p. 4 SB 5923