Pediatric transitional care

AN ACT Relating to facilities licensed to provide pediatric 1
transitional care services; amending RCW 71.12.455, 71.12.680, 2
71.12.684, and 71.12.686; adding a new section to chapter 71.24 RCW; 3
creating new sections; and providing an expiration date.4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
NEW SECTION. Sec. 1. (1) The legislature finds that thousands 6
of infants are born in Washington state each year exposed to harmful 7
substances including, but not limited to: Opiates and synthetic 8
opioids such as heroin; methadone and fentanyl; methamphetamines; 9
tobacco; marijuana; alcohol; morphine; buprenorphine; codeine; 10
cocaine; and other substances. Prenatal substance exposure frequently 11
results in infants suffering from neonatal abstinence syndrome and 12
its accompanying withdrawal symptoms after birth. Consequently, the 13
legislature finds that substance-exposed infants have unique medical 14
and nonmedical needs and benefit from specialized health care that 15
addresses, not only their unique withdrawal symptoms, but their 16
bonding and attachment needs.17
(2) The legislature further finds that the pilot project which 18
provides medical and nonmedical, nonpharmacologic care and wraparound 19
support to infants and their families in a nurturing environment, 20
demonstrated that its nonhospital treatment model promotes bonding 21
S-3726.1
SENATE BILL 6094
State of Washington 69th Legislature 2026 Regular Session
By Senators Riccelli, Christian, and Saldaña
Read first time 01/13/26. Referred to Committee on Health & Long-
Term Care.
p. 1 SB 6094
and attachment between substance-exposed infants and their parents 1
and caregivers. Of the 49 parents who have resided full time with 2
their infants in the study of the pilot project, 88 percent are in 3
recovery, in custody of their infant, and housed. 4
(3) The legislature further finds that substance-exposed infants 5
are currently being treated in neonatal intensive care unit hospital 6
settings for extended periods of time resulting in a high systemic 7
cost and a lessened opportunity for parental bonding compared to the 8
structure and the therapeutic environment provided at significantly 9
lower cost to the state by the pilot project. 10
(4) The legislature further finds that it is in the interest of 11
the state to keep substance-exposed infants with their parents who 12
are also in recovery. Promoting bonding and attachment during the 13
first few weeks of the life of an infant increases the chance that 14
the infant will not go into the foster care system and results in 15
further cost savings to the state. 16
(5) The legislature, therefore, intends to encourage alternatives 17
to continued hospitalization for substance-exposed infants, including 18
the continuation and development of pediatric transitional care 19
facilities through the creation of a bundled, sustainable funding 20
model for pediatric transitional care facilities using a combination 21
of existing federal and state resources. 22
NEW SECTION. Sec. 2. (1) By July 1, 2027, and within existing 23
resources, the health care authority shall develop and submit a state 24
plan amendment to the federal centers for medicare and medicaid 25
services to allow for facility-based payments to residential 26
pediatric recovery centers as provided in section 1007 of P.L. 27
115-271.28
(2) By January 1, 2027, and within existing resources, the health 29
care authority shall submit a status report to the appropriate policy 30
and fiscal committees of the legislature detailing the feasibility of 31
an approval for a state plan amendment as outlined in subsection (1) 32
of this section. 33
(3) Until the state plan amendment submitted under subsection (1) 34
of this section is approved and the bundled funding model detailed in 35
section 3 (1) of this act is implemented, and subject to amounts 36
appropriated for this specific purpose, the health care authority 37
shall provide grant funds to the facility that was the subject of the 38
pilot project created in section 215 (117), chapter 475, Laws of 2023 39
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to ensure the availability of services to infants with a history of 1
substance exposure. It is the intent of the legislature to 2
appropriate funds from the opioid abatement settlement account for 3
this purpose. 4
(4) This section expires December 31, 2028. 5
NEW SECTION. Sec. 3. A new section is added to chapter 71.24 6
RCW to read as follows: 7
(1) Subject to amounts appropriated for this specific purpose, by 8
July 1, 2027, the department of children, youth, and families, in 9
coordination with the authority, shall develop and implement a 10
bundled funding model for nonmedical maternal and child health 11
programmatic services provided by residential pediatric recovery 12
centers to infants born substance exposed and their families.13
(2) The bundled funding model established under this section 14
shall support family centered nonmedical maternal and child health 15
services that promote infant stabilization, caregiver capacity, and 16
safe transition to the home environment. The department shall 17
identify allowable service components, which may include, but are not 18
limited to: 19
(a) Caregiver coaching, education, and skill building related to 20
infant care, feeding, soothing, safe sleep, and developmental 21
support; 22
(b) Dyadic services that promote bonding, attachment, and 23
caregiver-infant interaction; 24
(c) Family support services, including peer navigation, case 25
management, and coordination with child welfare and community-based 26
providers; 27
(d) Respite, overnight accommodations, and on-site supports for 28
caregivers while the infant is receiving services at a residential 29
pediatric recovery center; and 30
(e) Discharge and transition planning, including linkage to early 31
intervention, home visiting, substance use disorder treatment, 32
primary care, and community supports. 33
(3) For the purposes of this section, "residential pediatric 34
recovery center" means a health care facility licensed or certified 35
by the department to provide pediatric transitional care services 36
under this chapter that is able to provide medically necessary 37
recovery services to infants affected by neonatal abstinence 38
syndrome, neonatal opioid withdrawal syndrome, or prenatal substance 39
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exposure, as well as nonmedical treatment and wraparound support 1
services for infants born substance exposed and their families.2
Sec. 4. RCW 71.12.455 and 2024 c 121 s 19 are each amended to 3
read as follows: 4
The definitions in this section apply throughout this chapter 5
unless the context clearly requires otherwise. 6
(1) "Department" means the department of health.7
(2) "Elopement" means any situation in which an admitted patient 8
of a private establishment who is cognitively, physically, mentally, 9
emotionally, and/or chemically impaired wanders, walks, runs away, 10
escapes, or otherwise leaves a private establishment or the grounds 11
of a private establishment prior to the patient's scheduled discharge 12
unsupervised, unnoticed, and without the staff's knowledge.13
(3) "Private establishment," "establishment," and "institution" 14
mean: 15
(a) Every private or county or municipal hospital, including 16
public hospital districts, homes, behavioral health hospitals, 17
residential treatment facilities, or other places receiving or caring 18
for any person with a behavioral health or substance use disorder; 19
and 20
(b) Beginning January 1, 2019, facilities providing pediatric 21
transitional care services. 22
(4) "Immediate jeopardy" means a situation in which the private 23
establishment's noncompliance with one or more statutory or 24
regulatory requirements has placed the health and safety of patients 25
in its care at risk for serious injury, serious harm, serious 26
impairment, or death. 27
(5) "Pediatric transitional care services" means ((short-term, 28
temporary, health and comfort services for drug exposed infants )) any 29
medical and nonmedical treatment and wraparound support services for 30
substance-exposed infants and one or more parents of the infant 31
according to the requirements of this chapter and provided in an 32
establishment licensed by the department. 33
(6) "Behavioral health hospital" means an establishment caring 34
for any person with mental illness or substance use disorder 35
excluding acute care hospitals licensed under chapter 70.41 RCW, 36
state psychiatric hospitals established under chapter 72.23 RCW, and 37
residential treatment facilities as defined in this section.38
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(7) "Residential treatment facility" means an establishment in 1
which 24-hour on-site care is provided for the evaluation, 2
stabilization, or treatment of residents for substance use, mental 3
health, co-occurring disorders, or for ((drug exposed infants )) 4
substance-exposed infants and their parents. 5
(8) "Secretary" means the secretary of the department of health.6
(9) "Technical assistance" means the provision of information on 7
the state laws and rules applicable to the regulation of private 8
establishments, the process to apply for a license, and methods and 9
resources to avoid or address compliance problems. Technical 10
assistance does not include assistance provided under chapter 43.05 11
RCW. 12
(10) "Trained caregiver" means a noncredentialed, unlicensed 13
person trained by the establishment providing pediatric transitional 14
care services to provide hands-on care to ((drug exposed)) substance-15
exposed infants. Caregivers may not provide medical care to infants 16
and may only work under the supervision of an appropriate health care 17
professional. 18
Sec. 5. RCW 71.12.680 and 2017 c 263 s 3 are each amended to 19
read as follows: 20
(1) An establishment providing pediatric transitional care 21
services to ((drug exposed infants )) substance-exposed infants and 22
their parents must demonstrate that it is capable of providing 23
services for ((children who:24
(a) Are no more than one year of age;25
(b) Have been exposed to drugs before birth;26
(c) Require twenty-four hour continuous residential care and 27
skilled nursing services as a result of prenatal substance exposure; 28
and29
(d) Are referred to the establishment by the department of social 30
and health services, regional hospitals, and private parties.31
(2))) infants who:32
(a) Have been exposed to substances before birth;33
(b) Have been determined by the clinical director or medical 34
director of the establishment to respond favorably developmentally to 35
specialized care to assist bonding and attachment from 24-hour 36
continuous residential care treatment services including nursing and 37
infant care services as a result of prenatal substance exposure; and38
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(c) Are referred to the establishment by the department of 1
children, youth, and families, regional hospitals, and private 2
parties.3
(2) An establishment providing pediatric transitional care 4
services to substance-exposed infants and their parents shall:5
(a) Provide services including, but not limited to: Medication 6
management for withdrawal of neonatal abstinence syndrome and 7
neonatal opioid withdrawal syndrome; specialized feeding in 8
collaboration with the early support for infants and toddlers program 9
at the department of children, youth, and families; oxygen therapy; 10
feeding tubes when necessary; wound care; and comorbid conditions 11
that are managed in a nonacute setting;12
(b) Have capacity to provide room and board to one or both 13
parents of an infant receiving treatment at the establishment; and14
(c) Provide wraparound services as described in section 3 (3) of 15
this act to one or both parents of an infant receiving treatment at 16
the establishment regardless of whether the parent is residing at the 17
establishment when the infant is receiving treatment.18
(3) After January 1, 2019, no person may operate or maintain an 19
establishment that provides pediatric transitional care services 20
without a license under this chapter. 21
Sec. 6. RCW 71.12.684 and 2017 c 263 s 5 are each amended to 22
read as follows: 23
The secretary must, in consultation with the department of 24
((social and health services )) children, youth, and families , adopt 25
rules on pediatric transitional care services. The rules must:26
(1) Establish requirements for medical examinations and 27
consultations which must be delivered by an appropriate health care 28
professional; 29
(2) Require twenty-four hour medical supervision for children 30
receiving pediatric transitional services in accordance with the 31
staffing ratios established under subsection (3) of this section;32
(3) Include staffing ratios that consider the number of 33
registered nurses or licensed practical nurses employed by the 34
establishment and the number of trained caregivers on duty at the 35
establishment. These staffing ratios may not require more than:36
(a) One registered nurse to be on duty at all times;37
(b) One registered nurse or licensed practical nurse to eight 38
infants; and 39
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(c) One trained caregiver to four infants; 1
(4) Require establishments that provide pediatric transitional 2
care services to prepare weekly plans specific to each infant in 3
their care and in ((accordance)) collaboration with the health care 4
professional's standing orders. The health care professional may 5
modify an infant's weekly plan without reexamining the infant if he 6
or she determines the modification is in the best interest of the 7
child. This modification may be communicated to the registered nurse 8
on duty at the establishment who must then implement the 9
modification. Weekly plans are to include short-term goals for each 10
infant and outcomes must be included in reports required by the 11
department; 12
(5) Ensure that neonatal abstinence syndrome scoring is conducted 13
by an appropriate health care professional; 14
(6) Establish drug exposed infant developmental screening tests 15
for establishments that provide pediatric transitional care services 16
to administer according to a schedule established by the secretary;17
(7) Require the establishment to collaborate with the department 18
of ((social and health services )) children, youth, and families to 19
develop an individualized safety plan for each child and to meet 20
other contractual requirements of the department of ((social and 21
health services )) children, youth, and families to identify 22
strategies to meet supervision needs, medical concerns, and family 23
support needs; 24
(8) ((Establish the maximum amount of days an infant may be 25
placed at an establishment )) Require, at a minimum, weekly 26
assessments on each infant to determine whether the infant continues 27
to benefit from receiving care or services; 28
(9) Develop timelines for initial and ongoing parent-infant 29
visits to nurture and help develop attachment and bonding between the 30
child and parent, if the parents are not sharing a room with the 31
infant at the facility and if such visits are possible. Timelines 32
must be developed upon placement of the infant in the establishment 33
providing pediatric transitional care services; 34
(10) Determine how transportation for the infant will be 35
provided, if needed; 36
(11) Establish on-site training requirements for caregivers, 37
volunteers, parents, foster parents, and relatives;38
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(12) Establish background check requirements for caregivers, 1
volunteers, employees, and any other person with unsupervised access 2
to the infants under the care of the establishment; ((and))3
(13) Establish supportive family rules for the parent of an 4
infant to stay at the facility while the infant is receiving care. 5
Supportive family rules shall provide for:6
(a) Room and board for any parent who the establishment deems 7
eligible for such services;8
(b) Access to and secure storage for medication-assisted 9
treatment medications;10
(c) Training on infant cues to promote dyadic bonding and 11
attachment;12
(d) Transportation to inpatient or outpatient substance use 13
disorder services for the parents;14
(e) Training on safe sleep techniques;15
(f) Coordination between providers from the early support for 16
infants and toddlers program of the department of children, youth, 17
and families and parents to promote continuity of care;18
(g) Training on basic parental skills;19
(h) Care management services;20
(i) Support in securing housing;21
(j) Peer support;22
(k) Supervised visitation services; and23
(l) Education on secondary exposure to opioids; and24
(14) Establish other requirements necessary to support the infant 25
and the infant's family. 26
Sec. 7. RCW 71.12.686 and 2017 c 263 s 6 are each amended to 27
read as follows: 28
After referral by the department of ((social and health 29
services)) children, youth, and families of an infant to an 30
establishment approved to provide pediatric transitional care 31
services, the department of ((social and health services )) children, 32
youth, and families: 33
(1) Retains primary responsibility for case management and must 34
provide consultation to the establishment regarding all placements 35
and permanency planning issues, including developing a parent-child 36
visitation plan; 37
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(2) Must work with the department and the establishment to 1
identify and implement evidence-based practices that address current 2
and best medical practices and ((parent)) dyadic participation; and3
(3) ((Work)) Must work with the establishment to ensure medicaid-4
eligible services are so billed. 5
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