Rural hospital payments

AN ACT Relating to making payments for services provided by a 1
rural emergency hospital subject to appropriation; and amending RCW 2
74.09.5225. 3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
Sec. 1. RCW 74.09.5225 and 2017 c 198 s 1 are each amended to 5
read as follows: 6
(1) Payments for recipients eligible for medical assistance 7
programs under this chapter for services provided by hospitals, 8
regardless of the beneficiary's managed care enrollment status, shall 9
be made based on allowable costs incurred during the year, when 10
services are provided by a rural hospital certified by the centers 11
for medicare and medicaid services as a critical access hospital, 12
unless the critical access hospital is participating in the 13
Washington rural health access preservation pilot described in 14
subsection (2)(b) of this section. Any additional payments made by 15
the authority for the healthy options program shall be no more than 16
the additional amounts per service paid under this section for other 17
medical assistance programs. 18
(2)(a) Beginning on July 24, 2005, except as provided in (b) of 19
this subsection, a moratorium shall be placed on additional hospital 20
participation in critical access hospital payments under this 21
S-3836.1
SENATE BILL 6103
State of Washington 69th Legislature 2026 Regular Session
By Senators Muzzall, Cleveland, Schoesler, and J. Wilson
Read first time 01/13/26. Referred to Committee on Health & Long-
Term Care.
p. 1 SB 6103
section. However, rural hospitals that applied for certification to 1
the centers for medicare and medicaid services prior to January 1, 2
2005, but have not yet completed the process or have not yet been 3
approved for certification, remain eligible for medical assistance 4
payments under this section. 5
(b)(i) The purpose of the Washington rural health access 6
preservation pilot is to develop an alternative service and payment 7
system to the critical access hospital authorized under section 1820 8
of the social security act to sustain essential services in rural 9
communities. 10
(ii) For the purposes of state law, any rural hospital approved 11
by the department of health for participation in critical access 12
hospital payments under this section that participates in the 13
Washington rural health access preservation pilot identified by the 14
state office of rural health and ceases to participate in critical 15
access hospital payments may renew participation in critical access 16
hospital associated payment methodologies under this section at any 17
time. 18
(iii) The Washington rural health access preservation pilot is 19
subject to the following requirements: 20
(A) In the pilot formation or development, the department of 21
health, health care authority, and Washington state hospital 22
association will identify goals for the pilot project before any 23
hospital joins the pilot project; 24
(B) Participation in the pilot is optional and no hospital may be 25
required to join the pilot; 26
(C) Before a hospital enters the pilot program, the health care 27
authority must provide information to the hospital regarding how the 28
hospital could end its participation in the pilot if the pilot is not 29
working in its community; 30
(D) Payments for services delivered by public health care service 31
districts participating in the Washington rural health access 32
preservation pilot to recipients eligible for medical assistance 33
programs under this chapter must be based on an alternative, value-34
based payment methodology established by the authority. Subject to 35
the availability of amounts appropriated for this specific purpose, 36
the payment methodology must provide sufficient funding to sustain 37
essential services in the areas served, including but not limited to 38
emergency and primary care services. The methodology must adjust 39
payment amounts based on measures of quality and value, rather than 40
p. 2 SB 6103
volume. As part of the pilot, the health care authority shall 1
encourage additional payers to use the adopted payment methodology 2
for services delivered by the pilot participants to individuals 3
insured by those payers; 4
(E) The department of health, health care authority, and 5
Washington state hospital association will report interim progress to 6
the legislature no later than December 1, 2018, and will report on 7
the results of the pilot no later than six months following the 8
conclusion of the pilot. The reports will describe any policy changes 9
identified during the course of the pilot that would support small 10
critical access hospitals; and 11
(F) Funds appropriated for the Washington rural health access 12
preservation pilot will be used to help participating hospitals 13
transition to a new payment methodology and will not extend beyond 14
the anticipated three-year pilot period. 15
(3)(a) Beginning January 1, 2015, payments for recipients 16
eligible for medical assistance programs under this chapter for 17
services provided by a hospital, regardless of the beneficiary's 18
managed care enrollment status, shall be increased to one hundred 19
twenty-five percent of the hospital's fee-for-service rates, when 20
services are provided by a rural hospital that: 21
(i) Was certified by the centers for medicare and medicaid 22
services as a sole community hospital as of January 1, 2013;23
(ii) Had a level III adult trauma service designation from the 24
department of health as of January 1, 2014; 25
(iii) Had less than one hundred fifty acute care licensed beds in 26
fiscal year 2011; and 27
(iv) Is owned and operated by the state or a political 28
subdivision. 29
(b) The enhanced payment rates under this subsection shall be 30
considered the hospital's medicaid payment rate for purposes of any 31
other state or private programs that pay hospitals according to 32
medicaid payment rates. 33
(c) Hospitals participating in the certified public expenditures 34
program may not receive the increased reimbursement rates provided in 35
this subsection (3) for inpatient services. 36
(4) Payments for recipients eligible for medical assistance 37
programs under this chapter for services provided by a rural hospital 38
designated by the federal centers for medicare and medicaid services 39
p. 3 SB 6103
as a rural emergency hospital, regardless of the managed care 1
enrollment status of the beneficiary, are subject to appropriation.2
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p. 4 SB 6103