On page 119, line 5, increase the General Fund—State Appropriation (FY 2022) by $3,462,000

On page 119, line 6, increase the General Fund—State Appropriation (FY 2023) by $3,462,000

On page 119, line 7, increase the General Fund—Federal Appropriation by $13,164,000

Adjust the total appropriation accordingly.

On page 125, line 28, after "participating hospitals." insert "It is the intent of the legislature in the 2023-2025 fiscal biennium to provide funding for state grants for participating hospitals at levels assuming federal disproportionate share hospital reductions continue to be suspended in fiscal years 2024 and 2025."

On page 139, after line 20, insert the following:

"(59) $2,362,000 of the general fund—state appropriation for fiscal year 2022, $2,362,000 of the general fund—state appropriation for fiscal year 2023, and $8,264,000 of the general fund—federal appropriation are provided solely to increase the rates paid to low volume, small rural hospitals that meet the criteria in (a) through (d) of this subsection. Payments for state and federal medical assistance programs for services provided by such a hospital, regardless of the beneficiary's managed care enrollment status, must be increased to 150 percent of the hospital's fee-for-service rates beginning July 1, 2021. The authority must discontinue this rate increase after June 30, 2023, and return to the payment levels and methodology for these hospitals that were in place as of June 30, 2020. A hospital qualifying for this rate increase must:

(a) Have fewer than 70 available acute beds as reported in the hospital's 2018 department of health year-end report;

(b) Not be currently designated as a critical access hospital, and not meet the current federal eligibility requirements for designation as a critical access hospital;

(c) Not be a certified public expenditure hospital;

(d) Have combined medicare and medicaid inpatient days greater than 80 percent as reported in the hospital's 2018 cost report.

(60) $1,100,000 of the general fund—state appropriation for fiscal year 2022, $1,100,000 of the general fund—state appropriation for fiscal year 2023, and $4,900,000 of the general fund—federal appropriation are provided solely to increase the rates paid to rural regional referral hospitals that meet the criteria in (a) through (g) of this subsection. Payments for state and federal medical assistance programs for services provided by such a hospital, regardless of the beneficiary's managed care enrollment status, must be increased to 110 percent of the current medicaid hospital's fee-for-service rates beginning July 1, 2021, for the state medicaid plan and for each of the managed care organization's contracted rates with the hospital. The authority must discontinue this rate increase after June 30, 2023, and return to the payment levels and methodology for these hospitals that were in place as of June 30, 2021. To qualify for this increase, a hospital must:

(a) Have greater than 170 available acute beds as reported in the hospital's 2019 department of health year-end report;

(b) Be currently designated by the centers for medicare and medicaid services as a sole community hospital located in north central Washington;

(c) Have a medicaid eligible population greater than 30 percent of the service population;

(d) Have medicaid revenue greater than 17 percent of total gross revenue as reported on the hospital's 2019 medicare cost report;

(e) Be designated by the state of Washington as a level 3 adult trauma center and a level 3 pediatric trauma center;

(f) Be designated by the state of Washington as a level 2 nursery; and

(g) Be designated as a certified stroke center."