BILL REQ. #:  H-3784.1 

     AN ACT Relating to the dual eligibles pilot project; adding a new section to chapter 74.48 RCW; adding a new section to chapter 74.46 RCW; and adding a new section to chapter 74.39A RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   A new section is added to chapter 74.48 RCW to read as follows:
     Subject to the applicable conditions set forth in RCW 74.48.060 the department shall:
     (1) Require that health care service contractors participating in the Washington medicaid integration partnership or the medicare integration project, or both, as described in section 201(3) (a) and (b), chapter 4, Laws of 2013 2nd sp. sess., compensate nursing facility medicaid rates, at a minimum, as follows:
     (a) It is the intent of the legislature that savings under the integration project be achieved through shifts in utilization, and reducing rehospitalization rates and not through reduced reimbursement rates to providers;
     (b) Health care service contractors shall pay nursing facilities providing postacute skilled and rehabilitation care or long-term and chronic care rates that reflect the different levels of services and intensity required to provide these services;
     (c) For the purposes of determining the appropriate rate for the type of care identified in (b) of this subsection, the health care service contractor shall pay no less than the recognized rates under medicare and medicaid for these service types. Health care service contractors shall not combine medicare and medicaid rates in order to establish a single rate for dual eligible beneficiaries requiring skilled nursing services.
     (2) Ensure that nursing facilities receive the full benefit of all disbursements made pursuant to RCW 74.48.020(4) (a), (b), (c), and (f), including pass-throughs, rate add-ons, and rate enhancements. Health care service contractors participating in the Washington medicaid integration partnership and the medicare integration project, as described in section 201(3) (a) and (b), chapter 4, Laws of 2013 2nd sp. sess., contracting with nursing facilities shall pay all disbursements made pursuant to RCW 74.48.020(4) (a), (b), (c), and (f), to nursing facilities.
     (3) Require managed care organizations or health care service contractors participating in the Washington medicaid integration partnership and the medicare integration project, as described in section 201(3) (a) and (b), chapter 4, Laws of 2013 2nd sp. sess., to demonstrate compliance with this section.

NEW SECTION.  Sec. 2   A new section is added to chapter 74.46 RCW to read as follows:
     (1) Health care service contractors participating in the Washington medicaid integration partnership or the medicare integration project, or both, as described in section 201(3) (a) and (b), chapter 4, Laws of 2013 2nd sp. sess., shall compensate nursing facility medicaid rates, at a minimum, as follows:
     (a) It is the intent of the legislature that savings under the integration project be achieved through shifts in utilization, and reducing rehospitalization rates and not through reduced reimbursement rates to providers;
     (b) Health care service contractors shall pay nursing facilities providing postacute skilled and rehabilitation care or long-term and chronic care rates that reflect the different levels of services and intensity required to provide these services;
     (c) For the purposes of determining the appropriate rate for the type of care identified in (b) of this subsection, the health care service contractor shall pay no less than the recognized rates under medicare and medicaid for these service types. Health care service contractors shall not combine medicare and medicaid rates in order to establish a single rate for dual eligible beneficiaries requiring skilled nursing services;
     (d) The cost of allowable services and ancillary charges not included in the nursing facility rates established in this chapter, or paid through another mechanism as identified by the published state medicaid fee schedule, medicaid state plan, or other source may not be included in the rates paid to the nursing facility; and
     (e) Service rate add-ons may be paid to nursing facilities for services or populations not compensated for under this chapter.
     (2) Health care service contractors participating in the Washington medicaid integration partnership and the medicare integration project, as described in section 201(3) (a) and (b), chapter 4, Laws of 2013 2nd sp. sess., shall contract with all willing medicaid certified nursing facilities. Nursing facilities contracted under this section may not be terminated unless the nursing facility is terminated from the medicare or medicaid program.

NEW SECTION.  Sec. 3   A new section is added to chapter 74.39A RCW to read as follows:
     (1) Health care service contractors participating in the Washington medicaid integration partnership or the medicare integration project, or both, as described in section 201(3) (a) and (b), chapter 4, Laws of 2013 2nd sp. sess., shall compensate assisted living, adult residential care, and enhanced adult residential care provider medicaid rates, at a minimum, as follows:
     (a) Assisted living, adult residential care, and enhanced adult residential care providers' medicaid rates must be paid at rates equal to or greater than those rates established according to RCW 74.39A.030;
     (b) The cost of allowable services and ancillary charges not included in the rates established according to this chapter, or paid through another mechanism as identified by the published state medicaid fee schedule, medicaid state plan, or other source may not be included in the rates described in (a) of this subsection; and
     (c) Service rate add-ons may be paid to assisted living, adult residential care, and enhanced adult residential care providers for services or populations not compensated for under the rates established according to this chapter.
     (2) Health care service contractors participating in the Washington medicaid integration partnership or the medicare integration project, or both, as described in section 201(3) (a) and (b), chapter 4, Laws of 2013 2nd sp. sess., shall contract with all willing assisted living, adult residential care, and enhanced adult residential care providers contracted to provide medicaid services. Providers contracted under this section may not be terminated unless the provider is terminated from the medicaid program.