WSR 25-15-109
PROPOSED RULES
HEALTH CARE AUTHORITY
[Filed July 17, 2025, 4:03 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 25-06-042.
Title of Rule and Other Identifying Information: Chapter 182-565 WAC, new subchapter III, Medical respite program, which includes: WAC 182-565-0300 General, 182-565-0310 Definitions, 182-565-0320 Eligibility, 182-565-0330 Admission, 182-565-0340 Discharge, 182-565-0350 Program requirements, 182-565-0360 Coordination and services, 182-565-0370 Duration of services, 182-565-0380 Provider requirements, and 182-565-0390 Grievance and appeals.
Hearing Location(s): On August 26, 2025, at 10:00 a.m. The health care authority (HCA) holds public hearings virtually without a physical meeting place. To attend the virtual public hearing, you must register in advance at https://us02web.zoom.us/webinar/register/WN_8Nt1PNm-Tf-IeJnRVSYXPg#/registration.
If the link above opens with an error message, please try using a different browser. After registering, you will receive a confirmation email containing information about joining the public hearing.
Date of Intended Adoption: Not sooner than August 27, 2025.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email arc@hca.wa.gov, fax 360-586-9727, beginning July 18, 2025, 8:00 a.m., by August 26, 2025, 11:59 p.m.
Assistance for Persons with Disabilities: Contact HCA rules coordinator, phone 360-725-1306, fax 360-586-9727, telecommunication relay service 711, email arc@hca.wa.gov, by August 8, 2025.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: HCA is proposing to add new subchapter III, Medical respite program, under chapter 182-565 WAC, Health-related social needs (HRSN) program.
Reasons Supporting Proposal: This program is intended to provide medical respite care for individuals with significant behavioral health needs. The program is intended to serve individuals with significant behavioral health needs and medical issues who do not require hospitalization but are unable to provide adequate self-care for their medical conditions. The program prioritizes services to individuals with complex medical and behavioral health issues who are homeless or who were recently discharged from a hospital setting.
Statutory Authority for Adoption: RCW
41.05.021,
41.05.160, and ESSB 5187, 68th legislature, 2023 regular session, section 215(64).
Statute Being Implemented: RCW
41.05.021,
41.05.160, and ESSB 5187, 68th legislature, 2023 regular session, section 215(64).
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Valerie Freudenstein, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1344; Implementation and Enforcement: Rob McDonough, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-5135.
A school district fiscal impact statement is not required under RCW
28A.305.135.
A cost-benefit analysis is not required under RCW
34.05.328. RCW
34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
Scope of exemption for rule proposal from Regulatory Fairness Act requirements:
Is not exempt.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The proposed rule establishes coverage of medical respite services for apple health (medicaid) clients. With the help of HRSN infrastructure funding, the rule does not impose more-than-minor costs on small businesses.
July 17, 2025
Wendy Barcus
Rules Coordinator
RDS-6385.3
SUBCHAPTER III - MEDICAL RESPITE PROGRAM
NEW SECTION
WAC 182-565-0300General.
Medical respite programs offer a lower-intensity care setting for patients who are homeless or at risk of homelessness and who would otherwise require a hospital stay or lack a safe option for discharge and recovery. Medical respite programs must meet the minimum operating standards and meet the required medical respite standards of the facility through the national institute for medical respite care (NIMRC), offer required services, meet local codes and ordinances for licensing, safety, and occupancy.
NEW SECTION
WAC 182-565-0310Definitions.
The following definitions and those found in chapter 182-500 WAC apply to this chapter:
"Behavioral health need" - See WAC 182-565-0110.
"Demonstration period" - See WAC 182-565-0110.
"Facility" - The physical location where the medical respite program provides medical respite care services to clients.
"Homelessness" or "at risk of homelessness" - See WAC 182-565-0110.
"Medical respite care services" - Temporary, short-term room and board, health care services and supports.
"Medical respite program (a.k.a., recuperative care and short-term post-hospitalization housing)" - A not-for-profit organization that serves clients whose medical and behavioral health need medical respite care services.
NEW SECTION
WAC 182-565-0320Eligibility.
(1) A person must have or be eligible for apple health coverage before entering a medical respite program. If a person does not have coverage and wants to participate in the medical respite program, the program can help them register for coverage.
(2) To receive medical respite care services, a client must have a qualifying acute medical condition that requires treatment and/or care, does not require a hospital inpatient stay, and is too ill or frail to recover from a physical illness or injury while living on the street and is at risk of being homeless or experiencing homelessness.
NEW SECTION
WAC 182-565-0330Admission.
A client is eligible for admission to a medical respite program when the client:
(1) Is experiencing homelessness or is at risk of becoming homeless;
(2) Is experiencing medical and behavioral health needs and meets one of the following:
(a) Has recently been discharged from a hospital setting including emergency room visits; or
(b) Is referred from a medical clinic (e.g., a primary care clinic, federally qualified health center, urgent care facility, mobile medical clinic, street medicine) and both of the following are true:
(i) The client has an acute medical condition that can be safely managed in a sheltered outpatient setting; and
(ii) Medical respite care is appropriate to provide the conditions to support recovery from the acute medical condition;
(3) Can perform activities of daily living (ADLs) with minimal or no assistance; and
(4) Has signed an admission agreement.
NEW SECTION
WAC 182-565-0340Discharge.
(1) The medical respite program will discharge the client when the client meets one of the following:
(a) No longer benefits from medical respite care services;
(b) Reaches the 90-day utilization limit for their current admission or the six-month utilization during the demonstration period; or
(c) An appropriate alternative service becomes available.
(2) The six-month utilization period limit is shared amongst other housing support services including, but not limited to, housing transition navigation services, and rent/temporary housing.
(3) The medical respite program must begin discharge planning upon the client's admission and maintain discharge planning throughout the client's stay at the facility.
(4) To discharge a client, the program must provide a referral tailored to client needs, to include:
(a) Potential housing options;
(b) Referrals to appropriate health care providers;
(c) Supportive services; and
(d) Provide advance and written notice of discharge to the client, and as applicable, the client's health care provider, managed care organization, and caregivers.
(5) Upon admission and discharge, the program must provide an admission or discharge summary to the client, the health care provider, the managed care organization if applicable, and other persons or entities requested by the client. The admission or discharge summary must include the following:
(a) Written medication list and medication refill information;
(b) Admitting primary diagnosis following discharge from the hospital or referral from a medical clinic;
(c) Estimated or documented length of stay in the medical respite program;
(d) Ongoing medical needs or conditions;
(e) Instructions for accessing relevant resources within the community including shelters or other housing options;
(f) A list of follow-up appointments and contact information for treating providers;
(g) Special medical instructions (e.g., weight-bearing limitations, dietary precautions, allergies, wound orders);
(h) Pain management plan; and
(i) A point of contact for the client.
(6) The medical respite program must ensure adequate protocols are in place for the transfer of client information and access to electronic records to appropriate providers and, if applicable, the client's managed care organization.
NEW SECTION
WAC 182-565-0350Program requirements.
(1) Medical respite programs must provide or arrange for the provision of the following services:
(a) Room and board which must include, at a minimum:
(i) A dedicated bed that is available to the client 24 hours a day, seven days a week;
(ii) Three meals a day in accordance with medical respite standards;
(iii) Laundry services;
(iv) Secured storage for personal belongings and medications;
(v) Compliance with standards set by NIMRC; and
(vi) Compliance with local codes and ordinances for licensing, safety, and occupancy.
(b) The medical respite provider must notify the agency if they no longer meet the requirements to provide medical respite care.
(2) The agency may conduct a post pay review to ensure medical respite care requirements are met. If requirements are not met at the time services are provided, the agency may recoup payment.
NEW SECTION
WAC 182-565-0360Coordination and services.
The medical respite program must provide coordination such that the client can access the following services:
(1) Clinical assessments;
(2) Behavioral health screenings for psychosocial needs;
(3) Medical case management;
(4) Case management support in accessing benefits and housing;
(5) Twenty-four hour wellness checks;
(6) Medical oversight to include:
(a) Medication monitoring; and
(b) Ongoing assessments to determine effectiveness of care plan and/or treatments;
(7) Minor clinical interventions (e.g., wound care, infection control, nonpharmacological pain management);
(8) Arrangement for transportation for the client to and from appointments that are not covered by nonemergency transportation as defined in WAC 182-546-5500; and
(9) Access to equipment for telehealth services and communication related to medical needs or care.
NEW SECTION
WAC 182-565-0370Duration of services.
Medical respite care services are short-term, limited to 90 consecutive days and no more than six months (180 days) during the demonstration period. See WAC 182-565-0340.
NEW SECTION
WAC 182-565-0380Provider requirements.
A medical respite program may provide medical respite care services when the medical respite program:
(1) Is enrolled as a Washington apple health medicaid provider for claims to be paid and be able to provide documentation of proof of service;
(2) Meets the standards for medical respite care programs set by NIMRC;
(3) Completes all necessary agency forms and attestation and receives agency approval; and
(4) Meets local codes and ordinances for licensing, safety, and occupancy.
NEW SECTION
WAC 182-565-0390Grievance and appeals.
Grievance and appeals related to medical respite care services follow the process described in chapter 182-526 WAC.