This bill adds new provisions to chapter 71.24 RCW and amends multiple sections of chapter 71.12 RCW to establish and regulate "residential pediatric recovery centers," require licensure for pediatric transitional care services, and change programmatic, funding, and operational requirements for facilities that care for substance‑exposed infants and their families. It requires the Health Care Authority (HCA) to develop and submit a Medicaid state plan amendment (SPA) to CMS by July 1, 2027, and to provide a feasibility/status report to legislative policy and fiscal committees by January 1, 2027. Until the SPA is approved and a bundled funding model is implemented, HCA must provide grant funds, subject to appropriation and with legislative intent to use opioid abatement settlement account money, to the facility that was the subject of the 2023 pilot project; that temporary grant authority expires December 31, 2028. The Department of Children, Youth, and Families (DCYF), in coordination with HCA and subject to appropriation, must develop and implement a bundled funding model for nonmedical maternal and child health services at these centers by July 1, 2027. The bill makes procedural and regulatory changes for establishments providing pediatric transitional care services rather than creating a new criminal offense. It sets staffing limits (an RN on duty at all times; one RN or LPN per eight infants; one trained caregiver per four infants), requires weekly individualized infant plans and at least weekly clinical assessments, mandates neonatal abstinence syndrome scoring by an appropriate health care professional, requires developmental screening per a schedule set by the Secretary of Health, and requires collaboration with DCYF on individualized safety plans. Facilities must set on‑site training and background check requirements, establish supportive family rules that can allow a parent to stay and receive specified supports (including room and board for eligible parents, secure storage for medication‑assisted treatment medications, caregiver and safe‑sleep training, linkage to substance use disorder services, coordination with Early Support for Infants and Toddlers, care management, housing and peer support, and supervised visitation), and develop timelines for parent‑infant visits and transportation arrangements. The act also adds a definition of “residential pediatric recovery center” and defines terms such as “trained caregiver” in the amended statute. Affected state and federal entities named in the text include HCA, DCYF, the Department of Health and its Secretary, CMS, the Early Support for Infants and Toddlers program, the pilot facility referenced from 2023 legislation, infants born substance‑exposed and their parents/caregivers, and legislative policy and fiscal committees. The provided text is incomplete in places: the rulemaking language in the amendment to RCW 71.12.684 is cut off, the amended text for RCW 71.12.686 is referenced but not included, details of the 2023 pilot project facility are not provided, and the specific SPA content required by section 1007 of P.L. 115‑271 is not described.

If enacted, state agencies will have to set up Medicaid billing and a bundled payment approach so residential pediatric recovery centers can be paid for caring for substance‑exposed infants and their families. In practice HCA must seek federal approval by July 1, 2027 and report on feasibility by January 1, 2027, while DCYF must design a bundled funding model by July 1, 2027; until federal approval and the new payment model are in place the pilot facility from the 2023 law is intended to receive state grant support (funding subject to appropriation and the legislature’s stated intent to use opioid abatement settlement funds) through December 31, 2028. This shifts planning and budgeting work onto HCA and DCYF, offers the pilot facility short‑term grant stability, and could move ongoing costs from state grants to Medicaid reimbursement if the SPA is approved. Facilities and frontline staff will face new licensing, staffing, and service requirements that will change day‑to‑day operations and likely raise costs. The Department of Health will expand licensing and rulemaking for “residential pediatric recovery centers,” which must maintain minimum staffing (an RN on duty at all times, one RN/LPN per eight infants, one trained caregiver per four infants), create weekly individualized care plans and assessments, perform NAS scoring and developmental screenings, and support parent stays with specified services (room and board, medication storage, training, care coordination, housing and peer supports, etc.). These requirements make services more comprehensive for infants and families but will likely increase staffing, training, and compliance costs for providers; key details about federal SPA content, some rulemaking provisions, and the pilot project funding mechanics are not fully included in the extracted text.