The bill adds a new section to chapter 74.09 RCW requiring the state authority to establish and adopt network adequacy standards for postacute care services by January 1, 2028. Those standards must address nursing homes (chapter 18.51 RCW) and inpatient rehabilitation facilities (chapter 70.41 RCW), consider keeping care local, account for provider availability and timeliness of care, and comply with federal Medicaid requirements. Stakeholder feedback (hospitals, nursing homes, MCOs, relevant associations and any additional included provider types) must be obtained at least three times during standards development. The bill also defines “nonparticipating provider” and defines “timeliness of care,” and states that the new standards do not change a facility’s ability to determine if it can meet a prospective resident’s needs. The bill amends RCW 74.09.522 to impose new contracting, payment, monitoring, and procedural requirements for managed care organizations and contractors. Key changes include payment rules for nonparticipating providers (if an MCO made good faith efforts to contract, it must pay no more than the lowest amount it pays similar providers in state, and nonparticipating providers must accept that payment plus patient cost-sharing as payment in full), requirements that MCO contracts offer opportunities to mental health and substance use disorder providers to deliver integrated primary care in behavioral health settings, and a requirement that MCO networks meet federal managed care access standards (42 C.F.R. Sec. 438). The authority must monitor and report, by county and by MCO, the share of services provided by contracted versus nonparticipating providers and report findings to the legislature by January 1 each year. MCO contracts or amendments effective on or after July 1, 2028 must meet the postacute care network adequacy requirements. The authority must adopt minimum net worth rules for contractors not otherwise regulated, may take contractual action if financial status jeopardizes contract performance, must include clear dispute resolution in procurement documents, and must meet other specified contract terms (including statewide minimum enrollment thresholds, limits on mid-period termination without cause, and rate limits when certain care management items are included). Payments under RCW 74.60.130 are exempted from a provision of this section. The provided extracts stop mid-sentence in places and do not identify the entity called “the authority,” nor do they include the full amended statutory text or any implementation, enforcement, or penalty details that may appear elsewhere in the bill. Those missing portions are necessary to fully understand all duties, definitions, and any additional procedures or penalties the bill may impose.

If enacted, the bill will require a state authority to set enforceable network adequacy rules for postacute services (nursing homes and inpatient rehabilitation) by January 1, 2028, and to fold those rules into Medicaid managed care contracts. Managed care organizations will need to meet new geographic and timeliness expectations, offer contracts to mental health and substance use disorder providers for integrated care, comply with state net-worth and financial oversight requirements, and face annual county-level reporting that compares services delivered by contracted versus nonparticipating providers. Providers who remain out of network will generally be paid no more than the lowest in-network rate an MCO pays similar providers, and Medicaid enrollees will generally not be billed beyond normal cost-sharing for covered services. The groups most affected are managed care organizations (which will likely see higher contracting, reporting, and solvency compliance costs and less flexibility in network design), nursing homes and inpatient rehab facilities (which will face clearer expectations about the geographic areas they serve and stronger incentives to join networks but retain the right to refuse based on staffing and resident needs), behavioral health providers (who will be asked to provide integrated primary care), and Medicaid enrollees (who could see improved local access and protection from surprise bills). Important details are missing from the extracted text—most notably the exact identity of “the authority,” enforcement mechanisms, and any penalties—so the precise timing, scope of costs, and how strictly standards will be applied remain unclear.