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WashingtonSB 51242025-2026 Regular SessionSenateWALLET

Establishing network adequacy standards for skilled nursing facilities and rehabilitation hospitals.

Sponsored By: Ron Muzzall (Republican)

Became Law

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 4 benefits, 0 costs, 1 mixed.

Better coordinated care in Medicaid plans

The state uses uniform contract rules for Medicaid plans. Contracts require quality standards and financial integrity. They reward chronic care and comprehensive medication management. They aim to cut emergency room and hospital use. Plans must offer contracts to behavioral health and substance use providers that integrate primary care. The state may prioritize health home services for complex, high‑cost, or multi‑condition enrollees. Total rates cannot exceed what they would be without these items. Where possible, prepaid capitation includes inpatient care; it can be excluded if not feasible.

More plan choice and rural access

You can choose a Medicaid managed care plan and end enrollment. The state may allow ending without cause only in the first month. An enrollment period cannot be longer than 12 months. You can always leave for good cause under the rules. The Authority considers public community health centers and rural providers as contractors. It tracks contracted versus nonparticipating use by county and reports each January 1. Contracts together must cover at least 30,000 recipients statewide. At least one county enrolls all recipients when federal approval allows.

Stronger local networks for nursing and rehab

The Health Care Authority sets postacute network standards by January 1, 2028. Standards cover nursing homes and inpatient rehab and aim to keep care local. They consider provider availability, referral patterns, and how fast patients get care. Beginning July 1, 2028, managed care contracts must meet these standards. The agency gathers stakeholder input at least three times before finalizing. Facilities still decide if they can safely serve a new resident.

Stronger protections for out-of-network bills

If a plan tried to contract, it pays out‑of‑network providers its lowest in‑state rate. Nonparticipating providers must accept that payment plus your cost-sharing as full payment. You are not billed more for covered services. The Authority defines when plans must pay for out‑of‑plan care. The law defines who counts as a nonparticipating provider.

Federal waivers and funding to implement

The Health Care Authority can seek federal waivers to run these programs. It consults with CMMI and looks for federal funding for health homes. It works with Oregon and nearby states on federal recommendations. Payments under RCW 74.60.130 are exempt from these rules.

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Sponsors & Cosponsors

Sponsor

  • Ron Muzzall

    Republican • Senate

Cosponsors

  • Mike Chapman

    Democratic • Senate

  • Perry Dozier

    Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 194 • No: 0

House vote • 3/6/2026

3rd Reading & Final Passage

Yes: 96 • No: 0 • Other: 2

Senate vote • 1/21/2026

3rd Reading & Final Passage

Yes: 49 • No: 0

Senate vote • 3/3/2025

3rd Reading & Final Passage

Yes: 49 • No: 0

Actions Timeline

  1. Effective date 6/11/2026.

    3/24/2026Senate

  2. Chapter 206, 2026 Laws.

    3/24/2026Senate

  3. Governor signed.

    3/24/2026legislature

  4. Delivered to Governor.

    3/12/2026legislature

  5. Speaker signed.

    3/11/2026legislature

  6. President signed.

    3/9/2026legislature

  7. Third reading, passed; yeas, 96; nays, 0; absent, 0; excused, 2.

    3/6/2026Senate

  8. Rules suspended. Placed on Third Reading.

    3/6/2026Senate

  9. Rules Committee relieved of further consideration. Placed on second reading.

    3/4/2026Senate

  10. Referred to Rules 2 Review.

    3/2/2026Senate

  11. APP - Executive action taken by committee.

    2/27/2026Senate

  12. APP - Majority; do pass.

    2/27/2026Senate

  13. Referred to Appropriations.

    2/23/2026Senate

  14. HCW - Executive action taken by committee.

    2/20/2026Senate

  15. HCW - Majority; do pass.

    2/20/2026Senate

  16. First reading, referred to Health Care & Wellness.

    1/26/2026Senate

  17. Third reading, passed; yeas, 49; nays, 0; absent, 0; excused, 0.

    1/21/2026Senate

  18. Rules suspended. Placed on Third Reading.

    1/21/2026Senate

  19. Floor amendment(s) adopted.

    1/21/2026Senate

  20. Returned to second reading for amendment.

    1/21/2026Senate

  21. Rules suspended.

    1/21/2026Senate

  22. Placed on third reading by Rules Committee.

    1/13/2026Senate

  23. By resolution, reintroduced and retained in present status.

    1/12/2026Senate

  24. By resolution, returned to Senate Rules Committee for third reading.

    4/27/2025Senate

  25. Rules Committee relieved of further consideration. Placed on second reading.

    4/10/2025Senate

Bill Text

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