Title 74 — Title 74 PUBLIC ASSISTANCE

(1) The purpose of this chapter is to establish a safety net program, including an assessment on certain nongovernmental medicaid prospective payment system hospitals and critical access hospitals and an allowance for intergovernmental transfers for designated public hospitals, w…

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Authority" means the health care authority.(2) "Base year" for medicaid fee-for-service payments for state fiscal year 2024 is state fiscal year 2021. For each followi…

(1) A dedicated fund is hereby established within the state treasury to be known as the hospital safety net assessment fund. The purpose and use of the fund shall be to receive and disburse funds, together with accrued interest, in accordance with this chapter. Moneys in the fund…

(1) Upon satisfaction of the conditions in RCW 74.60.150(1), and so long as the conditions in RCW 74.60.150(2) have not occurred, an annual assessment is imposed as set forth in this subsection, which shall be paid in equal quarterly installments. For calendar year 2024, the firs…

The following hospitals are exempt from any assessment under this chapter provided that if and to the extent any exemption is held invalid by a court of competent jurisdiction or by the centers for medicare and medicaid services, hospitals previously exempted shall be liable for …

(1) The authority, in cooperation with the office of financial management, shall develop rules for determining the amount to be assessed to individual hospitals, notifying individual hospitals of the assessed amount, and collecting the amounts due. Such rule making shall specific…

Nothing in this chapter shall be construed to authorize any unit of local government to impose a tax or assessment on hospitals, including but not limited to a tax or assessment measured by a hospital's income, earnings, bed days, or other similar measures.[ 2010 1st sp.s. c 30 s…

The incidence and burden of assessments imposed under this chapter shall be on hospitals and the expense associated with the assessments shall constitute a part of the operating overhead of hospitals. Hospitals shall not increase charges or billings to patients or third-party pay…

In each calendar year and upon satisfaction of the conditions in RCW 74.60.150(1), and so long as none of the conditions in RCW 74.60.150(2) occur, after deducting or reserving amounts authorized to be disbursed under RCW 74.60.020(4) (d), (e), (f), and (g), disbursements from th…

(1) In consultation with the Washington state hospital association, the authority shall design and implement a medicaid directed payment program, consistent with 42 C.F.R. Sec. 438.6(c), intended to promote access to high quality inpatient and outpatient care provided by designat…

(1) In each calendar year commencing upon satisfaction of the conditions in RCW 74.60.150(1), the authority may make grants to financially distressed hospitals.(2) To qualify for a grant, a hospital must:(a) Be located in Washington, and not be part of a system of three or more h…

In each fiscal year commencing upon satisfaction of the applicable conditions in RCW 74.60.150(1), $2,040,000 must be distributed from the fund and, with available federal matching funds, paid to hospitals eligible for small rural disproportionate share payments under WAC 182-550…

(1) For each calendar year, beginning January 1, 2024, or upon satisfaction of the applicable conditions in RCW 74.60.150(1), whichever is later, the authority shall make supplemental payments directly to Washington hospitals, separately for inpatient and outpatient fee-for-servi…

(1) Beginning on the later of January 1, 2024, or 30 calendar days after satisfaction of the conditions in RCW 74.60.150(1) and subsection (3) of this section, and for each subsequent calendar year so long as none of the conditions stated in RCW 74.60.150(2) have occurred, the au…

(1) If an entity owns or operates more than one hospital subject to assessment under this chapter, the entity shall pay the assessment for each hospital separately. However, if the entity operates multiple hospitals under a single medicaid provider number, it may pay the assessme…

(1) The assessment, collection, and disbursement of funds under this chapter shall be conditional upon:(a) Final approval by the centers for medicare and medicaid services in order to implement the applicable sections of this chapter, except under RCW 74.60.090, including, if nec…

(1) The legislature intends to provide the hospitals with an opportunity to contract with the authority each fiscal biennium to protect the hospitals from future legislative action during the biennium that could result in hospitals receiving less from supplemental payments, incre…

(1) The estimated hospital net financial benefit under this chapter shall be determined by the authority by summing the following anticipated hospital payments, including all applicable federal matching funds, RCW 74.60.110 for payments to small rural disproportionate share hospi…

(1) The provisions of RCW 74.60.090 is [are] severable from the remainder of this chapter, unless the condition stated in RCW 74.60.150(3)(c) occurs. The other provisions of this chapter are not severable; if the conditions set forth in RCW 74.60.150(1) cannot be satisfied or if …

Upon expiration of chapter 74.60 RCW, inpatient and outpatient hospital reimbursement rates shall return to a funding level as if the four percent medicaid inpatient and outpatient rate reductions did not occur on July 1, 2009, using the rate structure in effect July 1, 2015, or …

(1) The legislature finds that:(a) Persons who have a long-term disability and apply for federal supplemental security income benefits should receive assistance while their application for federal benefits is pending;(b) Persons who are incapacitated from gainful employment for a…

For the purposes of this chapter, unless the context indicates otherwise, the following definitions shall apply:(1) "Aged, blind, and [or] disabled assistance program" means the program established under RCW 74.62.030.(2) "Department" means the department of social and health ser…

Effective October 31, 2011, the disability lifeline program, as defined under chapter 74.04 RCW, is terminated and all benefits provided under that program shall expire and cease to exist.[ 2011 1st sp.s. c 36 s 2.]Notes:Effective date—2011 1st sp.s. c 36: See note following RCW …

*** CHANGE IN 2026 *** (SEE 2632.SL) ***(1)(a) The aged, blind, or disabled assistance program shall provide financial grants to persons in need who:(i) Are not eligible to receive supplemental security income, refugee cash assistance, temporary assistance for needy families, or …

It is the intent of the legislature to:(1) Implement waste, fraud, and abuse detection, prevention, and recovery solutions to improve program integrity for medical services programs in the state and create efficiency and cost savings through a shift from a retrospective "pay and …

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Authority" means the Washington state health care authority.(2) "Enrollee" means an individual who receives benefits through a medical services program.(3) "Medical se…

(1) Not later than September 1, 2012, the authority shall issue a request for information to seek input from potential contractors on capabilities that the authority does not currently possess, functions that the authority is not currently performing, and the cost structures asso…

It is the intent of the legislature that the savings achieved through this chapter shall more than cover the cost of implementation and administration. Therefore, to the extent possible, technology services used in carrying out this chapter must be secured using the savings gener…

This act takes effect July 1, 2012.[ 2012 c 234 s 7.]

This chapter may be known and cited as the medicaid fraud false claims act.[ 2012 c 241 s 214.]Notes:Intent—Finding—2012 c 241: See note following RCW 74.66.010.

Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter:(1)(a) "Claim" means any request or demand made for a medicaid payment under chapter 74.09 RCW or other applicable law, whether under a contract or otherwise, for money or…

(1) Subject to subsections (2) and (4) of this section, a person is liable to the government entity for a civil penalty of not less than the greater of ten thousand nine hundred fifty-seven dollars or the minimum inflation adjusted penalty amount imposed as provided by 31 U.S.C. …

Any information furnished pursuant to this chapter is exempt from disclosure under the public records act, chapter 42.56 RCW, until final disposition and all court-ordered seals are lifted.[ 2012 c 241 s 203.]Notes:Intent—Finding—2012 c 241: See note following RCW 74.66.010.

The attorney general must diligently investigate a violation under RCW 74.66.020. If the attorney general finds that a person has violated or is violating RCW 74.66.020, the attorney general may bring a civil action under this section against the person.[ 2012 c 241 s 204.]Notes:…

(1) A person may bring a civil action for a violation of RCW 74.66.020 for the person and for the government entity. The action may be known as a qui tam action and the person bringing the action as a qui tam relator. The action must be brought in the name of the government entit…

(1) If the attorney general proceeds with the qui tam action, the attorney general shall have the primary responsibility for prosecuting the action, and is not bound by an act of the relator. The relator has the right to continue as a party to the action, subject to the limitatio…

(1)(a) Subject to (b) of this subsection, if the attorney general proceeds with a qui tam action, the relator must receive at least fifteen percent but not more than twenty-five percent of the proceeds of the action or settlement of the claim, depending upon the extent to which t…

(1) In no event may a person bring a qui tam action which is based upon allegations or transactions which are the subject of a civil suit or an administrative civil money penalty proceeding in which the state is already a party.(2)(a) The court must dismiss an action or claim und…

(1) Any employee, contractor, or agent is entitled to all relief necessary to make that employee, contractor, or agent whole, if that employee, contractor, or agent , is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the term…

(1) A subpoena requiring the attendance of a witness at a trial or hearing conducted under RCW 74.66.040 or 74.66.050 may be served at any place in the state of Washington.(2) A civil action under RCW 74.66.040 or 74.66.050 may be brought at any time, without limitation after the…

(1) Any action under RCW 74.66.040 or 74.66.050 may be brought in the superior court in any county in which the defendant or, in the case of multiple defendants, any one defendant can be found, resides, transacts business, or in which any act proscribed by RCW 74.66.020 occurred.…

(1)(a) Whenever the attorney general, or a designee, for purposes of this section, has reason to believe that any person may be in possession, custody, or control of any documentary material or information relevant to a false claims act investigation, the attorney general, or a d…

Beginning November 15, 2012, and annually thereafter, the attorney general in consultation with the health care authority must report results of implementing the medicaid fraud false claims act. This report must include:(1) The number of attorneys assigned to qui tam initiated ac…

The legislature finds that medicaid provider fraud and the abuse and neglect of persons in nursing facilities, adult family homes, and long-term care services present a serious risk of harm to the people of the state of Washington in general and to vulnerable adults in particular…

(1) The attorney general shall establish and maintain within his or her office the medicaid fraud control unit.(2) The attorney general shall employ and train personnel to achieve the purposes of this chapter, including attorneys, investigators, auditors, clerical support personn…

The legislature finds that the payments to private emergency ambulance service providers for transports for medicaid recipients have not been increased since 2004, resulting in a loss for carriers who provide this service. This has resulted in the shifting of cost of medicaid tra…

*** CHANGE IN 2026 *** (SEE 2531.SL) ***The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Aggregate fee schedule amount" means the product of the add-on calculated pursuant to RCW 74.70.060(1) multiplied by the number…

(1) A dedicated fund is hereby established within the state treasury to be known as the ambulance transport fund. The purpose and use of the fund shall be to receive and disburse funds, together with accrued interest, in accordance with this chapter. Moneys in the fund, including…

(1) Each ambulance transport provider must report to the authority the number of emergency ambulance transports by payer type and the annual gross receipts for the state fiscal year ending June 30, 2020, pursuant to form and timing required by the authority. The authority shall e…

*** CHANGE IN 2026 *** (SEE 2531.SL) ***(1) Beginning July 1, 2021, and annually thereafter, the authority shall assess each ambulance transport provider a quality assurance fee. Each ambulance transport provider must pay the quality assurance fee on a quarterly basis. The quarte…