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Bill

SB 5124

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

2025-2026 Regular Session Introduced by Mike Chapman and 2 co-sponsors

Establishes by 1/1/2027 state standards to ensure timely, locally accessible post-acute care for Apple Health, with MCO contracts meeting network adequacy and monitoring.

Effective date 6/11/2026.
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Bill Summary · SB 5124

Summary: SB 5124 (Substitute) — Network Adequacy Standards for Post-Acute Care

What the bill aims to do

SB 5124 seeks to improve timely and medically necessary post-acute care for Medicaid enrollees (Apple Health) by requiring the Health Care Authority (HCA) to establish and adopt network adequacy standards for post-acute care services. The standards would apply to nursing homes and inpatient rehabilitation facilities within managed care organization (MCO) contracts for Medicaid.

Key provisions (as amended in the substitute bill)

  • Sec. 1 — Network adequacy standards

    • The HCA must establish and adopt network adequacy standards for post-acute care services by no later than January 1, 2027.
    • Standards must include nursing homes (licensed under ch. 18.51 RCW) and inpatient rehabilitation facilities (licensed under ch. 70.41 RCW).
    • Geographic considerations: keep care local to the enrollee’s community; geographic thresholds should not be broader than the regional service area contracted by the MCO. The authority may narrow geographic standards during development.
    • Core factors to assess:
    • Provider availability in a regional service area
    • Timeliness of care (reasonable access based on medical need)
    • Compliance with federal Medicaid requirements
    • Stakeholder feedback: include hospitals, nursing homes, MCOs, and representative associations; gather input at least three times (initial criteria, draft standards, final standards prior to publication and inclusion in contracts).
    • Standards do not limit a facility’s ability to determine whether it can meet a resident’s needs with staffing and reasonable accommodations.

  • Sec. 2 — Amendments to RCW 74.09.522 and related provisions

    • Definitions: clarifies “nonparticipating provider.”
    • MCO contracting: requires agreements for at least 30,000 recipients statewide; enrollment options and non-discrimination considerations; uniform contracting procedures for service quality, financial integrity, and provider reimbursement (including incentives for chronic care management and integration of behavioral health).
    • Monitoring: HCA must periodically report the share of services provided by contracted vs. nonparticipating providers by county for each MCO to ensure network adequacy.
    • Additional alignment: as amended, the standards are tied to federal access monitoring requirements (42 C.F.R. 438) with potential secret shopper elements in monitoring.

  • Substitution-specific note: The amended language uses terminology changes (skilled nursing facilities → nursing homes; rehabilitation hospitals → inpatient rehabilitation facilities).

Who is affected

  • Medicaid enrollees (Apple Health) receiving post-acute care services.
  • Hospitals, nursing homes, inpatient rehabilitation facilities, and other post-acute care providers.
  • Managed care organizations (MCOs) operating Apple Health contracts.
  • Health Care Authority (HCA) as the oversight and standard-setting body.

Implementation timeline

  • Standards must be established and adopted by January 1, 2027.
  • MCO contracts or amendments effective on or after July 1, 2027 must meet the new network adequacy standards for post-acute care.

Fiscal and procedural notes

  • Appropriation: None.
  • Fiscal note: Available.
  • Effective date: 90 days after adjournment of the session in which the bill is passed.
  • Status: By resolution, returned to the Senate Rules Committee for third reading (as of 2025-04-27). The substitute bill has been advanced through multiple committee stages with amended language.

Why this matters

The bill addresses delays and barriers in post-acute placement by establishing formal network adequacy standards, emphasizing local care, timely access, and federal compliance, while increasing transparency through monitoring and stakeholder engagement.

Compiled from official sources — confirm details with the bill’s official record.

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