Revised Code of Washington
Chapter 74.09 - Medical Care.
74.09.035 - Medical care services—Eligibility, standards—Limits.

RCW 74.09.035
Medical care services—Eligibility, standards—Limits.

(1) To the extent of available funds, medical care services may be provided to:
(a) Victims of human trafficking, as defined in RCW 74.04.005, who are not eligible for medicaid under RCW 74.09.510, section 1902(a)(10)(A)(i)(VIII) of the social security act, or apple health for kids under RCW 74.09.470, who otherwise qualify for state family assistance programs under RCW 74.04.820;
(b) Persons eligible for the aged, blind, or disabled assistance program authorized in RCW 74.62.030 and who are not eligible for medicaid under RCW 74.09.510; and
(c) Persons eligible for essential needs and housing support under RCW 74.04.805 and who are not eligible for medicaid under RCW 74.09.510.
(2) Enrollment in medical care services may not result in expenditures that exceed the amount that has been appropriated in the operating budget. If it appears that continued enrollment will result in expenditures exceeding the appropriated level for a particular fiscal year, the department may freeze new enrollment and establish a waiting list of persons who may receive benefits only when sufficient funds are available.
(3) Determination of the amount, scope, and duration of medical care services shall be limited to coverage as defined by the authority, except that adult dental, and routine foot care shall not be included unless there is a specific appropriation for these services.
(4) The authority shall enter into performance-based contracts with one or more managed health care systems for the provision of medical care services under this section. The contract must provide for integrated delivery of medical and mental health services.
(5) The authority shall establish standards of assistance and resource and income exemptions, which may include deductibles and coinsurance provisions. In addition, the authority may include a prohibition against the voluntary assignment of property or cash for the purpose of qualifying for assistance.
(6) Eligibility for medical care services shall commence with the date of eligibility for the aged, blind, or disabled assistance program provided under RCW 74.62.030 or the date of eligibility for the essential needs and housing support program under RCW 74.04.805.
(7) To the extent possible, the authority must coordinate with the department of social and health services, food assistance programs for legal immigrants, state family assistance programs, and refugee cash assistance programs.

[ 2020 c 136 § 4; 2013 2nd sp.s. c 10 § 7. Prior: 2011 1st sp.s. c 36 § 6; 2011 1st sp.s. c 15 § 3; 2011 c 284 § 3; prior: 2010 1st sp.s. c 8 § 29; 2010 c 94 § 22; 1987 c 406 § 12; 1985 c 5 § 1; 1983 1st ex.s. c 43 § 2; 1982 1st ex.s. c 19 § 3; 1981 1st ex.s. c 6 § 19.]
NOTES:

Effective date—2020 c 136: See note following RCW 74.04.005.


Effective date—2013 2nd sp.s. c 10: See note following RCW 74.62.030.


Effective date—2011 1st sp.s. c 36 § 6: "Section 6 of this act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 22, 2011." [ 2011 1st sp.s. c 36 § 39.]


Findings—Intent—2011 1st sp.s. c 36: See RCW 74.62.005.


Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.


Implementation—2010 1st sp.s. c 8 §§ 1-10 and 29: See note following RCW 74.04.225.


Findings—Intent—Short title—Effective date—2010 1st sp.s. c 8: See notes following RCW 74.04.225.


Purpose—2010 c 94: See note following RCW 44.04.280.


Effective date—1983 1st ex.s. c 43: See note following RCW 74.09.700.


Effective date—1982 1st ex.s. c 19: "This act is necessary for the immediate preservation of the public peace, health, and safety, the support of the state government and its existing public institutions, and shall take effect April 1, 1982 [April 3, 1982]." [ 1982 1st ex.s. c 19 § 6.]


Effective date—Severability—1981 1st ex.s. c 6: See notes following RCW 74.04.005.

Structure Revised Code of Washington

Revised Code of Washington

Title 74 - Public Assistance

Chapter 74.09 - Medical Care.

74.09.010 - Definitions.

74.09.015 - Nurse hotline, when funded.

74.09.035 - Medical care services—Eligibility, standards—Limits.

74.09.037 - Identification card—Social security number restriction.

74.09.050 - Director's powers and duties—Personnel—Medical screeners—Medical director.

74.09.053 - Annual reporting requirement (as amended by 2009 c 479).

74.09.055 - Copayment, deductible, coinsurance, other cost-sharing requirements authorized.

74.09.075 - Employability and disability evaluation—Medical condition—Medical reports—Medical consultations and assistance.

74.09.080 - Methods of performing administrative responsibilities.

74.09.120 - Purchases of services, care, supplies—Nursing homes—Veterans' homes—Institutions for persons with intellectual disabilities—Institutions for mental diseases.

74.09.150 - Personnel to be under existing merit system.

74.09.160 - Presentment of charges by contractors.

74.09.171 - Contracts for medicaid services—Border communities.

74.09.180 - Chapter does not apply if another party is liable—Exception—Subrogation—Lien—Reimbursement—Delegation of lien and subrogation rights.

74.09.185 - Third party has legal liability to make payments—State acquires rights—Lien—Equitable subrogation does not apply.

74.09.190 - Religious beliefs—Construction of chapter.

74.09.195 - Audits of health care providers by the authority—Requirements—Procedure.

74.09.200 - Audits and investigations—Legislative declaration—State authority.

74.09.210 - Fraudulent practices—Penalties.

74.09.215 - Medicaid fraud penalty account.

74.09.220 - Liability for receipt of excess payments.

74.09.230 - False statements, fraud—Penalties.

74.09.240 - Bribes, kickbacks, rebates—Self-referrals—Penalties.

74.09.250 - False statements regarding institutions, facilities—Penalties.

74.09.260 - Excessive charges, payments—Penalties.

74.09.270 - Failure to maintain trust funds in separate account—Penalties.

74.09.280 - False verification of written statements—Penalties.

74.09.290 - Audits and investigations of providers—Patient records—Penalties.

74.09.295 - Disclosure of involuntary commitment information.

74.09.300 - Department to report penalties to appropriate licensing agency or disciplinary board.

74.09.315 - Whistleblowers—Workplace reprisal or retaliatory action.

74.09.325 - Reimbursement of a health care service provided through telemedicine or store and forward technology—Audio-only telemedicine.

74.09.327 - Audio-only telemedicine—Fee-for-service reimbursement.

74.09.328 - Use of substitute providers—When permitted—Reimbursement requirements.

74.09.330 - Reimbursement methodology for ambulance services—Transport of a medical assistance enrollee to a mental health facility or chemical dependency program.

74.09.335 - Reimbursement of health care services provided by fire departments—Adoption of standards.

74.09.340 - Personal needs allowance, adjusted.

74.09.390 - Access to baby and child dentistry program—Coverage for eligible children—Authority's duties—Report to legislature.

74.09.395 - Access to baby and child dentistry program—Outreach and engagement—Stakeholder collaboration.

74.09.402 - Children's health care—Findings—Intent.

74.09.460 - Children's affordable health coverage—Findings—Intent.

74.09.470 - Children's affordable health coverage—Authority duties.

74.09.4701 - Apple health for kids—Unemployment compensation.

74.09.475 - Newborn delivery services to medical assistance clients—Policies and procedures—Reporting.

74.09.480 - Performance measures—Provider rate increases—Report.

74.09.490 - Children's mental health—Improving medication management and care coordination.

74.09.495 - Access to children's behavioral health services—Report to legislature.

74.09.4951 - Children and youth behavioral health work group—Advisory groups—Report to governor and legislature.

74.09.497 - Authority review of payment codes available to health plans and providers related to primary care and behavioral health—Requirements—Principles considered—Matrices—Reporting.

74.09.500 - Medical assistance—Established.

74.09.510 - Medical assistance—Eligibility.

74.09.515 - Medical assistance—Coverage for youth released from confinement.

74.09.520 - Medical assistance—Care and services included—Funding limitations.

74.09.522 - Medical assistance—Agreements with managed health care systems for provision of services to medicaid recipients—Principles to be applied in purchasing managed health care.

74.09.5222 - Medical assistance—Section 1115 demonstration waiver request.

74.09.5223 - Findings—Chronic care management.

74.09.5225 - Medical assistance—Payments for services provided by rural hospitals—Participation in Washington rural health access preservation pilot.

74.09.5229 - Primary care health homes—Chronic care management—Findings—Intent.

74.09.523 - PACE program—Definitions—Requirements.

74.09.530 - Medical assistance—Powers and duties of authority.

74.09.540 - Medical assistance—Working individuals with disabilities—Intent.

74.09.545 - Medical assistance or limited casualty program—Eligibility—Agreements between spouses to transfer future income—Community income.

74.09.555 - Medical assistance—Reinstatement upon release from confinement—Expedited eligibility determinations.

74.09.557 - Medical assistance—Complex rehabilitation technology products.

74.09.565 - Medical assistance for institutionalized persons—Treatment of income between spouses.

74.09.575 - Medical assistance for institutionalized persons—Treatment of resources.

74.09.585 - Medical assistance for institutionalized persons—Period of ineligibility for transfer of resources.

74.09.595 - Medical assistance for institutionalized persons—Due process procedures.

74.09.597 - Medical assistance—Durable medical equipment and medical supplies—Providers.

74.09.600 - Post audit examinations by state auditor.

74.09.605 - Incorporation of outcomes/criteria into contracts with managed care organizations.

74.09.611 - Hospital quality incentive payments—Noncritical access hospitals.

74.09.630 - Opioid overdose reversal medications—Reimbursement.

74.09.632 - Opioid overdose reversal medications—Technical assistance—Written materials.

74.09.634 - Opioid overdose reversal medications—Bulk purchasing and distribution program.

74.09.640 - Opioid use disorder—Nonpharmacologic treatments.

74.09.645 - Opioid use disorder—Coverage without prior authorization.

74.09.650 - Prescription drug assistance program.

74.09.653 - Drug reimbursement policy recommendations.

74.09.655 - Smoking cessation assistance.

74.09.657 - Findings—Family planning services expansion.

74.09.658 - Home health—Reimbursement—Telemedicine.

74.09.659 - Family planning waiver program request.

74.09.660 - Prescription drug education for seniors—Grant qualifications.

74.09.670 - Medical assistance benefits—Incarcerated or committed persons—Suspension.

74.09.671 - Incarcerated persons—Local jails—Behavioral health services—Federal funding.

74.09.672 - Inmates of a public institution—Exclusion from medicaid coverage—Work release and partial confinement programs.

74.09.675 - Gender affirming care services—Prohibited discrimination.

74.09.700 - Medical care—Limited casualty program.

74.09.710 - Chronic care management programs—Medical homes—Definitions.

74.09.715 - Access to dental care.

74.09.717 - Dental health aide therapist services—Federal funding.

74.09.719 - Compact of free association islander dental care program.

74.09.720 - Prevention of blindness program.

74.09.725 - Prostate cancer screening.

74.09.730 - Disproportionate share hospital adjustment.

74.09.741 - Adjudicative proceedings.

74.09.745 - Medicaid funding for home visiting services—Recommendations to legislature.

74.09.748 - Regional service areas—Certain reimbursements required or allowed upon adoption of fully integrated managed health care system.

74.09.756 - Medicaid and state children's health insurance program demonstration project.

74.09.758 - Medicaid procurement of services—Value-based contracting for medicaid and public employee purchasing.

74.09.760 - Short title—1989 1st ex.s. c 10.

74.09.770 - Maternity care access system established.

74.09.780 - Reservation of legislative power.

74.09.790 - Definitions.

74.09.800 - Maternity care access program established.

74.09.810 - Alternative maternity care service delivery system established—Remedial action report.

74.09.820 - Maternity care provider's loan repayment program.

74.09.825 - Donor human milk—Standards—Federal funding.

74.09.830 - Postpartum health care coverage.

74.09.850 - Conflict with federal requirements.

74.09.860 - Request for proposals—Foster children—Integrated managed health and behavioral health care—Continuation of health care benefits following reunification.

74.09.870 - Regional service areas—Establishment.

74.09.871 - Behavioral health services—Contracting process.

74.09.875 - Reproductive health care services—Prohibited discrimination.

74.09.877 - Statewide plan to implement coordinated specialty care programs providing early identification and intervention for psychosis.

74.09.880 - Z code collection—Incentives and funding.

74.09.885 - Apple health and homes program—Definitions.

74.09.886 - Apple health and homes program—Establishment—Eligibility—Services.

74.09.888 - Apple health and homes program—Authority duties—Funding—Reports to legislature.

74.09.900 - Other laws applicable.

74.09.920 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.