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Senators hear bill requiring network adequacy standards for post-acute care under Medicaid managed care
Summary
Senate Bill 5124 would require the Health Care Authority to set network adequacy standards for post-acute services, including skilled nursing facilities and rehabilitation hospitals, and require managed-care contracts effective Jan. 1, 2027 to meet those standards.
The Senate Health and Long Term Care Committee held a public hearing Jan. 28 on Senate Bill 5124, sponsored by Sen. Mazal, which would direct the Health Care Authority (HCA) to adopt network adequacy standards for post-acute care services and require Medicaid managed-care contracts effective on or after Jan. 1, 2027 to meet those standards.
Committee staff described the bill's two primary requirements: HCA must establish and adopt network adequacy standards for post-acute care by June 30, 2026; and managed care organization (MCO) contracts or amendments effective Jan. 1, 2027, or later, must meet those standards. Post-acute services named include licensed skilled nursing facilities and licensed rehabilitation hospitals; HCA may designate other services necessary to achieve a full continuum of care.
Hospital and provider witnesses described long delays discharging medically cleared patients into post-acute settings. Katie Collin said hospitals often need single-case agreements to place patients, which take days to negotiate, and that unpredictable approvals and low payment rates can discourage facilities from accepting managed-care patients. MultiCare's Dina Hannon and Olympic Medical Center case manager Isaac Balu both testified that patients can wait multiple days in acute beds after medical clearance because of approval processes and lack of local SNF capacity.
The Association of Washington Health Care Plans urged caution, telling the committee that stricter network standards do not automatically produce better access and that meeting new standards could prompt contract renegotiations and rate increases with fiscal impacts. The association pointed to HCA's complex discharge pilot program as one tool already in use and highlighted positive pilot outcomes cited in testimony: a 90.6% discharge rate and a 36% decrease in denied length-of-stay days in the pilot.
Providers and a rehabilitation hospital physician said the bill would improve predictability and speed in transitions from acute care to appropriate post-acute care, potentially freeing acute beds. No committee vote was taken; the committee closed the hearing after testimony.
