Committee hears bill to require Medicaid network adequacy standards for nursing homes and rehab facilities

The House Health Care and Wellness Committee considered testimony Feb. 10 on a bill directing the Health Care Authority to set Medicaid network adequacy standards for nursing homes and inpatient rehabilitation facilities.

Chris Blake, staff to the committee, described the bill’s requirements: in setting standards the Health Care Authority must consider keeping care local to an enrollee’s community, availability in a regional service area, timeliness of care and federal Medicaid requirements. Blake said the authority must adopt standards by Jan. 1, 2028, and managed care organizations must meet those requirements by July 1, 2028.

Sen. Ron Mazzall, the bill sponsor, called the measure a follow-up to earlier work on patients who are ‘difficult to discharge’ and said it creates a preapproved pathway for members who are hard to place. Hospital and system representatives testified that the lack of post-acute network standards forces reliance on single-case agreements, which add days to hospital stays and can require patients to leave their communities for placement.

“Single-case agreements are not predictable. That’s not timely,” said Katie Kolan of a hospital perspective, urging the committee to move the bill out of committee. Dina Hannon, vice president of case management and chief nursing executive for MultiCare Healthcare System, described rural challenges and administrative steps hospitals now take: staff must identify an accepting skilled nursing facility or rehab hospital and then ask insurers for permission; if a contract does not exist, a single-case agreement must be completed, which can add days to a patient’s hospital stay.

Supporters told the committee the measure would speed appropriate placement, improve patient outcomes and reduce costs associated with prolonged hospital stays. No formal action was taken; public testimony concluded and the committee adjourned.