Washington Code 48.43.125 – Coverage at a long-term care facility following hospitalization — Definition
Current as of: 2023 | Check for updates
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(1) A carrier that provides coverage for a person at a long-term care facility following the person’s hospitalization shall, upon the request of the person or his or her legal representative as authorized in RCW 7.70.065, provide such coverage at the facility in which the person resided immediately prior to the hospitalization if:
Terms Used In Washington Code 48.43.125
- Contract: A legal written agreement that becomes binding when signed.
- person: may be construed to include the United States, this state, or any state or territory, or any public or private corporation or limited liability company, as well as an individual. See Washington Code 1.16.080
(a) The person’s primary care physician determines that the medical care needs of the person can be met at the requested facility;
(b) The requested facility has all applicable licenses and certifications, and is not under a stop placement order that prevents the person’s readmission;
(c) The requested facility agrees to accept payment from the carrier for covered services at the rate paid to similar facilities that otherwise contract with the carrier to provide such services; and
(d) The requested facility, with regard to the following, agrees to abide by the standards, terms, and conditions required by the carrier of similar facilities with which the carrier otherwise contracts: (i) Utilization review, quality assurance, and peer review; and (ii) management and administrative procedures, including data and financial reporting that may be required by the carrier.
NOTES:
Application—2012 c 10: See note following RCW 18.20.010.
Findings—1999 c 312: “The legislature finds that a long-term care facility is home for any individual who resides there, and the individual has the right to receive services in his or her own home and to be cared for by the organization with which he or she has a contractual agreement to provide housing and related services. The legislature further finds that restricting individuals from returning to the long-term care facility in which they were residing prior to hospitalization may detrimentally impact the health and well-being of frail individuals and their families.” [ 1999 c 312 § 1.]
Short title—1999 c 312: “This act may be known and cited as the Kitson act.” [ 1999 c 312 § 3.]