Duties — Health care authority, department of social and health services, office of the state actuary, employment security department. (Effective January 1, 2026.)

RCW 50B.04.020
in effect
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(1) The health care authority, the department of social and health services, the office of the state actuary, and the employment security department each have distinct responsibilities in the implementation and administration of the program. In the performance of their activities, they shall actively collaborate to realize program efficiencies and provide persons served by the program with a well-coordinated experience. (2) The health care authority shall: (a) Track the use of lifetime benefit units to verify the individual's status as an eligible beneficiary as determined by the department of social and health services; (b) Ensure approved services are provided through audits or service verification processes within the service provider payment system for registered long-term services and supports providers and recoup any inappropriate payments; (c) Establish criteria for the payment of benefits to long-term services and supports providers under RCW 50B.04.070 ; (d) Establish rules and procedures for benefit coordination when the eligible beneficiary is also funded for medicaid and other long-term services and supports, including medicare, coverage through the department of labor and industries, and private long-term care coverage; (e) Assist the department of social and health services with the leveraging of existing payment systems for the provision of approved services to beneficiaries under RCW 50B.04.070 ; and (f) Adopt rules and procedures necessary to implement and administer the activities specified in this section related to the program. (3) The department of social and health services shall: (a) Make determinations regarding an individual's status as an eligible beneficiary under RCW 50B.04.060 ; (b) Approve long-term services and supports eligible for payment as approved services under the program, as informed by the commission; (c) Register long-term services and supports providers that meet minimum qualifications; (d) Discontinue the registration of long-term services and supports providers that: (i) Fail to meet the minimum qualifications applicable in law to the approved service that they provide; or (ii) violate the operational standards of the program; (e) Disburse payments of benefits to registered long-term services and supports providers, utilizing and leveraging existing payment systems for the provision of approved services to eligible beneficiaries under RCW 50B.04.070 ; (f) Prepare and distribute written or electronic materials to qualified individuals, eligible beneficiaries, and the public as deemed necessary by the commission to inform them of program design and updates; (g) Provide customer service and address questions and complaints, including referring individuals to other appropriate agencies; (h) Provide administrative and operational support to the commission; (i) Track data useful in monitoring and informing the program, as identified by the commission; (j) Develop criteria to deem a family member as qualified when providing approved services outside of Washington; (k) Adopt rules and procedures necessary to implement and administer the activities specified in this section related to the program; and (l) Establish, by rule, the scope of the long-term services and supports identified in RCW 50B.04.010 (2) that may be an approved service and identify the types of goods and services that are and are not covered under each approved service in order to maximize usage of all available public and private benefits for eligible beneficiaries. (4) The employment security department shall: (a) Collect and assess employee premiums as provided in RCW 50B.04.080 , 50B.04.090 , and 50B.04.180 ; (b) Assist the commission and state actuary in monitoring the solvency and financial status of the program; (c) Perform investigations to determine the compliance of premium payments in RCW 50B.04.080 , 50B.04.090 , and 50B.04.180 in coordination with the same activities conducted under the family and medical leave act, Title 50A RCW, to the extent possible; (d) Make determinations regarding an individual's status as a qualified individual under RCW 50B.04.050 , including criteria to determine the status of persons receiving partial benefit units under RCW 50B.04.050 (2) and out-of-state participants under RCW 50B.04.180 ; and (e) Adopt rules and procedures necessary to implement and administer the activities specified in this section related to the program. (5) The office of the state actuary shall: (a) Beginning July 1, 2025, and biennially thereafter, perform an actuarial audit and valuation of the long-term services and supports trust fund. Additional or more frequent actuarial audits and valuations may be performed at the request of the commission; (b) Make recommendations to the commission and the legislature on actions necessary to maintain trust solvency. The recommendations must include options to redesign or reduce benefit units, approved services, or both, to prevent or eliminate any unfunded actuarially accrued liability in the trust or to maintain solvency; and (c) Select and contract for such actuarial, research, technical, and other consultants as the actuary deems necessary to perform its duties under chapter 363, Laws of 2019. (6) By October 1, 2021, the employment security department and the department of social and health services shall jointly conduct outreach to provide employers with educational materials to ensure employees are aware of the program and that the premium assessments will begin on July 1, 2023. In conducting the outreach, the employment security department and the department of social and health services shall provide on a public website information that explains the program and premium assessment in an easy to understand format. Outreach information must be available in English and other primary languages as defined in RCW 74.04.025 . (1) The health care authority, the department of social and health services, the office of the state actuary, and the employment security department each have distinct responsibilities in the implementation and administration of the program. In the performance of their activities, they shall actively collaborate to realize program efficiencies and provide persons served by the program with a well-coordinated experience. (2) The health care authority shall: (a) Track the use of lifetime benefit units to verify the individual's status as an eligible beneficiary as determined by the department of social and health services; (b) Ensure approved services are provided through audits or service verification processes within the service provider payment system for registered long-term services and supports providers and recoup any inappropriate payments; (c) Establish criteria for the payment of benefits to long-term services and supports providers under RCW 50B.04.070 ; (d) Establish rules and procedures for benefit coordination when the eligible beneficiary is also funded for medicaid and other long-term services and supports, including medicare, coverage through the department of labor and industries, and private long-term care coverage; (e) Assist the department of social and health services with the leveraging of existing payment systems for the provision of approved services to beneficiaries under RCW 50B.04.070 ; and (f) Adopt rules and procedures necessary to implement and administer the activities specified in this section related to the program. (3) The department of social and health services shall: (a) Make determinations regarding an individual's status as an eligible beneficiary under RCW 50B.04.060 ; (b) Approve long-term services and supports eligible for payment as approved services under the program, as informed by the commission; (c) Register long-term services and supports providers that meet minimum qualifications; (d) Discontinue the registration of long-term services and supports providers that: (i) Fail to meet the minimum qualifications applicable in law to the approved service that they provide; or (ii) violate the operational standards of the program; (e) Disburse payments of benefits to registered long-term services and supports providers, utilizing and leveraging existing payment systems for the provision of approved services to eligible beneficiaries under RCW 50B.04.070 ; (f) Prepare and distribute written or electronic materials to qualified individuals, eligible beneficiaries, and the public as deemed necessary by the commission to inform them of program design and updates; (g) Provide customer service and address questions and complaints, including referring individuals to other appropriate agencies; (h) Provide administrative and operational support to the commission; (i) Track data useful in monitoring and informing the program, as identified by the commission; (j) Develop criteria to deem a family member as qualified when providing approved services outside of Washington; (k) Adopt rules and procedures necessary to implement and administer the activities specified in this section related to the program; and (l) Establish, by rule, the scope of the long-term services and supports identified in RCW 50B.04.010 (2) that may be an approved service and identify the types of goods and services that are and are not covered under each approved service in order to maximize usage of all available public and private benefits for eligible beneficiaries. (4) The employment security department shall: (a) Collect and assess employee premiums as provided in RCW 50B.04.080 , 50B.04.090 , and 50B.04.180 ; (b) Assist the commission and state actuary in monitoring the solvency and financial status of the program; (c) Perform investigations to determine the compliance of premium payments in RCW 50B.04.080 , 50B.04.090 , and 50B.04.180 in coordination with the same activities conducted under the family and medical leave act, Title 50A RCW, to the extent possible; (d) Make determinations regarding an individual's status as a qualified individual under RCW 50B.04.050 , including criteria to determine the status of persons receiving partial benefit units under RCW 50B.04.050 (2) and out-of-state participants under RCW 50B.04.180 ; and (e) Adopt rules and procedures necessary to implement and administer the activities specified in this section related to the program. (5) The office of the state actuary shall: (a) Beginning July 1, 2025, and biennially thereafter, perform an actuarial audit and valuation of the long-term services and supports trust fund. Additional or more frequent actuarial audits and valuations may be performed at the request of the commission; (b) Make recommendations to the commission and the legislature on actions necessary to maintain trust solvency. The recommendations must include options to redesign or reduce benefit units, approved services, or both, to prevent or eliminate any unfunded actuarially accrued liability in the trust or to maintain solvency; and (c) Select and contract for such actuarial, research, technical, and other consultants as the actuary deems necessary to perform its duties under chapter 363, Laws of 2019. (6) By October 1, 2021, the employment security department and the department of social and health services shall jointly conduct outreach to provide employers with educational materials to ensure employees are aware of the program and that the premium assessments will begin on July 1, 2023. In conducting the outreach, the employment security department and the department of social and health services shall provide on a public website information that explains the program and premium assessment in an easy to understand format. Outreach information must be available in English and other primary languages as defined in RCW 74.04.025 .
Source: WA Statutes (Official Site)URL: https://app.leg.wa.gov/RCW/default.aspx?cite=50B.04&full=trueFetched: 6/29/2026

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