WA SB5083

Caps reimbursement for in-network Washington hospitals at 200% of Medicare rates for inpatient and outpatient services beginning January 1, 2027, with lower caps for children's hospitals (150% in King County, 190% in Pierce County based on Medicaid cost ratios)

Sets minimum reimbursement floors of 150% of Medicare rates for in-network primary care and nonfacility-based behavioral health services

Requires critical access hospitals receive at least 101% of allowable costs as defined by CMS for Medicare cost reporting

Limits out-of-network hospital reimbursement to 185% of Medicare rates (135-175% for children's hospitals) and prohibits balance billing patients beyond authorized cost-sharing

Exempts sole community hospitals, critical access hospitals not part of larger health systems, island hospitals in Skagit County public hospital districts, and certain tribal hospitals from the caps