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(ii) The plan must include methods for outreach and communication 1 with those who face barriers, language or otherwise, to 2 participation. 3 (4) During the 2021-2023 fiscal biennium, the requirements of 4 subsection (3)(c) of this section for agencies other than covered 5 agencies to create and adopt community engagement plans apply only to 6 executive branch agencies and institutions of higher education, as 7 defined in RCW 28B.10.016, receiving total appropriations of more 8 than $2,000,000 for the 2021-2023 fiscal biennium from the accounts 9 listed in subsection (1) of this section. 10 Sec. 1903. RCW 74.46.561 and 2022 c 297 s 966 are each amended 11 to read as follows: 12 (1) The legislature adopts a new system for establishing nursing 13 home payment rates beginning July 1, 2016. Any payments to nursing 14 homes for services provided after June 30, 2016, must be based on the 15 new system. The new system must be designed in such a manner as to 16 decrease administrative complexity associated with the payment 17 methodology, reward nursing homes providing care for high acuity 18 residents, incentivize quality care for residents of nursing homes, 19 and establish minimum staffing standards for direct care. 20 (2) The new system must be based primarily on industry-wide 21 costs, and have three main components: Direct care, indirect care, 22 and capital. 23 (3)(a) The direct care component must include the direct care and 24 therapy care components of the previous system, along with food, 25 laundry, and dietary services. ((Direct)) Except as provided in (b) 26 of this subsection, direct care must be paid at a fixed rate, based 27 on one hundred percent or greater of statewide case mix neutral 28 median costs, but ((for fiscal year 2023)) shall be capped so that a 29 nursing home provider's direct care rate does not exceed ((165)) 118 30 percent of its base year's direct care allowable costs except if the 31 provider is below the minimum staffing standard established in RCW 32 74.42.360(2). The legislature intends to remove the cap on direct 33 care rates by June 30, 2027. Direct care must be performance-adjusted 34 for acuity every six months, using case mix principles. Direct care 35 must be regionally adjusted using countywide wage index information 36 available through the United States department of labor's bureau of 37 labor statistics. There is no minimum occupancy for direct care. The 38 direct care component rate allocations calculated in accordance with 39 p. 1390 ESSB 5187.SL