BP BHEAD INT H

AN ACT Relating to long-term care; adding a new section to chapter 18.51 RCW; and creating new sections.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The legislature finds that long-term care provided in nursing homes is a vital part of our health care system and that maintaining the highest standards and quality of care in nursing homes is essential to an efficient and effective health care system. The upwardly spiraling costs of health care is occurring in every segment of the health care system including the nursing home setting. Efforts to control the rising costs of health care must also take place in the nursing home setting and among all health care providers responsible for generating health care charges for nursing home residents.

The legislature finds that the causes for rising medical costs in the nursing home setting are complex and not always easily identified. To this end, it is in the best interest of the nursing home residents and their families, and all parties involved with generating health care charges to be aware of the costs incurred and reimbursement given for residents in long-term care facilities. Full disclosure of health care charges is especially important for physicians, mid-level practitioners, and any other associated health care practitioners directly responsible for generating charges and managing the care of such patients.

The legislature further finds that both the rising cost and quality of care in the nursing home setting are directly related to the efficient and effective use of the time and skills of licensed health care professionals. The amount of time health care providers spend directly on nursing home resident care affects the overall quality of care and life of nursing home residents. The greater the amount of time spent directly on hands-on patient care, translates to the increased health, safety, and well-being of the nursing home resident. Unfortunately, the combination of federal, state, and local regulations on nursing homes has created an inordinate, cumbersome, and redundant volume of paperwork for care providers. As a result, many nursing home care providers are required to spend valuable time on duplicate paperwork at the expense of caring directly for nursing home residents. The legislature recognizes and values the need for thorough, accurate, and sufficient documentation of resident care in nursing homes. However, if quality of care is to be maintained in light of the need to control spiraling nursing home health care costs, duplicity and inefficiencies in nursing home care documentation protocols must be identified and appropriately modified. The residents' health and safety must not be compromised, and such modifications should enhance the efficacy of health care delivery to the resident.

NEW SECTION. Sec. 2. The department of social and health services aging and adult services administration shall review all federal and state laws, and departmental rules that require health care providers in nursing homes to submit documentation. The departmental review shall be conducted to determine what documentation or protocols are redundant and can be modified or eliminated without jeopardizing the health and safety of residents or violating federal regulations. The review shall result in an itemized evaluation of the number of forms requiring physician's review and signature together with a citation of their origin. In addition, the department shall review and suggest efficiencies that could be realized through the development of standardized physicians' protocols for repetitive but nonlife-threatening conditions, such as but not limited to, skin tears, early stage decubiti, bowel and bladder care, and other common and predictable nursing home patient conditions. Whenever possible source documentation should be enabled to allow multiple attestations to be consolidated into a single document. The department shall conduct this review in coordination with different nursing home care constituent groups and professions, including but not limited to, a gerontologist to be selected by the Washington state medical association, a nurse to be selected by the Washington state nurses association, one representative each from the not-for-profit nursing home association and the for-profit nursing home association, and a representative of a nursing home residency advocacy group to be selected by the department. The department shall submit a final report of their findings and suggestions to the chair of the house of representatives health care committee and the chair of the senate health and human services committee by December 12, 1993.

NEW SECTION. Sec. 3. A new section is added to chapter 18.51 RCW to read as follows:

All nursing home directors in facilities licensed under this chapter shall be required to develop and maintain a written procedure for disclosing patient charges to attending physicians with admitting privileges. The nursing home director shall have the capability to provide a written record of the charges for all health care services ordered on behalf of their patients on a monthly basis, and shall include an itemization of charges for the previous month. The information shall be made available on request of the physicians or other appropriate health care providers responsible for prescribing care. Physicians or other health care providers may inform the resident or their family of these charges.