AN
ACT Relating to in-home care services; amending RCW 74.39A.090; adding a new
section to chapter 74.39A RCW; and creating new sections.
BE IT ENACTED BY THE
LEGISLATURE OF THE STATE OF WASHINGTON:
NEW
SECTION. Sec. 1. (1)
The legislature finds that the quality of long-term care services provided to,
and protection of, Washington's low-income elderly and disabled residents is of
great importance to the state. The legislature further finds that revised
in-home care policies are needed to more effectively address concerns about the
quality of these services.
(2)
The legislature finds that consumers of in-home care services frequently are in
contact with multiple health and long-term care providers in the public and
private sector. The legislature further finds that better coordination between
these health and long-term care providers, and case managers, can increase the
consumer's understanding of their plan of care, maximize the health benefits of
coordinated care, and facilitate cost efficiencies across health and long-term
care systems.
Sec.
2. RCW
74.39A.090 and 1995 1st sp.s. c 18 s 38 are each amended to read as follows:
(1)
The legislature intends that any staff reassigned by the department as a result
of shifting of the reauthorization responsibilities by contract outlined in
this section shall be dedicated for discharge planning and assisting with
discharge planning and information on existing discharge planning cases.
Discharge planning, as directed in this section, is intended for residents and
patients identified for discharge to long-term care pursuant to RCW 70.41.320,
74.39A.040, and 74.42.058. The purpose of discharge planning is to protect
residents and patients from the financial incentives inherent in keeping
residents or patients in a more expensive higher level of care and shall focus
on care options that are in the best interest of the patient or resident.
(2)
The department shall contract with area agencies on aging:
(a)
To provide case management services to ((individuals)) consumers
receiving home and community services in their own home; and
(b)
To reassess and reauthorize home and community services in home or in other
settings for ((individuals)) consumers consistent with the intent
of this section:
(i)
Who have been initially authorized by the department to receive home and
community services; and
(ii)
Who, at the time of reassessment and reauthorization, are receiving home and
community services in their own home.
(3)
In the event that an area agency on aging is unwilling to enter into or
satisfactorily fulfill a contract to provide these services, the department is
authorized to:
(a)
Obtain the services through competitive bid; and
(b)
Provide the services directly until a qualified contractor can be found.
(4)
The department shall include, in its oversight and monitoring of area agency on
aging performance, assessment of case management roles undertaken by area
agencies on aging in this section. The scope of oversight and monitoring must
be expanded to include, but is not limited to, assessing the degree and quality
of the case management performed by area agency on aging staff for elderly and
disabled persons in the community.
(5)
Area agencies on aging shall assess the quality of the in-home care services
provided to consumers who are receiving services under the medicaid personal
care, community options programs entry system or chore services program through
an individual provider or home care agency. Quality indicators may include,
but are not limited to, home care consumers satisfaction surveys, how quickly
home care consumers are linked with home care workers, and whether the plan of
care under section 3 of this act has been honored by the agency or the
individual provider.
(6)
The department shall develop model language for the plan of care established in
section 3 of this act. The plan of care shall be in clear language, and
written at a reading level that will ensure the ability of consumers to
understand the rights and responsibilities expressed in the plan of care.
NEW
SECTION. Sec. 3. A
new section is added to chapter 74.39A RCW to read as follows:
(1)
In carrying out case management responsibilities established under RCW
74.39A.090 for consumers who are receiving services under the medicaid personal
care, community options programs entry system or chore services program through
an individual provider, each area agency on aging shall provide adequate
oversight of the care being provided to consumers receiving services under this
section. Such oversight shall include, but is not limited to:
(a)
Verification that the individual provider has met any training requirements
established by the department;
(b)
Verification of a sample of worker time sheets;
(c)
Home visits or telephone contacts sufficient to ensure that the plan of care is
being appropriately implemented;
(d)
Reassessment and reauthorization of services;
(e)
Monitoring of individual provider performance; and
(f)
Conducting criminal background checks or verifying that criminal background checks
have been conducted.
(2)
The area agency on aging case manager shall work with each consumer to develop
a plan of care under this section that identifies and ensures coordination of
health and long-term care services that meet the consumer's needs. In
developing the plan, they shall utilize, and modify as needed, any
comprehensive community service plan developed by the department as provided in
RCW 74.39A.040. The plan of care shall include, at a minimum:
(a)
The name and telephone number of the consumer's area agency on aging case
manager, and a statement as to how the case manager can be contacted about any
concerns related to the consumer's well-being or the adequacy of care provided;
(b)
The name and telephone numbers of the consumer's primary health care provider,
and other health or long-term care providers with whom the consumer has
frequent contacts;
(c)
A clear description of the roles and responsibilities of the area agency on
aging case manager and the consumer receiving services under this section;
(d)
The duties and tasks to be performed by the area agency on aging case manager
and the consumer receiving services under this section;
(e)
The type of in-home services authorized, and the number of hours of services to
be provided;
(f)
The terms of compensation of the individual provider;
(g)
A statement that the individual provider has the ability and willingness to
carry out his or her responsibilities relative to the plan of care; and
(h)(i)
Except as provided in (h)(ii) of this subsection, a clear statement indicating
that a consumer receiving services under this section has the right to waive
any of the case management services offered by the area agency on aging under
this section, and a clear indication of whether the consumer has, in fact,
waived any of these services.
(ii)
The consumer's right to waive case management services does not include the
right to waive reassessment or reauthorization of services, or verification
that services are being provided in accordance with the plan of care.
(3)
Each area agency on aging shall retain a record of each waiver of services
included in a plan of care under this section.
(4)
Each consumer has the right to direct and participate in the development of
their plan of care to the maximum practicable extent of their abilities and
desires, and to be provided with the time and support necessary to facilitate
that participation.
(5)
A copy of the plan of care must be distributed to the consumer's primary care
provider, individual provider, and other relevant providers with whom the
consumer has frequent contact, as authorized by the consumer.
(6)
The consumer's plan of care shall be an attachment to the contract between the
department, or their designee, and the individual provider.
(7)
If the area agency on aging case manager finds that an individual provider's
inadequate performance or inability to deliver quality care is jeopardizing the
health, safety, or well-being of a consumer receiving service under this
section, the department or the area agency on aging may take action to
terminate the contract between the department and the individual provider. If
the department or the area agency on aging has a reasonable, good faith belief
that the health, safety, or well-being of a consumer is in imminent jeopardy,
the department or area agency on aging may summarily suspend the contract
pending a fair hearing. The consumer may request a fair hearing to contest the
planned action of the case manager, as provided in chapter 34.05 RCW.
(8)
The area agency on aging may reject a request by an consumer receiving services
under this section to have a family member serve as his or her individual
provider if the case manager has a reasonable, good faith belief that the
family member will be unable to appropriately meet the care needs of the
consumer. The consumer may request a fair hearing to contest the decision of
the case manager, as provided in chapter 34.05 RCW.
NEW SECTION. Sec. 4. If
specific funding for the purposes of this act, referencing this act by bill or
chapter number, is not provided by June 30, 1999, in the omnibus appropriations
act, this act is null and void.
