2693-S AMH MORE H5704.2

SHB 2693  - H AMD1241
     By Representative Morrell

ADOPTED 02/18/2008

     Strike everything after the enacting clause and insert the following:

"NEW SECTION.  Sec. 1   (1) The legislature finds that:
     (a) An underlying premise of Washington's long-term care system is the value of consumer choice across a full continuum of care with the right to accessible, quality care;
     (b) An appropriately trained and motivated long-term care workforce contributes to the quality of long-term care services;
     (c) The level and content of basic training should be focused upon the client with respect to client care needs, health status, choice, and flexibility;
     (d) There is a need for increased workforce diversity throughout the long-term care system;
     (e) Long-term care worker training should acknowledge cultural diversity and strive to achieve a greater understanding of the relationships between culture and health;
     (f) The long-term care workforce has diverse work-life expectations such as career advancement and quality job performance;
     (g) The long-term care workforce has variable learning styles, and can benefit from flexibility in training settings, modalities, accessibility, and methods;
     (h) Long-term care training should prepare workers and caregivers to perform in as many long-term care settings as possible with economic security and safety, but also should accommodate the interests of those workers who intend to care exclusively for their family members;
     (i) The care and support provided by unpaid long-term caregivers should not be disrupted, but enhanced and stabilized by any changes to long-term care training and credentialing; and
     (j) The long-term care workforce should be increased and enhanced to meet current and future needs. New policies and requirements should not result in decreasing the available workforce or the services available to consumers.
     (2) The legislature intends to establish long-term care worker training standards that are consistent with the findings of subsection (1) of this section and to establish a credentialing program that will allow for career advancement in the long-term care work force.

Sec. 2   RCW 74.39A.009 and 2007 c 361 s 2 are each amended to read as follows:
     Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
     (1) "Adult family home" means a home licensed under chapter 70.128 RCW.
     (2) "Adult residential care" means services provided by a boarding home that is licensed under chapter 18.20 RCW and that has a contract with the department under RCW 74.39A.020 to provide personal care services.
     (3) "Assisted living services" means services provided by a boarding home that has a contract with the department under RCW 74.39A.010 to provide personal care services, intermittent nursing services, and medication administration services, and the resident is housed in a private apartment-like unit.
     (4) "Boarding home" means a facility licensed under chapter 18.20 RCW.
     (5) "Cost-effective care" means care provided in a setting of an individual's choice that is necessary to promote the most appropriate level of physical, mental, and psychosocial well-being consistent with client choice, in an environment that is appropriate to the care and safety needs of the individual, and such care cannot be provided at a lower cost in any other setting. But this in no way precludes an individual from choosing a different residential setting to achieve his or her desired quality of life.
     (6) "Department" means the department of social and health services.
     (7) "Enhanced adult residential care" means services provided by a boarding home that is licensed under chapter 18.20 RCW and that has a contract with the department under RCW 74.39A.010 to provide personal care services, intermittent nursing services, and medication administration services.
     (8) "Functionally disabled person" or "person who is functionally disabled" is synonymous with chronic functionally disabled and means a person who because of a recognized chronic physical or mental condition or disease, including chemical dependency, is impaired to the extent of being dependent upon others for direct care, support, supervision, or monitoring to perform activities of daily living. "Activities of daily living", in this context, means self-care abilities related to personal care such as bathing, eating, using the toilet, dressing, and transfer. Instrumental activities of daily living may also be used to assess a person's functional abilities as they are related to the mental capacity to perform activities in the home and the community such as cooking, shopping, house cleaning, doing laundry, working, and managing personal finances.
     (9) "Home and community services" means adult family homes, in-home services, and other services administered or provided by contract by the department directly or through contract with area agencies on aging or similar services provided by facilities and agencies licensed by the department.
     (10) "Long-term care" is synonymous with chronic care and means care and supports delivered indefinitely, intermittently, or over a sustained time to persons of any age disabled by chronic mental or physical illness, disease, chemical dependency, or a medical condition that is permanent, not reversible or curable, or is long-lasting and severely limits their mental or physical capacity for self-care. The use of this definition is not intended to expand the scope of services, care, or assistance by any individuals, groups, residential care settings, or professions unless otherwise expressed by law.
     (11)(a) "Long-term care workers" includes all persons who are ((long-term care workers for the elderly or)) paid to provide personal care services to persons with functional disabilities, including but not limited to individual providers of home care services, direct care employees of home care agencies, providers of home care services to persons with developmental disabilities under Title 71 RCW, all direct care workers in state-licensed boarding homes, assisted living facilities, and adult family homes, respite care providers, community residential service providers, and any other direct care worker providing home or community-based services to ((the elderly or)) persons with functional disabilities or developmental disabilities.
     (b) "Long-term care workers" do not include persons employed in nursing homes subject to chapter 18.51 RCW, hospitals or other acute care settings, hospice agencies subject to chapter 70.127 RCW, adult day care centers, and adult day health care centers.
     (12) "Nursing home" means a facility licensed under chapter 18.51 RCW.
     (13) "Personal care services" means physical or verbal assistance with activities of daily living and instrumental activities of daily living provided because of a person's functional limitations.
     (14)
"Secretary" means the secretary of social and health services.
     (((14))) (15) "Training partnership" means a joint partnership or trust established and maintained jointly by the office of the governor and the exclusive bargaining representative of individual providers under RCW 74.39A.270 to provide training((,)) and peer mentoring((, and examinations)) required under this chapter, and educational, career development, or other related services to individual providers.
     (((15))) (16) "Tribally licensed boarding home" means a boarding home licensed by a federally recognized Indian tribe which home provides services similar to boarding homes licensed under chapter 18.20 RCW.

NEW SECTION.  Sec. 3   A new section is added to chapter 74.39A RCW to read as follows:
     (1)(a) This section establishes the basic training requirements for long-term care workers initially contracted or employed on or after January 1, 2010. Except as provided otherwise in this section, these long-term care workers must complete:
     (i) Worker orientation under (b)(i) of this subsection before the worker has routine interaction with the person or persons the worker will be caring for; and
     (ii) The remaining hours of basic training required in this section within one hundred twenty days after the date of the long-term care worker's initial contracting or employment as a long-term care worker unless the department, for good cause, extends the time period by up to sixty days.
     (b) Basic training:
     (i) Consists of thirty-five hours of classroom training on a set of modules covering the core knowledge and competencies that caregivers need to learn and understand to meet the needs of and to provide care effectively and safely to persons with functional disabilities. Basic training must include a worker orientation consisting of introductory information on residents' rights, communication skills, fire and life safety, and universal precautions; and
     (ii) Must be outcome-based, and the effectiveness of the training must be measured through the use of a competency test.
     (2) Training standards and the delivery system for basic training must be relevant to the varied needs of persons served by long-term care workers and be sufficient to ensure that long-term care workers have the skills and knowledge necessary to provide high quality, appropriate care in a manner that respects the preferences of each person served. In an effort to improve the quality of training, increase access to training, and reduce costs, especially for rural communities, the classroom training provided in a coordinated system of long-term care training and education should include:
     (a) The use of innovative learning strategies such as internet resources, videotapes, and distance learning using satellite technology coordinated through community colleges or other entities, as defined by the department; and
     (b) The use of varied adult learner strategies, such as opportunities to practice or demonstrate skills, role playing, and group discussions.
     (3) As specified in this section, the following persons are fully or partially exempt from the basic training requirements of this section:
     (a) As specified by the department in rule, registered nurses, licensed practical nurses, certified nursing assistants, medicare certified home health aides, or persons who hold a similar health certification or license. However, these persons must complete worker orientation training as described in subsection (1)(b)(i) of this section;
     (b) Persons who successfully challenge the competency test for basic training. Such persons shall be deemed to have completed the relevant hours of basic training. However, these persons must complete worker orientation training as described in subsection (1)(b)(i) of this section;
     (c) Long-term care workers employed by supportive living providers regulated under chapter 388-101 WAC who are subject to the training required in WAC 388-101-1680;
     (d) Biological, step, or adoptive parents who are the individual provider for only their son or daughter who is developmentally disabled or functionally disabled, and persons who provide respite care on an intermittent basis to such son or daughter of a biological, step, or adoptive parent who is either an individual provider or an unpaid caregiver. However, these workers must complete: (i) Six hours of training relevant to the needs of adults with developmental disabilities and related functional disabilities, as appropriate; and (ii) safety training, which may be completed using distance learning or other alternative methods of training. As used in this subsection, "intermittent basis" means care provided exclusively to one individual for not more than an average of twenty-four hours per month; and
     (e) Long-term care workers who were initially contracted or employed as long-term care workers before January 1, 2010. However, these long-term care workers must complete all training requirements in effect before that date.

NEW SECTION.  Sec. 4   A new section is added to chapter 74.39A RCW to read as follows:
     (1)(a) The department shall develop qualification requirements for trainers and criteria for the approval of basic training programs under section 3 of this act. Only training curricula approved by the department may be used to fulfill the requirements of section 3 of this act.
     (b)(i) The department shall develop criteria for reviewing and approving trainers and training materials that are substantially similar to or better than the materials developed by the department. The department may approve a curriculum based upon attestation by a boarding home administrator, an adult family home provider or resident manager, a home care agency administrator, or the administrator of the training partnership designated in RCW 74.39A.360 that the facility's, agency's, or training partnership's training curriculum addresses required training competencies identified by the department, and shall review a curriculum to verify that it meets these requirements. The department, or the department of health, as applicable, may conduct the review as part of the regularly scheduled inspection and investigation required under RCW 18.20.110, 70.128.090, or 70.127.100. The department shall rescind approval of any curriculum if it determines that the curriculum does not meet these requirements.
     (ii) A facility, agency, or the training partnership with an approved curriculum must provide reports as required by the department on the long-term care workers who began training and those who completed training, and verifying that all long-term care workers required to do so have complied with all training requirements.
     (c) Boarding homes, adult family homes, home care agencies, or other entities employing long-term care workers that desire to deliver facility or agency-based required basic training with facility or agency designated trainers, or facilities and agencies that desire to pool their resources to create shared training systems, must be encouraged by the department in their efforts.
     (d) The department shall consult with the state board for community and technical colleges, the superintendent of public instruction, and the training partnership to ensure, to the extent possible, that long-term care worker training programs approved by the department assist with opportunities to articulate to relevant degree or skills programs offered in community colleges, vocational-technical institutes, skill centers, and secondary schools, as defined in chapter 28B.50 RCW.
     (2) The department shall adopt rules by September 1, 2009, necessary to implement the training provisions of section 3 of this act. In developing rules, the department shall consult with the department of health, the nursing care quality assurance commission, adult family home providers, boarding home providers, in-home personal care providers, affected labor organizations, community and technical colleges, and long-term care consumers and other interested organizations.

Sec. 5   RCW 74.39A.340 and 2007 c 361 s 4 are each amended to read as follows:
     (1) Except as provided in subsection (2) of this section, beginning January 1, 2010, long-term care workers shall complete twelve hours of continuing education training in advanced training topics each year. ((This requirement applies beginning on January 1, 2010.))
     (2) This section does not apply to persons described in section 3(3)(d) of this act. However, this subsection does not prohibit requiring continuing education for such persons who elect to become registered or certified under chapter 18.-- RCW (the chapter created in section 31 of this act).

Sec. 6   RCW 74.39A.360 and 2007 c 361 s 6 are each amended to read as follows:
     (1) Beginning January 1, 2010, for individual providers represented by an exclusive bargaining representative under RCW 74.39A.270, all training and peer mentoring required under this chapter shall be provided by a training partnership. Contributions to the partnership pursuant to a collective bargaining agreement negotiated under this chapter shall be made beginning July 1, 2009. The training partnership shall provide reports as required by the department on the individual providers who began training and those who completed training, and verifying that all individual providers required to do so have complied with all training requirements. The exclusive bargaining representative shall designate the training partnership.
     (2) The training partnership shall offer persons who are acting as unpaid informal caregivers for family members or friends the opportunity to attend training offered through the partnership at no cost to the individual caregiver or the state. Attendance opportunities may be limited to the extent that:
     (a) There is fixed maximum seating or participation capacity for a training module that satisfies long-term care worker basic training or continuing education requirements under this chapter; and
     (b) The maximum capacity for a particular training module is fully reserved twenty-four hours in advance of the scheduled date and time of the module.

NEW SECTION.  Sec. 7   (1) The legislature finds that:
     (a) It is in the public interest to promote quality long-term care services through registration for long-term care workers; and
     (b) An additional level of credentialing for those long-term care workers who seek to increase their skills and knowledge or enter a health care professional career track will increase, stabilize, and enhance the long-term care workforce and further promote quality long-term care services.
     (2) The legislature, therefore, intends to provide opportunities to increase skills and knowledge or to pursue a career track through certification and specialty endorsements, and potential articulation from long-term care worker certification to other health care credentialing or degrees.

NEW SECTION.  Sec. 8   The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Department" means the department of health.
     (2) "Secretary" means the secretary of health.
     (3) "Long-term care worker" has the same meaning as in RCW 74.39A.009. There are two levels of credentialed long-term care workers:
     (a) "Registered long-term care worker" is an individual registered under this chapter; and
     (b) "Certified long-term care worker" is an individual certified under this chapter.
     (4) "Individual provider" has the same meaning as in RCW 74.39A.240.
     (5) "Personal care services" has the same meaning as in RCW 74.39A.009.
     (6) "Approved training program" means a program of not less than eighty-five hours of training that is approved by the secretary in consultation with the department of social and health services, the state board for community and technical colleges, and the superintendent of public instruction. The department shall ensure, to the extent possible, that long-term care worker training programs approved by the department assist with opportunities to articulate to relevant degree or skill programs offered in community colleges, vocational-technical institutes, skill centers, and secondary schools as defined in chapter 28B.50 RCW. A training program approved under this section may include, but is not limited to, the following elements:
     (a) Basic training under section 3 of this act, which is a required element of an approved training program. For purposes of this subsection, a person who successfully challenges the competency test for basic training shall be deemed to have completed the relevant hours of basic training other than worker orientation training;
     (b) Hours that individual providers spend with peer mentors under RCW 74.39A.330;
     (c) Advanced training offered under RCW 74.39A.350;
     (d) Up to ten hours spent being trained by the person to whom a worker is providing care regarding the person's caregiving preferences and needs;
     (e) On-the-job training provided by the worker's employer, including specialty training required under RCW 18.20.270(5) and 70.128.230(5);
     (f) Structured training in population or setting specific competencies that allow long-term care workers to acquire competencies unique to the persons they will be serving or the care setting in which they will be working;
     (g) Attendance at relevant conferences sponsored by national or state professional associations, governmental agencies, or institutions of higher education; and
     (h) Other structured or documented training approved by the secretary. For the purposes of this subsection, "documented training" means a written training program that describes the subject covered by the training, the methods by which the training is conducted, and the qualifications of the instructor.
     (7) "Certification examination" means the measurement of an individual's knowledge and skills as related to safe, competent performance as a long-term care worker.

NEW SECTION.  Sec. 9   (1)(a) Registration under this chapter commences January 1, 2010. If the department determines that administrative capacities essential to implementation of long-term care worker registration under this chapter will not be fully functional by January 1, 2010, the department may defer the implementation date to no later than July 1, 2010.
     (b) Except as provided otherwise in this chapter, long-term care workers contracted or employed on or after January 1, 2010, must register within one hundred twenty days after the date of the long-term care worker's initial contracting or employment as a long-term care worker, except that workers initially contracted or employed before January 1, 2010, must register within one hundred twenty days after January 1, 2010. However, the department, for good cause, may extend the one hundred twenty day time period by up to sixty days.
     (2) Beginning January 1, 2012, long-term care workers may elect to be certified, with or without a specialty endorsement under section 14 of this act.

NEW SECTION.  Sec. 10   (1) A registered or certified long-term care worker may provide direct, hands-on personal care services to persons with functional disabilities requiring long-term care services.
     (2) No person may practice or, by use of any title or description, represent himself or herself as:
     (a) A registered long-term care worker without being registered pursuant to this chapter; or
     (b) A certified long-term care worker without applying for certification, meeting the qualifications, and being certified pursuant to this chapter.

NEW SECTION.  Sec. 11   In addition to any other authority provided by law, the secretary has the authority to:
     (1) Set all certification, registration, and renewal fees in accordance with RCW 43.70.250 and to collect and deposit all such fees in the health professions account established under RCW 43.70.320;
     (2) Establish forms, procedures, and examinations necessary to administer this chapter;
     (3) Hire clerical, administrative, and investigative staff as needed to implement this chapter;
     (4) Issue a registration to any applicant who has met the requirements for registration;
     (5) Issue a certificate to any applicant who has met the education, training, and conduct requirements for certification;
     (6) Maintain the official record for the department of all applicants and persons with registrations and certificates;
     (7) Exercise disciplinary authority as authorized in chapter 18.130 RCW;
     (8) Deny registration to any applicant who fails to meet requirement for registration; and
     (9) Deny certification to applicants who do not meet the education, training, competency evaluation, and conduct requirements for certification.

NEW SECTION.  Sec. 12   The secretary shall issue a registration to any applicant who:
     (1) Pays any applicable fees;
     (2) Submits, on forms provided by the secretary, the applicant's name, address, and other information as determined by the secretary; and
     (3) Establishes, to the secretary's satisfaction, that:
     (a) The applicant has successfully completed the basic training required under section 3 of this act. For purposes of this subsection, a person who successfully challenges the competency test for basic training shall be deemed to have completed the relevant hours of basic training other than worker orientation training;
     (b) The applicant has completed any required background check; and
     (c) There are no grounds for denial of registration or issuance of a conditional registration under this chapter or chapter 18.130 RCW.

NEW SECTION.  Sec. 13   (1) The secretary shall issue a certificate to any applicant who:
     (a) Pays any applicable fees;
     (b) Submits, on forms provided by the secretary, the applicant's name, address, and other information as determined by the secretary;
     (c) Establishes to the secretary's satisfaction that:
     (i) The applicant has successfully completed an approved training program;
     (ii) The applicant has successfully completed a certification examination;
     (iii) The applicant has completed any required background check; and
     (iv) There exist no grounds for denial of certification under chapter 18.130 RCW.
     (2) The date and location of examinations shall be established by the secretary. Applicants who have been found by the secretary to meet the requirements for certification shall be scheduled for the next examination following the filing of the application. The secretary shall establish by rule the examination application deadline.
     (3) The examination must include both a skills demonstration and a written or oral knowledge test. Examinations shall be limited to the purpose of determining whether the applicant possesses the minimum skill and knowledge necessary to practice competently.
     (4) The examination papers, all grading of the papers, and the grading of skills demonstration shall be preserved for a period of not less than one year after the secretary has made and published the decisions. All examinations shall be conducted under fair and wholly impartial methods.
     (5) Any applicant failing to make the required grade in the first examination may take up to three subsequent examinations as the applicant desires upon prepaying a fee determined by the secretary under RCW 43.70.250 for each subsequent examination. Upon failing four examinations, the secretary may invalidate the original application and require such remedial education before the person may take future examinations.
     (6) The certification examination must be administered and evaluated by the department or by a contractor to the department that is neither an employer of long-term care workers, a private contractor providing training services under this chapter or section 3 of this act, or the training partnership defined in RCW 74.39A.009.

NEW SECTION.  Sec. 14   (1) A long-term care worker certified under this chapter may apply for a specialty endorsement in the specialty areas identified by the secretary in consultation with the department of social and health services. The secretary shall issue an endorsement to an applicant who:
     (a) Completes the hours of training and practical experience required in rules adopted by the secretary for the relevant specialty endorsement;     
     (b) Pays any applicable fee; and
     (c) Submits any other information as determined by the secretary.
     (2) A certified long-term care worker who has been granted a specialty endorsement under this section may include the specialty in his or her title, as permitted under rules adopted by the secretary.

NEW SECTION.  Sec. 15   An applicant holding a credential in another state may be certified in this state without examination if the secretary determines that the other state's credentialing standards for long-term care workers are substantially equivalent to the standards in this state.

NEW SECTION.  Sec. 16   (1) Registrations and certifications shall be renewed according to administrative procedures, administrative requirements, and fees determined by the secretary under RCW 43.70.250 and 43.70.280.
     (2) Completion of continuing education as required in RCW 74.39A.340 is a prerequisite to renewing a registration or certification under this chapter.

NEW SECTION.  Sec. 17   (1) This chapter does not apply to:
     (a) Registered nurses, licensed practical nurses, certified nursing assistants, medicare certified home health aides, or other persons who hold a similar health credential, as determined by the secretary, or persons with special education training and an endorsement granted by the superintendent of public instruction that is recognized by the secretary as appropriate to specified personal care services circumstances;
     (b) Biological, step, or adoptive parents who are the individual provider for only their son or daughter who is developmentally disabled or functionally disabled, and persons who provide respite care on an intermittent basis to such son or daughter of a biological, step, or adoptive parent who is either an individual provider or an unpaid caregiver. As used in this subsection, "intermittent basis" means the same as the definition in section 3(3)(d) of this act.
     (2) Nothing in this chapter may be construed to prohibit or restrict:
     (a) The practice by an individual licensed, certified, or registered under the laws of this state and performing services within their authorized scope of practice;
     (b) The practice by an individual employed by the government of the United States while engaged in the performance of duties prescribed by the laws of the United States;
     (c) The practice by a person who is a regular student in an educational program approved by the secretary, and whose performance of services is pursuant to a regular course of instruction or assignments from an instructor and under the general supervision of the instructor;
     (d) A registered or certified long-term care worker from accepting direction from a person who is self-directing his or her care; or
     (e) A long-term care worker exempt under subsection (1) of this section from applying for registration or certification, subject to meeting the requirements for such application.

NEW SECTION.  Sec. 18   (1) The uniform disciplinary act, chapter 18.130 RCW, governs unregistered or uncertified practice, issuance of certificates and registrations, and the discipline of persons registered or with certificates under this chapter. The secretary shall be the disciplinary authority under this chapter.
     (2)(a) The secretary may take action to immediately suspend the registration or certification of a long-term care worker upon finding that conduct of the long-term care worker has caused or presents an imminent threat of harm to a functionally disabled person in his or her care.
     (b) If the secretary imposes suspension or conditions for continuation of a registration or certification, the suspension or conditions for continuation are effective immediately upon notice and shall continue in effect pending the outcome of any hearing.

NEW SECTION.  Sec. 19   (1) The department shall adopt rules by September 1, 2009, necessary to implement the registration provisions of this chapter. In developing rules, the department shall consult with the department of social and health services, the nursing care quality assurance commission, adult family home providers, boarding home providers, in-home personal care providers, the training partnership defined in RCW 74.39A.009, affected labor organizations, community and technical colleges, and long-term care consumers and other interested organizations.
     (2)(a) The department shall also consult with these parties on a plan to implement the voluntary certification program under this chapter by January 1, 2012, in a cost-effective manner considering the following:
     (i) The certification program should assist a long-term care worker to enter, if desired, a career path to other health care or allied health professions, including articulation, to the maximum extent possible under federal law, from long-term care worker certification to nursing assistant certification under chapter 18.88A RCW;
     (ii) The department should consider the relative merits of certification and/or specialty endorsement examinations and of practical work experience for certification and/or specialty endorsements. If recommendations are made for practical work experience requirements, the department's plan should include recommendations on the hours and type of practical work experience that would be appropriate for the credential sought.
     (b) The department shall report on the certification plan to the appropriate committees of the legislature by December 1, 2009.

Sec. 20   RCW 18.130.040 and 2007 c 269 s 17 and 2007 c 70 s 11 are each reenacted and amended to read as follows:
     (1) This chapter applies only to the secretary and the boards and commissions having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.
     (2)(a) The secretary has authority under this chapter in relation to the following professions:
     (i) Dispensing opticians licensed and designated apprentices under chapter 18.34 RCW;
     (ii) Naturopaths licensed under chapter 18.36A RCW;
     (iii) Midwives licensed under chapter 18.50 RCW;
     (iv) Ocularists licensed under chapter 18.55 RCW;
     (v) Massage operators and businesses licensed under chapter 18.108 RCW;
     (vi) Dental hygienists licensed under chapter 18.29 RCW;
     (vii) Acupuncturists licensed under chapter 18.06 RCW;
     (viii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;
     (ix) Respiratory care practitioners licensed under chapter 18.89 RCW;
     (x) Persons registered under chapter 18.19 RCW;
     (xi) Persons licensed as mental health counselors, marriage and family therapists, and social workers under chapter 18.225 RCW;
     (xii) Persons registered as nursing pool operators under chapter 18.52C RCW;
     (xiii) Nursing assistants registered or certified under chapter 18.88A RCW;
     (xiv) Health care assistants certified under chapter 18.135 RCW;
     (xv) Dietitians and nutritionists certified under chapter 18.138 RCW;
     (xvi) Chemical dependency professionals certified under chapter 18.205 RCW;
     (xvii) Sex offender treatment providers and certified affiliate sex offender treatment providers certified under chapter 18.155 RCW;
     (xviii) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;
     (xix) Denturists licensed under chapter 18.30 RCW;
     (xx) Orthotists and prosthetists licensed under chapter 18.200 RCW;
     (xxi) Surgical technologists registered under chapter 18.215 RCW;
     (xxii) Recreational therapists; ((and))
     (xxiii) Animal massage practitioners certified under chapter 18.240 RCW; and
     (xxiv) Long-term care workers registered or certified under chapter 18.-- RCW (the new chapter created in section 31 of this act)
.
     (b) The boards and commissions having authority under this chapter are as follows:
     (i) The podiatric medical board as established in chapter 18.22 RCW;
     (ii) The chiropractic quality assurance commission as established in chapter 18.25 RCW;
     (iii) The dental quality assurance commission as established in chapter 18.32 RCW governing licenses issued under chapter 18.32 RCW and licenses and registrations issued under chapter 18.260 RCW;
     (iv) The board of hearing and speech as established in chapter 18.35 RCW;
     (v) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;
     (vi) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;
     (vii) The board of osteopathic medicine and surgery as established in chapter 18.57 RCW governing licenses issued under chapters 18.57 and 18.57A RCW;
     (viii) The board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;
     (ix) The medical quality assurance commission as established in chapter 18.71 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;
     (x) The board of physical therapy as established in chapter 18.74 RCW;
     (xi) The board of occupational therapy practice as established in chapter 18.59 RCW;
     (xii) The nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses and registrations issued under that chapter;
     (xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW; and
     (xiv) The veterinary board of governors as established in chapter 18.92 RCW.
     (3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses based on the conditions and criteria established in this chapter and the chapters specified in subsection (2) of this section. This chapter also governs any investigation, hearing, or proceeding relating to denial of licensure or issuance of a license conditioned on the applicant's compliance with an order entered pursuant to RCW 18.130.160 by the disciplining authority.
     (4) All disciplining authorities shall adopt procedures to ensure substantially consistent application of this chapter, the Uniform Disciplinary Act, among the disciplining authorities listed in subsection (2) of this section.

Sec. 21   RCW 18.130.040 and 2007 c 269 s 17, 2007 c 253 s 13, and 2007 c 70 s 11 are each reenacted and amended to read as follows:
     (1) This chapter applies only to the secretary and the boards and commissions having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.
     (2)(a) The secretary has authority under this chapter in relation to the following professions:
     (i) Dispensing opticians licensed and designated apprentices under chapter 18.34 RCW;
     (ii) Naturopaths licensed under chapter 18.36A RCW;
     (iii) Midwives licensed under chapter 18.50 RCW;
     (iv) Ocularists licensed under chapter 18.55 RCW;
     (v) Massage operators and businesses licensed under chapter 18.108 RCW;
     (vi) Dental hygienists licensed under chapter 18.29 RCW;
     (vii) Acupuncturists licensed under chapter 18.06 RCW;
     (viii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;
     (ix) Respiratory care practitioners licensed under chapter 18.89 RCW;
     (x) Persons registered under chapter 18.19 RCW;
     (xi) Persons licensed as mental health counselors, marriage and family therapists, and social workers under chapter 18.225 RCW;
     (xii) Persons registered as nursing pool operators under chapter 18.52C RCW;
     (xiii) Nursing assistants registered or certified under chapter 18.88A RCW;
     (xiv) Health care assistants certified under chapter 18.135 RCW;
     (xv) Dietitians and nutritionists certified under chapter 18.138 RCW;
     (xvi) Chemical dependency professionals certified under chapter 18.205 RCW;
     (xvii) Sex offender treatment providers and certified affiliate sex offender treatment providers certified under chapter 18.155 RCW;
     (xviii) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;
     (xix) Denturists licensed under chapter 18.30 RCW;
     (xx) Orthotists and prosthetists licensed under chapter 18.200 RCW;
     (xxi) Surgical technologists registered under chapter 18.215 RCW;
     (xxii) Recreational therapists;
     (xxiii) Animal massage practitioners certified under chapter 18.240 RCW; ((and))
     (xxiv) Athletic trainers licensed under chapter 18.250 RCW; and
     (xxv) Long-term care workers registered or certified under chapter 18.-- RCW (the new chapter created in section 31 of this act)
.
     (b) The boards and commissions having authority under this chapter are as follows:
     (i) The podiatric medical board as established in chapter 18.22 RCW;
     (ii) The chiropractic quality assurance commission as established in chapter 18.25 RCW;
     (iii) The dental quality assurance commission as established in chapter 18.32 RCW governing licenses issued under chapter 18.32 RCW and licenses and registrations issued under chapter 18.260 RCW;
     (iv) The board of hearing and speech as established in chapter 18.35 RCW;
     (v) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;
     (vi) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;
     (vii) The board of osteopathic medicine and surgery as established in chapter 18.57 RCW governing licenses issued under chapters 18.57 and 18.57A RCW;
     (viii) The board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;
     (ix) The medical quality assurance commission as established in chapter 18.71 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;
     (x) The board of physical therapy as established in chapter 18.74 RCW;
     (xi) The board of occupational therapy practice as established in chapter 18.59 RCW;
     (xii) The nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses and registrations issued under that chapter;
     (xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW; and
     (xiv) The veterinary board of governors as established in chapter 18.92 RCW.
     (3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses based on the conditions and criteria established in this chapter and the chapters specified in subsection (2) of this section. This chapter also governs any investigation, hearing, or proceeding relating to denial of licensure or issuance of a license conditioned on the applicant's compliance with an order entered pursuant to RCW 18.130.160 by the disciplining authority.
     (4) All disciplining authorities shall adopt procedures to ensure substantially consistent application of this chapter, the Uniform Disciplinary Act, among the disciplining authorities listed in subsection (2) of this section.

Sec. 22   RCW 74.39A.240 and 2002 c 3 s 3 are each amended to read as follows:
     The definitions in this section apply throughout RCW 74.39A.030 and 74.39A.095 and 74.39A.220 through 74.39A.300, sections 3 and 23 of this act, 41.56.026, 70.127.041, and 74.09.740 unless the context clearly requires otherwise.
     (1) "Authority" means the home care quality authority.
     (2) "Board" means the board created under RCW 74.39A.230.
     (3) "Consumer" means a person to whom an individual provider provides any such services.
     (4) "Individual provider" means a person, including a personal aide, who has contracted with the department to provide personal care or respite care services to ((functionally disabled persons)) persons with functional disabilities under the medicaid personal care, community options program entry system, chore services program, or respite care program, or to provide respite care or residential services and support to persons with developmental disabilities under chapter 71A.12 RCW, or to provide respite care as defined in RCW 74.13.270.

NEW SECTION.  Sec. 23   A new section is added to chapter 74.39A RCW to read as follows:
     (1) The department shall deny payment to any individual provider of home care services who does not complete the training requirements of section 3 of this act or obtain registration as a long-term care worker as specified in chapter 18.-- RCW (the new chapter created in section 31 of this act).
     (2) The department may terminate the contract of any individual provider of home care services, or take any other enforcement measure deemed appropriate by the department if the individual provider's registration or certification is revoked under chapter 18.-- RCW (the new chapter created in section 31 of this act).
     (3) The department may take action to immediately terminate the contract of an individual provider of home care services upon finding that conduct of the individual provider has caused or presents an imminent threat of harm to a functionally disabled person in their care.
     (4) The department shall take appropriate enforcement action related to the contract or licensure of a provider of home and community-based services, other than an individual provider, who knowingly employs a long-term care worker who has failed to complete the training requirements of section 3 of this act or obtain registration as a long-term care worker as specified in chapter 18.-- RCW (the new chapter created in section 31 of this act).
     (5) Chapter 34.05 RCW shall govern department actions under this section.

Sec. 24   RCW 74.39A.050 and 2004 c 140 s 6 are each amended to read as follows:
     The department's system of quality improvement for long-term care services shall use the following principles, consistent with applicable federal laws and regulations:
     (1) The system shall be client-centered and promote privacy, independence, dignity, choice, and a home or home-like environment for consumers consistent with chapter 392, Laws of 1997.
     (2) The goal of the system is continuous quality improvement with the focus on consumer satisfaction and outcomes for consumers. This includes that when conducting licensing or contract inspections, the department shall interview an appropriate percentage of residents, family members, resident case managers, and advocates in addition to interviewing providers and staff.
     (3) Providers should be supported in their efforts to improve quality and address identified problems initially through training, consultation, technical assistance, and case management.
     (4) The emphasis should be on problem prevention both in monitoring and in screening potential providers of service.
     (5) Monitoring should be outcome based and responsive to consumer complaints and based on a clear set of health, quality of care, and safety standards that are easily understandable and have been made available to providers, residents, and other interested parties.
     (6) Prompt and specific enforcement remedies shall also be implemented without delay, pursuant to RCW 74.39A.080, RCW 70.128.160, chapter 18.51 RCW, or chapter 74.42 RCW, for providers found to have delivered care or failed to deliver care resulting in problems that are serious, recurring, or uncorrected, or that create a hazard that is causing or likely to cause death or serious harm to one or more residents. These enforcement remedies may also include, when appropriate, reasonable conditions on a contract or license. In the selection of remedies, the safety, health, and well-being of residents shall be of paramount importance.
     (7) To the extent funding is available, all long-term care staff directly responsible for the care, supervision, or treatment of vulnerable persons should be screened through background checks in a uniform and timely manner to ensure that they do not have a criminal history that would disqualify them from working with vulnerable persons. Whenever a state conviction record check is required by state law, persons may be employed or engaged as volunteers or independent contractors on a conditional basis according to law and rules adopted by the department.
     (8) No provider or staff, or prospective provider or staff, with a stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into a state registry finding him or her guilty of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW shall be employed in the care of and have unsupervised access to vulnerable adults.
     (9) The department shall establish, by rule, a state registry which contains identifying information about personal care aides identified under this chapter who have substantiated findings of abuse, neglect, financial exploitation, or abandonment of a vulnerable adult as defined in RCW 74.34.020. The rule must include disclosure, disposition of findings, notification, findings of fact, appeal rights, and fair hearing requirements. The department shall disclose, upon request, substantiated findings of abuse, neglect, financial exploitation, or abandonment to any person so requesting this information.
     (10) ((The department shall by rule develop training requirements for individual providers and home care agency providers. Effective March 1, 2002, individual providers and home care agency providers must satisfactorily complete department-approved orientation, basic training, and continuing education within the time period specified by the department in rule. The department shall adopt rules by March 1, 2002, for the implementation of this section based on the recommendations of the community long-term care training and education steering committee established in RCW 74.39A.190. The department shall deny payment to an individual provider or a home care provider who does not complete the training requirements within the time limit specified by the department by rule.
     (11) In an effort to improve access to training and education and reduce costs, especially for rural communities, the coordinated system of long-term care training and education must include the use of innovative types of learning strategies such as internet resources, videotapes, and distance learning using satellite technology coordinated through community colleges or other entities, as defined by the department.
     (12) The department shall create an approval system by March 1, 2002, for those seeking to conduct department-approved training. In the rule-making process, the department shall adopt rules based on the recommendations of the community long-term care training and education steering committee established in RCW 74.39A.190.
     (13)
)) The department shall establish, by rule, ((training,)) background checks((,)) and other quality assurance requirements for personal aides who provide in-home services funded by medicaid personal care as described in RCW 74.09.520, community options program entry system waiver services as described in RCW 74.39A.030, or chore services as described in RCW 74.39A.110 that are equivalent to requirements for individual providers.
     (((14))) (11) Under existing funds the department shall establish internally a quality improvement standards committee to monitor the development of standards and to suggest modifications.
     (((15) Within existing funds, the department shall design, develop, and implement a long-term care training program that is flexible, relevant, and qualifies towards the requirements for a nursing assistant certificate as established under chapter 18.88A RCW. This subsection does not require completion of the nursing assistant certificate training program by providers or their staff. The long-term care teaching curriculum must consist of a fundamental module, or modules, and a range of other available relevant training modules that provide the caregiver with appropriate options that assist in meeting the resident's care needs. Some of the training modules may include, but are not limited to, specific training on the special care needs of persons with developmental disabilities, dementia, mental illness, and the care needs of the elderly. No less than one training module must be dedicated to workplace violence prevention. The nursing care quality assurance commission shall work together with the department to develop the curriculum modules. The nursing care quality assurance commission shall direct the nursing assistant training programs to accept some or all of the skills and competencies from the curriculum modules towards meeting the requirements for a nursing assistant certificate as defined in chapter 18.88A RCW. A process may be developed to test persons completing modules from a caregiver's class to verify that they have the transferable skills and competencies for entry into a nursing assistant training program. The department may review whether facilities can develop their own related long-term care training programs. The department may develop a review process for determining what previous experience and training may be used to waive some or all of the mandatory training. The department of social and health services and the nursing care quality assurance commission shall work together to develop an implementation plan by December 12, 1998.))

Sec. 25   RCW 70.127.100 and 2000 c 175 s 9 are each amended to read as follows:
     Upon receipt of an application under RCW 70.127.080 for a license and the license fee, the department shall issue a license if the applicant meets the requirements established under this chapter. A license issued under this chapter shall not be transferred or assigned without thirty days prior notice to the department and the department's approval. A license, unless suspended or revoked, is effective for a period of two years, however an initial license is only effective for twelve months. The department shall conduct a survey within each licensure period, and may conduct a licensure survey after ownership transfer, to assure compliance with this chapter and the rules adopted under this chapter and under section 3 of this act, and to enforce section 23(4) of this act.

Sec. 26   RCW 18.20.110 and 2004 c 144 s 3 are each amended to read as follows:
     (1) The department shall make or cause to be made, at least every eighteen months with an annual average of fifteen months, an inspection and investigation of all boarding homes. However, the department may delay an inspection to twenty-four months if the boarding home has had three consecutive inspections with no written notice of violations and has received no written notice of violations resulting from complaint investigation during that same time period. The department may at anytime make an unannounced inspection of a licensed home to assure that the licensee is in compliance with this chapter and the rules adopted under this chapter and section 3 of this act, and to enforce section 23(4) of this act. Every inspection shall focus primarily on actual or potential resident outcomes, and may include an inspection of every part of the premises and an examination of all records, methods of administration, the general and special dietary, and the stores and methods of supply; however, the department shall not have access to financial records or to other records or reports described in RCW 18.20.390. Financial records of the boarding home may be examined when the department has reasonable cause to believe that a financial obligation related to resident care or services will not be met, such as a complaint that staff wages or utility costs have not been paid, or when necessary for the department to investigate alleged financial exploitation of a resident.
     (2) Following such an inspection or inspections, written notice of any violation of this law or the rules adopted hereunder shall be given to the applicant or licensee and the department.
     (3) The department may prescribe by rule that any licensee or applicant desiring to make specified types of alterations or additions to its facilities or to construct new facilities shall, before commencing such alteration, addition, or new construction, submit plans and specifications therefor to the agencies responsible for plan reviews for preliminary inspection and approval or recommendations with respect to compliance with the rules and standards herein authorized.

Sec. 27   RCW 18.20.270 and 2002 c 233 s 1 are each amended to read as follows:
     (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
     (a) "Caregiver" includes any ((person)) long-term care worker who provides residents with hands-on personal care on behalf of a boarding home, except volunteers who are directly supervised.
     (b) "Direct supervision" means oversight by a person who has demonstrated competency in the core areas or has been fully exempted from the training requirements pursuant to this section, is on the premises, and is quickly and easily available to the caregiver.
     (c) "Long-term care worker" has the same meaning as defined in RCW 74.39A.009(11).
     (2) Training must have the following components: Orientation, basic training, specialty training as appropriate, and continuing education. All boarding home employees or volunteers who routinely interact with residents shall complete orientation. Boarding home administrators, or their designees, and caregivers shall complete orientation, basic training, specialty training as appropriate, and continuing education. Training of caregivers employed by boarding homes is governed by chapter 74.39A RCW. Any caregiver who has satisfied the training and competency testing requirements of section 3 of this act or the continuing education requirements of RCW 74.39A.340 shall be deemed to have satisfied, as applicable, the orientation, basic training, and continuing education requirements of this section.
     (3) Orientation consists of introductory information on residents' rights, communication skills, fire and life safety, and universal precautions. Orientation must be provided at the facility by appropriate boarding home staff to all boarding home employees before the employees have routine interaction with residents.
     (4) Basic training consists of modules on the core knowledge and skills that caregivers need to learn and understand to effectively and safely provide care to residents. Basic training must be outcome-based, and the effectiveness of the basic training must be measured by demonstrated competency in the core areas through the use of a competency test. ((Basic training must be completed by caregivers within one hundred twenty days of the date on which they begin to provide hands-on care or within one hundred twenty days of September 1, 2002, whichever is later.)) Until ((competency in the core areas has been demonstrated, caregivers)) a caregiver provides verification that he or she has met the basic training requirements under section 3 of this act, a caregiver shall not provide hands-on personal care to residents without direct supervision. Boarding home administrators, or their designees, must complete basic training and demonstrate competency within one hundred twenty days of employment or within one hundred twenty days of September 1, 2002, whichever is later.
     (5)(a) For boarding homes that serve residents with special needs such as dementia, developmental disabilities, or mental illness, specialty training is required of administrators, or designees, and caregivers. Specialty training consists of modules on the core knowledge and skills that caregivers need to effectively and safely provide care to residents with special needs. Specialty training should be integrated into basic training wherever appropriate. Specialty training must be outcome-based, and the effectiveness of the specialty training measured by demonstrated competency in the core specialty areas through the use of a competency test.
     (b) Specialty training must be completed by caregivers within one hundred twenty days of the date on which they begin to provide hands-on care to a resident having special needs or within one hundred twenty days of September 1, 2002, whichever is later. However, if specialty training is not integrated with basic training, the specialty training must be completed within ninety days of completion of basic training. Until competency in the core specialty areas has been demonstrated, caregivers shall not provide hands-on personal care to residents with special needs without direct supervision. If training received by a caregiver under section 3 of this act involves core knowledge and skills to effectively and safely provide care to residents of the boarding home with special needs, the hours of training received by the caregiver shall apply toward meeting the specialty training requirements under this section. Boarding home administrators, or their designees, must complete specialty training and demonstrate competency within one hundred twenty days of September 1, 2002, or one hundred twenty days from the date on which the administrator or his or her designee is hired, whichever is later, if the boarding home serves one or more residents with special needs.
     (((6) Continuing education consists of ongoing delivery of information to caregivers on various topics relevant to the care setting and care needs of residents. Competency testing is not required for continuing education. Continuing education is not required in the same calendar year in which basic or modified basic training is successfully completed. Continuing education is required in each calendar year thereafter.)) (c) If specialty training is completed, the specialty training applies toward any continuing education requirement for up to two years following the completion of the specialty training.
     (((7))) (6) Persons who successfully challenge the competency test for basic training are fully exempt from the basic training requirements of this section. Persons who successfully challenge the specialty training competency test are fully exempt from the specialty training requirements of this section.
     (((8))) (7) Licensed persons who perform the tasks for which they are licensed are fully or partially exempt from the training requirements of this section, as specified by the department in rule.
     (((9))) (8) In an effort to improve access to training and education and reduce costs, especially for rural communities, the coordinated system of long-term care training and education must include the use of innovative types of learning strategies such as internet resources, videotapes, and distance learning using satellite technology coordinated through community colleges or other entities, as defined by the department.
     (((10))) (9) The department shall develop criteria for the approval of orientation, basic training, and specialty training programs.
     (((11) Boarding homes that desire to deliver facility-based training with facility designated trainers, or boarding homes that desire to pool their resources to create shared training systems, must be encouraged by the department in their efforts. The department shall develop criteria for reviewing and approving trainers and training materials that are substantially similar to or better than the materials developed by the department. The department may approve a curriculum based upon attestation by a boarding home administrator that the boarding home's training curriculum addresses basic and specialty training competencies identified by the department, and shall review a curriculum to verify that it meets these requirements. The department may conduct the review as part of the next regularly scheduled yearly inspection and investigation required under RCW 18.20.110. The department shall rescind approval of any curriculum if it determines that the curriculum does not meet these requirements.
     (12) The department shall adopt rules by September 1, 2002, for the implementation of this section.
     (13)
)) (10) The orientation, basic training, specialty training, and continuing education requirements of this section commence September 1, 2002, or one hundred twenty days from the date of employment, whichever is later, and shall be applied to (a) employees hired subsequent to September 1, 2002; and (b) existing employees that on September 1, 2002, have not successfully completed the training requirements under RCW 74.39A.010 or 74.39A.020 and this section. Existing employees who have not successfully completed the training requirements under RCW 74.39A.010 or 74.39A.020 shall be subject to all applicable requirements of this section. ((However, prior to September 1, 2002, nothing in this section affects the current training requirements under RCW 74.39A.010.))

Sec. 28   RCW 70.128.090 and 2001 c 319 s 7 are each amended to read as follows:
     (1) During inspections of an adult family home, the department shall have access and authority to examine areas and articles in the home used to provide care or support to residents, including residents' records, accounts, and the physical premises, including the buildings, grounds, and equipment. The personal records of the provider are not subject to department inspection nor is the separate bedroom of the provider, not used in direct care of a client, subject to review. The department may inspect all rooms during the initial licensing of the home. However, during a complaint investigation, the department shall have access to the entire premises and all pertinent records when necessary to conduct official business. The department also shall have the authority to interview the provider and residents of an adult family home.
     (2) Whenever an inspection is conducted, the department shall prepare a written report that summarizes all information obtained during the inspection, and if the home is in violation of this chapter or the rules adopted under this chapter or under section 3 of this act, or the department is enforcing section 23(4) of this act, serve a copy of the inspection report upon the provider at the same time as a notice of violation. This notice shall be mailed to the provider within ten working days of the completion of the inspection process. If the home is not in violation of this chapter, a copy of the inspection report shall be mailed to the provider within ten calendar days of the inspection of the home. All inspection reports shall be made available to the public at the department during business hours.
     (3) The provider shall develop corrective measures for any violations found by the department's inspection. The department shall upon request provide consultation and technical assistance to assist the provider in developing effective corrective measures. The department shall include a statement of the provider's corrective measures in the department's inspection report.

NEW SECTION.  Sec. 29   A new section is added to chapter 70.128 RCW to read as follows:
     (1) Adult family homes may participate in a voluntary adult family home certification program through the University of Washington geriatric education center. In addition to the minimum qualifications required under RCW 70.128.120, individuals participating in the voluntary adult family home certification program must complete fifty-two hours of class requirements as established by the University of Washington geriatric education center. Subjects covered by the class requirements must include: Specific age-related physical or mental health conditions that can be prevented, postponed, or alleviated by a health promotion intervention, how to establish health promotion programs in residential settings and communities, preventing falls, addressing health issues of aging families, and issues and health concerns of ethnic older adults and those with developmental disabilities.
     (2) Individuals completing the requirements of RCW 70.128.120 and the voluntary adult family home certification program shall be issued a certified adult family home license by the department.
     (3) The department shall adopt rules implementing this section.

Sec. 30   RCW 70.128.120 and 2006 c 249 s 1 are each amended to read as follows:
     Each adult family home provider and each resident manager shall have the following minimum qualifications, except that only providers are required to meet the provisions of subsection (10) of this section:
     (1) Twenty-one years of age or older;
     (2) For those applying after September 1, 2001, to be licensed as providers, and for resident managers whose employment begins after September 1, 2001, a United States high school diploma or general educational development (GED) certificate or any English or translated government documentation of the following:
     (a) Successful completion of government-approved public or private school education in a foreign country that includes an annual average of one thousand hours of instruction over twelve years or no less than twelve thousand hours of instruction;
     (b) A foreign college, foreign university, or United States community college two-year diploma;
     (c) Admission to, or completion of coursework at, a foreign university or college for which credit was granted;
     (d) Admission to, or completion of coursework at, a United States college or university for which credits were awarded;
     (e) Admission to, or completion of postgraduate coursework at, a United States college or university for which credits were awarded; or
     (f) Successful passage of the United States board examination for registered nursing, or any professional medical occupation for which college or university education preparation was required;
     (3) Good moral and responsible character and reputation;
     (4) Literacy in the English language((,)). However, a person not literate in the English language may meet the requirements of this subsection by assuring that there is a person on staff and available who is able to communicate or make provisions for communicating with the resident in his or her primary language and capable of understanding and speaking English well enough to be able to respond appropriately to emergency situations and be able to read and understand resident care plans;
     (5) Management and administrative ability to carry out the requirements of this chapter;
     (6) Satisfactory completion of department-approved basic training and continuing education training as specified by the department in rule, based on recommendations of the community long-term care training and education steering committee and working in collaboration with providers, consumers, caregivers, advocates, family members, educators, and other interested parties in the rule-making process;
     (7) Satisfactory completion of department-approved, or equivalent, special care training before a provider may provide special care services to a resident;
     (8) Not been convicted of any crime listed in RCW 43.43.830 and 43.43.842;
     (9) For those applying after September 1, 2001, to be licensed as providers, and for resident managers whose employment begins after September 1, 2001, at least three hundred twenty hours of successful, direct caregiving experience obtained after age eighteen to vulnerable adults in a licensed or contracted setting prior to operating or managing an adult family home; ((and))
     (10) Prior to being granted a license, providers applying after January 1, 2007, must complete a department-approved forty-eight hour adult family home administration and business planning class. The department shall promote and prioritize bilingual capabilities within available resources and when materials are available for this purpose; and
     (11) Following licensure, completion annually of two hours of administrative continuing education administered by the department in collaboration with the adult family home advisory committee and taught by adult family home association providers with five or more years of experience, or by another entity as determined by the department. For the purpose of this subsection, "adult family home association" means an organized group of adult family home providers with a proven history of advocacy of at least five years with a sustained membership of at least one hundred members as approved by the department. Internet access and bilingual training materials shall be promoted and prioritized when available and appropriate. The department shall ensure balanced participation by the appointment of stakeholders equally between adult family home providers and consumers to the adult family home advisory committee
.

Sec. 31   RCW 70.128.230 and 2002 c 233 s 3 are each amended to read as follows:
     (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
     (a) "Caregiver" includes all adult family home resident managers and any ((person)) long-term care worker who provides residents with hands-on personal care on behalf of an adult family home, except volunteers who are directly supervised.
     (b) "Indirect supervision" means oversight by a person who has demonstrated competency in the core areas or has been fully exempted from the training requirements pursuant to this section and is quickly and easily available to the caregiver, but not necessarily on-site.
     (c) "Long-term care worker" has the same meaning as defined in RCW 74.39A.009(11).
     (2) Training must have three components: Orientation, basic training, and continuing education. All adult family home providers, resident managers, and employees, or volunteers who routinely interact with residents shall complete orientation. Caregivers shall complete orientation, basic training, and continuing education. Training of caregivers employed by adult family homes is governed by chapter 74.39A RCW. Any caregiver who has satisfied the training and competency testing requirements of section 3 of this act or the continuing education requirements of RCW 74.39A.340 shall be deemed to have satisfied, as applicable, the orientation, basic training, and continuing education requirements of this section.
     (3) Orientation consists of introductory information on residents' rights, communication skills, fire and life safety, and universal precautions. Orientation must be provided at the facility by appropriate adult family home staff to all adult family home employees before the employees have routine interaction with residents.
     (4) Basic training consists of modules on the core knowledge and skills that caregivers need to learn and understand to effectively and safely provide care to residents. Basic training must be outcome-based, and the effectiveness of the basic training must be measured by demonstrated competency in the core areas through the use of a competency test. ((Basic training must be completed by caregivers within one hundred twenty days of the date on which they begin to provide hands-on care or within one hundred twenty days of September 1, 2002, whichever is later.)) Until ((competency in the core areas has been demonstrated, caregivers)) a caregiver provides verification that he or she has satisfied the basic training requirements under section 3 of this act, a caregiver shall not provide hands-on personal care to residents without indirect supervision.
     (5)(a) For adult family homes that serve residents with special needs such as dementia, developmental disabilities, or mental illness, specialty training is required of providers and resident managers. Specialty training consists of modules on the core knowledge and skills that providers and resident managers need to effectively and safely provide care to residents with special needs. Specialty training should be integrated into basic training wherever appropriate. Specialty training must be outcome-based, and the effectiveness of the specialty training measured by demonstrated competency in the core specialty areas through the use of a competency test.
     (b) Specialty training must be completed by providers and resident managers before admitting and serving residents who have been determined to have special needs related to mental illness, dementia, or a developmental disability. Should a resident develop special needs while living in a home without specialty designation, the provider and resident manager have one hundred twenty days to complete specialty training.
     (((6) Continuing education consists of ongoing delivery of information to caregivers on various topics relevant to the care setting and care needs of residents. Competency testing is not required for continuing education. Continuing education is not required in the same calendar year in which basic or modified basic training is successfully completed. Continuing education is required in each calendar year thereafter.)) If training received by a caregiver under section 3 of this act involves core knowledge and skills to effectively and safely provide care to residents of the adult family home with special needs, the hours of training received by the caregiver shall apply toward meeting the specialty training requirements under this section.
     (c)
If specialty training is completed, the specialty training applies toward any continuing education requirement for up to two years following the completion of the specialty training.
     (((7))) (6) Persons who successfully challenge the competency test for basic training are fully exempt from the basic training requirements of this section. Persons who successfully challenge the specialty training competency test are fully exempt from the specialty training requirements of this section.
     (((8))) (7) Licensed persons who perform the tasks for which they are licensed are fully or partially exempt from the training requirements of this section, as specified by the department in rule.
     (((9))) (8) In an effort to improve access to training and education and reduce costs, especially for rural communities, the coordinated system of long-term care training and education must include the use of innovative types of learning strategies such as internet resources, videotapes, and distance learning using satellite technology coordinated through community colleges, private associations, or other entities, as defined by the department.
     (((10) Adult family homes that desire to deliver facility-based training with facility designated trainers, or adult family homes that desire to pool their resources to create shared training systems, must be encouraged by the department in their efforts. The department shall develop criteria for reviewing and approving trainers and training materials. The department may approve a curriculum based upon attestation by an adult family home administrator that the adult family home's training curriculum addresses basic and specialty training competencies identified by the department, and shall review a curriculum to verify that it meets these requirements. The department may conduct the review as part of the next regularly scheduled inspection authorized under RCW 70.128.070. The department shall rescind approval of any curriculum if it determines that the curriculum does not meet these requirements.
     (11)
)) (9) The department shall adopt rules by September 1, 2002, for the implementation of this section.
     (((12))) (10) The orientation, basic training, specialty training, and continuing education requirements of this section commence September 1, 2002, and shall be applied to (a) employees hired subsequent to September 1, 2002; or (b) existing employees that on September 1, 2002, have not successfully completed the training requirements under RCW 70.128.120 or 70.128.130 and this section. Existing employees who have not successfully completed the training requirements under RCW 70.128.120 or 70.128.130 shall be subject to all applicable requirements of this section. ((However, until September 1, 2002, nothing in this section affects the current training requirements under RCW 70.128.120 and 70.128.130.))

NEW SECTION.  Sec. 32   The following acts or parts of acts are each repealed:
     (1) RCW 18.20.230 (Training standards review -- Proposed enhancements) and 1999 c 372 s 3 & 1998 c 272 s 2; and
     (2) RCW 70.128.210 (Training standards review -- Delivery system--Issues reviewed -- Report to the legislature) and 1998 c 272 s 3.

NEW SECTION.  Sec. 33   Sections 7 through 19 of this act constitute a new chapter in Title 18 RCW.

NEW SECTION.  Sec. 34   Section 20 of this act expires July 1, 2008.

NEW SECTION.  Sec. 35   Section 21 of this act takes effect July 1, 2008.

NEW SECTION.  Sec. 36   If specific funding for the purposes of this act, referencing this act by bill or chapter number, is not provided by June 30, 2008, in the omnibus appropriations act, this act is null and void."

     Correct the title.

EFFECT:  The striking amendment makes the following major changes to the substitute bill:

     Training
     (1) Beginning with initial hire after January 1, 2010, requires long-term care workers to complete basic training (classroom training) of 35 hours, but makes the additional 50 hours of experiential training a prerequisite to taking a certification examination under a voluntary certification program.
     (2) For purposes of the exemption from basic training for parent caregivers for their adult children: (a) Expands the exemption to include all such caregivers, whether the child is developmentally or functionally disabled; (b) adds a requirement to complete safety training, which may be completed by distance learning; and (c)increases the average number of hours that their exempt "intermittent" respite caregivers can provide from 16 to 24 hours per month.
     (3) Requires boarding homes, adult family homes, and the Training Partnership that develop their own training programs to report to DSHS on the workers who start training and those who complete training, and to verify the completion of training.
     (4) Requires adult family home providers and resident managers, following licensure, to complete two hours of administrative continuing education administered by DSHS, with collaboration by an advisory committee, and taught by adult family home association providers with five or more years of experience or by another entity determined by DSHS.

     Registration
     (1) Beginning January 1, 2010, adds a requirement for the registration of all long-term care workers with the Department of Health (DOH) within 120 days of initial hire or within 120 days after January 1, 2010, if the worker was hired before that date (with exemptions for parents who are caregivers for only their developmentally or functionally disabled adult children and certain respite caregivers, and certain credentialed personnel).
     (2) To apply for registration, requires long-term care workers to complete basic training or successfully challenge the basic training competency test.

     Certification
     (1) Beginning January 1, 2012, allows long-term care workers to elect certification, and provides for specialty endorsements; requires the DOH to report on a plan for implementing the certification program by December 1, 2009.
     (2) Moves administration of the certification program from DSHS to DOH.
     (3) Defines the "approved training" that is required for the certification examination to be not less than 85 hours of training, including basic training, that will assist with opportunities to articulate to relevant degree or skill programs in community colleges or similar schools.

     Technical
     (1) Makes various technical clarifications to the training and credentialing programs, including: (a) Clarifying or adding definitions; (b) adding title and practice protection for both registered and certified long-term care workers; (c) granting authority for DOH to deny, as well as issue, certifications and registrations; (d) specifying that continuing education is a requirement for renewal of registration or certification; (e) making the Uniform Disciplinary Act apply under Secretary of Health's authority; (f) allowing four attempts to pass the certification examination; and (g) allowing reciprocity for an equivalent out-of-state credential.
     (2) Adds a cross-reference to DSHS authority to take licensure enforcement action against adult family homes and boarding homes that have workers who fail to complete required training or registration.
     (3) Allows adult family homes that meet specified training to participate in a voluntary adult family home certification program through the University of Washington Geriatric Education Center.

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