| Passed by the House February 9, 2012 Yeas 97 ________________________________________ Speaker of the House of Representatives Passed by the Senate February 27, 2012 Yeas 47 ________________________________________ President of the Senate | I, Barbara Baker, Chief Clerk of the House of Representatives of the State of Washington, do hereby certify that the attached is SUBSTITUTE HOUSE BILL 2056 as passed by the House of Representatives and the Senate on the dates hereon set forth. ________________________________________ Chief Clerk | |
| Approved ________________________________________ Governor of the State of Washington | Secretary of State State of Washington |
| State of Washington | 62nd Legislature | 2012 Regular Session |
READ FIRST TIME 01/18/12.
AN ACT Relating to assisted living facilities; amending RCW 18.20.030, 18.20.050, 18.20.090, 18.20.110, 18.20.115, 18.20.130, 18.20.140, 18.20.150, 18.20.160, 18.20.170, 18.20.190, 18.20.220, 18.20.230, 18.20.270, 18.20.280, 18.20.290, 18.20.300, 18.20.310, 18.20.320, 18.20.330, 18.20.340, 18.20.350, 18.20.360, 18.20.370, 18.20.380, 18.20.390, 18.20.400, 18.20.410, 18.20.420, 18.20.430, 18.20.440, 18.20.900, 18.51.010, 18.52C.020, 18.79.260, 18.100.140, 35.21.766, 35A.70.020, 43.43.832, 46.19.020, 48.43.125, 69.41.010, 69.41.085, 69.50.308, 70.79.090, 70.87.305, 70.97.060, 70.97.090, 70.122.020, 70.127.040, 70.128.030, 70.128.210, 70.129.005, 70.129.160, 71.24.025, 74.09.120, 74.15.020, 74.39A.009, 74.39A.010, 74.39A.020, 74.39A.030, 74.39A.320, 74.41.040, 74.42.055, 82.04.2908, 82.04.4264, 82.04.4337, 84.36.381, and 84.36.383; reenacting and amending RCW 18.20.010, 18.20.020, 70.38.105, 70.38.111, and 74.34.020; and creating a new section.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 18.20.010 and 2000 c 171 s 3 and 2000 c 121 s 1 are
each reenacted and amended to read as follows:
The purpose of this chapter is to provide for the development,
establishment, and enforcement of standards for the maintenance and
operation of ((boarding homes)) assisted living facilities, which, in
the light of advancing knowledge, will promote safe and adequate care
of the individuals therein. It is further the intent of the
legislature that ((boarding homes)) assisted living facilities be
available to meet the needs of those for whom they care by recognizing
the capabilities of individuals to direct their self-medication or to
use supervised self-medication techniques when ordered and approved by
a physician licensed under chapter 18.57 or 18.71 RCW or a podiatric
physician and surgeon licensed under chapter 18.22 RCW.
The legislature finds that many residents of community-based long-term care facilities are vulnerable and their health and well-being are
dependent on their caregivers. The quality, skills, and knowledge of
their caregivers are often the key to good care. The legislature finds
that the need for well-trained caregivers is growing as the state's
population ages and residents' needs increase. The legislature intends
that current training standards be enhanced.
Sec. 2 RCW 18.20.020 and 2011 c 366 s 2 are each reenacted and
amended to read as follows:
((As used in this chapter:)) The definitions in this section apply
throughout this chapter unless the context clearly requires otherwise.
(1) "Adult day services" means care and services provided to a
nonresident individual by the ((boarding home)) assisted living
facility on the ((boarding home)) assisted living facility premises,
for a period of time not to exceed ten continuous hours, and does not
involve an overnight stay.
(2) "Basic services" means housekeeping services, meals, nutritious
snacks, laundry, and activities.
(3) "((Boarding home)) Assisted living facility" means any home or
other institution, however named, which is advertised, announced, or
maintained for the express or implied purpose of providing housing,
basic services, and assuming general responsibility for the safety and
well-being of the residents, and may also provide domiciliary care,
consistent with chapter 142, Laws of 2004, to seven or more residents
after July 1, 2000. However, ((a boarding home)) an assisted living
facility that is licensed for three to six residents prior to or on
July 1, 2000, may maintain its ((boarding home)) assisted living
facility license as long as it is continually licensed as ((a boarding
home)) an assisted living facility. "((Boarding home)) Assisted living
facility" shall not include facilities certified as group training
homes pursuant to RCW 71A.22.040, nor any home, institution or section
thereof which is otherwise licensed and regulated under the provisions
of state law providing specifically for the licensing and regulation of
such home, institution or section thereof. Nor shall it include any
independent senior housing, independent living units in continuing care
retirement communities, or other similar living situations including
those subsidized by the department of housing and urban development.
(4) "Department" means the state department of social and health
services.
(5) "Domiciliary care" means: Assistance with activities of daily
living provided by the ((boarding home)) assisted living facility
either directly or indirectly; or health support services, if provided
directly or indirectly by the ((boarding home)) assisted living
facility; or intermittent nursing services, if provided directly or
indirectly by the ((boarding home)) assisted living facility.
(6) "General responsibility for the safety and well-being of the
resident" means the provision of the following: Prescribed general low
sodium diets; prescribed general diabetic diets; prescribed mechanical
soft foods; emergency assistance; monitoring of the resident; arranging
health care appointments with outside health care providers and
reminding residents of such appointments as necessary; coordinating
health care services with outside health care providers consistent with
RCW 18.20.380; assisting the resident to obtain and maintain glasses,
hearing aids, dentures, canes, crutches, walkers, wheelchairs, and
assistive communication devices; observation of the resident for
changes in overall functioning; blood pressure checks as scheduled;
responding appropriately when there are observable or reported changes
in the resident's physical, mental, or emotional functioning; or
medication assistance as permitted under RCW 69.41.085 and as defined
in RCW 69.41.010.
(7) "Legal representative" means a person or persons identified in
RCW 7.70.065 who may act on behalf of the resident pursuant to the
scope of their legal authority. The legal representative shall not be
affiliated with the licensee, ((boarding home)) assisted living
facility, or management company, unless the affiliated person is a
family member of the resident.
(8) "Nonresident individual" means a person who resides in
independent senior housing, independent living units in continuing care
retirement communities, or in other similar living environments or in
an unlicensed room located within ((a boarding home)) an assisted
living facility. Nothing in this chapter prohibits nonresidents from
receiving one or more of the services listed in RCW 18.20.030(5) or
requires licensure as ((a boarding home)) an assisted living facility
when one or more of the services listed in RCW 18.20.030(5) are
provided to nonresidents. A nonresident individual may not receive
domiciliary care, as defined in this chapter, directly or indirectly by
the ((boarding home)) assisted living facility and may not receive the
items and services listed in subsection (6) of this section, except
during the time the person is receiving adult day services as defined
in this section.
(9) "Person" means any individual, firm, partnership, corporation,
company, association, or joint stock association, and the legal
successor thereof.
(10) "Resident" means an individual who is not related by blood or
marriage to the operator of the ((boarding home)) assisted living
facility, and by reason of age or disability, chooses to reside in the
((boarding home)) assisted living facility and receives basic services
and one or more of the services listed under general responsibility for
the safety and well-being of the resident and may receive domiciliary
care or respite care provided directly or indirectly by the ((boarding
home)) assisted living facility and shall be permitted to receive
hospice care through an outside service provider when arranged by the
resident or the resident's legal representative under RCW 18.20.380.
(11) "Resident applicant" means an individual who is seeking
admission to a licensed ((boarding home)) assisted living facility and
who has completed and signed an application for admission, or such
application for admission has been completed and signed in their behalf
by their legal representative if any, and if not, then the designated
representative if any.
(12) "Resident's representative" means a person designated
voluntarily by a competent resident, in writing, to act in the
resident's behalf concerning the care and services provided by the
((boarding home)) assisted living facility and to receive information
from the ((boarding home)) assisted living facility, if there is no
legal representative. The resident's competence shall be determined
using the criteria in RCW 11.88.010(1)(e). The resident's
representative may not be affiliated with the licensee, ((boarding
home)) assisted living facility, or management company, unless the
affiliated person is a family member of the resident. The resident's
representative shall not have authority to act on behalf of the
resident once the resident is no longer competent.
(13) "Secretary" means the secretary of social and health services.
Sec. 3 RCW 18.20.030 and 2011 c 366 s 3 are each amended to read
as follows:
(1) After January 1, 1958, no person shall operate or maintain ((a
boarding home)) an assisted living facility as defined in this chapter
within this state without a license under this chapter.
(2) ((A boarding home)) An assisted living facility license is not
required for the housing, or services, that are customarily provided
under landlord tenant agreements governed by the residential landlord-tenant act, chapter 59.18 RCW, or when housing nonresident individuals
who chose to participate in programs or services under subsection (5)
of this section, when offered by the ((boarding home)) assisted living
facility licensee or the licensee's contractor. This subsection does
not prohibit the licensee from furnishing written information
concerning available community resources to the nonresident individual
or the individual's family members or legal representatives. The
licensee may not require the use of any particular service provider.
(3) Residents receiving domiciliary care, directly or indirectly by
the ((boarding home)) assisted living facility, are not considered
nonresident individuals for the purposes of this section.
(4) ((A boarding home)) An assisted living facility license is
required when any person other than an outside service provider, under
RCW 18.20.380, or family member:
(a) Assumes general responsibility for the safety and well-being of
a resident;
(b) Provides assistance with activities of daily living, either
directly or indirectly;
(c) Provides health support services, either directly or
indirectly; or
(d) Provides intermittent nursing services, either directly or
indirectly.
(5) ((A boarding home)) An assisted living facility license is not
required for one or more of the following services that may, upon the
request of the nonresident, be provided to a nonresident individual:
(a) Emergency assistance provided on an intermittent or nonroutine
basis; (b) systems, including technology-based monitoring devices,
employed by independent senior housing, or independent living units in
continuing care retirement communities, to respond to the potential
need for emergency services; (c) scheduled and nonscheduled blood
pressure checks; (d) nursing assessment services to determine whether
referral to an outside health care provider is recommended; (e) making
and reminding the nonresident of health care appointments; (f)
preadmission assessment for the purposes of transitioning to a licensed
care setting; (g) medication assistance which may include reminding or
coaching the nonresident, opening the nonresident's medication
container, using an enabler, and handing prefilled insulin syringes to
the nonresident; (h) falls risk assessment; (i) nutrition management
and education services; (j) dental services; (k) wellness programs; (l)
prefilling insulin syringes when performed by a nurse licensed under
chapter 18.79 RCW; or (m) services customarily provided under landlord
tenant agreements governed by the residential landlord-tenant act,
chapter 59.18 RCW.
Sec. 4 RCW 18.20.050 and 2011 1st sp.s. c 3 s 402 are each
amended to read as follows:
(1)(a) Upon receipt of an application for license, if the applicant
and the ((boarding home's)) facilities of the assisted living facility
meet the requirements established under this chapter, the department
may issue a license. If there is a failure to comply with the
provisions of this chapter or the rules adopted under this chapter, the
department may in its discretion issue a provisional license to an
applicant for a license or for the renewal of a license. A provisional
license permits the operation of the ((boarding home)) assisted living
facility for a period to be determined by the department, but not to
exceed twelve months and is not subject to renewal. The department may
also place conditions on the license under RCW 18.20.190.
(b) At the time of the application for or renewal of a license or
provisional license, the licensee shall pay a license fee. Beginning
July 1, 2011, and thereafter, the per bed license fee must be
established in the omnibus appropriations act and any amendment or
additions made to that act. The license fees established in the
omnibus appropriations act and any amendment or additions made to that
act may not exceed the department's annual licensing and oversight
activity costs and must include the department's cost of paying
providers for the amount of the license fee attributed to medicaid
clients.
(c) A license issued under this chapter may not exceed twelve
months in duration and expires on a date set by the department. ((A
boarding home)) An assisted living facility license must be issued only
to the person that applied for the license. All applications for
renewal of a license shall be made not later than thirty days prior to
the date of expiration of the license. Each license shall be issued
only for the premises and persons named in the application, and no
license shall be transferable or assignable. Licenses shall be posted
in a conspicuous place on the licensed premises.
(2) A licensee who receives notification of the department's
initiation of a denial, suspension, nonrenewal, or revocation of ((a
boarding home)) an assisted living facility license may, in lieu of
appealing the department's action, surrender or relinquish the license.
The department shall not issue a new license to or contract with the
licensee, for the purposes of providing care to vulnerable adults or
children, for a period of twenty years following the surrendering or
relinquishment of the former license. The licensing record shall
indicate that the licensee relinquished or surrendered the license,
without admitting the violations, after receiving notice of the
department's initiation of a denial, suspension, nonrenewal, or
revocation of a license.
(3) The department shall establish, by rule, the circumstances
requiring a change in licensee, which include, but are not limited to,
a change in ownership or control of the ((boarding home)) assisted
living facility or licensee, a change in the licensee's form of legal
organization, such as from sole proprietorship to partnership or
corporation, and a dissolution or merger of the licensed entity with
another legal organization. The new licensee is subject to the
provisions of this chapter, the rules adopted under this chapter, and
other applicable law. In order to ensure that the safety of residents
is not compromised by a change in licensee, the new licensee is
responsible for correction of all violations that may exist at the time
of the new license.
(4) The department may deny, suspend, modify, revoke, or refuse to
renew a license when the department finds that the applicant or
licensee or any partner, officer, director, managerial employee, or
majority owner of the applicant or licensee:
(a) Operated ((a boarding home)) an assisted living facility
without a license or under a revoked or suspended license; or
(b) Knowingly or with reason to know made a false statement of a
material fact (i) in an application for license or any data attached to
the application, or (ii) in any matter under investigation by the
department; or
(c) Refused to allow representatives or agents of the department to
inspect (i) the books, records, and files required to be maintained, or
(ii) any portion of the premises of the ((boarding home)) assisted
living facility; or
(d) Willfully prevented, interfered with, or attempted to impede in
any way (i) the work of any authorized representative of the
department, or (ii) the lawful enforcement of any provision of this
chapter; or
(e) Has a history of significant noncompliance with federal or
state regulations in providing care or services to vulnerable adults or
children. In deciding whether to deny, suspend, modify, revoke, or
refuse to renew a license under this section, the factors the
department considers shall include the gravity and frequency of the
noncompliance.
(5) The department shall serve upon the applicant a copy of the
decision granting or denying an application for a license. An
applicant shall have the right to contest denial of his or her
application for a license as provided in chapter 34.05 RCW by
requesting a hearing in writing within twenty-eight days after receipt
of the notice of denial.
Sec. 5 RCW 18.20.090 and 1985 c 213 s 6 are each amended to read
as follows:
The department shall adopt, amend, and promulgate such rules,
regulations, and standards with respect to all ((boarding homes))
assisted living facilities and operators thereof to be licensed
hereunder as may be designed to further the accomplishment of the
purposes of this chapter in promoting safe and adequate care of
individuals in ((boarding homes)) assisted living facilities and the
sanitary, hygienic and safe conditions of the ((boarding home))
assisted living facility in the interest of public health, safety, and
welfare.
Sec. 6 RCW 18.20.110 and 2004 c 144 s 3 are each amended to read
as follows:
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)) assisted living facilities.
However, the department may delay an inspection to twenty-four months
if the ((boarding home)) assisted living facility 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)) facility
to assure that the licensee is in compliance with this chapter and the
rules adopted under this chapter. 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))
assisted living facility 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. 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. 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. 7 RCW 18.20.115 and 2001 c 85 s 1 are each amended to read
as follows:
The department shall, within available funding for this purpose,
develop and make available to ((boarding homes)) assisted living
facilities a quality improvement consultation program using the
following principles:
(1) The system shall be resident-centered and promote privacy,
independence, dignity, choice, and a home or home-like environment for
residents consistent with chapter 70.129 RCW.
(2) The goal of the system is continuous quality improvement with
the focus on resident satisfaction and outcomes for residents. The
quality improvement consultation program shall be offered to ((boarding
homes)) assisted living facilities on a voluntary basis. Based on
requests for the services of the quality improvement consultation
program, the department may establish a process for prioritizing
service availability.
(3) ((Boarding homes)) Assisted living facilities should be
supported in their efforts to improve quality and address problems, as
identified by the licensee, initially through training, consultation,
and technical assistance. At a minimum, the department may, within
available funding, at the request of the ((boarding home)) assisted
living facility, conduct on-site visits and telephone consultations.
(4) To facilitate collaboration and trust between the ((boarding
homes)) assisted living facilities and the department's quality
improvement consultation program staff, the consultation program staff
shall not simultaneously serve as department licensors, complaint
investigators, or participate in any enforcement-related decisions,
within the region in which they perform consultation activities; except
such staff may investigate on an emergency basis, complaints anywhere
in the state when the complaint indicates high risk to resident health
or safety. Any records or information gained as a result of their work
under the quality improvement consultation program shall not be
disclosed to or shared with nonmanagerial department licensing or
complaint investigation staff, unless necessary to carry out duties
described under chapter 74.34 RCW. The emphasis should be on problem
prevention. Nothing in this section shall limit or interfere with the
consultant's mandated reporting duties under chapter 74.34 RCW.
(5) The department shall promote the development of a training
system that is practical and relevant to the needs of residents and
staff. To improve access to training, especially for rural
communities, the training system may include, but is not limited to,
the use of satellite technology distance learning that is coordinated
through community colleges or other appropriate organizations.
Sec. 8 RCW 18.20.130 and 2000 c 47 s 6 are each amended to read
as follows:
Standards for fire protection and the enforcement thereof, with
respect to all ((boarding homes)) assisted living facilities to be
licensed hereunder, shall be the responsibility of the chief of the
Washington state patrol, through the director of fire protection, who
shall adopt such recognized standards as may be applicable to
((boarding homes)) assisted living facilities for the protection of
life against the cause and spread of fire and fire hazards. The
department, upon receipt of an application for a license, shall submit
to the chief of the Washington state patrol, through the director of
fire protection, in writing, a request for an inspection, giving the
applicant's name and the location of the premises to be licensed. Upon
receipt of such a request, the chief of the Washington state patrol,
through the director of fire protection, or his or her deputy, shall
make an inspection of the ((boarding home)) assisted living facility to
be licensed, and if it is found that the premises do not comply with
the required safety standards and fire rules as adopted by the chief of
the Washington state patrol, through the director of fire protection,
he or she shall promptly make a written report to the ((boarding home))
assisted living facility and the department as to the manner and time
allowed in which the premises must qualify for a license and set forth
the conditions to be remedied with respect to fire rules. The
department, applicant, or licensee shall notify the chief of the
Washington state patrol, through the director of fire protection, upon
completion of any requirements made by him or her, and the chief of the
Washington state patrol, through the director of fire protection, or
his or her deputy, shall make a reinspection of such premises.
Whenever the ((boarding home)) assisted living facility to be licensed
meets with the approval of the chief of the Washington state patrol,
through the director of fire protection, he or she shall submit to the
department a written report approving same with respect to fire
protection before a full license can be issued. The chief of the
Washington state patrol, through the director of fire protection, shall
make or cause to be made inspections of such ((homes)) facilities at
least annually.
In cities which have in force a comprehensive building code, the
provisions of which are determined by the chief of the Washington state
patrol, through the director of fire protection, to be equal to the
minimum standards of the code for ((boarding homes)) assisted living
facilities adopted by the chief of the Washington state patrol, through
the director of fire protection, the chief of the fire department,
provided the latter is a paid chief of a paid fire department, shall
make the inspection with the chief of the Washington state patrol,
through the director of fire protection, or his or her deputy, and they
shall jointly approve the premises before a full license can be issued.
Sec. 9 RCW 18.20.140 and 1957 c 253 s 14 are each amended to read
as follows:
Any person operating or maintaining any ((boarding home)) assisted
living facility without a license under this chapter shall be guilty of
a misdemeanor and each day of a continuing violation shall be
considered a separate offense.
Sec. 10 RCW 18.20.150 and 1957 c 253 s 15 are each amended to
read as follows:
Notwithstanding the existence or use of any other remedy, the
department, may, in the manner provided by law, upon the advice of the
attorney general who shall represent the department in the proceedings,
maintain an action in the name of the state for an injunction or other
process against any person to restrain or prevent the operation or
maintenance of ((a boarding home)) an assisted living facility without
a license under this chapter.
Sec. 11 RCW 18.20.160 and 2004 c 142 s 12 are each amended to
read as follows:
No person operating ((a boarding home)) an assisted living facility
licensed under this chapter shall admit to or retain in the ((boarding
home)) assisted living facility any aged person requiring nursing or
medical care of a type provided by institutions licensed under chapters
18.51, 70.41 or 71.12 RCW, except that when registered nurses are
available, and upon a doctor's order that a supervised medication
service is needed, it may be provided. Supervised medication services,
as defined by the department and consistent with chapters 69.41 and
18.79 RCW, may include an approved program of self-medication or self-directed medication. Such medication service shall be provided only to
residents who otherwise meet all requirements for residency in ((a
boarding home)) an assisted living facility. No ((boarding home))
assisted living facility shall admit or retain a person who requires
the frequent presence and frequent evaluation of a registered nurse,
excluding persons who are receiving hospice care or persons who have a
short-term illness that is expected to be resolved within fourteen
days.
Sec. 12 RCW 18.20.170 and 1957 c 253 s 17 are each amended to
read as follows:
Nothing in this chapter or the rules and regulations adopted
pursuant thereto shall be construed as authorizing the supervision,
regulation, or control of the remedial care or treatment of residents
in any ((boarding home)) assisted living facility conducted for those
who rely upon treatment by prayer or spiritual means in accordance with
the creed or tenets of any well-recognized church or religious
denomination.
Sec. 13 RCW 18.20.190 and 2003 c 231 s 6 are each amended to read
as follows:
(1) The department of social and health services is authorized to
take one or more of the actions listed in subsection (2) of this
section in any case in which the department finds that ((a boarding
home)) an assisted living facility provider has:
(a) Failed or refused to comply with the requirements of this
chapter or the rules adopted under this chapter;
(b) Operated ((a boarding home)) an assisted living facility
without a license or under a revoked license;
(c) Knowingly, or with reason to know, made a false statement of
material fact on his or her application for license or any data
attached thereto, or in any matter under investigation by the
department; or
(d) Willfully prevented or interfered with any inspection or
investigation by the department.
(2) When authorized by subsection (1) of this section, the
department may take one or more of the following actions:
(a) Refuse to issue a license;
(b) Impose reasonable conditions on a license, such as correction
within a specified time, training, and limits on the type of clients
the provider may admit or serve;
(c) Impose civil penalties of not more than one hundred dollars per
day per violation;
(d) Suspend, revoke, or refuse to renew a license;
(e) Suspend admissions to the ((boarding home)) assisted living
facility by imposing stop placement; or
(f) Suspend admission of a specific category or categories of
residents as related to the violation by imposing a limited stop
placement.
(3) When the department orders stop placement or a limited stop
placement, the facility shall not admit any new resident until the stop
placement or limited stop placement order is terminated. The
department may approve readmission of a resident to the facility from
a hospital or nursing home during the stop placement or limited stop
placement. The department shall terminate the stop placement or
limited stop placement when: (a) The violations necessitating the stop
placement or limited stop placement have been corrected; and (b) the
provider exhibits the capacity to maintain correction of the violations
previously found deficient. However, if upon the revisit the
department finds new violations that the department reasonably believes
will result in a new stop placement or new limited stop placement, the
previous stop placement or limited stop placement shall remain in
effect until the new stop placement or new limited stop placement is
imposed.
(4) After a department finding of a violation for which a stop
placement or limited stop placement has been imposed, the department
shall make an on-site revisit of the provider within fifteen working
days from the request for revisit, to ensure correction of the
violation. For violations that are serious or recurring or uncorrected
following a previous citation, and create actual or threatened harm to
one or more residents' well-being, including violations of residents'
rights, the department shall make an on-site revisit as soon as
appropriate to ensure correction of the violation. Verification of
correction of all other violations may be made by either a department
on-site revisit or by written or photographic documentation found by
the department to be credible. This subsection does not prevent the
department from enforcing license suspensions or revocations. Nothing
in this subsection shall interfere with or diminish the department's
authority and duty to ensure that the provider adequately cares for
residents, including to make departmental on-site revisits as needed to
ensure that the provider protects residents, and to enforce compliance
with this chapter.
(5) RCW 43.20A.205 governs notice of a license denial, revocation,
suspension, or modification. Chapter 34.05 RCW applies to department
actions under this section, except that orders of the department
imposing license suspension, stop placement, limited stop placement, or
conditions for continuation of a license are effective immediately upon
notice and shall continue pending any hearing.
(6) For the purposes of this section, "limited stop placement"
means the ability to suspend admission of a specific category or
categories of residents.
Sec. 14 RCW 18.20.220 and 1997 c 164 s 1 are each amended to read
as follows:
For the purpose of encouraging a nursing home licensed under
chapter 18.51 RCW to convert a portion or all of its licensed bed
capacity to provide enhanced adult residential care contracted services
under chapter 74.39A RCW, the department shall:
(1) Find the nursing home to be in satisfactory compliance with RCW
18.20.110 and 18.20.130, upon application for ((boarding home))
assisted living facility licensure and the production of copies of its
most recent nursing home inspection reports demonstrating compliance
with the safety standards and fire regulations, as required by RCW
18.51.140, and the state building code, as required by RCW 18.51.145,
including any waivers that may have been granted. However, ((boarding
home)) assisted living facility licensure requirements pertaining to
resident to bathing fixture/toilet ratio, corridor call system,
resident room door closures, and resident room windows may require
modification, unless determined to be functionally equivalent, based
upon a prelicensure survey inspection.
(2) Allow residents receiving enhanced adult residential care
services to make arrangements for on-site health care services,
consistent with Title 18 RCW regulating health care professions, to the
extent that such services can be provided while maintaining the
resident's right to privacy and safety in treatment, but this in no way
means that such services may only be provided in a private room. The
provision of on-site health care services must otherwise be consistent
with RCW 18.20.160 and the rules adopted under RCW 18.20.160.
Sec. 15 RCW 18.20.230 and 1999 c 372 s 3 are each amended to read
as follows:
(1) The department of social and health services shall review, in
coordination with the department of health, the nursing care quality
assurance commission, adult family home providers, ((boarding home))
assisted living facility providers, in-home personal care providers,
and long-term care consumers and advocates, training standards for
administrators and resident caregiving staff. Any proposed
enhancements shall be consistent with this section, shall take into
account and not duplicate other training requirements applicable to
((boarding homes)) assisted living facilities and staff, and shall be
developed with the input of ((boarding home)) assisted living facility
and resident representatives, health care professionals, and other
vested interest groups. Training standards and the delivery system
shall be relevant to the needs of residents served by the ((boarding
home)) assisted living facility and recipients of long-term in-home
personal care services and shall be sufficient to ensure that
administrators and caregiving staff have the skills and knowledge
necessary to provide high quality, appropriate care.
(2) The recommendations on training standards and the delivery
system developed under subsection (1) of this section shall be based on
a review and consideration of the following: Quality of care;
availability of training; affordability, including the training costs
incurred by the department of social and health services and private
providers; portability of existing training requirements; competency
testing; practical and clinical course work; methods of delivery of
training; standards for management and caregiving staff training; and
necessary enhancements for special needs populations and resident
rights training. Residents with special needs include, but are not
limited to, residents with a diagnosis of mental illness, dementia, or
developmental disability.
Sec. 16 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 who provides residents with
hands-on personal care on behalf of ((a boarding home)) an assisted
living facility, 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.
(2) Training must have the following components: Orientation,
basic training, specialty training as appropriate, and continuing
education. All ((boarding home)) assisted living facility employees or
volunteers who routinely interact with residents shall complete
orientation. ((Boarding home)) Assisted living facility
administrators, or their designees, and caregivers shall complete
orientation, basic training, specialty training as appropriate, and
continuing education.
(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)) assisted living facility staff to all
((boarding home)) assisted living facility 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 shall not provide hands-on personal care to
residents without direct supervision. ((Boarding home)) Assisted
living facility 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) For ((boarding homes)) assisted living facilities 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. 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. ((Boarding home)) Assisted
living facility 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)) assisted living facility 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. 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) 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) 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) 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) The department shall develop criteria for the approval of
orientation, basic training, and specialty training programs.
(11) ((Boarding homes)) assisted living facilities that desire to
deliver facility-based training with facility designated trainers, or
((boarding homes)) assisted living facilities 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)) an assisted living facility
administrator that the ((boarding home's)) assisted living facility'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) 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. 17 RCW 18.20.280 and 2003 c 231 s 7 are each amended to read
as follows:
(1) The ((boarding home)) assisted living facility must assume
general responsibility for each resident and must promote each
resident's health, safety, and well-being consistent with the resident
negotiated care plan.
(2) The ((boarding home)) assisted living facility is not required
to supervise the activities of a person providing care or services to
a resident when the resident, or legal representative, has
independently arranged for or contracted with the person and the person
is not directly or indirectly controlled or paid by the ((boarding
home)) assisted living facility. However, the ((boarding home))
assisted living facility is required to coordinate services with such
person to the extent allowed by the resident, or legal representative,
and consistent with the resident's negotiated care plan. Further, the
((boarding home)) assisted living facility is required to observe the
resident and respond appropriately to any changes in the resident's
overall functioning consistent with chapter 70.129 RCW, this chapter,
and rules adopted under this chapter.
Sec. 18 RCW 18.20.290 and 2006 c 64 s 1 are each amended to read
as follows:
(1) When ((a boarding home)) an assisted living facility contracts
with the department to provide adult residential care services,
enhanced adult residential care services, or assisted living services
under chapter 74.39A RCW, the ((boarding home)) assisted living
facility must hold a medicaid eligible resident's room or unit when
short-term care is needed in a nursing home or hospital, the resident
is likely to return to the ((boarding home)) assisted living facility,
and payment is made under subsection (2) of this section.
(2) The medicaid resident's bed or unit shall be held for up to
twenty days. The per day bed or unit hold compensation amount shall be
seventy percent of the daily rate paid for the first seven days the bed
or unit is held for the resident who needs short-term nursing home care
or hospitalization. The rate for the eighth through the twentieth day
a bed is held shall be established in rule, but shall be no lower than
ten dollars per day the bed or unit is held.
(3) The ((boarding home)) assisted living facility may seek third-party payment to hold a bed or unit for twenty-one days or longer. The
third-party payment shall not exceed the medicaid daily rate paid to
the facility for the resident. If third-party payment is not
available, the medicaid resident may return to the first available and
appropriate bed or unit, if the resident continues to meet the
admission criteria under this chapter.
Sec. 19 RCW 18.20.300 and 2004 c 142 s 2 are each amended to read
as follows:
(1) ((A boarding home)) An assisted living facility, licensed under
this chapter, may provide domiciliary care services, as defined in this
chapter, and shall disclose the scope of care and services that it
chooses to provide.
(2) The ((boarding home)) assisted living facility licensee shall
disclose to the residents, the residents' legal representative if any,
and if not, the residents' representative if any, and to interested
consumers upon request, the scope of care and services offered, using
the form developed and provided by the department, in addition to any
supplemental information that may be provided by the licensee. The
form that the department develops shall be standardized, reasonable in
length, and easy to read. The ((boarding home's)) assisted living
facility's disclosure statement shall indicate the scope of domiciliary
care assistance provided and shall indicate that it permits the
resident or the resident's legal representative to independently
arrange for outside services under RCW 18.20.380.
(3)(a) If the ((boarding home)) assisted living facility licensee
decreases the scope of services that it provides due to circumstances
beyond the licensee's control, the licensee shall provide a minimum of
thirty days' written notice to the residents, the residents' legal
representative if any, and if not, the residents' representative if
any, before the effective date of the decrease in the scope of care or
services provided.
(b) If the licensee voluntarily decreases the scope of services,
and any such decrease in the scope of services provided will result in
the discharge of one or more residents, then ninety days' written
notice shall be provided prior to the effective date of the decrease.
Notice shall be provided to the affected residents, the residents'
legal representative if any, and if not, the residents' representative
if any.
(c) If the ((boarding home)) assisted living facility licensee
increases the scope of services that it chooses to provide, the
licensee shall promptly provide written notice to the residents, the
residents' legal representative if any, and if not, the residents'
representative if any, and shall indicate the date on which the
increase in the scope of care or services is effective.
(4) When the care needs of a resident exceed the disclosed scope of
care or services that ((a boarding home)) an assisted living facility
licensee provides, the licensee may exceed the care or services
disclosed consistent with RCW 70.129.030(3) and 70.129.110(3)(a).
Providing care or services to a resident that exceed the care and
services disclosed may or may not mean that the provider is capable of
or required to provide the same care or services to other residents.
(5) Even though the ((boarding home)) assisted living facility
licensee may disclose that it can provide certain care or services to
resident applicants or to their legal representative if any, and if
not, to the resident applicants' representative if any, the licensee
may deny admission to a resident applicant when the licensee determines
that the needs of the resident applicant cannot be met, as long as the
provider operates in compliance with state and federal law, including
RCW 70.129.030(3).
(6) The disclosure form is intended to assist consumers in
selecting ((boarding home)) assisted living facility services and,
therefore, shall not be construed as an implied or express contract
between the ((boarding home)) assisted living facility licensee and the
resident.
Sec. 20 RCW 18.20.310 and 2004 c 142 s 3 are each amended to read
as follows:
(1) ((Boarding homes)) Assisted living facilities are not required
to provide assistance with one or more activities of daily living.
(2) If ((a boarding home)) an assisted living facility licensee
chooses to provide assistance with activities of daily living, the
licensee shall provide at least the minimal level of assistance for all
activities of daily living consistent with subsection (3) of this
section and consistent with the reasonable accommodation requirements
in state or federal laws. Activities of daily living are limited to
and include the following:
(a) Bathing;
(b) Dressing;
(c) Eating;
(d) Personal hygiene;
(e) Transferring;
(f) Toileting; and
(g) Ambulation and mobility.
(3) The department shall, in rule, define the minimum level of
assistance that will be provided for all activities of daily living,
however, such rules shall not require more than occasional stand-by
assistance or more than occasional physical assistance.
(4) The licensee shall clarify, through the disclosure form, the
assistance with activities of daily living that may be provided, and
any limitations or conditions that may apply. The licensee shall also
clarify through the disclosure form any additional services that may be
provided.
(5) In providing assistance with activities of daily living, the
((boarding home)) assisted living facility shall observe the resident
for changes in overall functioning and respond appropriately when there
are observable or reported changes in the resident's physical, mental,
or emotional functioning.
Sec. 21 RCW 18.20.320 and 2004 c 142 s 4 are each amended to read
as follows:
(1) The ((boarding home)) assisted living facility licensee may
choose to provide any of the following health support services,
however, the facility may or may not need to provide additional health
support services to comply with the reasonable accommodation
requirements in federal or state law:
(a) Blood glucose testing;
(b) Puree diets;
(c) Calorie controlled diabetic diets;
(d) Dementia care;
(e) Mental health care; and
(f) Developmental disabilities care.
(2) The licensee shall clarify on the disclosure form any
limitations, additional services, or conditions that may apply.
(3) In providing health support services, the ((boarding home))
assisted living facility shall observe the resident for changes in
overall functioning and respond appropriately when there are observable
or reported changes in the resident's physical, mental, or emotional
functioning.
Sec. 22 RCW 18.20.330 and 2004 c 142 s 5 are each amended to read
as follows:
(1) ((Boarding homes)) Assisted living facilities are not required
to provide intermittent nursing services. The ((boarding home))
assisted living facility licensee may choose to provide any of the
following intermittent nursing services through appropriately licensed
and credentialed staff, however, the facility may or may not need to
provide additional intermittent nursing services to comply with the
reasonable accommodation requirements in federal or state law:
(a) Medication administration;
(b) Administration of health care treatments;
(c) Diabetic management;
(d) Nonroutine ostomy care;
(e) Tube feeding; and
(f) Nurse delegation consistent with chapter 18.79 RCW.
(2) The licensee shall clarify on the disclosure form any
limitations, additional services, or conditions that may apply under
this section.
(3) In providing intermittent nursing services, the ((boarding
home)) assisted living facility shall observe the resident for changes
in overall functioning and respond appropriately when there are
observable or reported changes in the resident's physical, mental, or
emotional functioning.
(4) The ((boarding home)) assisted living facility may provide
intermittent nursing services to the extent permitted by RCW 18.20.160.
Sec. 23 RCW 18.20.340 and 2004 c 142 s 6 are each amended to read
as follows:
(1) ((A boarding home)) An assisted living facility licensee may
permit a resident's family member to administer medications or
treatments or to provide medication or treatment assistance to the
resident. The licensee shall disclose to the department, residents,
the residents' legal representative if any, and if not, the residents'
representative if any, and to interested consumers upon request,
information describing whether the licensee permits such family
administration or assistance and, if so, the extent of limitations or
conditions thereof.
(2) If ((a boarding home)) an assisted living facility licensee
permits a resident's family member to administer medications or
treatments or to provide medication or treatment assistance, the
licensee shall request that the family member submit to the licensee a
written medication or treatment plan. At a minimum, the written
medication or treatment plan shall identify:
(a) By name, the family member who will administer the medication
or treatment or provide assistance therewith;
(b) The medication or treatment administration or assistance that
the family member will provide consistent with subsection (1) of this
section. This will be referred to as the primary plan;
(c) An alternate plan that will meet the resident's medication or
treatment needs if the family member is unable to fulfill his or her
duties as specified in the primary plan; and
(d) An emergency contact person and telephone number if the
((boarding home)) assisted living facility licensee observes changes in
the resident's overall functioning or condition that may relate to the
medication or treatment plan.
(3) The ((boarding home)) assisted living facility licensee may
require that the primary or alternate medication or treatment plan
include other information in addition to that specified in subsection
(2) of this section.
(4) The medication or treatment plan shall be signed and dated by:
(a) The resident, if able;
(b) The resident's legal representative, if any, and, if not, the
resident's representative, if any;
(c) The resident's family member; and
(d) The ((boarding home)) assisted living facility licensee.
(5) The ((boarding home)) assisted living facility may through
policy or procedure require the resident's family member to immediately
notify the ((boarding home)) assisted living facility licensee of any
change in the primary or alternate medication or treatment plan.
(6) When ((a boarding home)) an assisted living facility licensee
permits residents' family members to assist with or administer
medications or treatments, the licensee's duty of care, and any
negligence that may be attributed thereto, shall be limited to:
Observation of the resident for changes in overall functioning
consistent with RCW 18.20.280; notification to the person or persons
identified in RCW 70.129.030 when there are observed changes in the
resident's overall functioning or condition, or when the ((boarding
home)) assisted living facility is aware that both the primary and
alternate plan are not implemented; and appropriately responding to
obtain needed assistance when there are observable or reported changes
in the resident's physical or mental functioning.
Sec. 24 RCW 18.20.350 and 2008 c 146 s 3 are each amended to read
as follows:
(1) The ((boarding home)) assisted living facility licensee shall
conduct a preadmission assessment for each resident applicant. The
preadmission assessment shall include the following information, unless
unavailable despite the best efforts of the licensee:
(a) Medical history;
(b) Necessary and contraindicated medications;
(c) A licensed medical or health professional's diagnosis, unless
the individual objects for religious reasons;
(d) Significant known behaviors or symptoms that may cause concern
or require special care;
(e) Mental illness diagnosis, except where protected by
confidentiality laws;
(f) Level of personal care needs;
(g) Activities and service preferences; and
(h) Preferences regarding other issues important to the resident
applicant, such as food and daily routine.
(2) The ((boarding home)) assisted living facility licensee shall
complete the preadmission assessment before admission unless there is
an emergency. If there is an emergency admission, the preadmission
assessment shall be completed within five days of the date of
admission. For purposes of this section, "emergency" includes, but is
not limited to: Evening, weekend, or Friday afternoon admissions if
the resident applicant would otherwise need to remain in an unsafe
setting or be without adequate and safe housing.
(3) The ((boarding home)) assisted living facility licensee shall
complete an initial resident service plan upon move-in to identify the
resident's immediate needs and to provide direction to staff and
caregivers relating to the resident's immediate needs. The initial
resident service plan shall include as much information as can be
obtained, under subsection (1) of this section.
(4) When a facility provides respite care, before or at the time of
admission, the facility must obtain sufficient information to meet the
individual's anticipated needs. At a minimum, such information must
include:
(a) The name, address, and telephone number of the individual's
attending physician, and alternate physician if any;
(b) Medical and social history, which may be obtained from a
respite care assessment and service plan performed by a case manager
designated by an area agency on aging under contract with the
department, and mental and physical assessment data;
(c) Physician's orders for diet, medication, and routine care
consistent with the individual's status on admission;
(d) Ensure the individuals have assessments performed, where
needed, and where the assessment of the individual reveals symptoms of
tuberculosis, follow required tuberculosis testing requirements; and
(e) With the participation of the individual and, where
appropriate, their representative, develop a plan of care to maintain
or improve their health and functional status during their stay in the
facility.
Sec. 25 RCW 18.20.360 and 2004 c 142 s 8 are each amended to read
as follows:
(1) The ((boarding home)) assisted living facility licensee shall
within fourteen days of the resident's date of move-in, unless extended
by the department for good cause, and thereafter at least annually,
complete a full reassessment addressing the following:
(a) The individual's recent medical history, including, but not
limited to: A health professional's diagnosis, unless the resident
objects for religious reasons; chronic, current, and potential skin
conditions; known allergies to foods or medications; or other
considerations for providing care or services;
(b) Current necessary and contraindicated medications and
treatments for the individual, including:
(i) Any prescribed medications and over-the-counter medications
that are commonly taken by the individual, and that the individual is
able to independently self-administer or safely and accurately direct
others to administer to him or her;
(ii) Any prescribed medications and over-the-counter medications
that are commonly taken by the individual and that the individual is
able to self-administer when he or she has the assistance of a
resident-care staff person; and
(iii) Any prescribed medications and over-the-counter medications
that are commonly taken by the individual and that the individual is
not able to self-administer;
(c) The individual's nursing needs when the individual requires the
services of a nurse on the ((boarding home)) assisted living facility
premises;
(d) The individual's sensory abilities, including vision and
hearing;
(e) The individual's communication abilities, including modes of
expression, ability to make himself or herself understood, and ability
to understand others;
(f) Significant known behaviors or symptoms of the individual
causing concern or requiring special care, including: History of
substance abuse; history of harming self, others, or property, or other
conditions that may require behavioral intervention strategies; the
individual's ability to leave the ((boarding home)) assisted living
facility unsupervised; and other safety considerations that may pose a
danger to the individual or others, such as use of medical devices or
the individual's ability to smoke unsupervised, if smoking is permitted
in the ((boarding home)) assisted living facility;
(g) The individual's special needs, by evaluating available
information, or selecting and using an appropriate tool to determine
the presence of symptoms consistent with, and implications for care and
services of: Mental illness, or needs for psychological or mental
health services, except where protected by confidentiality laws;
developmental disability; dementia; or other conditions affecting
cognition, such as traumatic brain injury;
(h) The individual's level of personal care needs, including:
Ability to perform activities of daily living; medication management
ability, including the individual's ability to obtain and appropriately
use over-the-counter medications; and how the individual will obtain
prescribed medications for use in the ((boarding home)) assisted living
facility;
(i) The individual's activities, typical daily routines, habits,
and service preferences;
(j) The individual's personal identity and lifestyle, to the extent
the individual is willing to share the information, and the manner in
which they are expressed, including preferences regarding food,
community contacts, hobbies, spiritual preferences, or other sources of
pleasure and comfort; and
(k) Who has decision-making authority for the individual,
including: The presence of any advance directive, or other legal
document that will establish a substitute decision maker in the future;
the presence of any legal document that establishes a current
substitute decision maker; and the scope of decision-making authority
of any substitute decision maker.
(2) The assisted living facility shall complete a limited
assessment of a resident's change of condition when the resident's
negotiated service agreement no longer addresses the resident's current
needs.
Sec. 26 RCW 18.20.370 and 2004 c 142 s 9 are each amended to read
as follows:
(1) The ((boarding home)) assisted living facility licensee shall
complete a negotiated service agreement using the preadmission
assessment, initial resident service plan, and full reassessment
information obtained under RCW 18.20.350 and 18.20.360. The licensee
shall include the resident and the resident's legal representative if
any, or the resident's representative if any, in the development of the
negotiated service agreement. If the resident is a medicaid client,
the department's case manager shall also be involved.
(2) The negotiated service agreement shall be completed or updated:
(a) Within thirty days of the date of move-in;
(b) As necessary following the annual full assessment of the
resident; and
(c) Whenever the resident's negotiated service agreement no longer
adequately addresses the resident's current needs and preferences.
Sec. 27 RCW 18.20.380 and 2004 c 142 s 10 are each amended to
read as follows:
(1) The ((boarding home)) assisted living facility licensee shall
permit the resident, or the resident's legal representative if any, to
independently arrange for or contract with a practitioner licensed
under Title 18 RCW regulating health care professions, or a home
health, hospice, or home care agency licensed under chapter 70.127 RCW,
to provide on-site care and services to the resident, consistent with
RCW 18.20.160 and chapter 70.129 RCW. The ((boarding home)) licensee
may permit the resident, or the resident's legal representative if any,
to independently arrange for other persons to provide on-site care and
services to the resident.
(2) The ((boarding home)) assisted living facility licensee may
establish policies and procedures that describe limitations,
conditions, or requirements that must be met prior to an outside
service provider being allowed on-site.
(3) When the resident or the resident's legal representative
independently arranges for outside services under subsection (1) of
this section, the licensee's duty of care, and any negligence that may
be attributed thereto, shall be limited to: The responsibilities
described under subsection (4) of this section, excluding supervising
the activities of the outside service provider; observation of the
resident for changes in overall functioning, consistent with RCW
18.20.280; notification to the person or persons identified in RCW
70.129.030 when there are observed changes in the resident's overall
functioning or condition; and appropriately responding to obtain needed
assistance when there are observable or reported changes in the
resident's physical or mental functioning.
(4) Consistent with RCW 18.20.280, the ((boarding home)) assisted
living facility licensee shall not be responsible for supervising the
activities of the outside service provider. When information sharing
is authorized by the resident or the resident's legal representative,
the licensee shall request such information and integrate relevant
information from the outside service provider into the resident's
negotiated service agreement, only to the extent that such information
is actually shared with the licensee.
Sec. 28 RCW 18.20.390 and 2006 c 209 s 3 are each amended to read
as follows:
(1) To ensure the proper delivery of services and the maintenance
and improvement in quality of care through self-review, any ((boarding
home)) assisted living facility licensed under this chapter may
maintain a quality assurance committee that, at a minimum, includes:
(a) A licensed registered nurse under chapter 18.79 RCW;
(b) The administrator; and
(c) Three other members from the staff of the ((boarding home))
assisted living facility.
(2) When established, the quality assurance committee shall meet at
least quarterly to identify issues that may adversely affect quality of
care and services to residents and to develop and implement plans of
action to correct identified quality concerns or deficiencies in the
quality of care provided to residents.
(3) To promote quality of care through self-review without the fear
of reprisal, and to enhance the objectivity of the review process, the
department shall not require, and the long-term care ombudsman program
shall not request, disclosure of any quality assurance committee
records or reports, unless the disclosure is related to the committee's
compliance with this section, if:
(a) The records or reports are not maintained pursuant to statutory
or regulatory mandate; and
(b) The records or reports are created for and collected and
maintained by the committee.
(4) If the ((boarding home)) assisted living facility refuses to
release records or reports that would otherwise be protected under this
section, the department may then request only that information that is
necessary to determine whether the ((boarding home)) assisted living
facility has a quality assurance committee and to determine that it is
operating in compliance with this section. However, if the ((boarding
home)) assisted living facility offers the department documents
generated by, or for, the quality assurance committee as evidence of
compliance with ((boarding home)) assisted living facility
requirements, the documents are protected as quality assurance
committee documents under subsections (6) and (8) of this section when
in the possession of the department. The department is not liable for
an inadvertent disclosure, a disclosure related to a required federal
or state audit, or disclosure of documents incorrectly marked as
quality assurance committee documents by the facility.
(5) Good faith attempts by the committee to identify and correct
quality deficiencies shall not be used as a basis for sanctions.
(6) Information and documents, including the analysis of complaints
and incident reports, created specifically for, and collected and
maintained by, a quality assurance committee are not subject to
discovery or introduction into evidence in any civil action, and no
person who was in attendance at a meeting of such committee or who
participated in the creation, collection, or maintenance of information
or documents specifically for the committee shall be permitted or
required to testify as to the content of such proceedings or the
documents and information prepared specifically for the committee.
This subsection does not preclude:
(a) In any civil action, the discovery of the identity of persons
involved in the care that is the basis of the civil action whose
involvement was independent of any quality improvement committee
activity;
(b) In any civil action, the testimony of any person concerning the
facts which form the basis for the institution of such proceedings of
which the person had personal knowledge acquired independently of their
participation in the quality assurance committee activities.
(7) A quality assurance committee under subsection (1) of this
section, RCW 70.41.200, 74.42.640, 4.24.250, or 43.70.510 may share
information and documents, including the analysis of complaints and
incident reports, created specifically for, and collected and
maintained by, the committee, with one or more other quality assurance
committees created under subsection (1) of this section, RCW 70.41.200,
74.42.640, 4.24.250, or 43.70.510 for the improvement of the quality of
care and services rendered to ((boarding home)) assisted living
facility residents. Information and documents disclosed by one quality
assurance committee to another quality assurance committee and any
information and documents created or maintained as a result of the
sharing of information and documents shall not be subject to the
discovery process and confidentiality shall be respected as required by
subsections (6) and (8) of this section, RCW 43.70.510(4),
70.41.200(3), 4.24.250(1), and 74.42.640 (7) and (9). The privacy
protections of chapter 70.02 RCW and the federal health insurance
portability and accountability act of 1996 and its implementing
regulations apply to the sharing of individually identifiable patient
information held by a coordinated quality improvement program. Any
rules necessary to implement this section shall meet the requirements
of applicable federal and state privacy laws.
(8) Information and documents, including the analysis of complaints
and incident reports, created specifically for, and collected and
maintained by, a quality assurance committee are exempt from disclosure
under chapter 42.56 RCW.
(9) Notwithstanding any records created for the quality assurance
committee, the facility shall fully set forth in the resident's
records, available to the resident, the department, and others as
permitted by law, the facts concerning any incident of injury or loss
to the resident, the steps taken by the facility to address the
resident's needs, and the resident outcome.
Sec. 29 RCW 18.20.400 and 2004 c 144 s 4 are each amended to read
as follows:
If during an inspection, reinspection, or complaint investigation
by the department, ((a boarding home)) an assisted living facility
corrects a violation or deficiency that the department discovers, the
department shall record and consider such violation or deficiency for
purposes of the facility's compliance history, however the licensor or
complaint investigator shall not include in the facility report the
violation or deficiency if the violation or deficiency:
(1) Is corrected to the satisfaction of the department prior to the
exit conference;
(2) Is not recurring; and
(3) Did not pose a significant risk of harm or actual harm to a
resident.
For the purposes of this section, "recurring" means that the
violation or deficiency was found under the same regulation or statute
in one of the two most recent preceding inspections, reinspections, or
complaint investigations.
Sec. 30 RCW 18.20.410 and 2005 c 505 s 1 are each amended to read
as follows:
The department of health, the department, and the building code
council shall develop standards for small ((boarding homes)) assisted
living facilities between seven and sixteen beds that address at least
the following issues:
(1) Domestic food refrigeration and freezer storage;
(2) Sinks and sink placement;
(3) Dishwashers;
(4) Use of heat supplements for water temperature in clothes
washers;
(5) Yard shrubbery;
(6) Number of janitorial rooms in a facility;
(7) Number and cross-purpose of dirty rooms;
(8) Instant hot water faucets;
(9) Medication refrigeration; and
(10) Walled and gated facilities.
Based on the standards developed under this section, the department
of health and the building code council shall study the risks and
benefits of modifying and simplifying construction and equipment
standards for ((boarding homes)) assisted living facilities with a
capacity of seven to sixteen persons. The study shall include
coordination with the department. The department of health shall
report its findings and recommendations to appropriate committees of
the legislature no later than December 1, 2005.
Sec. 31 RCW 18.20.420 and 2007 c 162 s 1 are each amended to read
as follows:
(1) If the department determines that the health, safety, or
welfare of residents is immediately jeopardized by ((a boarding
home's)) an assisted living facility's failure or refusal to comply
with the requirements of this chapter or the rules adopted under this
chapter, and the department summarily suspends the ((boarding home))
assisted living facility license, the department may appoint a
temporary manager of the ((boarding home)) assisted living facility, or
the licensee may, subject to the department's approval, voluntarily
participate in the temporary management program.
The purposes of the temporary management program are as follows:
(a) To mitigate dislocation and transfer trauma of residents while
the department and licensee may pursue dispute resolution or appeal of
a summary suspension of license;
(b) To facilitate the continuity of safe and appropriate resident
care and services;
(c) To protect the health, safety, and welfare of residents, by
providing time for an orderly closure of the ((boarding home)) assisted
living facility, or for the deficiencies that necessitated temporary
management to be corrected; and
(d) To preserve a residential option that meets a specialized
service need or is in a geographical area that has a lack of available
providers.
(2) The department may recruit, approve, and appoint qualified
individuals, partnerships, corporations, and other entities interested
in serving as a temporary manager of ((a boarding home)) an assisted
living facility. These individuals and entities shall satisfy the
criteria established under this chapter or by the department for
approving licensees. The department shall not approve or appoint any
person, including partnerships and other entities, if that person is
affiliated with the ((boarding home)) assisted living facility subject
to the temporary management, or has owned or operated ((a boarding
home)) an assisted living facility ordered into temporary management or
receivership in any state. When approving or appointing a temporary
manager, the department shall consider the temporary manager's past
experience in long-term care, the quality of care provided, the
temporary manager's availability, and the person's familiarity with
applicable state and federal laws. Subject to the provisions of this
section and RCW 18.20.430, the department's authority to approve or
appoint a temporary manager is discretionary and not subject to the
administrative procedure act, chapter 34.05 RCW.
(3) When the department appoints a temporary manager, the
department shall enter into a contract with the temporary manager and
shall order the licensee to cease operating the ((boarding home))
assisted living facility and immediately turn over to the temporary
manager possession and control of the ((boarding home)) assisted living
facility, including but not limited to all resident care records,
financial records, and other records necessary for operation of the
facility while temporary management is in effect. If the department
has not appointed a temporary manager and the licensee elects to
participate in the temporary management program, the licensee shall
select the temporary manager, subject to the department's approval, and
enter into a contract with the temporary manager, consistent with this
section. The department has the discretion to approve or revoke any
temporary management arrangements made by the licensee.
(4) When the department appoints a temporary manager, the costs
associated with the temporary management may be paid for through the
((boarding home)) assisted living facility temporary management account
established by RCW 18.20.430, or from other departmental funds, or a
combination thereof. All funds must be administered according to
department procedures. The department may enter into an agreement with
the licensee allowing the licensee to pay for some of the costs
associated with a temporary manager appointed by the department. If
the department has not appointed a temporary manager and the licensee
elects to participate in the temporary management program, the licensee
is responsible for all costs related to administering the temporary
management program at the ((boarding home)) assisted living facility
and contracting with the temporary manager.
(5) The temporary manager shall assume full responsibility for the
daily operations of the ((boarding home)) assisted living facility and
is responsible for correcting cited deficiencies and ensuring that all
minimum licensing requirements are met. The temporary manager must
comply with all state and federal laws and regulations applicable to
((boarding homes)) assisted living facilities. The temporary manager
shall protect the health, safety, and welfare of the residents for the
duration of the temporary management and shall perform all acts
reasonably necessary to ensure residents' needs are met. The temporary
management contract shall address the responsibility of the temporary
manager to pay past due debts. The temporary manager's specific
responsibilities may include, but are not limited to:
(a) Receiving and expending in a prudent and business-like manner
all current revenues of the ((boarding home)) assisted living facility,
provided that priority is given to debts and expenditures directly
related to providing care and meeting residents' needs;
(b) Hiring and managing all consultants and employees and firing
them for good cause;
(c) Making necessary purchases, repairs, and replacements, provided
that such expenditures in excess of five thousand dollars by a
temporary manager appointed by the department must be approved by the
department;
(d) Entering into contracts necessary for the operation of the
((boarding home)) assisted living facility;
(e) Preserving resident trust funds and resident records; and
(f) Preparing all department-required reports, including a detailed
monthly accounting of all expenditures and liabilities, which shall be
sent to the department and the licensee.
(6) The licensee and department shall provide written notification
immediately to all residents, resident representatives, interested
family members, and the state long-term care ombudsman program of the
temporary management and the reasons for it. This notification shall
include notice that residents may move from the ((boarding home))
assisted living facility without notifying the licensee or temporary
manager in advance, and without incurring any charges, fees, or costs
otherwise available for insufficient advance notice, during the
temporary management period. The notification shall also inform
residents and their families or representatives that the temporary
management team will provide residents help with relocation and
appropriate discharge planning and coordination if desired. The
department shall provide assistance with relocation to residents who
are department clients and may provide such assistance to other
residents. The temporary manager shall meet regularly with staff,
residents, residents' representatives, and families to inform them of
the plans for and progress achieved in the correction of deficiencies,
and of the plans for facility closure or continued operation.
(7) The department shall terminate temporary management:
(a) After sixty days unless good cause is shown to continue the
temporary management. Good cause for continuing the temporary
management exists when returning the ((boarding home)) assisted living
facility to its former licensee would subject residents to a threat to
health, safety, or welfare;
(b) When all residents are transferred and the ((boarding home))
assisted living facility is closed;
(c) When deficiencies threatening residents' health, safety, or
welfare are eliminated and the former licensee agrees to
department-specified conditions regarding the continued facility
operation; or
(d) When a new licensee assumes control of the ((boarding home))
assisted living facility.
Nothing in this section precludes the department from revoking its
approval of the temporary management or exercising its licensing
enforcement authority under this chapter. The department's decision
whether to approve or to revoke a temporary management arrangement is
not subject to the administrative procedure act, chapter 34.05 RCW.
(8) The department shall indemnify, defend, and hold harmless any
temporary manager appointed or approved under this section against
claims made against the temporary manager for any actions by the
temporary manager or its agents that do not amount to intentional torts
or criminal behavior.
(9) The department may adopt rules implementing this section. In
the development of rules or policies implementing this section, the
department shall consult with residents and their representatives,
resident advocates, financial professionals, ((boarding home)) assisted
living facility providers, and organizations representing ((boarding
homes)) assisted living facilities.
Sec. 32 RCW 18.20.430 and 2007 c 162 s 2 are each amended to read
as follows:
The ((boarding home)) assisted living facility temporary management
account is created in the custody of the state treasurer. All receipts
from civil penalties imposed under this chapter must be deposited into
the account. Only the director or the director's designee may
authorize expenditures from the account. The account is subject to
allotment procedures under chapter 43.88 RCW, but an appropriation is
not required for expenditures. Expenditures from the account may be
used only for the protection of the health, safety, welfare, or
property of residents of ((boarding homes)) assisted living facilities
found to be deficient. Uses of the account include, but are not
limited to:
(1) Payment for the costs of relocation of residents to other
facilities;
(2) Payment to maintain operation of ((a boarding home)) an
assisted living facility pending correction of deficiencies or closure,
including payment of costs associated with temporary management
authorized under this chapter; and
(3) Reimbursement of residents for personal funds or property lost
or stolen when the resident's personal funds or property cannot be
recovered from the ((boarding home)) assisted living facility or third-party insurer.
Sec. 33 RCW 18.20.440 and 2008 c 251 s 1 are each amended to read
as follows:
(1) If ((a boarding home)) an assisted living facility voluntarily
withdraws from participation in a state medicaid program for
residential care and services under chapter 74.39A RCW, but continues
to provide services of the type provided by ((boarding homes)) assisted
living facilities, the facility's voluntary withdrawal from
participation is not an acceptable basis for the transfer or discharge
of residents of the facility (a) who were receiving medicaid on the day
before the effective date of the withdrawal; or (b) who have been
paying the facility privately for at least two years and who become
eligible for medicaid within one hundred eighty days of the date of
withdrawal.
(2) ((A boarding home)) An assisted living facility that has
withdrawn from the state medicaid program for residential care and
services under chapter 74.39A RCW must provide the following oral and
written notices to prospective residents. The written notice must be
prominent and must be written on a page that is separate from the other
admission documents. The notice shall provide that:
(a) The facility will not participate in the medicaid program with
respect to that resident; and
(b) The facility may transfer or discharge the resident from the
facility for nonpayment, even if the resident becomes eligible for
medicaid.
(3) Notwithstanding any other provision of this section, the
medicaid contract under chapter 74.39A RCW that exists on the day the
facility withdraws from medicaid participation is deemed to continue in
effect as to the persons described in subsection (1) of this section
for the purposes of:
(a) Department payments for the residential care and services
provided to such persons;
(b) Maintaining compliance with all requirements of the medicaid
contract between the department and the facility; and
(c) Ongoing inspection, contracting, and enforcement authority
under the medicaid contract, regulations, and law.
(4) Except as provided in subsection (1) of this section, this
section shall not apply to a person who begins residence in a facility
on or after the effective date of the facility's withdrawal from
participation in the medicaid program for residential care and
services.
(5) ((A boarding home)) An assisted living facility that is
providing residential care and services under chapter 74.39A RCW shall
give the department and its residents sixty days' advance notice of the
facility's intent to withdraw from participation in the medicaid
program.
(6) Prior to admission to the facility, ((a boarding home)) an
assisted living facility participating in the state medicaid program
for residential care and services under chapter 74.39A RCW must provide
the following oral and written notices to prospective residents. The
written notice must be prominent and must be written on a page that is
separate from the other admission documents, and must provide that:
(a) In the future, the facility may choose to withdraw from
participating in the medicaid program;
(b) If the facility withdraws from the medicaid program, it will
continue to provide services to residents (i) who were receiving
medicaid on the day before the effective date of the withdrawal; or
(ii) who have been paying the facility privately for at least two years
and who will become eligible for medicaid within one hundred eighty
days of the date of withdrawal;
(c) After a facility withdraws from the medicaid program, it may
transfer or discharge residents who do not meet the criteria described
in this section for nonpayment, even if the resident becomes eligible
for medicaid.
Sec. 34 RCW 18.20.900 and 1957 c 253 s 20 are each amended to
read as follows:
If any part, or parts, of this chapter shall be held
unconstitutional, the remaining provisions shall be given full force
and effect, as completely as if the part held unconstitutional had not
been included herein, if any such remaining part can then be
administered for the purpose of establishing and maintaining standards
for ((boarding homes)) assisted living facilities.
Sec. 35 RCW 18.51.010 and 1983 c 236 s 1 are each amended to read
as follows:
(1) "Nursing home" means any home, place or institution which
operates or maintains facilities providing convalescent or chronic
care, or both, for a period in excess of twenty-four consecutive hours
for three or more patients not related by blood or marriage to the
operator, who by reason of illness or infirmity, are unable properly to
care for themselves. Convalescent and chronic care may include but not
be limited to any or all procedures commonly employed in waiting on the
sick, such as administration of medicines, preparation of special
diets, giving of bedside nursing care, application of dressings and
bandages, and carrying out of treatment prescribed by a duly licensed
practitioner of the healing arts. It may also include care of mentally
incompetent persons. It may also include community-based care.
Nothing in this definition shall be construed to include general
hospitals or other places which provide care and treatment for the
acutely ill and maintain and operate facilities for major surgery or
obstetrics, or both. Nothing in this definition shall be construed to
include any ((boarding home)) assisted living facility, guest home,
hotel or related institution which is held forth to the public as
providing, and which is operated to give only board, room and laundry
to persons not in need of medical or nursing treatment or supervision
except in the case of temporary acute illness. The mere designation by
the operator of any place or institution as a hospital, sanitarium, or
any other similar name, which does not provide care for the acutely ill
and maintain and operate facilities for major surgery or obstetrics, or
both, shall not exclude such place or institution from the provisions
of this chapter: PROVIDED, That any nursing home providing psychiatric
treatment shall, with respect to patients receiving such treatment,
comply with the provisions of RCW 71.12.560 and 71.12.570.
(2) "Person" means any individual, firm, partnership, corporation,
company, association, or joint stock association, and the legal
successor thereof.
(3) "Secretary" means the secretary of the department of social and
health services.
(4) "Department" means the state department of social and health
services.
(5) "Community-based care" means but is not limited to the
following:
(a) Home delivered nursing services;
(b) Personal care;
(c) Day care;
(d) Nutritional services, both in-home and in a communal dining
setting;
(e) Habilitation care; and
(f) Respite care.
Sec. 36 RCW 18.52C.020 and 2001 c 319 s 3 are each amended to
read as follows:
Unless the context clearly requires otherwise, the definitions in
this section apply throughout this chapter.
(1) "Secretary" means the secretary of the department of health.
(2) "Health care facility" means a nursing home, hospital, hospice
care facility, home health care agency, hospice agency, ((boarding
home)) assisted living facility, group home, or other entity for the
delivery of health care or long-term care services, including chore
services provided under chapter 74.39A RCW.
(3) "Nursing home" means any nursing home facility licensed
pursuant to chapter 18.52 RCW.
(4) "Nursing pool" means any person engaged in the business of
providing, procuring, or referring health care or long-term care
personnel for temporary employment in health care facilities, such as
licensed nurses or practical nurses, nursing assistants, and chore
service providers. "Nursing pool" does not include an individual who
only engages in providing his or her own services.
(5) "Person" includes an individual, firm, corporation,
partnership, or association.
(6) "Adult family home" means a residential home licensed pursuant
to chapter 70.128 RCW.
Sec. 37 RCW 18.79.260 and 2009 c 203 s 1 are each amended to read
as follows:
(1) A registered nurse under his or her license may perform for
compensation nursing care, as that term is usually understood, to
individuals with illnesses, injuries, or disabilities.
(2) A registered nurse may, at or under the general direction of a
licensed physician and surgeon, dentist, osteopathic physician and
surgeon, naturopathic physician, optometrist, podiatric physician and
surgeon, physician assistant, osteopathic physician assistant, or
advanced registered nurse practitioner acting within the scope of his
or her license, administer medications, treatments, tests, and
inoculations, whether or not the severing or penetrating of tissues is
involved and whether or not a degree of independent judgment and skill
is required. Such direction must be for acts which are within the
scope of registered nursing practice.
(3) A registered nurse may delegate tasks of nursing care to other
individuals where the registered nurse determines that it is in the
best interest of the patient.
(a) The delegating nurse shall:
(i) Determine the competency of the individual to perform the
tasks;
(ii) Evaluate the appropriateness of the delegation;
(iii) Supervise the actions of the person performing the delegated
task; and
(iv) Delegate only those tasks that are within the registered
nurse's scope of practice.
(b) A registered nurse, working for a home health or hospice agency
regulated under chapter 70.127 RCW, may delegate the application,
instillation, or insertion of medications to a registered or certified
nursing assistant under a plan of care.
(c) Except as authorized in (b) or (e) of this subsection, a
registered nurse may not delegate the administration of medications.
Except as authorized in (e) of this subsection, a registered nurse may
not delegate acts requiring substantial skill, and may not delegate
piercing or severing of tissues. Acts that require nursing judgment
shall not be delegated.
(d) No person may coerce a nurse into compromising patient safety
by requiring the nurse to delegate if the nurse determines that it is
inappropriate to do so. Nurses shall not be subject to any employer
reprisal or disciplinary action by the nursing care quality assurance
commission for refusing to delegate tasks or refusing to provide the
required training for delegation if the nurse determines delegation may
compromise patient safety.
(e) For delegation in community-based care settings or in-home care
settings, a registered nurse may delegate nursing care tasks only to
registered or certified nursing assistants. Simple care tasks such as
blood pressure monitoring, personal care service, diabetic insulin
device set up, verbal verification of insulin dosage for sight-impaired
individuals, or other tasks as defined by the nursing care quality
assurance commission are exempted from this requirement.
(i) "Community-based care settings" includes: Community
residential programs for people with developmental disabilities,
certified by the department of social and health services under chapter
71A.12 RCW; adult family homes licensed under chapter 70.128 RCW; and
((boarding homes)) assisted living facilities licensed under chapter
18.20 RCW. Community-based care settings do not include acute care or
skilled nursing facilities.
(ii) "In-home care settings" include an individual's place of
temporary or permanent residence, but does not include acute care or
skilled nursing facilities, and does not include community-based care
settings as defined in (e)(i) of this subsection.
(iii) Delegation of nursing care tasks in community-based care
settings and in-home care settings is only allowed for individuals who
have a stable and predictable condition. "Stable and predictable
condition" means a situation in which the individual's clinical and
behavioral status is known and does not require the frequent presence
and evaluation of a registered nurse.
(iv) The determination of the appropriateness of delegation of a
nursing task is at the discretion of the registered nurse. Other than
delegation of the administration of insulin by injection for the
purpose of caring for individuals with diabetes, the administration of
medications by injection, sterile procedures, and central line
maintenance may never be delegated.
(v) When delegating insulin injections under this section, the
registered nurse delegator must instruct the individual regarding
proper injection procedures and the use of insulin, demonstrate proper
injection procedures, and must supervise and evaluate the individual
performing the delegated task weekly during the first four weeks of
delegation of insulin injections. If the registered nurse delegator
determines that the individual is competent to perform the injection
properly and safely, supervision and evaluation shall occur at least
every ninety days thereafter.
(vi) The registered nurse shall verify that the nursing assistant
has completed the required core nurse delegation training required in
chapter 18.88A RCW prior to authorizing delegation.
(vii) The nurse is accountable for his or her own individual
actions in the delegation process. Nurses acting within the protocols
of their delegation authority are immune from liability for any action
performed in the course of their delegation duties.
(viii) Nursing task delegation protocols are not intended to
regulate the settings in which delegation may occur, but are intended
to ensure that nursing care services have a consistent standard of
practice upon which the public and the profession may rely, and to
safeguard the authority of the nurse to make independent professional
decisions regarding the delegation of a task.
(f) The nursing care quality assurance commission may adopt rules
to implement this section.
(4) Only a person licensed as a registered nurse may instruct
nurses in technical subjects pertaining to nursing.
(5) Only a person licensed as a registered nurse may hold herself
or himself out to the public or designate herself or himself as a
registered nurse.
Sec. 38 RCW 18.100.140 and 2011 c 336 s 503 are each amended to
read as follows:
Nothing in this chapter shall authorize a director, officer,
shareholder, agent, or employee of a corporation organized under this
chapter, or a corporation itself organized under this chapter, to do or
perform any act which would be illegal, unethical, or unauthorized
conduct under the provisions of the following acts: (1) Physicians and
surgeons, chapter 18.71 RCW; (2) anti-rebating act, chapter 19.68 RCW;
(3) state bar act, chapter 2.48 RCW; (4) professional accounting act,
chapter 18.04 RCW; (5) professional architects act, chapter 18.08 RCW;
(6) professional auctioneers act, chapter 18.11 RCW; (7)
cosmetologists, barbers, and manicurists, chapter 18.16 RCW; (8)
((boarding homes)) assisted living facilities act, chapter 18.20 RCW;
(9) podiatric medicine and surgery, chapter 18.22 RCW; (10)
chiropractic act, chapter 18.25 RCW; (11) registration of contractors,
chapter 18.27 RCW; (12) debt adjusting act, chapter 18.28 RCW; (13)
dental hygienist act, chapter 18.29 RCW; (14) dentistry, chapter 18.32
RCW; (15) dispensing opticians, chapter 18.34 RCW; (16) naturopathic
physicians, chapter 18.36A RCW; (17) embalmers and funeral directors,
chapter 18.39 RCW; (18) engineers and land surveyors, chapter 18.43
RCW; (19) escrow agents registration act, chapter 18.44 RCW; (20)
birthing centers, chapter 18.46 RCW; (21) midwifery, chapter 18.50 RCW;
(22) nursing homes, chapter 18.51 RCW; (23) optometry, chapter 18.53
RCW; (24) osteopathic physicians and surgeons, chapter 18.57 RCW; (25)
pharmacists, chapter 18.64 RCW; (26) physical therapy, chapter 18.74
RCW; (27) registered nurses, advanced registered nurse practitioners,
and practical nurses, chapter 18.79 RCW; (28) psychologists, chapter
18.83 RCW; (29) real estate brokers and salespersons, chapter 18.85
RCW; (30) veterinarians, chapter 18.92 RCW.
Sec. 39 RCW 35.21.766 and 2011 c 139 s 1 are each amended to read
as follows:
(1) Whenever a regional fire protection service authority
determines that the fire protection jurisdictions that are members of
the authority are not adequately served by existing private ambulance
service, the governing board of the authority may by resolution provide
for the establishment of a system of ambulance service to be operated
by the authority as a public utility or operated by contract after a
call for bids.
(2) The legislative authority of any city or town may establish an
ambulance service to be operated as a public utility. However, the
legislative authority of the city or town shall not provide for the
establishment of an ambulance service utility that would compete with
any existing private ambulance service, unless the legislative
authority of the city or town determines that the city or town, or a
substantial portion of the city or town, is not adequately served by an
existing private ambulance service. In determining the adequacy of an
existing private ambulance service, the legislative authority of the
city or town shall take into consideration objective generally accepted
medical standards and reasonable levels of service which shall be
published by the city or town legislative authority. The decision of
the city council or legislative body shall be a discretionary,
legislative act. When it is preliminarily concluded that the private
ambulance service is inadequate, before issuing a call for bids or
before the city or town establishes an ambulance service utility, the
legislative authority of the city or town shall allow a minimum of
sixty days for the private ambulance service to meet the generally
accepted medical standards and reasonable levels of service. In the
event of a second preliminary conclusion of inadequacy within a twenty-four month period, the legislative authority of the city or town may
immediately issue a call for bids or establish an ambulance service
utility and is not required to afford the private ambulance service
another sixty-day period to meet the generally accepted medical
standards and reasonable levels of service. Nothing in chapter 482,
Laws of 2005 is intended to supersede requirements and standards
adopted by the department of health. A private ambulance service which
is not licensed by the department of health or whose license is denied,
suspended, or revoked shall not be entitled to a sixty-day period
within which to demonstrate adequacy and the legislative authority may
immediately issue a call for bids or establish an ambulance service
utility.
(3) The city or town legislative authority is authorized to set and
collect rates and charges in an amount sufficient to regulate, operate,
and maintain an ambulance utility. Prior to setting such rates and
charges, the legislative authority must determine, through a cost-of-service study, the total cost necessary to regulate, operate, and
maintain the ambulance utility. Total costs shall not include capital
cost for the construction, major renovation, or major repair of the
physical plant. Once the legislative authority determines the total
costs, the legislative authority shall then identify that portion of
the total costs that are attributable to the availability of the
ambulance service and that portion of the total costs that are
attributable to the demand placed on the ambulance utility.
(a) Availability costs are those costs attributable to the basic
infrastructure needed to respond to a single call for service within
the utility's response criteria. Availability costs may include costs
for dispatch, labor, training of personnel, equipment, patient care
supplies, and maintenance of equipment.
(b) Demand costs are those costs that are attributable to the
burden placed on the ambulance service by individual calls for
ambulance service. Demand costs shall include costs related to
frequency of calls, distances from hospitals, and other factors
identified in the cost-of-service study conducted to assess burdens
imposed on the ambulance utility.
(4) A city or town legislative authority is authorized to set and
collect rates and charges as follows:
(a) The rate attributable to costs for availability described under
subsection (3)(a) of this section shall be uniformly applied across
user classifications within the utility;
(b) The rate attributable to costs for demand described under
subsection (3)(b) of this section shall be established and billed to
each utility user classification based on each user classification's
burden on the utility;
(c) The fee charged by the utility shall reflect a combination of
the availability cost and the demand cost;
(d)(i) Except as provided in (d)(ii) of this subsection, the
combined rates charged shall reflect an exemption for persons who are
medicaid eligible and who reside in a nursing facility, ((boarding
home)) assisted living facility, adult family home, or receive in-home
services. The combined rates charged may reflect an exemption or
reduction for designated classes consistent with Article VIII, section
7 of the state Constitution. The amounts of exemption or reduction
shall be a general expense of the utility, and designated as an
availability cost, to be spread uniformly across the utility user
classifications.
(ii) For cities with a population less than two thousand five
hundred that established an ambulance utility before May 6, 2004, the
combined rates charged may reflect an exemption or reduction for
persons who are medicaid eligible, and for designated classes
consistent with Article VIII, section 7 of the state Constitution;
(e)(i) Except as provided in (e)(ii) of this subsection (4), the
legislative authority must continue to allocate at least seventy
percent of the total amount of general fund revenues expended, as of
May 5, 2004, toward the total costs necessary to regulate, operate, and
maintain the ambulance service utility. However, cities or towns that
operated an ambulance service before May 6, 2004, and commingled
general fund dollars and ambulance service dollars, may reasonably
estimate that portion of general fund dollars that were, as of May 5,
2004, applied toward the operation of the ambulance service, and at
least seventy percent of such estimated amount must then continue to be
applied toward the total cost necessary to regulate, operate, and
maintain the ambulance utility. Cities and towns which first
established an ambulance service utility after May 6, 2004, must
allocate, from the general fund or emergency medical service levy
funds, or a combination of both, at least an amount equal to seventy
percent of the total costs necessary to regulate, operate, and maintain
the ambulance service utility as of May 5, 2004, or the date that the
utility is established.
(ii) After January 1, 2012, the legislative authority may allocate
general fund revenues toward the total costs necessary to regulate,
operate, and maintain the ambulance service utility in an amount less
than required by (e)(i) of this subsection (4). However, before making
any reduction to the general fund allocation, the legislative authority
must hold a public hearing, preceded by at least thirty days' notice
provided in each ratepayer's utility bill, at which the legislative
authority must allow for public comment and present:
(A) The utility's most recent cost of service study;
(B) A summary of the utility's current revenue sources;
(C) A proposed budget reflecting the reduced allocation of general
fund revenues;
(D) Any proposed change to utility rates; and
(E) Any anticipated impact to the utility's level of service;
(f) The legislative authority must allocate available emergency
medical service levy funds, in an amount proportionate to the
percentage of the ambulance service costs to the total combined
operating costs for emergency medical services and ambulance services,
towards the total costs necessary to regulate, operate, and maintain
the ambulance utility;
(g) The legislative authority must allocate all revenues received
through direct billing to the individual user of the ambulance service
to the demand-related costs under subsection (3)(b) of this section;
(h) The total revenue generated by the rates and charges shall not
exceed the total costs necessary to regulate, operate, and maintain an
ambulance utility; and
(i) Revenues generated by the rates and charges must be deposited
in a separate fund or funds and be used only for the purpose of paying
for the cost of regulating, maintaining, and operating the ambulance
utility.
(5) Ambulance service rates charged pursuant to this section do not
constitute taxes or charges under RCW 82.02.050 through 82.02.090, or
35.21.768, or charges otherwise prohibited by law.
Sec. 40 RCW 35A.70.020 and 1967 ex.s. c 119 s 35A.70.020 are each
amended to read as follows:
A code city may exercise the powers relating to enforcement of
regulations for ((boarding homes as authorized by RCW 18.20.100, in
accordance with the procedures therein prescribed and subject to any
limitations therein provided)) assisted living facilities.
Sec. 41 RCW 43.43.832 and 2011 c 253 s 6 are each amended to read
as follows:
(1) The legislature finds that businesses and organizations
providing services to children, developmentally disabled persons, and
vulnerable adults need adequate information to determine which
employees or licensees to hire or engage. The legislature further
finds that many developmentally disabled individuals and vulnerable
adults desire to hire their own employees directly and also need
adequate information to determine which employees or licensees to hire
or engage. Therefore, the Washington state patrol identification and
criminal history section shall disclose, upon the request of a business
or organization as defined in RCW 43.43.830, a developmentally disabled
person, or a vulnerable adult as defined in RCW 43.43.830 or his or her
guardian, an applicant's conviction record as defined in chapter 10.97
RCW.
(2) The legislature also finds that the Washington professional
educator standards board may request of the Washington state patrol
criminal identification system information regarding a certificate
applicant's conviction record under subsection (1) of this section.
(3) The legislature also finds that law enforcement agencies, the
office of the attorney general, prosecuting authorities, and the
department of social and health services may request this same
information to aid in the investigation and prosecution of child,
developmentally disabled person, and vulnerable adult abuse cases and
to protect children and adults from further incidents of abuse.
(4) The legislature further finds that the secretary of the
department of social and health services must establish rules and set
standards to require specific action when considering the information
listed in subsection (1) of this section, and when considering
additional information including but not limited to civil adjudication
proceedings as defined in RCW 43.43.830 and any out-of-state
equivalent, in the following circumstances:
(a) When considering persons for state employment in positions
directly responsible for the supervision, care, or treatment of
children, vulnerable adults, or individuals with mental illness or
developmental disabilities;
(b) When considering persons for state positions involving
unsupervised access to vulnerable adults to conduct comprehensive
assessments, financial eligibility determinations, licensing and
certification activities, investigations, surveys, or case management;
or for state positions otherwise required by federal law to meet
employment standards;
(c) When licensing agencies or facilities with individuals in
positions directly responsible for the care, supervision, or treatment
of children, developmentally disabled persons, or vulnerable adults,
including but not limited to agencies or facilities licensed under
chapter 74.15 or 18.51 RCW;
(d) When contracting with individuals or businesses or
organizations for the care, supervision, case management, or treatment,
including peer counseling, of children, developmentally disabled
persons, or vulnerable adults, including but not limited to services
contracted for under chapter 18.20, 70.127, 70.128, 72.36, or 74.39A
RCW or Title 71A RCW;
(e) When individual providers are paid by the state or providers
are paid by home care agencies to provide in-home services involving
unsupervised access to persons with physical, mental, or developmental
disabilities or mental illness, or to vulnerable adults as defined in
chapter 74.34 RCW, including but not limited to services provided under
chapter 74.39 or 74.39A RCW.
(5) The director of the department of early learning shall
investigate the conviction records, pending charges, and other
information including civil adjudication proceeding records of current
employees and of any person actively being considered for any position
with the department who will or may have unsupervised access to
children, or for state positions otherwise required by federal law to
meet employment standards. "Considered for any position" includes
decisions about (a) initial hiring, layoffs, reallocations, transfers,
promotions, or demotions, or (b) other decisions that result in an
individual being in a position that will or may have unsupervised
access to children as an employee, an intern, or a volunteer.
(6) The director of the department of early learning shall adopt
rules and investigate conviction records, pending charges, and other
information including civil adjudication proceeding records, in the
following circumstances:
(a) When licensing or certifying agencies with individuals in
positions that will or may have unsupervised access to children who are
in child day care, in early learning programs, or receiving early
childhood education services, including but not limited to licensees,
agency staff, interns, volunteers, contracted providers, and persons
living on the premises who are sixteen years of age or older;
(b) When authorizing individuals who will or may have unsupervised
access to children who are in child day care, in early learning
programs, or receiving early childhood learning education services in
licensed or certified agencies, including but not limited to licensees,
agency staff, interns, volunteers, contracted providers, and persons
living on the premises who are sixteen years of age or older;
(c) When contracting with any business or organization for
activities that will or may have unsupervised access to children who
are in child day care, in early learning programs, or receiving early
childhood learning education services;
(d) When establishing the eligibility criteria for individual
providers to receive state paid subsidies to provide child day care or
early learning services that will or may involve unsupervised access to
children.
(7) 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 pending completion of the state
background investigation. Whenever a national criminal record check
through the federal bureau of investigation is required by state law,
a person may be employed or engaged as a volunteer or independent
contractor on a conditional basis pending completion of the national
check. The Washington personnel resources board shall adopt rules to
accomplish the purposes of this subsection as it applies to state
employees.
(8)(a) For purposes of facilitating timely access to criminal
background information and to reasonably minimize the number of
requests made under this section, recognizing that certain health care
providers change employment frequently, health care facilities may,
upon request from another health care facility, share copies of
completed criminal background inquiry information.
(b) Completed criminal background inquiry information may be shared
by a willing health care facility only if the following conditions are
satisfied: The licensed health care facility sharing the criminal
background inquiry information is reasonably known to be the person's
most recent employer, no more than twelve months has elapsed from the
date the person was last employed at a licensed health care facility to
the date of their current employment application, and the criminal
background information is no more than two years old.
(c) If criminal background inquiry information is shared, the
health care facility employing the subject of the inquiry must require
the applicant to sign a disclosure statement indicating that there has
been no conviction or finding as described in RCW 43.43.842 since the
completion date of the most recent criminal background inquiry.
(d) Any health care facility that knows or has reason to believe
that an applicant has or may have a disqualifying conviction or finding
as described in RCW 43.43.842, subsequent to the completion date of
their most recent criminal background inquiry, shall be prohibited from
relying on the applicant's previous employer's criminal background
inquiry information. A new criminal background inquiry shall be
requested pursuant to RCW 43.43.830 through 43.43.842.
(e) Health care facilities that share criminal background inquiry
information shall be immune from any claim of defamation, invasion of
privacy, negligence, or any other claim in connection with any
dissemination of this information in accordance with this subsection.
(f) Health care facilities shall transmit and receive the criminal
background inquiry information in a manner that reasonably protects the
subject's rights to privacy and confidentiality.
(g) For the purposes of this subsection, "health care facility"
means a nursing home licensed under chapter 18.51 RCW, ((a boarding
home)) an assisted living facility licensed under chapter 18.20 RCW, or
an adult family home licensed under chapter 70.128 RCW.
Sec. 42 RCW 46.19.020 and 2010 c 161 s 702 are each amended to
read as follows:
(1) The following organizations may apply for special parking
privileges:
(a) Public transportation authorities;
(b) Nursing homes licensed under chapter 18.51 RCW;
(c) ((Boarding homes)) Assisted living facilities licensed under
chapter 18.20 RCW;
(d) Senior citizen centers;
(e) Private nonprofit corporations, as defined in RCW 24.03.005;
and
(f) Cabulance companies that regularly transport persons with
disabilities who have been determined eligible for special parking
privileges under this section and who are registered with the
department under chapter 46.72 RCW.
(2) An organization that qualifies for special parking privileges
may receive, upon application, parking license plates or placards, or
both, for persons with disabilities as defined by the department.
(3) Public transportation authorities, nursing homes, ((boarding
homes)) assisted living facilities, senior citizen centers, private
nonprofit corporations, and cabulance services are responsible for
ensuring that the special placards and license plates are not used
improperly and are responsible for all fines and penalties for improper
use.
(4) The department shall adopt rules to determine organization
eligibility.
Sec. 43 RCW 48.43.125 and 1999 c 312 s 2 are each amended to read
as follows:
(1) A carrier that provides coverage for a person at a long-term
care facility following the person's hospitalization shall, upon the
request of the person or his or her legal representative as authorized
in RCW 7.70.065, provide such coverage at the facility in which the
person resided immediately prior to the hospitalization if:
(a) The person's primary care physician determines that the medical
care needs of the person can be met at the requested facility;
(b) The requested facility has all applicable licenses and
certifications, and is not under a stop placement order that prevents
the person's readmission;
(c) The requested facility agrees to accept payment from the
carrier for covered services at the rate paid to similar facilities
that otherwise contract with the carrier to provide such services; and
(d) The requested facility, with regard to the following, agrees to
abide by the standards, terms, and conditions required by the carrier
of similar facilities with which the carrier otherwise contracts: (i)
Utilization review, quality assurance, and peer review; and (ii)
management and administrative procedures, including data and financial
reporting that may be required by the carrier.
(2) For purposes of this section, "long-term care facility" or
"facility" means a nursing facility licensed under chapter 18.51 RCW,
continuing care retirement community defined under RCW 70.38.025,
((boarding home)) or assisted living facility licensed under chapter
18.20 RCW((, or assisted living facility)).
Sec. 44 RCW 69.41.010 and 2009 c 549 s 1024 are each amended to
read as follows:
As used in this chapter, the following terms have the meanings
indicated unless the context clearly requires otherwise:
(1) "Administer" means the direct application of a legend drug
whether by injection, inhalation, ingestion, or any other means, to the
body of a patient or research subject by:
(a) A practitioner; or
(b) The patient or research subject at the direction of the
practitioner.
(2) "Community-based care settings" include: Community residential
programs for the developmentally disabled, certified by the department
of social and health services under chapter 71A.12 RCW; adult family
homes licensed under chapter 70.128 RCW; and ((boarding homes))
assisted living facilities licensed under chapter 18.20 RCW.
Community-based care settings do not include acute care or skilled
nursing facilities.
(3) "Deliver" or "delivery" means the actual, constructive, or
attempted transfer from one person to another of a legend drug, whether
or not there is an agency relationship.
(4) "Department" means the department of health.
(5) "Dispense" means the interpretation of a prescription or order
for a legend drug and, pursuant to that prescription or order, the
proper selection, measuring, compounding, labeling, or packaging
necessary to prepare that prescription or order for delivery.
(6) "Dispenser" means a practitioner who dispenses.
(7) "Distribute" means to deliver other than by administering or
dispensing a legend drug.
(8) "Distributor" means a person who distributes.
(9) "Drug" means:
(a) Substances recognized as drugs in the official United States
pharmacopoeia, official homeopathic pharmacopoeia of the United States,
or official national formulary, or any supplement to any of them;
(b) Substances intended for use in the diagnosis, cure, mitigation,
treatment, or prevention of disease in human beings or animals;
(c) Substances (other than food, minerals or vitamins) intended to
affect the structure or any function of the body of human beings or
animals; and
(d) Substances intended for use as a component of any article
specified in (a), (b), or (c) of this subsection. It does not include
devices or their components, parts, or accessories.
(10) "Electronic communication of prescription information" means
the communication of prescription information by computer, or the
transmission of an exact visual image of a prescription by facsimile,
or other electronic means for original prescription information or
prescription refill information for a legend drug between an authorized
practitioner and a pharmacy or the transfer of prescription information
for a legend drug from one pharmacy to another pharmacy.
(11) "In-home care settings" include an individual's place of
temporary and permanent residence, but does not include acute care or
skilled nursing facilities, and does not include community-based care
settings.
(12) "Legend drugs" means any drugs which are required by state law
or regulation of the state board of pharmacy to be dispensed on
prescription only or are restricted to use by practitioners only.
(13) "Legible prescription" means a prescription or medication
order issued by a practitioner that is capable of being read and
understood by the pharmacist filling the prescription or the nurse or
other practitioner implementing the medication order. A prescription
must be hand printed, typewritten, or electronically generated.
(14) "Medication assistance" means assistance rendered by a
nonpractitioner to an individual residing in a community-based care
setting or in-home care setting to facilitate the individual's self-administration of a legend drug or controlled substance. It includes
reminding or coaching the individual, handing the medication container
to the individual, opening the individual's medication container, using
an enabler, or placing the medication in the individual's hand, and
such other means of medication assistance as defined by rule adopted by
the department. A nonpractitioner may help in the preparation of
legend drugs or controlled substances for self-administration where a
practitioner has determined and communicated orally or by written
direction that such medication preparation assistance is necessary and
appropriate. Medication assistance shall not include assistance with
intravenous medications or injectable medications, except prefilled
insulin syringes.
(15) "Person" means individual, corporation, government or
governmental subdivision or agency, business trust, estate, trust,
partnership or association, or any other legal entity.
(16) "Practitioner" means:
(a) A physician under chapter 18.71 RCW, an osteopathic physician
or an osteopathic physician and surgeon under chapter 18.57 RCW, a
dentist under chapter 18.32 RCW, a podiatric physician and surgeon
under chapter 18.22 RCW, a veterinarian under chapter 18.92 RCW, a
registered nurse, advanced registered nurse practitioner, or licensed
practical nurse under chapter 18.79 RCW, an optometrist under chapter
18.53 RCW who is certified by the optometry board under RCW 18.53.010,
an osteopathic physician assistant under chapter 18.57A RCW, a
physician assistant under chapter 18.71A RCW, a naturopath licensed
under chapter 18.36A RCW, a pharmacist under chapter 18.64 RCW, or,
when acting under the required supervision of a dentist licensed under
chapter 18.32 RCW, a dental hygienist licensed under chapter 18.29 RCW;
(b) A pharmacy, hospital, or other institution licensed,
registered, or otherwise permitted to distribute, dispense, conduct
research with respect to, or to administer a legend drug in the course
of professional practice or research in this state; and
(c) A physician licensed to practice medicine and surgery or a
physician licensed to practice osteopathic medicine and surgery in any
state, or province of Canada, which shares a common border with the
state of Washington.
(17) "Secretary" means the secretary of health or the secretary's
designee.
Sec. 45 RCW 69.41.085 and 2003 c 140 s 12 are each amended to
read as follows:
Individuals residing in community-based care settings, such as
adult family homes, ((boarding homes)) assisted living facilities, and
residential care settings for ((the developmentally disabled))
individuals with developmental disabilities, including an individual's
home, may receive medication assistance. Nothing in this chapter
affects the right of an individual to refuse medication or requirements
relating to informed consent.
Sec. 46 RCW 69.50.308 and 2001 c 248 s 1 are each amended to read
as follows:
(a) A controlled substance may be dispensed only as provided in
this section.
(b) Except when dispensed directly by a practitioner authorized to
prescribe or administer a controlled substance, other than a pharmacy,
to an ultimate user, a substance included in Schedule II may not be
dispensed without the written prescription of a practitioner.
(1) Schedule II narcotic substances may be dispensed by a pharmacy
pursuant to a facsimile prescription under the following circumstances:
(i) The facsimile prescription is transmitted by a practitioner to
the pharmacy; and
(ii) The facsimile prescription is for a patient in a long-term
care facility. "Long-term care facility" means nursing homes licensed
under chapter 18.51 RCW, ((boarding homes)) assisted living facilities
licensed under chapter 18.20 RCW, and adult family homes licensed under
chapter 70.128 RCW; or
(iii) The facsimile prescription is for a patient of a hospice
program certified or paid for by medicare under Title XVIII; or
(iv) The facsimile prescription is for a patient of a hospice
program licensed by the state; and
(v) The practitioner or the practitioner's agent notes on the
facsimile prescription that the patient is a long-term care or hospice
patient.
(2) Injectable Schedule II narcotic substances that are to be
compounded for patient use may be dispensed by a pharmacy pursuant to
a facsimile prescription if the facsimile prescription is transmitted
by a practitioner to the pharmacy.
(3) Under (1) and (2) of this subsection the facsimile prescription
shall serve as the original prescription and shall be maintained as
other Schedule II narcotic substances prescriptions.
(c) In emergency situations, as defined by rule of the state board
of pharmacy, a substance included in Schedule II may be dispensed upon
oral prescription of a practitioner, reduced promptly to writing and
filed by the pharmacy. Prescriptions shall be retained in conformity
with the requirements of RCW 69.50.306. A prescription for a substance
included in Schedule II may not be refilled.
(d) Except when dispensed directly by a practitioner authorized to
prescribe or administer a controlled substance, other than a pharmacy,
to an ultimate user, a substance included in Schedule III or IV, which
is a prescription drug as determined under RCW 69.04.560, may not be
dispensed without a written or oral prescription of a practitioner.
Any oral prescription must be promptly reduced to writing. The
prescription shall not be filled or refilled more than six months after
the date thereof or be refilled more than five times, unless renewed by
the practitioner.
(e) A valid prescription or lawful order of a practitioner, in
order to be effective in legalizing the possession of controlled
substances, must be issued in good faith for a legitimate medical
purpose by one authorized to prescribe the use of such controlled
substance. An order purporting to be a prescription not in the course
of professional treatment is not a valid prescription or lawful order
of a practitioner within the meaning and intent of this chapter; and
the person who knows or should know that the person is filling such an
order, as well as the person issuing it, can be charged with a
violation of this chapter.
(f) A substance included in Schedule V must be distributed or
dispensed only for a medical purpose.
(g) A practitioner may dispense or deliver a controlled substance
to or for an individual or animal only for medical treatment or
authorized research in the ordinary course of that practitioner's
profession. Medical treatment includes dispensing or administering a
narcotic drug for pain, including intractable pain.
(h) No administrative sanction, or civil or criminal liability,
authorized or created by this chapter may be imposed on a pharmacist
for action taken in reliance on a reasonable belief that an order
purporting to be a prescription was issued by a practitioner in the
usual course of professional treatment or in authorized research.
(i) An individual practitioner may not dispense a substance
included in Schedule II, III, or IV for that individual practitioner's
personal use.
Sec. 47 RCW 70.38.105 and 2009 c 315 s 1 and 2009 c 242 s 3 are
each reenacted and amended to read as follows:
(1) The department is authorized and directed to implement the
certificate of need program in this state pursuant to the provisions of
this chapter.
(2) There shall be a state certificate of need program which is
administered consistent with the requirements of federal law as
necessary to the receipt of federal funds by the state.
(3) No person shall engage in any undertaking which is subject to
certificate of need review under subsection (4) of this section without
first having received from the department either a certificate of need
or an exception granted in accordance with this chapter.
(4) The following shall be subject to certificate of need review
under this chapter:
(a) The construction, development, or other establishment of a new
health care facility including, but not limited to, a hospital
constructed, developed, or established by a health maintenance
organization or by a combination of health maintenance organizations
except as provided in subsection (7)(a) of this section;
(b) The sale, purchase, or lease of part or all of any existing
hospital as defined in RCW 70.38.025 including, but not limited to, a
hospital sold, purchased, or leased by a health maintenance
organization or by a combination of health maintenance organizations
except as provided in subsection (7)(b) of this section;
(c) Any capital expenditure for the construction, renovation, or
alteration of a nursing home which substantially changes the services
of the facility after January 1, 1981, provided that the substantial
changes in services are specified by the department in rule;
(d) Any capital expenditure for the construction, renovation, or
alteration of a nursing home which exceeds the expenditure minimum as
defined by RCW 70.38.025. However, a capital expenditure which is not
subject to certificate of need review under (a), (b), (c), or (e) of
this subsection and which is solely for any one or more of the
following is not subject to certificate of need review:
(i) Communications and parking facilities;
(ii) Mechanical, electrical, ventilation, heating, and air
conditioning systems;
(iii) Energy conservation systems;
(iv) Repairs to, or the correction of, deficiencies in existing
physical plant facilities which are necessary to maintain state
licensure, however, other additional repairs, remodeling, or
replacement projects that are not related to one or more deficiency
citations and are not necessary to maintain state licensure are not
exempt from certificate of need review except as otherwise permitted by
(d)(vi) of this subsection or RCW 70.38.115(13);
(v) Acquisition of equipment, including data processing equipment,
which is not or will not be used in the direct provision of health
services;
(vi) Construction or renovation at an existing nursing home which
involves physical plant facilities, including administrative, dining
areas, kitchen, laundry, therapy areas, and support facilities, by an
existing licensee who has operated the beds for at least one year;
(vii) Acquisition of land; and
(viii) Refinancing of existing debt;
(e) A change in bed capacity of a health care facility which
increases the total number of licensed beds or redistributes beds among
acute care, nursing home care, and ((boarding home)) assisted living
facility care if the bed redistribution is to be effective for a period
in excess of six months, or a change in bed capacity of a rural health
care facility licensed under RCW 70.175.100 that increases the total
number of nursing home beds or redistributes beds from acute care or
((boarding home)) assisted living facility care to nursing home care if
the bed redistribution is to be effective for a period in excess of six
months. A health care facility certified as a critical access hospital
under 42 U.S.C. 1395i-4 may increase its total number of licensed beds
to the total number of beds permitted under 42 U.S.C. 1395i-4 for acute
care and may redistribute beds permitted under 42 U.S.C. 1395i-4 among
acute care and nursing home care without being subject to certificate
of need review. If there is a nursing home licensed under chapter
18.51 RCW within twenty-seven miles of the critical access hospital,
the critical access hospital is subject to certificate of need review
except for:
(i) Critical access hospitals which had designated beds to provide
nursing home care, in excess of five swing beds, prior to December 31,
2003;
(ii) Up to five swing beds; or
(iii) Up to twenty-five swing beds for critical access hospitals
which do not have a nursing home licensed under chapter 18.51 RCW
within the same city or town limits. Up to one-half of the additional
beds designated for swing bed services under this subsection
(4)(e)(iii) may be so designated before July 1, 2010, with the balance
designated on or after July 1, 2010.
Critical access hospital beds not subject to certificate of need
review under this subsection (4)(e) will not be counted as either acute
care or nursing home care for certificate of need review purposes. If
a health care facility ceases to be certified as a critical access
hospital under 42 U.S.C. 1395i-4, the hospital may revert back to the
type and number of licensed hospital beds as it had when it requested
critical access hospital designation;
(f) Any new tertiary health services which are offered in or
through a health care facility or rural health care facility licensed
under RCW 70.175.100, and which were not offered on a regular basis by,
in, or through such health care facility or rural health care facility
within the twelve-month period prior to the time such services would be
offered;
(g) Any expenditure for the construction, renovation, or alteration
of a nursing home or change in nursing home services in excess of the
expenditure minimum made in preparation for any undertaking under this
subsection (4) of this section and any arrangement or commitment made
for financing such undertaking. Expenditures of preparation shall
include expenditures for architectural designs, plans, working
drawings, and specifications. The department may issue certificates of
need permitting predevelopment expenditures, only, without authorizing
any subsequent undertaking with respect to which such predevelopment
expenditures are made; and
(h) Any increase in the number of dialysis stations in a kidney
disease center.
(5) The department is authorized to charge fees for the review of
certificate of need applications and requests for exemptions from
certificate of need review. The fees shall be sufficient to cover the
full cost of review and exemption, which may include the development of
standards, criteria, and policies.
(6) No person may divide a project in order to avoid review
requirements under any of the thresholds specified in this section.
(7)(a) The requirement that a health maintenance organization
obtain a certificate of need under subsection (4)(a) of this section
for the construction, development, or other establishment of a hospital
does not apply to a health maintenance organization operating a group
practice that has been continuously licensed as a health maintenance
organization since January 1, 2009;
(b) The requirement that a health maintenance organization obtain
a certificate of need under subsection (4)(b) of this section to sell,
purchase, or lease a hospital does not apply to a health maintenance
organization operating a group practice that has been continuously
licensed as a health maintenance organization since January 1, 2009.
Sec. 48 RCW 70.38.111 and 2009 c 315 s 2 and 2009 c 89 s 1 are
each reenacted and amended to read as follows:
(1) The department shall not require a certificate of need for the
offering of an inpatient tertiary health service by:
(a) A health maintenance organization or a combination of health
maintenance organizations if (i) the organization or combination of
organizations has, in the service area of the organization or the
service areas of the organizations in the combination, an enrollment of
at least fifty thousand individuals, (ii) the facility in which the
service will be provided is or will be geographically located so that
the service will be reasonably accessible to such enrolled individuals,
and (iii) at least seventy-five percent of the patients who can
reasonably be expected to receive the tertiary health service will be
individuals enrolled with such organization or organizations in the
combination;
(b) A health care facility if (i) the facility primarily provides
or will provide inpatient health services, (ii) the facility is or will
be controlled, directly or indirectly, by a health maintenance
organization or a combination of health maintenance organizations which
has, in the service area of the organization or service areas of the
organizations in the combination, an enrollment of at least fifty
thousand individuals, (iii) the facility is or will be geographically
located so that the service will be reasonably accessible to such
enrolled individuals, and (iv) at least seventy-five percent of the
patients who can reasonably be expected to receive the tertiary health
service will be individuals enrolled with such organization or
organizations in the combination; or
(c) A health care facility (or portion thereof) if (i) the facility
is or will be leased by a health maintenance organization or
combination of health maintenance organizations which has, in the
service area of the organization or the service areas of the
organizations in the combination, an enrollment of at least fifty
thousand individuals and, on the date the application is submitted
under subsection (2) of this section, at least fifteen years remain in
the term of the lease, (ii) the facility is or will be geographically
located so that the service will be reasonably accessible to such
enrolled individuals, and (iii) at least seventy-five percent of the
patients who can reasonably be expected to receive the tertiary health
service will be individuals enrolled with such organization;
if, with respect to such offering or obligation by a nursing home, the
department has, upon application under subsection (2) of this section,
granted an exemption from such requirement to the organization,
combination of organizations, or facility.
(2) A health maintenance organization, combination of health
maintenance organizations, or health care facility shall not be exempt
under subsection (1) of this section from obtaining a certificate of
need before offering a tertiary health service unless:
(a) It has submitted at least thirty days prior to the offering of
services reviewable under RCW 70.38.105(4)(d) an application for such
exemption; and
(b) The application contains such information respecting the
organization, combination, or facility and the proposed offering or
obligation by a nursing home as the department may require to determine
if the organization or combination meets the requirements of subsection
(1) of this section or the facility meets or will meet such
requirements; and
(c) The department approves such application. The department shall
approve or disapprove an application for exemption within thirty days
of receipt of a completed application. In the case of a proposed
health care facility (or portion thereof) which has not begun to
provide tertiary health services on the date an application is
submitted under this subsection with respect to such facility (or
portion), the facility (or portion) shall meet the applicable
requirements of subsection (1) of this section when the facility first
provides such services. The department shall approve an application
submitted under this subsection if it determines that the applicable
requirements of subsection (1) of this section are met.
(3) A health care facility (or any part thereof) with respect to
which an exemption was granted under subsection (1) of this section may
not be sold or leased and a controlling interest in such facility or in
a lease of such facility may not be acquired and a health care facility
described in (1)(c) which was granted an exemption under subsection (1)
of this section may not be used by any person other than the lessee
described in (1)(c) unless:
(a) The department issues a certificate of need approving the sale,
lease, acquisition, or use; or
(b) The department determines, upon application, that (i) the
entity to which the facility is proposed to be sold or leased, which
intends to acquire the controlling interest, or which intends to use
the facility is a health maintenance organization or a combination of
health maintenance organizations which meets the requirements of
(1)(a)(i), and (ii) with respect to such facility, meets the
requirements of (1)(a)(ii) or (iii) or the requirements of (1)(b)(i)
and (ii).
(4) In the case of a health maintenance organization, an ambulatory
care facility, or a health care facility, which ambulatory or health
care facility is controlled, directly or indirectly, by a health
maintenance organization or a combination of health maintenance
organizations, the department may under the program apply its
certificate of need requirements to the offering of inpatient tertiary
health services to the extent that such offering is not exempt under
the provisions of this section or RCW 70.38.105(7).
(5)(a) The department shall not require a certificate of need for
the construction, development, or other establishment of a nursing
home, or the addition of beds to an existing nursing home, that is
owned and operated by a continuing care retirement community that:
(i) Offers services only to contractual members;
(ii) Provides its members a contractually guaranteed range of
services from independent living through skilled nursing, including
some assistance with daily living activities;
(iii) Contractually assumes responsibility for the cost of services
exceeding the member's financial responsibility under the contract, so
that no third party, with the exception of insurance purchased by the
retirement community or its members, but including the medicaid
program, is liable for costs of care even if the member depletes his or
her personal resources;
(iv) Has offered continuing care contracts and operated a nursing
home continuously since January 1, 1988, or has obtained a certificate
of need to establish a nursing home;
(v) Maintains a binding agreement with the state assuring that
financial liability for services to members, including nursing home
services, will not fall upon the state;
(vi) Does not operate, and has not undertaken a project that would
result in a number of nursing home beds in excess of one for every four
living units operated by the continuing care retirement community,
exclusive of nursing home beds; and
(vii) Has obtained a professional review of pricing and long-term
solvency within the prior five years which was fully disclosed to
members.
(b) A continuing care retirement community shall not be exempt
under this subsection from obtaining a certificate of need unless:
(i) It has submitted an application for exemption at least thirty
days prior to commencing construction of, is submitting an application
for the licensure of, or is commencing operation of a nursing home,
whichever comes first; and
(ii) The application documents to the department that the
continuing care retirement community qualifies for exemption.
(c) The sale, lease, acquisition, or use of part or all of a
continuing care retirement community nursing home that qualifies for
exemption under this subsection shall require prior certificate of need
approval to qualify for licensure as a nursing home unless the
department determines such sale, lease, acquisition, or use is by a
continuing care retirement community that meets the conditions of (a)
of this subsection.
(6) A rural hospital, as defined by the department, reducing the
number of licensed beds to become a rural primary care hospital under
the provisions of Part A Title XVIII of the Social Security Act Section
1820, 42 U.S.C., 1395c et seq. may, within three years of the reduction
of beds licensed under chapter 70.41 RCW, increase the number of
licensed beds to no more than the previously licensed number without
being subject to the provisions of this chapter.
(7) A rural health care facility licensed under RCW 70.175.100
formerly licensed as a hospital under chapter 70.41 RCW may, within
three years of the effective date of the rural health care facility
license, apply to the department for a hospital license and not be
subject to the requirements of RCW 70.38.105(4)(a) as the construction,
development, or other establishment of a new hospital, provided there
is no increase in the number of beds previously licensed under chapter
70.41 RCW and there is no redistribution in the number of beds used for
acute care or long-term care, the rural health care facility has been
in continuous operation, and the rural health care facility has not
been purchased or leased.
(8)(a) A nursing home that voluntarily reduces the number of its
licensed beds to provide assisted living, licensed ((boarding home))
assisted living facility care, adult day care, adult day health,
respite care, hospice, outpatient therapy services, congregate meals,
home health, or senior wellness clinic, or to reduce to one or two the
number of beds per room or to otherwise enhance the quality of life for
residents in the nursing home, may convert the original facility or
portion of the facility back, and thereby increase the number of
nursing home beds to no more than the previously licensed number of
nursing home beds without obtaining a certificate of need under this
chapter, provided the facility has been in continuous operation and has
not been purchased or leased. Any conversion to the original licensed
bed capacity, or to any portion thereof, shall comply with the same
life and safety code requirements as existed at the time the nursing
home voluntarily reduced its licensed beds; unless waivers from such
requirements were issued, in which case the converted beds shall
reflect the conditions or standards that then existed pursuant to the
approved waivers.
(b) To convert beds back to nursing home beds under this
subsection, the nursing home must:
(i) Give notice of its intent to preserve conversion options to the
department of health no later than thirty days after the effective date
of the license reduction; and
(ii) Give notice to the department of health and to the department
of social and health services of the intent to convert beds back. If
construction is required for the conversion of beds back, the notice of
intent to convert beds back must be given, at a minimum, one year prior
to the effective date of license modification reflecting the restored
beds; otherwise, the notice must be given a minimum of ninety days
prior to the effective date of license modification reflecting the
restored beds. Prior to any license modification to convert beds back
to nursing home beds under this section, the licensee must demonstrate
that the nursing home meets the certificate of need exemption
requirements of this section.
The term "construction," as used in (b)(ii) of this subsection, is
limited to those projects that are expected to equal or exceed the
expenditure minimum amount, as determined under this chapter.
(c) Conversion of beds back under this subsection must be completed
no later than four years after the effective date of the license
reduction. However, for good cause shown, the four-year period for
conversion may be extended by the department of health for one
additional four-year period.
(d) Nursing home beds that have been voluntarily reduced under this
section shall be counted as available nursing home beds for the purpose
of evaluating need under RCW 70.38.115(2) (a) and (k) so long as the
facility retains the ability to convert them back to nursing home use
under the terms of this section.
(e) When a building owner has secured an interest in the nursing
home beds, which are intended to be voluntarily reduced by the licensee
under (a) of this subsection, the applicant shall provide the
department with a written statement indicating the building owner's
approval of the bed reduction.
(9)(a) The department shall not require a certificate of need for
a hospice agency if:
(i) The hospice agency is designed to serve the unique religious or
cultural needs of a religious group or an ethnic minority and commits
to furnishing hospice services in a manner specifically aimed at
meeting the unique religious or cultural needs of the religious group
or ethnic minority;
(ii) The hospice agency is operated by an organization that:
(A) Operates a facility, or group of facilities, that offers a
comprehensive continuum of long-term care services, including, at a
minimum, a licensed, medicare-certified nursing home, assisted living,
independent living, day health, and various community-based support
services, designed to meet the unique social, cultural, and religious
needs of a specific cultural and ethnic minority group;
(B) Has operated the facility or group of facilities for at least
ten continuous years prior to the establishment of the hospice agency;
(iii) The hospice agency commits to coordinating with existing
hospice programs in its community when appropriate;
(iv) The hospice agency has a census of no more than forty
patients;
(v) The hospice agency commits to obtaining and maintaining
medicare certification;
(vi) The hospice agency only serves patients located in the same
county as the majority of the long-term care services offered by the
organization that operates the agency; and
(vii) The hospice agency is not sold or transferred to another
agency.
(b) The department shall include the patient census for an agency
exempted under this subsection (9) in its calculations for future
certificate of need applications.
Sec. 49 RCW 70.79.090 and 2009 c 90 s 4 are each amended to read
as follows:
The following boilers and unfired pressure vessels shall be exempt
from the requirements of RCW 70.79.220 and 70.79.240 through 70.79.330:
(1) Boilers or unfired pressure vessels located on farms and used
solely for agricultural purposes;
(2) Unfired pressure vessels that are part of fertilizer applicator
rigs designed and used exclusively for fertilization in the conduct of
agricultural operations;
(3) Steam boilers used exclusively for heating purposes carrying a
pressure of not more than fifteen pounds per square inch gauge and
which are located in private residences or in apartment houses of less
than six families;
(4) Hot water heating boilers carrying a pressure of not more than
thirty pounds per square inch and which are located in private
residences or in apartment houses of less than six families;
(5) Approved pressure vessels (hot water heaters, hot water storage
tanks, hot water supply boilers, and hot water heating boilers listed
by a nationally recognized testing agency), with approved safety
devices including a pressure relief valve, with a nominal water
containing capacity of one hundred twenty gallons or less having a heat
input of two hundred thousand b.t.u.'s per hour or less, at pressure of
one hundred sixty pounds per square inch or less, and at temperatures
of two hundred ten degrees Fahrenheit or less: PROVIDED, HOWEVER, That
such pressure vessels are not installed in schools, child care centers,
public and private hospitals, nursing ((and boarding)) homes, assisted
living facilities, churches, public buildings owned or leased and
maintained by the state or any political subdivision thereof, and
assembly halls;
(6) Unfired pressure vessels containing only water under pressure
for domestic supply purposes, including those containing air, the
compression of which serves only as a cushion or airlift pumping
systems, when located in private residences or in apartment houses of
less than six families, or in public water systems as defined in RCW
70.119.020;
(7) Unfired pressure vessels containing liquified petroleum gases.
Sec. 50 RCW 70.87.305 and 2004 c 66 s 3 are each amended to read
as follows:
(1) The department shall, by rule, establish licensing requirements
for conveyance work performed on private residence conveyances. These
rules shall include an exemption from licensing for maintenance work on
private residence conveyances performed by an owner or at the direction
of the owner, provided the owner resides in the residence at which the
conveyance is located and the conveyance is not accessible to the
general public. However, maintenance work performed on private
residence conveyances located in or at adult family homes licensed
under chapter 70.128 RCW, ((boarding homes)) assisted living facilities
licensed under chapter 18.20 RCW, or similarly licensed caregiving
facilities must comply with the licensing requirements of this chapter.
(2) The rules adopted under this section take effect July 1, 2004.
Sec. 51 RCW 70.97.060 and 2005 c 504 s 408 are each amended to
read as follows:
(1)(a) The department shall not license an enhanced services
facility that serves any residents under sixty-five years of age for a
capacity to exceed sixteen residents.
(b) The department may contract for services for the operation of
enhanced services facilities only to the extent that funds are
specifically provided for that purpose.
(2) The facility shall provide an appropriate level of security for
the characteristics, behaviors, and legal status of the residents.
(3) An enhanced services facility may hold only one license but, to
the extent permitted under state and federal law and medicaid
requirements, a facility may be located in the same building as another
licensed facility, provided that:
(a) The enhanced services facility is in a location that is totally
separate and discrete from the other licensed facility; and
(b) The two facilities maintain separate staffing, unless an
exception to this is permitted by the department in rule.
(4) Nursing homes under chapter 18.51 RCW, ((boarding homes))
assisted living facilities under chapter 18.20 RCW, or adult family
homes under chapter 70.128 RCW, that become licensed as facilities
under this chapter shall be deemed to meet the applicable state and
local rules, regulations, permits, and code requirements. All other
facilities are required to meet all applicable state and local rules,
regulations, permits, and code requirements.
Sec. 52 RCW 70.97.090 and 2005 c 504 s 411 are each amended to
read as follows:
This chapter does not apply to the following residential
facilities:
(1) Nursing homes licensed under chapter 18.51 RCW;
(2) ((Boarding homes)) Assisted living facilities licensed under
chapter 18.20 RCW;
(3) Adult family homes licensed under chapter 70.128 RCW;
(4) Facilities approved and certified under chapter 71A.22 RCW;
(5) Residential treatment facilities licensed under chapter 71.12
RCW; and
(6) Hospitals licensed under chapter 70.41 RCW.
Sec. 53 RCW 70.122.020 and 1992 c 98 s 2 are each amended to read
as follows:
Unless the context clearly requires otherwise, the definitions
contained in this section shall apply throughout this chapter.
(1) "Adult person" means a person who has attained the age of
majority as defined in RCW 26.28.010 and 26.28.015, and who has the
capacity to make health care decisions.
(2) "Attending physician" means the physician selected by, or
assigned to, the patient who has primary responsibility for the
treatment and care of the patient.
(3) "Directive" means a written document voluntarily executed by
the declarer generally consistent with the guidelines of RCW
70.122.030.
(4) "Health facility" means a hospital as defined in RCW
70.41.020(((2))) (4) or a nursing home as defined in RCW 18.51.010, a
home health agency or hospice agency as defined in RCW 70.126.010, or
((a boarding home)) an assisted living facility as defined in RCW
18.20.020.
(5) "Life-sustaining treatment" means any medical or surgical
intervention that uses mechanical or other artificial means, including
artificially provided nutrition and hydration, to sustain, restore, or
replace a vital function, which, when applied to a qualified patient,
would serve only to prolong the process of dying. "Life-sustaining
treatment" shall not include the administration of medication or the
performance of any medical or surgical intervention deemed necessary
solely to alleviate pain.
(6) "Permanent unconscious condition" means an incurable and
irreversible condition in which the patient is medically assessed
within reasonable medical judgment as having no reasonable probability
of recovery from an irreversible coma or a persistent vegetative state.
(7) "Physician" means a person licensed under chapters 18.71 or
18.57 RCW.
(8) "Qualified patient" means an adult person who is a patient
diagnosed in writing to have a terminal condition by the patient's
attending physician, who has personally examined the patient, or a
patient who is diagnosed in writing to be in a permanent unconscious
condition in accordance with accepted medical standards by two
physicians, one of whom is the patient's attending physician, and both
of whom have personally examined the patient.
(9) "Terminal condition" means an incurable and irreversible
condition caused by injury, disease, or illness, that, within
reasonable medical judgment, will cause death within a reasonable
period of time in accordance with accepted medical standards, and where
the application of life-sustaining treatment serves only to prolong the
process of dying.
Sec. 54 RCW 70.127.040 and 2011 c 366 s 6 are each amended to
read as follows:
The following are not subject to regulation for the purposes of
this chapter:
(1) A family member providing home health, hospice, or home care
services;
(2) A person who provides only meal services in an individual's
permanent or temporary residence;
(3) An individual providing home care through a direct agreement
with a recipient of care in an individual's permanent or temporary
residence;
(4) A person furnishing or delivering home medical supplies or
equipment that does not involve the provision of services beyond those
necessary to deliver, set up, and monitor the proper functioning of the
equipment and educate the user on its proper use;
(5) A person who provides services through a contract with a
licensed agency;
(6) An employee or volunteer of a licensed agency who provides
services only as an employee or volunteer;
(7) Facilities and institutions, including but not limited to
nursing homes under chapter 18.51 RCW, hospitals under chapter 70.41
RCW, adult family homes under chapter 70.128 RCW, ((boarding homes))
assisted living facilities under chapter 18.20 RCW, developmental
disability residential programs under chapter 71A.12 RCW, other
entities licensed under chapter 71.12 RCW, or other licensed facilities
and institutions, only when providing services to persons residing
within the facility or institution;
(8) Local and combined city-county health departments providing
services under chapters 70.05 and 70.08 RCW;
(9) An individual providing care to ill individuals, individuals
with disabilities, or vulnerable individuals through a contract with
the department of social and health services;
(10) Nursing homes, hospitals, or other institutions, agencies,
organizations, or persons that contract with licensed home health,
hospice, or home care agencies for the delivery of services;
(11) In-home assessments of an ill individual, an individual with
a disability, or a vulnerable individual that does not result in
regular ongoing care at home;
(12) Services conducted by and for the adherents of a church or
religious denomination that rely upon spiritual means alone through
prayer for healing in accordance with the tenets and practices of such
church or religious denomination and the bona fide religious beliefs
genuinely held by such adherents;
(13) A medicare-approved dialysis center operating a medicare-approved home dialysis program;
(14) A person providing case management services. For the purposes
of this subsection, "case management" means the assessment,
coordination, authorization, planning, training, and monitoring of home
health, hospice, and home care, and does not include the direct
provision of care to an individual;
(15) Pharmacies licensed under RCW 18.64.043 that deliver
prescription drugs and durable medical equipment that does not involve
the use of professional services beyond those authorized to be
performed by licensed pharmacists pursuant to chapter 18.64 RCW and
those necessary to set up and monitor the proper functioning of the
equipment and educate the person on its proper use;
(16) A volunteer hospice complying with the requirements of RCW
70.127.050;
(17) A person who provides home care services without compensation;
and
(18) Nursing homes that provide telephone or web-based transitional
care management services.
Sec. 55 RCW 70.128.030 and 1989 c 427 s 17 are each amended to
read as follows:
The following residential facilities shall be exempt from the
operation of this chapter:
(1) Nursing homes licensed under chapter 18.51 RCW;
(2) ((Boarding homes)) Assisted living facilities licensed under
chapter 18.20 RCW;
(3) Facilities approved and certified under chapter 71A.22 RCW;
(4) Residential treatment centers for ((the mentally ill))
individuals with mental illness licensed under chapter 71.24 RCW;
(5) Hospitals licensed under chapter 70.41 RCW;
(6) Homes for ((the developmentally disabled)) individuals with
developmental disabilities licensed under chapter 74.15 RCW.
Sec. 56 RCW 70.128.210 and 1998 c 272 s 3 are each amended to
read as follows:
(1) The department of social and health services shall review, in
coordination with the department of health, the nursing care quality
assurance commission, adult family home providers, ((boarding home))
assisted living facility providers, in-home personal care providers,
and long-term care consumers and advocates, training standards for
providers, resident managers, and resident caregiving staff. The
departments and the commission shall submit to the appropriate
committees of the house of representatives and the senate by December
1, 1998, specific recommendations on training standards and the
delivery system, including necessary statutory changes and funding
requirements. Any proposed enhancements shall be consistent with this
section, shall take into account and not duplicate other training
requirements applicable to adult family homes and staff, and shall be
developed with the input of adult family home and resident
representatives, health care professionals, and other vested interest
groups. Training standards and the delivery system shall be relevant
to the needs of residents served by the adult family home and
recipients of long-term in-home personal care services and shall be
sufficient to ensure that providers, resident managers, and caregiving
staff have the skills and knowledge necessary to provide high quality,
appropriate care.
(2) The recommendations on training standards and the delivery
system developed under subsection (1) of this section shall be based on
a review and consideration of the following: Quality of care;
availability of training; affordability, including the training costs
incurred by the department of social and health services and private
providers; portability of existing training requirements; competency
testing; practical and clinical course work; methods of delivery of
training; standards for management; uniform caregiving staff training;
necessary enhancements for special needs populations; and resident
rights training. Residents with special needs include, but are not
limited to, residents with a diagnosis of mental illness, dementia, or
developmental disability. Development of training recommendations for
developmental disabilities services shall be coordinated with the study
requirements in section 6, chapter 272, Laws of 1998.
(3) The department of social and health services shall report to
the appropriate committees of the house of representatives and the
senate by December 1, 1998, on the cost of implementing the proposed
training standards for state-funded residents, and on the extent to
which that cost is covered by existing state payment rates.
Sec. 57 RCW 70.129.005 and 1994 c 214 s 1 are each amended to
read as follows:
The legislature recognizes that long-term care facilities are a
critical part of the state's long-term care services system. It is the
intent of the legislature that individuals who reside in long-term care
facilities receive appropriate services, be treated with courtesy, and
continue to enjoy their basic civil and legal rights.
It is also the intent of the legislature that long-term care
facility residents have the opportunity to exercise reasonable control
over life decisions. The legislature finds that choice, participation,
privacy, and the opportunity to engage in religious, political, civic,
recreational, and other social activities foster a sense of self-worth
and enhance the quality of life for long-term care residents.
The legislature finds that the public interest would be best served
by providing the same basic resident rights in all long-term care
settings. Residents in nursing facilities are guaranteed certain
rights by federal law and regulation, 42 U.S.C. 1396r and 42 C.F.R.
part 483. It is the intent of the legislature to extend those basic
rights to residents in veterans' homes, ((boarding homes)) assisted
living facilities, and adult family homes.
The legislature intends that a facility should care for its
residents in a manner and in an environment that promotes maintenance
or enhancement of each resident's quality of life. A resident should
have a safe, clean, comfortable, and homelike environment, allowing the
resident to use his or her personal belongings to the extent possible.
Sec. 58 RCW 70.129.160 and 1998 c 245 s 113 are each amended to
read as follows:
The long-term care ombudsman shall monitor implementation of this
chapter and determine the degree to which veterans' homes, nursing
facilities, adult family homes, and ((boarding homes)) assisted living
facilities ensure that residents are able to exercise their rights.
The long-term care ombudsman shall consult with the departments of
health and social and health services, long-term care facility
organizations, resident groups, ((and)) senior ((and disabled)) citizen
organizations, and organizations concerning individuals with
disabilities.
Sec. 59 RCW 71.24.025 and 2008 c 261 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) "Acutely mentally ill" means a condition which is limited to a
short-term severe crisis episode of:
(a) A mental disorder as defined in RCW 71.05.020 or, in the case
of a child, as defined in RCW 71.34.020;
(b) Being gravely disabled as defined in RCW 71.05.020 or, in the
case of a child, a gravely disabled minor as defined in RCW 71.34.020;
or
(c) Presenting a likelihood of serious harm as defined in RCW
71.05.020 or, in the case of a child, as defined in RCW 71.34.020.
(2) "Available resources" means funds appropriated for the purpose
of providing community mental health programs, federal funds, except
those provided according to Title XIX of the Social Security Act, and
state funds appropriated under this chapter or chapter 71.05 RCW by the
legislature during any biennium for the purpose of providing
residential services, resource management services, community support
services, and other mental health services. This does not include
funds appropriated for the purpose of operating and administering the
state psychiatric hospitals.
(3) "Child" means a person under the age of eighteen years.
(4) "Chronically mentally ill adult" or "adult who is chronically
mentally ill" means an adult who has a mental disorder and meets at
least one of the following criteria:
(a) Has undergone two or more episodes of hospital care for a
mental disorder within the preceding two years; or
(b) Has experienced a continuous psychiatric hospitalization or
residential treatment exceeding six months' duration within the
preceding year; or
(c) Has been unable to engage in any substantial gainful activity
by reason of any mental disorder which has lasted for a continuous
period of not less than twelve months. "Substantial gainful activity"
shall be defined by the department by rule consistent with Public Law
92-603, as amended.
(5) "Clubhouse" means a community-based program that provides
rehabilitation services and is certified by the department of social
and health services.
(6) "Community mental health program" means all mental health
services, activities, or programs using available resources.
(7) "Community mental health service delivery system" means public
or private agencies that provide services specifically to persons with
mental disorders as defined under RCW 71.05.020 and receive funding
from public sources.
(8) "Community support services" means services authorized,
planned, and coordinated through resource management services
including, at a minimum, assessment, diagnosis, emergency crisis
intervention available twenty-four hours, seven days a week,
prescreening determinations for persons who are mentally ill being
considered for placement in nursing homes as required by federal law,
screening for patients being considered for admission to residential
services, diagnosis and treatment for children who are acutely mentally
ill or severely emotionally disturbed discovered under screening
through the federal Title XIX early and periodic screening, diagnosis,
and treatment program, investigation, legal, and other nonresidential
services under chapter 71.05 RCW, case management services, psychiatric
treatment including medication supervision, counseling, psychotherapy,
assuring transfer of relevant patient information between service
providers, recovery services, and other services determined by regional
support networks.
(9) "Consensus-based" means a program or practice that has general
support among treatment providers and experts, based on experience or
professional literature, and may have anecdotal or case study support,
or that is agreed but not possible to perform studies with random
assignment and controlled groups.
(10) "County authority" means the board of county commissioners,
county council, or county executive having authority to establish a
community mental health program, or two or more of the county
authorities specified in this subsection which have entered into an
agreement to provide a community mental health program.
(11) "Department" means the department of social and health
services.
(12) "Designated mental health professional" means a mental health
professional designated by the county or other authority authorized in
rule to perform the duties specified in this chapter.
(13) "Emerging best practice" or "promising practice" means a
practice that presents, based on preliminary information, potential for
becoming a research-based or consensus-based practice.
(14) "Evidence-based" means a program or practice that has had
multiple site random controlled trials across heterogeneous populations
demonstrating that the program or practice is effective for the
population.
(15) "Licensed service provider" means an entity licensed according
to this chapter or chapter 71.05 RCW or an entity deemed to meet state
minimum standards as a result of accreditation by a recognized
behavioral health accrediting body recognized and having a current
agreement with the department, that meets state minimum standards or
persons licensed under chapter 18.57, 18.71, 18.83, or 18.79 RCW, as it
applies to registered nurses and advanced registered nurse
practitioners.
(16) "Long-term inpatient care" means inpatient services for
persons committed for, or voluntarily receiving intensive treatment
for, periods of ninety days or greater under chapter 71.05 RCW. "Long-term inpatient care" as used in this chapter does not include: (a)
Services for individuals committed under chapter 71.05 RCW who are
receiving services pursuant to a conditional release or a court-ordered
less restrictive alternative to detention; or (b) services for
individuals voluntarily receiving less restrictive alternative
treatment on the grounds of the state hospital.
(17) "Mental health services" means all services provided by
regional support networks and other services provided by the state for
persons who are mentally ill.
(18) "Mentally ill persons," "persons who are mentally ill," and
"the mentally ill" mean persons and conditions defined in subsections
(1), (4), (27), and (28) of this section.
(19) "Recovery" means the process in which people are able to live,
work, learn, and participate fully in their communities.
(20) "Regional support network" means a county authority or group
of county authorities or other entity recognized by the secretary in
contract in a defined region.
(21) "Registration records" include all the records of the
department, regional support networks, treatment facilities, and other
persons providing services to the department, county departments, or
facilities which identify persons who are receiving or who at any time
have received services for mental illness.
(22) "Research-based" means a program or practice that has some
research demonstrating effectiveness, but that does not yet meet the
standard of evidence-based practices.
(23) "Residential services" means a complete range of residences
and supports authorized by resource management services and which may
involve a facility, a distinct part thereof, or services which support
community living, for persons who are acutely mentally ill, adults who
are chronically mentally ill, children who are severely emotionally
disturbed, or adults who are seriously disturbed and determined by the
regional support network to be at risk of becoming acutely or
chronically mentally ill. The services shall include at least
evaluation and treatment services as defined in chapter 71.05 RCW,
acute crisis respite care, long-term adaptive and rehabilitative care,
and supervised and supported living services, and shall also include
any residential services developed to service persons who are mentally
ill in nursing homes, ((boarding homes)) assisted living facilities,
and adult family homes, and may include outpatient services provided as
an element in a package of services in a supported housing model.
Residential services for children in out-of-home placements related to
their mental disorder shall not include the costs of food and shelter,
except for children's long-term residential facilities existing prior
to January 1, 1991.
(24) "Resilience" means the personal and community qualities that
enable individuals to rebound from adversity, trauma, tragedy, threats,
or other stresses, and to live productive lives.
(25) "Resource management services" mean the planning,
coordination, and authorization of residential services and community
support services administered pursuant to an individual service plan
for: (a) Adults and children who are acutely mentally ill; (b) adults
who are chronically mentally ill; (c) children who are severely
emotionally disturbed; or (d) adults who are seriously disturbed and
determined solely by a regional support network to be at risk of
becoming acutely or chronically mentally ill. Such planning,
coordination, and authorization shall include mental health screening
for children eligible under the federal Title XIX early and periodic
screening, diagnosis, and treatment program. Resource management
services include seven day a week, twenty-four hour a day availability
of information regarding enrollment of adults and children who are
mentally ill in services and their individual service plan to
designated mental health professionals, evaluation and treatment
facilities, and others as determined by the regional support network.
(26) "Secretary" means the secretary of social and health services.
(27) "Seriously disturbed person" means a person who:
(a) Is gravely disabled or presents a likelihood of serious harm to
himself or herself or others, or to the property of others, as a result
of a mental disorder as defined in chapter 71.05 RCW;
(b) Has been on conditional release status, or under a less
restrictive alternative order, at some time during the preceding two
years from an evaluation and treatment facility or a state mental
health hospital;
(c) Has a mental disorder which causes major impairment in several
areas of daily living;
(d) Exhibits suicidal preoccupation or attempts; or
(e) Is a child diagnosed by a mental health professional, as
defined in chapter 71.34 RCW, as experiencing a mental disorder which
is clearly interfering with the child's functioning in family or school
or with peers or is clearly interfering with the child's personality
development and learning.
(28) "Severely emotionally disturbed child" or "child who is
severely emotionally disturbed" means a child who has been determined
by the regional support network to be experiencing a mental disorder as
defined in chapter 71.34 RCW, including those mental disorders that
result in a behavioral or conduct disorder, that is clearly interfering
with the child's functioning in family or school or with peers and who
meets at least one of the following criteria:
(a) Has undergone inpatient treatment or placement outside of the
home related to a mental disorder within the last two years;
(b) Has undergone involuntary treatment under chapter 71.34 RCW
within the last two years;
(c) Is currently served by at least one of the following child-serving systems: Juvenile justice, child-protection/welfare, special
education, or developmental disabilities;
(d) Is at risk of escalating maladjustment due to:
(i) Chronic family dysfunction involving a caretaker who is
mentally ill or inadequate;
(ii) Changes in custodial adult;
(iii) Going to, residing in, or returning from any placement
outside of the home, for example, psychiatric hospital, short-term
inpatient, residential treatment, group or foster home, or a
correctional facility;
(iv) Subject to repeated physical abuse or neglect;
(v) Drug or alcohol abuse; or
(vi) Homelessness.
(29) "State minimum standards" means minimum requirements
established by rules adopted by the secretary and necessary to
implement this chapter for: (a) Delivery of mental health services;
(b) licensed service providers for the provision of mental health
services; (c) residential services; and (d) community support services
and resource management services.
(30) "Treatment records" include registration and all other records
concerning persons who are receiving or who at any time have received
services for mental illness, which are maintained by the department, by
regional support networks and their staffs, and by treatment
facilities. Treatment records do not include notes or records
maintained for personal use by a person providing treatment services
for the department, regional support networks, or a treatment facility
if the notes or records are not available to others.
(31) "Tribal authority," for the purposes of this section and RCW
71.24.300 only, means: The federally recognized Indian tribes and the
major Indian organizations recognized by the secretary insofar as these
organizations do not have a financial relationship with any regional
support network that would present a conflict of interest.
Sec. 60 RCW 74.09.120 and 2011 1st sp.s. c 15 s 9 are each
amended to read as follows:
(1) The department shall purchase nursing home care by contract and
payment for the care shall be in accordance with the provisions of
chapter 74.46 RCW and rules adopted by the department. No payment
shall be made to a nursing home which does not permit inspection by the
authority and the department of every part of its premises and an
examination of all records, including financial records, methods of
administration, general and special dietary programs, the disbursement
of drugs and methods of supply, and any other records the authority or
the department deems relevant to the regulation of nursing home
operations, enforcement of standards for resident care, and payment for
nursing home services.
(2) The department may purchase nursing home care by contract in
veterans' homes operated by the state department of veterans affairs
and payment for the care shall be in accordance with the provisions of
chapter 74.46 RCW and rules adopted by the department under the
authority of RCW 74.46.800.
(3) The department may purchase care in institutions for persons
with intellectual disabilities, also known as intermediate care
facilities for persons with intellectual disabilities. The department
shall establish rules for reasonable accounting and reimbursement
systems for such care. Institutions for persons with intellectual
disabilities include licensed nursing homes, public institutions,
licensed ((boarding homes)) assisted living facilities with fifteen
beds or less, and hospital facilities certified as intermediate care
facilities for persons with intellectual disabilities under the federal
medicaid program to provide health, habilitative, or rehabilitative
services and twenty-four hour supervision for persons with intellectual
disabilities or related conditions and includes in the program "active
treatment" as federally defined.
(4) The department may purchase care in institutions for mental
diseases by contract. The department shall establish rules for
reasonable accounting and reimbursement systems for such care.
Institutions for mental diseases are certified under the federal
medicaid program and primarily engaged in providing diagnosis,
treatment, or care to persons with mental diseases, including medical
attention, nursing care, and related services.
(5) Both the department and the authority may each purchase all
other services provided under this chapter by contract or at rates
established by the department or the authority respectively.
Sec. 61 RCW 74.15.020 and 2009 c 520 s 13 are each amended to
read as follows:
((For the purpose of)) The definitions in this section apply
throughout this chapter and RCW 74.13.031((, and)) unless the context
clearly requires otherwise ((clearly indicated by the context thereof,
the following terms shall mean:)).
(1) "Agency" means any person, firm, partnership, association,
corporation, or facility which receives children, expectant mothers, or
persons with developmental disabilities for control, care, or
maintenance outside their own homes, or which places, arranges the
placement of, or assists in the placement of children, expectant
mothers, or persons with developmental disabilities for foster care or
placement of children for adoption, and shall include the following
irrespective of whether there is compensation to the agency or to the
children, expectant mothers or persons with developmental disabilities
for services rendered:
(a) "Child-placing agency" means an agency which places a child or
children for temporary care, continued care, or for adoption;
(b) "Community facility" means a group care facility operated for
the care of juveniles committed to the department under RCW 13.40.185.
A county detention facility that houses juveniles committed to the
department under RCW 13.40.185 pursuant to a contract with the
department is not a community facility;
(c) "Crisis residential center" means an agency which is a
temporary protective residential facility operated to perform the
duties specified in chapter 13.32A RCW, in the manner provided in RCW
74.13.032 through 74.13.036;
(d) "Emergency respite center" is an agency that may be commonly
known as a crisis nursery, that provides emergency and crisis care for
up to seventy-two hours to children who have been admitted by their
parents or guardians to prevent abuse or neglect. Emergency respite
centers may operate for up to twenty-four hours a day, and for up to
seven days a week. Emergency respite centers may provide care for
children ages birth through seventeen, and for persons eighteen through
twenty with developmental disabilities who are admitted with a sibling
or siblings through age seventeen. Emergency respite centers may not
substitute for crisis residential centers or HOPE centers, or any other
services defined under this section, and may not substitute for
services which are required under chapter 13.32A or 13.34 RCW;
(e) "Foster-family home" means an agency which regularly provides
care on a twenty-four hour basis to one or more children, expectant
mothers, or persons with developmental disabilities in the family abode
of the person or persons under whose direct care and supervision the
child, expectant mother, or person with a developmental disability is
placed;
(f) "Group-care facility" means an agency, other than a foster-family home, which is maintained and operated for the care of a group
of children on a twenty-four hour basis;
(g) "HOPE center" means an agency licensed by the secretary to
provide temporary residential placement and other services to street
youth. A street youth may remain in a HOPE center for thirty days
while services are arranged and permanent placement is coordinated. No
street youth may stay longer than thirty days unless approved by the
department and any additional days approved by the department must be
based on the unavailability of a long-term placement option. A street
youth whose parent wants him or her returned to home may remain in a
HOPE center until his or her parent arranges return of the youth, not
longer. All other street youth must have court approval under chapter
13.34 or 13.32A RCW to remain in a HOPE center up to thirty days;
(h) "Maternity service" means an agency which provides or arranges
for care or services to expectant mothers, before or during
confinement, or which provides care as needed to mothers and their
infants after confinement;
(i) "Responsible living skills program" means an agency licensed by
the secretary that provides residential and transitional living
services to persons ages sixteen to eighteen who are dependent under
chapter 13.34 RCW and who have been unable to live in his or her
legally authorized residence and, as a result, the minor lived outdoors
or in another unsafe location not intended for occupancy by the minor.
Dependent minors ages fourteen and fifteen may be eligible if no other
placement alternative is available and the department approves the
placement;
(j) "Service provider" means the entity that operates a community
facility.
(2) "Agency" shall not include the following:
(a) Persons related to the child, expectant mother, or person with
developmental disability in the following ways:
(i) Any blood relative, including those of half-blood, and
including first cousins, second cousins, nephews or nieces, and persons
of preceding generations as denoted by prefixes of grand, great, or
great-great;
(ii) Stepfather, stepmother, stepbrother, and stepsister;
(iii) A person who legally adopts a child or the child's parent as
well as the natural and other legally adopted children of such persons,
and other relatives of the adoptive parents in accordance with state
law;
(iv) Spouses of any persons named in (i), (ii), or (iii) of this
subsection (2)(a), even after the marriage is terminated;
(v) Relatives, as named in (i), (ii), (iii), or (iv) of this
subsection (2)(a), of any half sibling of the child; or
(vi) Extended family members, as defined by the law or custom of
the Indian child's tribe or, in the absence of such law or custom, a
person who has reached the age of eighteen and who is the Indian
child's grandparent, aunt or uncle, brother or sister, brother-in-law
or sister-in-law, niece or nephew, first or second cousin, or
stepparent who provides care in the family abode on a twenty-four-hour
basis to an Indian child as defined in 25 U.S.C. Sec. 1903(4);
(b) Persons who are legal guardians of the child, expectant mother,
or persons with developmental disabilities;
(c) Persons who care for a neighbor's or friend's child or
children, with or without compensation, where the parent and person
providing care on a twenty-four-hour basis have agreed to the placement
in writing and the state is not providing any payment for the care;
(d) A person, partnership, corporation, or other entity that
provides placement or similar services to exchange students or
international student exchange visitors or persons who have the care of
an exchange student in their home;
(e) A person, partnership, corporation, or other entity that
provides placement or similar services to international children who
have entered the country by obtaining visas that meet the criteria for
medical care as established by the United States citizenship and
immigration services, or persons who have the care of such an
international child in their home;
(f) Schools, including boarding schools, which are engaged
primarily in education, operate on a definite school year schedule,
follow a stated academic curriculum, accept only school-age children
and do not accept custody of children;
(g) Hospitals licensed pursuant to chapter 70.41 RCW when
performing functions defined in chapter 70.41 RCW, nursing homes
licensed under chapter 18.51 RCW and ((boarding homes)) assisted living
facilities licensed under chapter 18.20 RCW;
(h) Licensed physicians or lawyers;
(i) Facilities approved and certified under chapter 71A.22 RCW;
(j) Any agency having been in operation in this state ten years
prior to June 8, 1967, and not seeking or accepting moneys or
assistance from any state or federal agency, and is supported in part
by an endowment or trust fund;
(k) Persons who have a child in their home for purposes of
adoption, if the child was placed in such home by a licensed child-placing agency, an authorized public or tribal agency or court or if a
replacement report has been filed under chapter 26.33 RCW and the
placement has been approved by the court;
(l) An agency operated by any unit of local, state, or federal
government or an agency licensed by an Indian tribe pursuant to RCW
74.15.190;
(m) A maximum or medium security program for juvenile offenders
operated by or under contract with the department;
(n) An agency located on a federal military reservation, except
where the military authorities request that such agency be subject to
the licensing requirements of this chapter.
(3) "Department" means the state department of social and health
services.
(4) "Juvenile" means a person under the age of twenty-one who has
been sentenced to a term of confinement under the supervision of the
department under RCW 13.40.185.
(5) "Performance-based contracts" or "contracting" means the
structuring of all aspects of the procurement of services around the
purpose of the work to be performed and the desired results with the
contract requirements set forth in clear, specific, and objective terms
with measurable outcomes. Contracts may also include provisions that
link the performance of the contractor to the level and timing of the
reimbursement.
(6) "Probationary license" means a license issued as a disciplinary
measure to an agency that has previously been issued a full license but
is out of compliance with licensing standards.
(7) "Requirement" means any rule, regulation, or standard of care
to be maintained by an agency.
(8) "Secretary" means the secretary of social and health services.
(9) "Street youth" means a person under the age of eighteen who
lives outdoors or in another unsafe location not intended for occupancy
by the minor and who is not residing with his or her parent or at his
or her legally authorized residence.
(10) "Supervising agency" means an agency licensed by the state
under RCW 74.15.090 or an Indian tribe under RCW 74.15.190 that has
entered into a performance-based contract with the department to
provide child welfare services.
(11) "Transitional living services" means at a minimum, to the
extent funds are available, the following:
(a) Educational services, including basic literacy and
computational skills training, either in local alternative or public
high schools or in a high school equivalency program that leads to
obtaining a high school equivalency degree;
(b) Assistance and counseling related to obtaining vocational
training or higher education, job readiness, job search assistance, and
placement programs;
(c) Counseling and instruction in life skills such as money
management, home management, consumer skills, parenting, health care,
access to community resources, and transportation and housing options;
(d) Individual and group counseling; and
(e) Establishing networks with federal agencies and state and local
organizations such as the United States department of labor, employment
and training administration programs including the workforce investment
act which administers private industry councils and the job corps;
vocational rehabilitation; and volunteer programs.
Sec. 62 RCW 74.34.020 and 2011 c 170 s 1 and 2011 c 89 s 18 are
each reenacted and amended to read as follows:
((Unless the context clearly requires otherwise,)) The definitions
in this section apply throughout this chapter unless the context
clearly requires otherwise.
(1) "Abandonment" means action or inaction by a person or entity
with a duty of care for a vulnerable adult that leaves the vulnerable
person without the means or ability to obtain necessary food, clothing,
shelter, or health care.
(2) "Abuse" means the willful action or inaction that inflicts
injury, unreasonable confinement, intimidation, or punishment on a
vulnerable adult. In instances of abuse of a vulnerable adult who is
unable to express or demonstrate physical harm, pain, or mental
anguish, the abuse is presumed to cause physical harm, pain, or mental
anguish. Abuse includes sexual abuse, mental abuse, physical abuse,
and exploitation of a vulnerable adult, which have the following
meanings:
(a) "Sexual abuse" means any form of nonconsensual sexual contact,
including but not limited to unwanted or inappropriate touching, rape,
sodomy, sexual coercion, sexually explicit photographing, and sexual
harassment. Sexual abuse includes any sexual contact between a staff
person, who is not also a resident or client, of a facility or a staff
person of a program authorized under chapter 71A.12 RCW, and a
vulnerable adult living in that facility or receiving service from a
program authorized under chapter 71A.12 RCW, whether or not it is
consensual.
(b) "Physical abuse" means the willful action of inflicting bodily
injury or physical mistreatment. Physical abuse includes, but is not
limited to, striking with or without an object, slapping, pinching,
choking, kicking, shoving, prodding, or the use of chemical restraints
or physical restraints unless the restraints are consistent with
licensing requirements, and includes restraints that are otherwise
being used inappropriately.
(c) "Mental abuse" means any willful action or inaction of mental
or verbal abuse. Mental abuse includes, but is not limited to,
coercion, harassment, inappropriately isolating a vulnerable adult from
family, friends, or regular activity, and verbal assault that includes
ridiculing, intimidating, yelling, or swearing.
(d) "Exploitation" means an act of forcing, compelling, or exerting
undue influence over a vulnerable adult causing the vulnerable adult to
act in a way that is inconsistent with relevant past behavior, or
causing the vulnerable adult to perform services for the benefit of
another.
(3) "Consent" means express written consent granted after the
vulnerable adult or his or her legal representative has been fully
informed of the nature of the services to be offered and that the
receipt of services is voluntary.
(4) "Department" means the department of social and health
services.
(5) "Facility" means a residence licensed or required to be
licensed under chapter 18.20 RCW, ((boarding homes)) assisted living
facilities; chapter 18.51 RCW, nursing homes; chapter 70.128 RCW, adult
family homes; chapter 72.36 RCW, soldiers' homes; or chapter 71A.20
RCW, residential habilitation centers; or any other facility licensed
or certified by the department.
(6) "Financial exploitation" means the illegal or improper use,
control over, or withholding of the property, income, resources, or
trust funds of the vulnerable adult by any person or entity for any
person's or entity's profit or advantage other than for the vulnerable
adult's profit or advantage. "Financial exploitation" includes, but is
not limited to:
(a) The use of deception, intimidation, or undue influence by a
person or entity in a position of trust and confidence with a
vulnerable adult to obtain or use the property, income, resources, or
trust funds of the vulnerable adult for the benefit of a person or
entity other than the vulnerable adult;
(b) The breach of a fiduciary duty, including, but not limited to,
the misuse of a power of attorney, trust, or a guardianship
appointment, that results in the unauthorized appropriation, sale, or
transfer of the property, income, resources, or trust funds of the
vulnerable adult for the benefit of a person or entity other than the
vulnerable adult; or
(c) Obtaining or using a vulnerable adult's property, income,
resources, or trust funds without lawful authority, by a person or
entity who knows or clearly should know that the vulnerable adult lacks
the capacity to consent to the release or use of his or her property,
income, resources, or trust funds.
(7) "Financial institution" has the same meaning as in RCW
30.22.040 and 30.22.041. For purposes of this chapter only, "financial
institution" also means a "broker-dealer" or "investment adviser" as
defined in RCW 21.20.005.
(8) "Incapacitated person" means a person who is at a significant
risk of personal or financial harm under RCW 11.88.010(1) (a), (b),
(c), or (d).
(9) "Individual provider" means a person under contract with the
department to provide services in the home under chapter 74.09 or
74.39A RCW.
(10) "Interested person" means a person who demonstrates to the
court's satisfaction that the person is interested in the welfare of
the vulnerable adult, that the person has a good faith belief that the
court's intervention is necessary, and that the vulnerable adult is
unable, due to incapacity, undue influence, or duress at the time the
petition is filed, to protect his or her own interests.
(11) "Mandated reporter" is an employee of the department; law
enforcement officer; social worker; professional school personnel;
individual provider; an employee of a facility; an operator of a
facility; an employee of a social service, welfare, mental health,
adult day health, adult day care, home health, home care, or hospice
agency; county coroner or medical examiner; Christian Science
practitioner; or health care provider subject to chapter 18.130 RCW.
(12) "Neglect" means (a) a pattern of conduct or inaction by a
person or entity with a duty of care that fails to provide the goods
and services that maintain physical or mental health of a vulnerable
adult, or that fails to avoid or prevent physical or mental harm or
pain to a vulnerable adult; or (b) an act or omission that demonstrates
a serious disregard of consequences of such a magnitude as to
constitute a clear and present danger to the vulnerable adult's health,
welfare, or safety, including but not limited to conduct prohibited
under RCW 9A.42.100.
(13) "Permissive reporter" means any person, including, but not
limited to, an employee of a financial institution, attorney, or
volunteer in a facility or program providing services for vulnerable
adults.
(14) "Protective services" means any services provided by the
department to a vulnerable adult with the consent of the vulnerable
adult, or the legal representative of the vulnerable adult, who has
been abandoned, abused, financially exploited, neglected, or in a state
of self-neglect. These services may include, but are not limited to
case management, social casework, home care, placement, arranging for
medical evaluations, psychological evaluations, day care, or referral
for legal assistance.
(15) "Self-neglect" means the failure of a vulnerable adult, not
living in a facility, to provide for himself or herself the goods and
services necessary for the vulnerable adult's physical or mental
health, and the absence of which impairs or threatens the vulnerable
adult's well-being. This definition may include a vulnerable adult who
is receiving services through home health, hospice, or a home care
agency, or an individual provider when the neglect is not a result of
inaction by that agency or individual provider.
(16) "Social worker" means:
(a) A social worker as defined in RCW 18.320.010(2); or
(b) Anyone engaged in a professional capacity during the regular
course of employment in encouraging or promoting the health, welfare,
support, or education of vulnerable adults, or providing social
services to vulnerable adults, whether in an individual capacity or as
an employee or agent of any public or private organization or
institution.
(17) "Vulnerable adult" includes a person:
(a) Sixty years of age or older who has the functional, mental, or
physical inability to care for himself or herself; or
(b) Found incapacitated under chapter 11.88 RCW; or
(c) Who has a developmental disability as defined under RCW
71A.10.020; or
(d) Admitted to any facility; or
(e) Receiving services from home health, hospice, or home care
agencies licensed or required to be licensed under chapter 70.127 RCW;
or
(f) Receiving services from an individual provider; or
(g) Who self-directs his or her own care and receives services from
a personal aide under chapter 74.39 RCW.
Sec. 63 RCW 74.39A.009 and 2009 c 580 s 1 are each amended to
read as follows:
((Unless the context clearly requires otherwise,)) The definitions
in this section apply throughout this chapter unless the context
clearly requires otherwise.
(1) "Adult family home" means a home licensed under chapter 70.128
RCW.
(2) "Adult residential care" means services provided by ((a
boarding home)) an assisted living facility 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)) an assisted living facility 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)) Assisted living facility" means a facility
licensed under chapter 18.20 RCW.
(5) "Core competencies" means basic training topics, including but
not limited to, communication skills, worker self-care, problem
solving, maintaining dignity, consumer directed care, cultural
sensitivity, body mechanics, fall prevention, skin and body care, long-term care worker roles and boundaries, supporting activities of daily
living, and food preparation and handling.
(6) "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.
(7) "Department" means the department of social and health
services.
(8) "Developmental disability" has the same meaning as defined in
RCW 71A.10.020.
(9) "Direct care worker" means a paid caregiver who provides
direct, hands-on personal care services to persons with disabilities or
the elderly requiring long-term care.
(10) "Enhanced adult residential care" means services provided by
((a boarding home)) an assisted living facility 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.
(11) "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, or developmental disability, 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.
(12) "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.
(13) "Home care aide" means a long-term care worker who has
obtained certification as a home care aide by the department of health.
(14) "Individual provider" is defined according to RCW 74.39A.240.
(15) "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.
(16)(a) "Long-term care workers for the elderly or persons with
disabilities" or "long-term care workers" includes all persons who are
long-term care workers for the elderly or persons with 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: (i) Persons employed
by the following facilities or agencies: Nursing homes subject to
chapter 18.51 RCW, hospitals or other acute care settings, residential
habilitation centers under chapter 71A.20 RCW, facilities certified
under 42 C.F.R., Part 483, hospice agencies subject to chapter 70.127
RCW, adult day care centers, and adult day health care centers; or (ii)
persons who are not paid by the state or by a private agency or
facility licensed by the state to provide personal care services.
(17) "Nursing home" means a facility licensed under chapter 18.51
RCW.
(18) "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 disability.
(19) "Population specific competencies" means basic training topics
unique to the care needs of the population the long-term care worker is
serving, including but not limited to, mental health, dementia,
developmental disabilities, young adults with physical disabilities,
and older adults.
(20) "Qualified instructor" means a registered nurse or other
person with specific knowledge, training, and work experience in the
provision of direct, hands-on personal care and other assistance
services to the elderly or persons with disabilities requiring
long-term care.
(21) "Secretary" means the secretary of social and health services.
(22) "Secretary of health" means the secretary of health or the
secretary's designee.
(23) "Training partnership" means a joint partnership or trust that
includes the office of the governor and the exclusive bargaining
representative of individual providers under RCW 74.39A.270 with the
capacity to provide training, peer mentoring, and workforce
development, or other services to individual providers.
(24) "Tribally licensed ((boarding home)) assisted living facility"
means ((a boarding home)) an assisted living facility licensed by a
federally recognized Indian tribe in which ((home)) a facility provides
services similar to ((boarding homes)) assisted living facilities
licensed under chapter 18.20 RCW.
Sec. 64 RCW 74.39A.010 and 1995 1st sp.s. c 18 s 14 are each
amended to read as follows:
(1) To the extent of available funding, the department of social
and health services may contract with licensed ((boarding homes))
assisted living facilities under chapter 18.20 RCW and tribally
licensed ((boarding homes)) assisted living facilities for assisted
living services and enhanced adult residential care. The department
shall develop rules for facilities that contract with the department
for assisted living services or enhanced adult residential care to
establish:
(a) Facility service standards consistent with the principles in
RCW ((74.39A.050)) 74.39A.051 and consistent with chapter 70.129 RCW;
(b) Standards for resident living areas consistent with RCW
74.39A.030;
(c) Training requirements for providers and their staff.
(2) The department's rules shall provide that services in assisted
living and enhanced adult residential care:
(a) Recognize individual needs, privacy, and autonomy;
(b) Include, but not be limited to, personal care, nursing
services, medication administration, and supportive services that
promote independence and self-sufficiency;
(c) Are of sufficient scope to assure that each resident who
chooses to remain in the assisted living or enhanced adult residential
care may do so, to the extent that the care provided continues to be
cost-effective and safe and promote the most appropriate level of
physical, mental, and psychosocial well-being consistent with client
choice;
(d) Are directed first to those persons most likely, in the absence
of enhanced adult residential care or assisted living services, to need
hospital, nursing facility, or other out-of-home placement; and
(e) Are provided in compliance with applicable facility and
professional licensing laws and rules.
(3) When a facility contracts with the department for assisted
living services or enhanced adult residential care, only services and
facility standards that are provided to or in behalf of the assisted
living services or enhanced adult residential care client shall be
subject to the department's rules.
Sec. 65 RCW 74.39A.020 and 2004 c 142 s 15 are each amended to
read as follows:
(1) To the extent of available funding, the department of social
and health services may contract for adult residential care.
(2) The department shall, by rule, develop terms and conditions for
facilities that contract with the department for adult residential care
to establish:
(a) Facility service standards consistent with the principles in
RCW ((74.39A.050)) 74.39A.051 and consistent with chapter 70.129 RCW;
and
(b) Training requirements for providers and their staff.
(3) The department shall, by rule, provide that services in adult
residential care facilities:
(a) Recognize individual needs, privacy, and autonomy;
(b) Include personal care and other services that promote
independence and self-sufficiency and aging in place;
(c) Are directed first to those persons most likely, in the absence
of adult residential care services, to need hospital, nursing facility,
or other out-of-home placement; and
(d) Are provided in compliance with applicable facility and
professional licensing laws and rules.
(4) When a facility contracts with the department for adult
residential care, only services and facility standards that are
provided to or in behalf of the adult residential care client shall be
subject to the adult residential care rules.
(5) To the extent of available funding, the department may also
contract under this section with a tribally licensed ((boarding home))
assisted living facility for the provision of services of the same
nature as the services provided by adult residential care facilities.
The provisions of subsections (2)(a) and (b) and (3)(a) through (d) of
this section apply to such a contract.
Sec. 66 RCW 74.39A.030 and 2002 c 3 s 10 are each amended to read
as follows:
(1) To the extent of available funding, the department shall expand
cost-effective options for home and community services for consumers
for whom the state participates in the cost of their care.
(2) In expanding home and community services, the department shall:
(a) Take full advantage of federal funding available under Title XVIII
and Title XIX of the federal social security act, including home
health, adult day care, waiver options, and state plan services; and
(b) be authorized to use funds available under its community options
program entry system waiver granted under section 1915(c) of the
federal social security act to expand the availability of in-home,
adult residential care, adult family homes, enhanced adult residential
care, and assisted living services. By June 30, 1997, the department
shall undertake to reduce the nursing home medicaid census by at least
one thousand six hundred by assisting individuals who would otherwise
require nursing facility services to obtain services of their choice,
including assisted living services, enhanced adult residential care,
and other home and community services. If a resident, or his or her
legal representative, objects to a discharge decision initiated by the
department, the resident shall not be discharged if the resident has
been assessed and determined to require nursing facility services. In
contracting with nursing homes and ((boarding homes)) assisted living
facilities for enhanced adult residential care placements, the
department shall not require, by contract or through other means,
structural modifications to existing building construction.
(3)(a) The department shall by rule establish payment rates for
home and community services that support the provision of cost-effective care. In the event of any conflict between any such rule and
a collective bargaining agreement entered into under RCW 74.39A.270 and
74.39A.300, the collective bargaining agreement prevails.
(b) The department may authorize an enhanced adult residential care
rate for nursing homes that temporarily or permanently convert their
bed use for the purpose of providing enhanced adult residential care
under chapter 70.38 RCW, when the department determines that payment of
an enhanced rate is cost-effective and necessary to foster expansion of
contracted enhanced adult residential care services. As an incentive
for nursing homes to permanently convert a portion of its nursing home
bed capacity for the purpose of providing enhanced adult residential
care, the department may authorize a supplemental add-on to the
enhanced adult residential care rate.
(c) The department may authorize a supplemental assisted living
services rate for up to four years for facilities that convert from
nursing home use and do not retain rights to the converted nursing home
beds under chapter 70.38 RCW, if the department determines that payment
of a supplemental rate is cost-effective and necessary to foster
expansion of contracted assisted living services.
Sec. 67 RCW 74.39A.320 and 2006 c 260 s 1 are each amended to
read as follows:
(1) To the extent funds are appropriated for this purpose, the
department shall establish a capital add-on rate, not less than the
July 1, 2005, capital add-on rate established by the department, for
those assisted living facilities contracting with the department that
have a medicaid occupancy percentage of sixty percent or greater.
(2) Effective for July 1, 2006, and for each July 1st rate-setting
period thereafter, the department shall determine the facility's
medicaid occupancy percentage using the last six months' medicaid
resident days from the preceding calendar year divided by the product
of all its licensed ((boarding home)) assisted living facility beds
irrespective of use, times calendar days for the six-month period. For
the purposes of this section, medicaid resident days include those
clients who are enrolled in a medicaid managed long-term care program,
including but not limited to the program for all inclusive care and the
medicaid integration project.
(3) The medicaid occupancy percentage established beginning on July
1, 2006, and for each July 1st thereafter, shall be used to determine
whether an assisted living facility qualifies for the capital add-on
rate under this section. Those facilities that qualify for the capital
add-on rate shall receive the capital add-on rate throughout the
applicable fiscal year.
Sec. 68 RCW 74.41.040 and 2008 c 146 s 2 are each amended to read
as follows:
The department shall administer this chapter and shall establish
such rules and standards as the department deems necessary in carrying
out this chapter. The department shall not require the development of
plans of care or discharge plans by nursing homes or adult family homes
providing respite care service under this chapter. ((Boarding homes))
Assisted living facilities providing respite care services shall comply
with the assessment and plan of care provisions of RCW 18.20.350.
The department shall develop standards for the respite program in
conjunction with the selected area agencies on aging. The program
standards shall serve as the basis for soliciting bids, entering into
subcontracts, and developing sliding fee scales to be used in
determining the ability of eligible participants to participate in
paying for respite care.
Sec. 69 RCW 74.42.055 and 2004 c 34 s 1 are each amended to read
as follows:
(1) The purpose of this section is to prohibit discrimination
against medicaid recipients by nursing homes which have contracted with
the department to provide skilled or intermediate nursing care services
to medicaid recipients.
(2) A nursing facility shall readmit a resident, who has been
hospitalized or on therapeutic leave, immediately to the first
available bed in a semiprivate room if the resident:
(a) Requires the services provided by the facility; and
(b) Is eligible for medicaid nursing facility services.
(3) It shall be unlawful for any nursing home which has a medicaid
contract with the department:
(a) To require, as a condition of admission, assurance from the
patient or any other person that the patient is not eligible for or
will not apply for medicaid;
(b) To deny or delay admission or readmission of a person to a
nursing home because of his or her status as a medicaid recipient;
(c) To transfer a patient, except from a private room to another
room within the nursing home, because of his or her status as a
medicaid recipient;
(d) To transfer a patient to another nursing home because of his or
her status as a medicaid recipient;
(e) To discharge a patient from a nursing home because of his or
her status as a medicaid recipient; or
(f) To charge any amounts in excess of the medicaid rate from the
date of eligibility, except for any supplementation permitted by the
department pursuant to RCW 18.51.070.
(4) Any nursing home which has a medicaid contract with the
department shall maintain one list of names of persons seeking
admission to the facility, which is ordered by the date of request for
admission. This information shall be retained for one year from the
month admission was requested. However, except as provided in
subsection (2) of this section, a nursing facility is permitted to give
preferential admission to individuals who seek admission from ((a
boarding home)) an assisted living facility, licensed under chapter
18.20 RCW, or from independent retirement housing, provided the nursing
facility is owned by the same entity that owns the ((boarding home))
assisted living facility or independent housing which are located
within the same proximate geographic area; and provided further, the
purpose of such preferential admission is to allow continued provision
of: (a) Culturally or faith-based services, or (b) services provided
by a continuing care retirement community as defined in RCW 70.38.025.
(5) The department may assess monetary penalties of a civil nature,
not to exceed three thousand dollars for each violation of this
section.
(6) Because it is a matter of great public importance to protect
senior citizens who need medicaid services from discriminatory
treatment in obtaining long-term health care, any violation of this
section shall be construed for purposes of the application of the
consumer protection act, chapter 19.86 RCW, to constitute an unfair or
deceptive act or practice or unfair method of competition in the
conduct of trade or commerce.
(7) It is not an act of discrimination under this chapter to refuse
to admit a patient if admitting that patient would prevent the needs of
the other patients residing in that facility from being met at that
facility, or if the facility's refusal is consistent with subsection
(4) of this section.
Sec. 70 RCW 82.04.2908 and 2005 c 514 s 302 are each amended to
read as follows:
(1) Upon every person engaging within this state in the business of
providing room and domiciliary care to residents of ((a boarding home))
an assisted living facility licensed under chapter 18.20 RCW, the
amount of tax with respect to such business shall be equal to the gross
income of the business, multiplied by the rate of 0.275 percent.
(2) For the purposes of this section, "domiciliary care" has the
meaning provided in RCW 18.20.020.
Sec. 71 RCW 82.04.4264 and 2005 c 514 s 301 are each amended to
read as follows:
(1) This chapter does not apply to amounts received by a nonprofit
((boarding home)) assisted living facility licensed under chapter 18.20
RCW for providing room and domiciliary care to residents of the
((boarding home)) assisted living facility.
(2) As used in this section:
(a) "Domiciliary care" has the meaning provided in RCW 18.20.020.
(b) "Nonprofit ((boarding home)) assisted living facility" means
((a boarding home)) an assisted living facility that is operated as a
religious or charitable organization, is exempt from federal income tax
under 26 U.S.C. Sec. 501(c)(3), is incorporated under chapter 24.03
RCW, is operated as part of a nonprofit hospital, or is operated as
part of a public hospital district.
Sec. 72 RCW 82.04.4337 and 2004 c 174 s 7 are each amended to
read as follows:
(1) ((A boarding home)) An assisted living facility licensed under
chapter 18.20 RCW may deduct from the measure of tax amounts received
as compensation for providing adult residential care, enhanced adult
residential care, or assisted living services under contract with the
department of social and health services authorized by chapter 74.39A
RCW to residents who are medicaid recipients.
(2) For purposes of this section, "adult residential care,"
"enhanced adult residential care," and "assisted living services" have
the same meaning as in RCW 74.39A.009.
Sec. 73 RCW 84.36.381 and 2011 c 174 s 105 are each amended to
read as follows:
A person is exempt from any legal obligation to pay all or a
portion of the amount of excess and regular real property taxes due and
payable in the year following the year in which a claim is filed, and
thereafter, in accordance with the following:
(1) The property taxes must have been imposed upon a residence
which was occupied by the person claiming the exemption as a principal
place of residence as of the time of filing. However, any person who
sells, transfers, or is displaced from his or her residence may
transfer his or her exemption status to a replacement residence, but no
claimant may receive an exemption on more than one residence in any
year. Moreover, confinement of the person to a hospital, nursing home,
((boarding home)) assisted living facility, or adult family home does
not disqualify the claim of exemption if:
(a) The residence is temporarily unoccupied;
(b) The residence is occupied by a spouse or a domestic partner
and/or a person financially dependent on the claimant for support; or
(c) The residence is rented for the purpose of paying nursing home,
hospital, ((boarding home)) assisted living facility, or adult family
home costs;
(2) The person claiming the exemption must have owned, at the time
of filing, in fee, as a life estate, or by contract purchase, the
residence on which the property taxes have been imposed or if the
person claiming the exemption lives in a cooperative housing
association, corporation, or partnership, such person must own a share
therein representing the unit or portion of the structure in which he
or she resides. For purposes of this subsection, a residence owned by
a marital community or state registered domestic partnership or owned
by cotenants is deemed to be owned by each spouse or each domestic
partner or each cotenant, and any lease for life is deemed a life
estate;
(3)(a) The person claiming the exemption must be:
(i) Sixty-one years of age or older on December 31st of the year in
which the exemption claim is filed, or must have been, at the time of
filing, retired from regular gainful employment by reason of
disability; or
(ii) A veteran of the armed forces of the United States entitled to
and receiving compensation from the United States department of
veterans affairs at a total disability rating for a service-connected
disability.
(b) However, any surviving spouse or surviving domestic partner of
a person who was receiving an exemption at the time of the person's
death will qualify if the surviving spouse or surviving domestic
partner is fifty-seven years of age or older and otherwise meets the
requirements of this section;
(4) The amount that the person is exempt from an obligation to pay
is calculated on the basis of combined disposable income, as defined in
RCW 84.36.383. If the person claiming the exemption was retired for
two months or more of the assessment year, the combined disposable
income of such person must be calculated by multiplying the average
monthly combined disposable income of such person during the months
such person was retired by twelve. If the income of the person
claiming exemption is reduced for two or more months of the assessment
year by reason of the death of the person's spouse or the person's
domestic partner, or when other substantial changes occur in disposable
income that are likely to continue for an indefinite period of time,
the combined disposable income of such person must be calculated by
multiplying the average monthly combined disposable income of such
person after such occurrences by twelve. If it is necessary to
estimate income to comply with this subsection, the assessor may
require confirming documentation of such income prior to May 31 of the
year following application;
(5)(a) A person who otherwise qualifies under this section and has
a combined disposable income of thirty-five thousand dollars or less is
exempt from all excess property taxes; and
(b)(i) A person who otherwise qualifies under this section and has
a combined disposable income of thirty thousand dollars or less but
greater than twenty-five thousand dollars is exempt from all regular
property taxes on the greater of fifty thousand dollars or thirty-five
percent of the valuation of his or her residence, but not to exceed
seventy thousand dollars of the valuation of his or her residence; or
(ii) A person who otherwise qualifies under this section and has a
combined disposable income of twenty-five thousand dollars or less is
exempt from all regular property taxes on the greater of sixty thousand
dollars or sixty percent of the valuation of his or her residence;
(6)(a) For a person who otherwise qualifies under this section and
has a combined disposable income of thirty-five thousand dollars or
less, the valuation of the residence is the assessed value of the
residence on the later of January 1, 1995, or January 1st of the
assessment year the person first qualifies under this section. If the
person subsequently fails to qualify under this section only for one
year because of high income, this same valuation must be used upon
requalification. If the person fails to qualify for more than one year
in succession because of high income or fails to qualify for any other
reason, the valuation upon requalification is the assessed value on
January 1st of the assessment year in which the person requalifies. If
the person transfers the exemption under this section to a different
residence, the valuation of the different residence is the assessed
value of the different residence on January 1st of the assessment year
in which the person transfers the exemption.
(b) In no event may the valuation under this subsection be greater
than the true and fair value of the residence on January 1st of the
assessment year.
(c) This subsection does not apply to subsequent improvements to
the property in the year in which the improvements are made.
Subsequent improvements to the property must be added to the value
otherwise determined under this subsection at their true and fair value
in the year in which they are made.
Sec. 74 RCW 84.36.383 and 2010 c 106 s 307 are each amended to
read as follows:
As used in RCW 84.36.381 through 84.36.389, except where the
context clearly indicates a different meaning:
(1) The term "residence" means a single family dwelling unit
whether such unit be separate or part of a multiunit dwelling,
including the land on which such dwelling stands not to exceed one
acre, except that a residence includes any additional property up to a
total of five acres that comprises the residential parcel if this
larger parcel size is required under land use regulations. The term
also includes a share ownership in a cooperative housing association,
corporation, or partnership if the person claiming exemption can
establish that his or her share represents the specific unit or portion
of such structure in which he or she resides. The term also includes
a single family dwelling situated upon lands the fee of which is vested
in the United States or any instrumentality thereof including an Indian
tribe or in the state of Washington, and notwithstanding the provisions
of RCW 84.04.080 and 84.04.090, such a residence is deemed real
property.
(2) The term "real property" also includes a mobile home which has
substantially lost its identity as a mobile unit by virtue of its being
fixed in location upon land owned or leased by the owner of the mobile
home and placed on a foundation (posts or blocks) with fixed pipe,
connections with sewer, water, or other utilities. A mobile home
located on land leased by the owner of the mobile home is subject, for
tax billing, payment, and collection purposes, only to the personal
property provisions of chapter 84.56 RCW and RCW 84.60.040.
(3) "Department" means the state department of revenue.
(4) "Combined disposable income" means the disposable income of the
person claiming the exemption, plus the disposable income of his or her
spouse or domestic partner, and the disposable income of each cotenant
occupying the residence for the assessment year, less amounts paid by
the person claiming the exemption or his or her spouse or domestic
partner during the assessment year for:
(a) Drugs supplied by prescription of a medical practitioner
authorized by the laws of this state or another jurisdiction to issue
prescriptions;
(b) The treatment or care of either person received in the home or
in a nursing home, ((boarding home)) assisted living facility, or adult
family home; and
(c) Health care insurance premiums for medicare under Title XVIII
of the social security act.
(5) "Disposable income" means adjusted gross income as defined in
the federal internal revenue code, as amended prior to January 1, 1989,
or such subsequent date as the director may provide by rule consistent
with the purpose of this section, plus all of the following items to
the extent they are not included in or have been deducted from adjusted
gross income:
(a) Capital gains, other than gain excluded from income under
section 121 of the federal internal revenue code to the extent it is
reinvested in a new principal residence;
(b) Amounts deducted for loss;
(c) Amounts deducted for depreciation;
(d) Pension and annuity receipts;
(e) Military pay and benefits other than attendant-care and
medical-aid payments;
(f) Veterans benefits, other than:
(i) Attendant-care payments;
(ii) Medical-aid payments;
(iii) Disability compensation, as defined in Title 38, part 3,
section 3.4 of the code of federal regulations, as of January 1, 2008;
and
(iv) Dependency and indemnity compensation, as defined in Title 38,
part 3, section 3.5 of the code of federal regulations, as of January
1, 2008;
(g) Federal social security act and railroad retirement benefits;
(h) Dividend receipts; and
(i) Interest received on state and municipal bonds.
(6) "Cotenant" means a person who resides with the person claiming
the exemption and who has an ownership interest in the residence.
(7) "Disability" has the same meaning as provided in 42 U.S.C. Sec.
423(d)(1)(A) as amended prior to January 1, 2005, or such subsequent
date as the department may provide by rule consistent with the purpose
of this section.
NEW SECTION. Sec. 75 All department of social and health
services rules that apply to licensed boarding homes on the effective
date of this section continue in effect and apply to licensed assisted
living facilities, as defined in RCW 18.20.020.