H-3662              _______________________________________________

 

                                                   HOUSE BILL NO. 1717

                        _______________________________________________

 

State of Washington                              49th Legislature                              1986 Regular Session

 

By Representative Braddock

 

 

Read first time 1/22/86 and referred to Committee on Ways & Means.

 

 


AN ACT Relating to voluntary long-term care organizations; and creating new sections.

 

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

 

          NEW SECTION.  Sec. 1.     (1) The purpose of this act is to establish the special joint committee of the Washington state legislature for the creation of long-term care corporations.  This committee shall:

          (a) Determine how to facilitate the establishment and operation of long-term care corporations in this state, including negotiating with the United States department of health and human services in seeking waivers or experimental authorities that might be necessary under Titles XVIII and XIX of the social security act to fulfill the purposes of this act;

          (b) Devise methods of regulating long-term care corporations; and

          (c) Recommend methods for the orderly and expeditious establishment of such corporations.

          (2) The committee shall produce a plan not later than September 1, 1986, and shall submit legislation at the outset of the 1987 legislative session.  This legislation shall establish:

          (a) The state's intent to facilitate the creation of long-term care corporations and the Washington state council of long-term care corporations;

          (b) Necessary changes to existing law required to accomplish those ends;

          (c) Required actions and designated persons to secure waivers or experimental authorities under Titles XVIII and XIX of the United States social security act to guarantee participation of the medicare and medicaid programs in the corporations established in the legislation;

          (d) The joint legislative oversight committee on long-term care corporations, which shall design and conduct evaluations of the implementation of activities under this act.

 

          NEW SECTION.  Sec. 2.     Unless the context clearly requires otherwise, the definitions in this section apply throughout this act.

          (1) "Council" means the Washington state council of long-term care corporations which shall be a voluntary, cooperative organization established by member long-term care corporations.

          (2) "Long-term care" means a combination of medical, social, and spiritual services provided to chronically functionally impaired persons for the purpose of maintaining or restoring maximum independence and enjoyment of life as long as is possible and is desired by the person or the person's guardian, followed by dignified and appropriate custody for persons for whom maintenance of independent functioning is not possible, and dignified death in manners prescribed by patients and their families.  Such services include, but are not limited to:

          (a) Medical services rendered under the supervision of appropriate clinical professionals in hospitals, nursing homes, personal care facilities, congregate care facilities, and other appropriate settings;

          (b) Home-based services required for personal care, proper nutrition, and maintenance of safe, comfortable, and accessible surroundings; and

          (c) Community-based services required to enhance participation in and enjoyment of community activities.

          (3) "Long-term care corporation" means a cooperatively owned and operated, nonprofit, tax-exempt,  voluntary organization that provides or secures the provision of long-term care services for its members.  The nature, scope, and intensity of services offered to members shall be defined by the trustees of the corporation and specified in contracts with members or their guardians, subject to minimum standards established by the state.  Decisions regarding the provision of services to particular members shall be made in accordance with such contracts by clinically educated case managers who are health care professionals licensed by the state and either employed or designated by the corporation.

          (4) "Long-term care insurance" means a joint life and health insurance plan that pays annuities to holders, their guardians, or the long-term care corporations in which holders are members upon certification by the corporations that holders require long-term care.  Upon the death of holders, balances shall be paid to beneficiaries as under customary life insurance plans.  Long-term care insurance policies shall be designated as qualified independent retirement accounts for purposes of federal tax statutes.

 

          NEW SECTION.  Sec. 3.     (1) Corporations shall provide case management services that assure the timely provision of appropriate long-term care services to their members.

          (2) When desired by members or their guardians and upon entering into contracts to that effect, corporations shall act as fiscal intermediaries on behalf of members in either directly providing long-term care services or in purchasing services on favorable and exclusive terms from other preferred providers.  Under such arrangements, where members' services are covered by other third parties, corporations may bill such third parties for services rendered and may charge such intermediaries necessary and reasonable costs associated with case management and administration.

          (3) Corporations shall provide members with financial services in negotiating reversed annuity mortgages, indemnification of life insurance policies, and other services that will assist members in converting fixed assets into liquid assets.  When members die before converted assets are exhausted, beneficiaries shall receive remaining funds held by the corporation less contractually agreed upon administrative costs.  If the corporation itself holds a member's fixed assets or was the member's agent in establishing annuities based on the sale or conversion of assets, the corporation shall make those assets available to the deceased member's beneficiaries on favorable terms, less contractually agreed upon administrative costs.

          (4) Corporations may charge members or their insurers capitated premiums and levy membership fees.

          (5) Corporations shall be designated as competitive medical organizations or health maintenance organizations and thereby shall be eligible to enter into risk-sharing contracts with medicare and be exempted from regulation under certificate of need requirements.  Under such arrangements, the risk pool upon which capitation rates are based shall be the entire age-adjusted population of the state of Washington, with other adjustments that are determined by the state to be proper.

          (6) Corporations shall be permitted to enroll as members' medicaid beneficiaries.  On behalf of such members, the state shall pay corporations capitated  rates based on age-adjusted formulae, including other  adjustments the state determines to be proper.  Payments shall be drawn from medicaid funds as well as from other funds authorized and appropriated for long-term care services.

          (7) Earnings from facilities, businesses, property, and investments owned or operated by corporations that are retained by corporations and employed for the purposes described in this act shall be exempt from state taxes.

 

          NEW SECTION.  Sec. 4.     (1) The council shall assist member corporations in carrying out their responsibilities.

          (2) The council shall be authorized by the state's insurance statutes to sell long-term care insurance to members of constituent corporations and to other citizens of the state.