HOUSE BILL REPORT

SB 6271

As Amended by the House

BYSenators Deccio, Wojahn, Smith, Kreidler and Nelson

Regulating care provided in the home to ill, disabled, or infirm persons.

House Committe on Health Care

Majority Report:  Do pass with amendments.  (11)

      Signed by Representatives Braddock, Chair; Day, Vice Chair; Bristow, Brooks, Bumgarner, Cantwell, Lewis, Lux, D. Sommers, Sprenkle and Vekich.

House Staff:Antonio Sanchez (786-7383)

Rereferred House Committee on Ways & Means/Appropriations

Majority Report:  The amended bill by Committee on Health Care as further amended by Committee on Ways & Means/Appropriations do pass.  (21)

      Signed by Representatives Locke, Chair; Belcher, Braddock, Brekke, Brough, Butterfield, Ebersole, Fuhrman, Grant, Grimm, Hine, Holland, McLean, Nealey, Peery, Sayan, H. Sommers, Spanel, Sprenkle, Wang and B. Williams.

House Staff:      Sandi Gray (786-7136)

AS REPORTED BY COMMITTEE ON WAYS & MEANS/APPROPRIATIONS

FEBRUARY 27, 1988

BACKGROUND:

In-home health services for the ill and disabled are classified into three major service delivery categories: home health care, hospice care, and home care.  Home health care refers to a range of medically related acute and health maintenance services such as nursing, rehabilitation therapies, nutritional therapies, and a full range of other essential medically related assistance.  Hospice care is provided to the terminally ill, in the form of supportive nursing services, medically based palliative care, social and emotional care and bereavement support to the family.  Home care services include nonmedical services such as, in-home assistance with daily household tasks, personal care assistance, and respite care services.

Currently there is no mandatory regulation of organizations that provide care in home settings, nor are there minimum standards established for the delivery of home health, hospice and home care services.  Home health and hospice service, however, are subject to a voluntary certification program administered by the department of social and health services.  Certification is required for participation in the federal Medicare program and for some agencies wishing to receive third party reimbursement.

Home based health and support services are currently undergoing tremendous expansion in size and scope of practice.  This rapid growth is the result of early patient discharges brought on by hospital cost containment efforts and an increased number of medically needy debilitated persons, many of whom are elderly.

SUMMARY:

The in-home health care industry is regulated by separately licensing home health, hospice and home care agencies. The Department of Social and Health Services (DSHS) is the designated licensure authority. Licensure standards are established for each type of agency. A certificate of need is not required for licensure.  DSHS is given enforcement authority and may revoke a license or assess a penalty in order to assure compliance. The Secretary of DSHS is authorized to establish licensure fees.

Home health agencies provide home health aide services or two or more medical or health related services.  Home care agencies provide personal care, homemaker services, respite care or other non-medical in-home services.  Hospice agencies provide medical and home care services to the terminally ill.

Exemptions from licensure are provided for family members, certain entities furnishing durable medical equipment; providers who contract with a licensed agency; employees, volunteers or contract providers of a licensed agency; certain facilities and institutions already licensed by the state; medically approved kidney dialysis programs and volunteer home care agencies.

Volunteer hospice programs established before January 1, 1988 that do not meet licensure requirements may use the term "volunteer hospice."  All volunteer hospice agencies that apply for licensure are exempted from professional liability, public liability and property damage insurance requirements.

Nursing homes and hospitals are required to be licensed for home health, home care and hospice services provided outside the nursing home or hospital facility.

Insurance requirements are established.

In-home service agencies must submit applications for licensure with licensure fee to DSHS by July 1, 1989.  DSHS must license these applicants by July 1, 1990.

DSHS collects data on services provided by licensed agencies.  DSHS may combine applications, on-site inspections and audits and may reduce fees for agencies applying for more than one in-home service license.

Each in-home agency is required to issue clients a consumer bill of rights.

Third party payment may be made only to licensed home health and hospice agencies, though third party payments may also require adherence to Medicare standards as a condition for payment.

The act will sunset on July 1, 1993.  The LBC is directed to conduct a fiscal and program review on this act by December 31, 1992.

The bill stipulates that a $50 surcharge per year be assessed to every licensed home health care agency until the cost of implementing the licensure act is repaid.

Appropriation:    $38,875 General-Fund State to the Department of Social and Health Services.

Fiscal Note:      Available.

House Committee ‑ Testified For:    (Health Care)  Margaret Shepherd, Home Care Association of Washington; Gail Toraason, Home Care Association of Washington; Betty Jergensen, Washington State Hospice Organization; Arnold Livingston, Senior Citizen Lobby, Ken Lewis, DSHS-Office of Licensing & Certification; Frank Chestnut, DSHS-Certificate of Need; Joan Gaumer, Blue Cross; Jane Boyajian, State Long Term Care Association; Glen Hudson, Washington State Health Care Association.

(Ways & Means/Appropriations)  Gail Toraason, Home Care Association of Washington.

House Committee - Testified Against:      (Health Care)  None Presented.

(Ways & Means/Appropriations)  None Presented.

House Committee - Testimony For:    (Health Care)  This measure will establish a range of appropriate standards to insure safe and competent home based care to ill, disabled, and infirm persons.

(Ways & Means/Appropriations)  Same as Committee on Health Care.

House Committee - Testimony Against:      (Health Care)  None Presented.

(Ways & Means/Appropriations)  None Presented.