HOUSE BILL REPORT

HB 1968

BYRepresentatives Braddock, Brooks, Day, Cantwell, Leonard, Prentice, Bristow, Brekke, Vekich, Kremen, Valle, Raiter, D. Sommers, Morris, Sprenkle, Ebersole, Wineberry, H. Sommers, Cole, Hine, Basich, Anderson, Van Luven, Dellwo, Todd, Winsley, Sayan, Cooper, R. King, Crane, Rector, Brough, Zellinsky, Phillips, Pruitt, O'Brien, Nelson, Spanel, G. Fisher, Rasmussen,  H. Myers and Fraser

Establishing a plan for long-term care services.

House Committe on Health Care

Majority Report:  The substitute bill be substituted therefor and the substitute bill do pass.  (9)

      Signed by Representatives Braddock, Chair; Day, Vice Chair; Brooks, Ranking Republican Member; Cantwell, Prentice, Sommers, Sprenkle, Vekich and Wolfe.

House Staff:Antonio Sanchez (786-7383)

Rereferred House Committee on Appropriations

Majority Report:  The substitute bill by Committee on Health Care be substituted therefor and the substitute bill do pass. (23)

      Signed by Representatives Locke, Chair; Grant, Vice Chair; H. Sommers, Vice Chair; Appelwick, Belcher, Bowman, Braddock, Brekke, Bristow, Dorn, Ebersole, Hine, May, McLean, Padden, Peery, Rust, Sayan, Spanel, Sprenkle, Valle, Wang and Wineberry.

Minority Report:  Do not pass. (2)

      Signed by Representatives Silver, Ranking Republican Member and Nealey.

House Staff:      Dave Knutson (786-7136)

AS REPORTED BY COMMITTEE ON APPROPRIATIONS MARCH 5, 1989

BACKGROUND:

In the next 10 years, the demand for long term care services is expected to grow substantially.  This impending demand is being driven by a virtual age wave of adults, many of whom are over the age of 85.  Persons with AIDS, the mentally retarded, traumatically brain injured, and others with functional dependency due to incapacity will also require an array of community based long term care services.

Long term care services in this state are composed of several independent systems that are not uniformly bound in terms of common goals, methods of approach, eligibility criteria, and overall coordination of services.  Both federal and state funding categories have influenced this fractured approach.  As a result, long term care services are scattered among several divisions within the Department of Social and Health Services (DSHS), including the division of Developmental Disabilities, Division of Aging and Adult Services, Division of Mental Health, Division of Children and Family Services, Division of Vocational Rehabilitation, Office on AIDS, Division of Health, and Bureau of Alcohol and Substance Abuse.

The inability of an individual to care for himself or herself because of functional disability, is the most likely reason persons seek long term care services.  However, despite this factor, eligibility for most long term care services is based on categorical eligibility guidelines, such as age and/or income.  The uniform measurement and application of functional disability to determine the need for long term care, is lacking.

A range of community based health, social and supportive services, including chore services, limited respite assistance, adult family homes, group homes and other types of long term care services are currently provided to the elderly, developmentally disabled, and mentally ill.  Respite services are not provided state-wide, uniform case management services are lacking, and currently there is no personal care services tailored to the needs of persons with AIDS.  Community based services only make up a small fraction of the state's total long term care budget, while nursing home care consumes the remainder.  Unequal funding for community based long term care is in part due to the lack of federal funds.  Title XIX federal Medicaid funding for personal care, hospice or case management is currently not part of our state's federal funding sources for community based long term care services.  This funding option is available if the state is willing to accept the eligibility requirements established by the federal government.

The need to have a balanced and funded array of community based long term care services has been uniformly expressed in several recent legislative and departmental reports and by advocates of long term care services.

SUMMARY:

SUBSTITUTE BILL:  A long term care policy is established for the state, that calls for the coordination of long term care services between all divisions involved in long term care, a state-wide balanced array of community based care, and the foundation of long term care service eligibility based on a person's measurable functional incapacity due to disability.

State funded chore services are revised to make service categories comply with similar categories mandated in Title XIX personal care and, in keeping consistency with current aging and adult services administrative policy.  Persons who were receiving assistance with household tasks only or attendant care prior to the Department of Social and Health Services' program changes in 1988 will be grandparented into the Chore program.

The Department of Social and Health Services is authorized to expand the current respite program state-wide for children as well as adults who are at risk, to placement in a long term care facility.  A DSHS progress report is required for the respite services provided before 1991. Case management services are limited to individuals with at least one personal care need diagnosed by a physician.  Eligibility for Title XIX personal care services will be based on the categorically needy while case management and hospice services will use the definition of medically needy.

The Department of Social and Health Services is directed to request an amendment from the federal government to their Medicaid waiver Community Options Program Entry System (COPES).  The amendment will include respite services. The department is also directed to request another separate Medicaid waiver to allow personal care services for persons with AIDS.  All persons receiving services under the Medicaid community based waver such as COPES, personal care, hospice, or in a nursing home, will be required to comply with the federal OBRA, Omnibus Reconciliation Act of 1987.  These federal requirements direct the Department of Social and Health Services to allow the spouse of the person receiving these services to retain the maximum amount of allowable resources, ($60,000), and starting September 30th the minimum monthly income, ($786).

The Department of Social and Health Services is allowed to retain the funds saved by taking advantage of Title XIX personal care for funding state funded Chore services and respite services.

A long term care implementation team consisting of 11 long term care experts is created to develop a plan for coordination between all Department of Social and Health Services long-term care providers; design a non-categorical long term care system; county designated long term care services;  statewide case management; improved non-institutional residential options; a uniform sliding fee scale for non-Title XIX federal social security act programs; creative and active involvement of volunteers in long term care; information systems development; coordinated long term care education; and long term care cost information.

Residential care facilities serving from five to 15 functionally disabled persons will be able to locate in zoning areas for single family housing.

Financing for the sections with fiscal impact is contingent upon a voter approved state levied tax of .25 for every $1,000 of assessed value for all taxable property within the state.  One hundred and fifty thousand dollars is appropriated for the Department of Social and Health Services to coordinate the activities of the long term care implementation team.

SUBSTITUTE BILL COMPARED TO ORIGINAL: Both technical and clarifying changes were made to carry out the original intent of the drafters.  Specific rate increases for adult family homes and congregate care facilities were eliminated as a result of proposed Title XIX implementation. The Department of Social and Health Services is authorized to define the Title XIX Case management services.  The 65 percent of nursing home costs lid and limiting the amount of Title XIX Medical assistance personal care services were eliminated.  All references authorizing the Department of Social and Health Services to base eligibility for Title XIX personal care services on medical need, is also deleted.  Specific dollar references assigned to Medicaid eligibility requirements of interspousal transfer of assets and allowable monthly income are eliminated and replaced with language that complies with federal requirements.  The savings generated by implementing Title XIX personal care are funneled back into community based state funded chore and respite services.  The implementation team is required to evaluate the feasibility of providing Title XIX funded personal care services to the medically needy.

CHANGES PROPOSED BY COMMITTEE ON APPROPRIATIONS:  None.

Fiscal Note:      Available.

House Committee ‑ Testified For:    (Health Care) Denise Klein, King County Area Agency on Aging; Norm DeShaw, Senior Services of Washington; Bea Kelleigh, Northwest AIDS Foundation; Betty Jorgensen, Washington State Hospice Organization; Frank Winslow, Alzheimers Society of Washington and Lisa Brodoff, Puget Sound Legal Services.

(Appropriations) Glen Hudson, Washington Association of Homes for the Aged; Denise Klein, King County Area Agency on Aging.

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

(Appropriations) None Presented.

House Committee - Testimony For:    (Health Care) A balanced long term care system based on functional disability will provide the most appropriate, effective, economical, and least restrictive array of services to the functionally incapacitated.  Appropriate use of the savings, resulting form the implementation of Title XIX will help in the balance of services.  Stability of the long term care system is dependent on the implementation of federally matched community based personal care, case management, and hospice care. The future of long term care services is important and the implementation team will provide the direction for appropriate system reform.

(Appropriations) Title XIX Personal Care will be an important new service in the long term care system.  A comprehensive approach to long term care services will result in improved service delivery to the elderly and the functionally disabled.

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

(Appropriations) None Presented.