SENATE BILL REPORT

SB 5682

BYSenators West, Kreidler, Niemi, Wojahn and Smitherman; by request of Department of Social and Health Services

Relating to long-term adult care.

Senate Committee on Health Care & Corrections

Senate Hearing Date(s):February 21, 1989; February 28, 1989

Majority Report:  That Substitute Senate Bill No. 5682 be substituted therefor, and the substitute bill do pass and be referred to Committee on Ways & Means.

      Signed by Senators West, Chairman; Smith, Vice Chairman; Johnson, Kreidler, Niemi, Wojahn.

Senate Staff:Scott Plack (786-7409)

                  March 1, 1989

Senate Committee on Ways & Means

Senate Hearing Date(s):March 20, 1989; March 21, 1989; March 23, 1989

Majority Report:  That Second Substitute Senate Bill No. 5682 be substituted therefor, and the second substitute bill do pass.

      Signed by Senators McDonald, Chairman; Amondson, Bailey, Bauer, Bluechel, Cantu, Gaspard, Hayner, Lee, Matson, Moore, Newhouse, Niemi, Owen, Saling, Talmadge, Williams, Wojahn.

Senate Staff:Jan Sharar (786-7715)

                  March 24, 1989

AS REPORTED BY COMMITTEE ON WAYS & MEANS, MARCH 23, 1989

BACKGROUND:

Nearly 80 percent of long term care services are now provided by family and friends.  However, between now and the year 2000, a 46 percent growth is projected in the population of individuals ages 85 years or older.  More than 30 percent growth is projected in the population of individuals between 75 to 85 years of age.  Because of these population changes, an increased demand is expected for publicly funded long term care services. 

Current state long term care policy provides a federal entitlement (Title XIX) for nursing home care for persons who meet income and disability requirements.  The entitlement combined with our state nursing home reimbursement statutes results in major increases in state and federal funds for nursing home services.  Other types of long term care such as chore services and respite care have not expanded to meet demand.

SUMMARY:

Chore services must be defined by the Department of Social and Health Services (DSHS) as personal care tasks which eligible persons are unable to do for themselves because of frailty or handicapping conditions.  Persons eligible for chore services are those with resources below levels determined by DSHS, who are at risk of residential facility placement as determined by DSHS and who are not eligible for Medicaid personal care services.

DSHS may implement ratable reductions in hours or services for persons eligible for chore services.

The requirement is deleted that chore services be provided only to the extent necessary to maintain a safe and healthy living environment.

The requirement that DSHS consider the availability and capability of relatives, friends and other community resources in determining the level of needed services is replaced by the requirement that DSHS consider whether such alternative help is being provided.

The Department of Social and Health Services must amend the state plan for Title XIX to provide for personal care services.

Effective October 1, 1989, DSHS must promulgate rules consistent with federal law concerning the transfer of income and assets between institutionalized and spouses who remain in the community.  Community assets may be transferred to and retained by the spouse of an institutionalized person up to the federal maximum.  The income of the spouse remaining in the community must be set at the federal minimum which is $786 per month plus special allowances for extraordinary living expenses.

Effective October 1, 1989, DSHS must promulgate rules consistent with federal law concerning due process in fair hearings regarding income and asset valuation and transfer.

The definitions of appraisal of real and personal property in the nursing home reimbursement laws are clarified.

The term "fair market value" is clarified in the nursing home reimbursement law.

A lid is placed on allowable legal and accounting costs for nursing homes at 85 percent of such costs for all providers.

Minimum occupancy levels for Medicaid reimbursed nursing homes are raised from 85 percent to 92 percent.

EFFECT OF PROPOSED SUBSTITUTE:

Chore services are defined as personal care and related tasks as provided for in the state medical assistance plan.  The department is permitted to implement rateable reductions in services to clients.  Some individuals receiving household and attendant care services are grandfathered.

State policy is established to encourage the development of volunteer chore services and to fund these services on a priority basis.

DSHS is directed to amend state plan for medical assistance to include personal care services.  Financial eligibility levels are to be revised as they are adjusted by the federal government for inflation.  Management controls from the growth of the personal care program are specified and include:  personal care services shall be provided subject to available funding; eligible client must be categorically needy; client assessment of medical condition by physician is required and updated every 90 days; functional assessment of client is required where clients with less disability are cut from program should funding be reduced.

Respite care is expanded statewide to the extent funding is available.

The Joint Select Commission on Long Term Care is established and provides for a legislative/public study of long-term care issues.  A report is due to the Legislature by December 1, 1990.

EFFECT OF PROPOSED SECOND SUBSTITUTE:

Nonpersonal care services cannot be provided through the chore services program.

It is clarified that the provision of Medicaid personal care services shall be given to clients based on the level of assessed functional disability to serve the most disabled first.

DSHS is required to report annually, beginning January 1, 1990, on the utilization and expenditures associated with the use of the personal care option under Medicaid law.

The mandate to DSHS to contract with all Area Agencies on Aging for respite care projects is removed.

Appropriation:    none

Revenue:    none

Fiscal Note:      available

Effective Date:July 1, 1989, except as noted above.

Senate Committee - Testified: HEALTH CARE & CORRECTIONS:  Charles Reed, DSHS (pro); Evan Iverson (pro); Michael T. Manley, Washington Association of Area Agencies on Aging (pro); Glen Hudson, Washington Health Care Association; M. Casey (pro); Karen McCarthy (pro)

Senate Committee - Testified: WAYS & MEANS:  Evan Iverson, Senior Citizens Lobby; Kamala Bremer, Dewey Desler, Washington State Assoc. Area Agencies on Aging (pro); Charles Reed, DSHS; Gwen Hudson, Jerry Reilly, Washington Health Care Association; Margaret Casey, Washington State Catholic Conf.