H-1421

AN ACT Relating to enhancement of community-based long-term care and support services; amending RCW 74.09.510 and 74.09.700; reenacting and amending RCW 74.09.520; adding new sections to chapter 74.09 RCW; adding a new section to chapter 71A.12 RCW; creating new sections; making appropriations; and providing a contingent effective date.

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

NEW SECTION. Sec. 1. The legislature recognizes that state-wide implementation of the community-based long-term care secured benefit program will require three to four years, to allow completion of necessary coordination with the federal government and sufficient testing of administrative models. It is the intent of the legislature that, during the transition from enactment and initial collection of dedicated community-based long-term care public insurance benefit funds to state-wide implementation, up to fifty percent of such public insurance benefit funds be made available for expansion of community-based long-term care and support services, including medicaid services and other services that support families, communities, individuals, and agencies providing community-based long-term care and support services to functionally disabled persons. The legislature further intends that expenses for model administrative projects, including administration, monitoring, data collection, and evaluation also be derived from these public insurance benefit funds. The service expansions authorized by this act shall be temporary measures pending state-wide implementation of the community-based long-term care secured benefit program, at which time such expansions shall be incorporated, in whole or in part, into the state-wide program.

PART I

MEDICAID COMMUNITY-BASED LONG-TERM CARE SERVICES

EXPANSIONS

Sec. 2. RCW 74.09.510 and 1989 1st ex.s. c 10 s 8 are each amended to read as follows:

Medical assistance may be provided in accordance with eligibility requirements established by the department of social and health services, as defined in the social security Title XIX state plan for mandatory categorically needy persons and: (1) Individuals who would be eligible for cash assistance except for their institutional status; (2) individuals who are under twenty-one years of age, who would be eligible for aid to families with dependent children, but do not qualify as dependent children and who are in (a) foster care, (b) subsidized adoption, (c) an intermediate care facility or an intermediate care facility for the mentally retarded, or (d) inpatient psychiatric facilities; (3) the aged, blind, and disabled who: (a) Receive only a state supplement, or (b) would not be eligible for cash assistance if they were not institutionalized; (4) individuals who would be eligible for but choose not to receive cash assistance; (5) individuals who are enrolled in managed health care systems, who have otherwise lost eligibility for medical assistance, but who have not completed a current six-month enrollment in a managed health care system, and who are eligible for federal financial participation under Title XIX of the social security act; (6) children and pregnant women allowed by federal statute for whom funding is appropriated; (7) disabled children eighteen years of age or younger who require a level of care provided in a hospital, nursing home, or intermediate care facility for the mentally retarded and can be cared for in the community for less than the cost of such institutional care, if such a child would be eligible for medical assistance if he or she were in a medical institution; and ((~~(7)~~)) (8) other individuals eligible for medical services under RCW 74.09.035 and 74.09.700 for whom federal financial participation is available under Title XIX of the social security act.

Sec. 3. RCW 74.09.520 and 1990 c 33 s 594 and 1990 c 25 s 1 are each reenacted and amended to read as follows:

(1) The term "medical assistance" may include the following care and services: (a) Inpatient hospital services; (b) outpatient hospital services; (c) other laboratory and x-ray services; (d) skilled nursing home services; (e) physicians' services, which shall include prescribed medication and instruction on birth control devices; (f) medical care, or any other type of remedial care as may be established by the secretary; (g) home health care services; (h) private duty nursing services; (i) dental services; (j) physical therapy and related services; (k) prescribed drugs, dentures, and prosthetic devices; and eyeglasses prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the individual may select; (l) personal care services, as provided in this section; (m) hospice services; (n) community-supported living arrangements for developmentally disabled persons; (o) other diagnostic, screening, preventive, and rehabilitative services; and ((~~(o)~~)) (p) like services when furnished to a handicapped child by a school district as part of an individualized education program established pursuant to RCW 28A.155.010 through 28A.155.100. For the purposes of this section, the department may not cut off any prescription medications, oxygen supplies, respiratory services, or other life-sustaining medical services or supplies.

"Medical assistance," notwithstanding any other provision of law, shall not include routine foot care, or dental services delivered by any health care provider, that are not mandated by Title XIX of the social security act unless there is a specific appropriation for these services. Services included in an individualized education program for a handicapped child under RCW 28A.155.010 through 28A.155.100 shall not qualify as medical assistance prior to the implementation of the funding process developed under RCW 74.09.524.

(2) The department shall amend the state plan for medical assistance under Title XIX of the federal social security act to include personal care services, as defined in 42 C.F.R. 440.170(f), in the categorically needy program.

(3) The department shall adopt, amend, or rescind such administrative rules as are necessary to ensure that Title XIX personal care services are provided to eligible persons in conformance with federal regulations.

(a) These administrative rules shall include financial eligibility indexed according to the requirements of the social security act providing for medicaid eligibility.

(b) The rules shall require clients be assessed as having a medical condition requiring assistance with personal care tasks. Plans of care must be approved by a physician and reviewed by a nurse every ninety days.

(4) The department shall design and implement a means to assess the level of functional disability of persons eligible for personal care services under this section. The personal care services benefit shall be provided to the extent funding is available according to the assessed level of functional disability. Any reductions in services made necessary for funding reasons should be accomplished in a manner that assures that priority for maintaining services is given to persons with the greatest need as determined by the assessment of functional disability.

(5) The department shall report to the appropriate fiscal committees of the legislature on the utilization and associated costs of the personal care option under Title XIX of the federal social security act, as defined in 42 C.F.R. 440.170(f), in the categorically needy program. This report shall be submitted by January 1, 1990, and submitted on a yearly basis thereafter.

(6) Effective July 1, 1989, the department shall offer hospice services in accordance with available funds. The department shall provide a complete accounting of the costs of providing hospice services under this section by December 20, 1990. The report shall include an assessment of cost savings which may result by providing hospice to persons who otherwise would use hospitals, nursing homes, or more expensive care. The hospice benefit under this section shall terminate on June 30, 1991, unless extended by the legislature.

Sec. 4. RCW 74.09.700 and 1989 c 87 s 3 are each amended to read as follows:

(1) To the extent of available funds, medical care may be provided under the limited casualty program to persons not otherwise eligible for medical assistance or medical care services who are medically needy as defined in the social security Title XIX state plan and medical indigents in accordance with medical eligibility requirements established by the department. This includes residents of skilled nursing homes, intermediate care facilities, and intermediate care facilities for the mentally retarded who are aged, blind, or disabled as defined in Title XVI of the federal social security act and whose income exceeds three hundred percent of the federal supplement security income benefit level.

(2) Determination of the amount, scope, and duration of medical coverage under the limited casualty program shall be the responsibility of the department, subject to the following:

(a) Only inpatient hospital services; outpatient hospital and rural health clinic services; physicians' and clinic services; prescribed drugs, dentures, prosthetic devices, and eyeglasses; skilled nursing home services, intermediate care facility services, and intermediate care facility services for the mentally retarded; home health services; other laboratory and x-ray services; rehabilitative services; medically necessary transportation; and other services for which funds are specifically provided in the omnibus appropriations act shall be covered;

(b) Personal care and hospice services shall be covered for persons who are medically needy as defined in the social security Title XIX state plan;

(c) Persons who are medically indigent and are not eligible for a federal aid program shall satisfy a deductible of not less than one hundred dollars nor more than five hundred dollars in any twelve-month period;

((~~(c)~~)) (d) Medical care services provided to the medically indigent and received no more than seven days prior to the date of application shall be retroactively certified and approved for payment on behalf of a person who was otherwise eligible at the time the medical services were furnished: PROVIDED, That eligible persons who fail to apply within the seven-day time period for medical reasons or other good cause may be retroactively certified and approved for payment.

(3) The department shall establish standards of assistance and resource and income exemptions. All nonexempt income and resources of limited casualty program recipients shall be applied against the cost of their medical care services.

NEW SECTION. Sec. 5. A new section is added to chapter 74.09 RCW to read as follows:

The department shall make the following changes in the community options program entry system program waiver, to the extent such changes are permissible under section 1915(c) of the federal social security act, to increase that program's ability to meet the community-based long-term care needs of functionally disabled persons who would otherwise require nursing-home care:

(1) Cover services such as assisted living housing units, adult day care, respite care, home-delivered meals, home modifications, and electronic emergency response systems;

(2) Change the monthly service expenditure lid so that, in the aggregate, the cost of services to recipients does not exceed the cost of nursing-home care, rather than applying such test to each such individual recipient; and

(3) Provide that the personal maintenance costs that are covered with a recipient's own income are no longer counted against the monthly service expenditure lid on the cost of their care plan.

PART II

COMMUNITY-BASED SERVICES FOR PERSONS

WITH DEVELOPMENTAL DISABILITIES

NEW SECTION. Sec. 6. A new section is added to chapter 71A.12 RCW to read as follows:

For each developmentally disabled person who is moved from a residential habilitation center into the community, a biennial amount adjusted for inflation equivalent to the amount of state funds that would have been spent to care for that individual in the residential habilitation center shall be deposited into the secured benefit fund established pursuant to section 20, chapter ..... (HB 1569), Laws of 1991, to finance long-term care services in the community where the individual resides.

PART III

SOCIAL HEALTH MAINTENANCE ORGANIZATION

NEW SECTION. Sec. 7. A new section is added to chapter 74.09 RCW to read as follows:

The department shall make every practicable effort to develop, in cooperation with one or more health maintenance organizations registered pursuant to chapter 48.46 RCW, a request for a demonstration waiver under the federal social security act to establish a social health maintenance organization.

PART IV

APPROPRIATIONS

NEW SECTION. Sec. 8. The sum of ........ dollars, or as much thereof as may be necessary, is appropriated for the biennium ending June 30, 1993, from the secured benefit fund to the department of social and health services, to carry out this act.

DEVELOPMENTAL DISABILITIES

(1) Of this amount, eight million dollars is provided solely for community support and family support services for developmentally disabled persons being cared for by their families.

(2) Of this amount, sixteen million nine hundred thousand dollars is provided solely for day programs and residential services for three thousand three hundred developmentally disabled persons on waiting lists for these services.

(3) Of this amount, five million nine hundred thousand dollars is provided solely for transition services for developmentally disabled persons leaving special education programs.

(4) Of this amount, two million seven hundred thirty thousand dollars is provided solely for services to six hundred twenty-seven developmentally disabled infants up to three years old and their families.

(5) Of this amount, seventeen million dollars is provided solely for increased rates for developmental disabilities day program and residential providers.

MENTAL HEALTH

(6) Of this amount, fifteen million dollars is provided solely for community support services, as defined in chapter 71.24 RCW for mentally ill persons.

(7) Of this amount, fifteen million dollars is provided solely for increased wages and benefits for mental health clinicians employed by or contracting with publicly funded mental health providers.

OTHER COMMUNITY-BASED SERVICES

(8) Of this amount, ....... dollars is provided solely for the medicaid expansions provided in sections 2 through 5 of this act.

(9) Of this amount, five million eight hundred thousand dollars is provided solely for respite services provided in accordance with chapter 74.41 RCW.

(10) Of this amount, ....... dollars is provided solely for adult day care and adult day health services.

(11) Of this amount, twenty million dollars is provided solely for: (a) Increased wages and benefits to persons providing community-based long-term care services through the chore program, community options program entry system (COPES) program, Title XIX personal care program, and in congregate care facilities and assisted living; and

(b) Increased adult family home payment rates.

NEW SECTION. Sec. 9. This act shall become effective one hundred eighty days after enactment of the community-based long-term care secured benefit act, chapter .... (HB 1569), Laws of 1991. If House Bill No. 1569 is not enacted into law during the 1991 legislative session, this act shall be null and void.

NEW SECTION. Sec. 10. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.

NEW SECTION. Sec. 11. Part headings as used in this act do not constitute any part of the law.