AN ACT
Relating to long-term care; amending RCW 74.39.005, 74.39.040, 74.39A.010,
70.128.007, 70.128.057, 70.128.070, 70.128.080, 70.128.090, 70.128.140,
70.128.150, 70.128.160, 70.128.175, 43.190.020, 43.190.060, 74.08.545,
74.09.520, 74.08.550, 74.08.570, 18.51.091, 18.51.140, 18.51.300, 18.79.040,
18.79.260, 18.88A.030, 11.40.010, 11.42.020, 11.62.010, 11.28.120, 18.39.250,
18.39.255, 74.42.450, 68.46.050, 70.129.040, 43.20B.080, 74.42.020, 74.46.450,
70.38.111, 70.38.115, 70.38.125, 48.85.010, 48.85.020, 48.85.030, 48.85.040,
48.85.050, 74.09.585, 74.34.010, 74.34.100, 74.34.020, 74.34.070, 74.34.030,
74.46.020, 74.46.105, 74.46.115, 74.46.160, 74.46.170, 74.46.180, 74.46.190,
74.46.410, 74.46.420, 74.46.430, 74.46.450, 74.46.460, 74.46.470, 74.46.481, 74.46.490,
74.46.500, 74.46.505, 74.46.510, 74.46.530, 74.46.560, 74.46.570, 74.46.640,
74.46.690, 74.46.770, 74.46.780, and 70.128.120; amending 1995 c 260 s 12
(uncodified); adding new sections to chapter 74.39A RCW; adding new sections to
chapter 70.41 RCW; adding new sections to chapter 74.42 RCW; adding a new
section to chapter 18.20 RCW; adding new sections to chapter 70.128 RCW; adding
new sections to chapter 18.88A RCW; adding new sections to chapter 74.46 RCW;
adding new sections to chapter 74.34 RCW; creating new sections; recodifying
RCW 74.08.530, 74.08.560, 74.08.570, 74.08.545, 74.08.550, and 74.34.100;
repealing RCW 70.128.180, 74.08.541, 74.46.420, 74.46.430, 74.46.440,
74.46.450, 74.46.460, 74.46.465, 74.46.470, 74.46.481, 74.46.490, 74.46.500,
74.46.505, 74.46.510, 74.46.530, 74.46.540, 74.46.550, 74.46.560, 74.46.570,
74.46.580, and 74.46.590; prescribing penalties; providing an effective date;
and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE
OF THE STATE OF WASHINGTON:
NEW
SECTION. Sec. 1. A new
section is added to chapter 74.39A RCW to read as follows:
Unless
the context clearly requires otherwise, the definitions in this section apply
throughout this chapter.
(1)
"Adult family home" means a facility licensed under chapter 70.128
RCW.
(2)
"Adult residential care" means personal care services provided by a
boarding home that is licensed under chapter 18.20 RCW and that has a contract
with the department under section 15 of this act.
(3)
"Aging and adult services administration" means the aging and adult
services administration of the department.
(4)
"Assisted living services" means services provided by a boarding home
that has a contract with the department under RCW 74.39A.010 and the resident
is housed in a private apartment-like unit.
(5)
"Boarding home" means a facility licensed under chapter 18.20 RCW.
(6)
"Cost-effective care" means care provided in a setting of an
individual's choice that is necessary to promote the most appropriate level of
physical, mental, and psychosocial well-being consistent with client choice, in
an environment that is appropriate to the care and safety needs of the
individual, and such care cannot be provided at a lower cost in any other
setting. But this in no way precludes an individual from choosing a different
residential setting to achieve his or her desired quality of life.
(7)
"Department" means the department of social and health services.
(8)
"Home and community services" means assisted living services,
enhanced adult residential care, adult residential care, adult family homes,
in-home services, and other services administered by the aging and adult
services administration of the department directly or through contract with
area agencies on aging.
(9)
"Long-term care services" means the services administered directly or
through contract by the aging and adult services administration of the
department, including but not limited to nursing facility care and home and
community services.
(10)
"Enhanced adult residential care" means personal care services and
limited nursing services, as defined by the department of health in rule, which
services are provided by a boarding home that is licensed under chapter 18.20
RCW and that has a contract with the department under section 15 of this act.
(11)
"Nursing facility" means a nursing facility as defined in section
1919(a) of the federal social security act and regulations adopted thereunder.
(12)
"Nursing home" means a facility licensed under chapter 18.51 RCW.
(13)
"Tribally licensed boarding home" means a boarding home licensed by a
federally recognized Indian tribe which home provides services similar to
boarding homes licensed under chapter 18.20 RCW.
NEW
SECTION. Sec. 2. A new
section is added to chapter 74.39A RCW to read as follows:
(1) To
the extent of available funding, the department shall expand cost-effective
options for home and community services for consumers for whom the state
participates in the cost of their care.
(2) In
expanding home and community services, the department shall: (a) Take full
advantage of federal funding available under Title XVIII and Title XIX of the
federal social security act, including home health, adult day care, waiver
options, and state plan services; and (b) be authorized to use funds available
under its community options program entry system waiver granted under section
1915(c) of the federal social security act to expand the availability of
in-home, adult residential care, adult family homes, enhanced adult residential
care, and assisted living services. By June 30, 1997, the department shall
undertake to reduce the nursing home medicaid census by at least one thousand
six hundred by assisting individuals who would otherwise require nursing
facility services to obtain services of their choice, including assisted living
services, enhanced adult residential care, and other home and community
services. If a resident, or his or her legal representative, objects to a
discharge decision initiated by the department, the resident shall not be
discharged if the resident has been assessed and determined to require nursing
facility services. In contracting with nursing homes and boarding homes for
enhanced adult residential care placements, the department shall not require,
by contract or through other means, structural modifications to existing
building construction.
(3)(a)
The department shall by rule establish payment rates for home and community
services that support the provision of cost-effective care.
(b)
The department may authorize an enhanced adult residential care rate for
nursing homes that temporarily or permanently convert their bed use for the
purpose of providing enhanced adult residential care under chapter 70.38 RCW,
when the department determines that payment of an enhanced rate is
cost-effective and necessary to foster expansion of contracted enhanced adult
residential care services. As an incentive for nursing homes to permanently
convert a portion of its nursing home bed capacity for the purpose of providing
enhanced adult residential care, the department may authorize a supplemental
add-on to the enhanced adult residential care rate.
(c)
The department may authorize a supplemental assisted living services rate for
up to four years for facilities that convert from nursing home use and do not
retain rights to the converted nursing home beds under chapter 70.38 RCW, if
the department determines that payment of a supplemental rate is cost-effective
and necessary to foster expansion of contracted assisted living services.
NEW
SECTION. Sec. 3. A new
section is added to chapter 70.41 RCW to read as follows:
(1)(a)
The department of social and health services, in consultation with hospitals
and acute care facilities, shall promote the most appropriate and
cost-effective use of long-term care services by developing and distributing to
hospitals and other appropriate health care settings information on the various
chronic long-term care programs that it administers directly or through
contract. The information developed by the department of social and health
services shall, at a minimum, include the following:
(i) An
identification and detailed description of each long-term care service
available in the state;
(ii)
Functional, cognitive, and medicaid eligibility criteria that may be required
for placement or admission to each long-term care service; and
(iii) A
long-term care services resource manual for each hospital, that identifies the
long-term care services operating within each hospital's patient service area.
The long-term care services resource manual shall, at a minimum, identify the
name, address, and telephone number of each entity known to be providing
long-term care services; a brief description of the programs or services
provided by each of the identified entities; and the name or names of a person
or persons who may be contacted for further information or assistance in
accessing the programs or services at each of the identified entities.
(b)
The information required in (a) of this subsection shall be periodically
updated and distributed to hospitals by the department of social and health
services so that the information reflects current long-term care service
options available within each hospital's patient service area.
(2) To
the extent that a patient will have continuing care needs, once discharged from
the hospital setting, hospitals shall, during the course of the patient's
hospital stay, promote each patient's family member's and/or legal
representative's understanding of available long-term care service discharge
options by, at a minimum:
(a)
Discussing the various and relevant long-term care services available,
including eligibility criteria;
(b)
Making available, to patients, their family members, and/or legal
representative, a copy of the most current long-term care services resource
manual;
(c)
Responding to long-term care questions posed by patients, their family members,
and/or legal representative;
(d)
Assisting the patient, their family members, and/or legal representative in
contacting appropriate persons or entities to respond to the question or
questions posed; and
(e)
Linking the patient and family to the local, state-designated aging and
long-term care network to ensure effective transitions to appropriate levels of
care and ongoing support.
NEW
SECTION. Sec. 4. A new
section is added to chapter 70.41 RCW to read as follows:
"Cost-effective
care" and "long-term care services," where used in sections 3
and 5 of this act, shall have the same meaning as that given in section 1 of
this act.
NEW
SECTION. Sec. 5. A new
section is added to chapter 70.41 RCW to read as follows:
(1)
Hospitals and acute care facilities shall:
(a)
Work cooperatively with the department of social and health services, area
agencies on aging, and local long-term care information and assistance
organizations in the planning and implementation of patient discharges to
long-term care services.
(b)
Establish and maintain a system for discharge planning and designate a person
responsible for system management and implementation.
(c)
Establish written policies and procedures to:
(i)
Identify patients needing further nursing, therapy, or supportive care
following discharge from the hospital;
(ii)
Develop a documented discharge plan for each identified patient, including
relevant patient history, specific care requirements, and date such follow-up
care is to be initiated;
(iii)
Coordinate with patient, family, caregiver, and appropriate members of the
health care team;
(iv)
Provide any patient, regardless of income status, written information and
verbal consultation regarding the array of long-term care options available in
the community, including the relative cost, eligibility criteria, location, and
contact persons;
(v)
Promote an informed choice of long-term care services on the part of patients,
family members, and legal representatives; and
(vi)
Coordinate with the department and specialized case management agencies,
including area agencies on aging and other appropriate long-term care
providers, as necessary, to ensure timely transition to appropriate home,
community residential, or nursing facility care.
(d)
Work in cooperation with the department which is responsible for ensuring that
patients eligible for medicaid long-term care receive prompt assessment and
appropriate service authorization.
(2) In
partnership with selected hospitals, the department of social and health
services shall develop and implement pilot projects in up to three areas of the
state with the goal of providing information about appropriate in-home and
community services to individuals and their families early during the
individual's hospital stay.
The
department shall not delay hospital discharges but shall assist and support the
activities of hospital discharge planners. The department also shall
coordinate with home health and hospice agencies whenever appropriate. The
role of the department is to assist the hospital and to assist patients and
their families in making informed choices by providing information regarding
home and community options.
The
department shall by December 12, 1995, report to the house of representatives
health care committee and the senate health and long-term care committee
regarding the progress and results of the pilot projects along with
recommendations regarding continuation or modification of the pilot projects.
In
conducting the pilot projects, the department shall:
(a)
Assess and offer information regarding appropriate in-home and community
services to individuals who are medicaid clients or applicants; and
(b)
Offer assessment and information regarding appropriate in-home and community
services to individuals who are reasonably expected to become medicaid
recipients within one hundred eighty days of admission to a nursing facility.
NEW
SECTION. Sec. 6. A new
section is added to chapter 74.39A RCW to read as follows:
The
department shall work in partnership with hospitals in assisting patients and
their families to find long-term care services of their choice. The department
shall not delay hospital discharges but shall assist and support the activities
of hospital discharge planners. The department also shall coordinate with home
health and hospice agencies whenever appropriate. The role of the department
is to assist the hospital and to assist patients and their families in making
informed choices by providing information regarding home and community options
to individuals who are hospitalized and likely to need long-term care.
(1) To
the extent of available funds, the department shall assess individuals who:
(a)
Are medicaid clients, medicaid applicants, or eligible for both medicare and
medicaid; and
(b)
Apply or are likely to apply for admission to a nursing facility.
(2)
For individuals who are reasonably expected to become medicaid recipients
within one hundred eighty days of admission to a nursing facility, the
department shall, to the extent of available funds, offer an assessment and
information regarding appropriate in-home and community services.
(3)
When the department finds, based on assessment, that the individual prefers and
could live appropriately and cost-effectively at home or in some other
community-based setting, the department shall:
(a)
Advise the individual that an in-home or other community service is
appropriate;
(b)
Develop, with the individual or the individual's representative, a
comprehensive community service plan;
(c)
Inform the individual regarding the availability of services that could meet
the applicant's needs as set forth in the community service plan and explain
the cost to the applicant of the available in-home and community services
relative to nursing facility care; and
(d)
Discuss and evaluate the need for on-going involvement with the individual or
the individual's representative.
(4)
When the department finds, based on assessment, that the individual prefers and
needs nursing facility care, the department shall:
(a)
Advise the individual that nursing facility care is appropriate and inform the
individual of the available nursing facility vacancies;
(b) If
appropriate, advise the individual that the stay in the nursing facility may be
short term; and
(c)
Describe the role of the department in providing nursing facility case
management.
NEW
SECTION. Sec. 7. A new
section is added to chapter 74.42 RCW to read as follows:
A
nursing facility shall not admit any individual who is medicaid eligible unless
that individual has been assessed by the department. Appropriate hospital
discharge shall not be delayed pending the assessment.
To
ensure timely hospital discharge of medicaid eligible persons, the date of the
request for a department long-term care assessment, or the date that nursing
home care actually begins, whichever is later, shall be deemed the effective
date of the initial service and payment authorization. The department shall
respond promptly to such requests.
A nursing
facility admitting an individual without a request for a department assessment
shall not be reimbursed by the department and shall not be allowed to collect
payment from a medicaid eligible individual for any care rendered before the
date the facility makes a request to the department for an assessment. The
date on which a nursing facility makes a request for a department long-term
care assessment, or the date that nursing home care actually begins, whichever
is later, shall be deemed the effective date of initial service and payment
authorization for admissions regardless of the source of referral.
A
medicaid eligible individual residing in a nursing facility who is transferred
to an acute care hospital shall not be required to have a department assessment
under this section prior to returning to the same or another nursing facility.
NEW
SECTION. Sec. 8. A new
section is added to chapter 74.42 RCW to read as follows:
If a
nursing facility has reason to know that a resident is likely to become
financially eligible for medicaid benefits within one hundred eighty days, the
nursing facility shall notify the patient or his or her representative and the
department. The department may:
(1)
Assess any such resident to determine if the resident prefers and could live
appropriately at home or in some other community-based setting; and
(2)
Provide case management services to the resident.
NEW
SECTION. Sec. 9. A new
section is added to chapter 74.42 RCW to read as follows:
(1) To
the extent of available funding, the department shall provide case management
services to assist nursing facility residents, in conjunction and partnership
with nursing facility staff. The purpose of the case management services is to
assist residents and their families to assess the appropriateness and
availability of home and community services that could meet the resident's
needs so that the resident and family can make informed choices.
(2) To
the extent of available funding, the department shall provide case management
services to nursing facility residents who are:
(a)
Medicaid funded;
(b)
Dually medicaid and medicare eligible;
(c)
Medicaid applicants; and
(d)
Likely to become financially eligible for medicaid within one hundred eighty
days, pursuant to section 8 of this act.
Sec.
10. RCW
74.39.005 and 1989 c 427 s 2 are each amended to read as follows:
The
purpose of this chapter is to:
(1)
Establish a balanced range of ((community-based)) health, social, and
supportive services that deliver long-term care services to chronically,
functionally disabled persons of all ages;
(2)
Ensure that functional ((disability)) ability shall be the
determining factor in defining long-term care service needs and that these
needs will be determined by a uniform system for comprehensively assessing
functional disability;
(3)
Ensure that services are provided in the most independent living situation
consistent with individual needs;
(4)
Ensure that long-term care service options shall be developed and made
available that enable functionally disabled persons to continue to live in
their homes or other community residential facilities while in the care of
their families or other volunteer support persons;
(5)
Ensure that long-term care services are coordinated in a way that minimizes
administrative cost, eliminates unnecessarily complex organization, minimizes
program and service duplication, and maximizes the use of financial resources
in directly meeting the needs of persons with functional limitations;
(6)
Develop a systematic plan for the coordination, planning, budgeting, and
administration of long-term care services now fragmented between the division
of developmental disabilities, division of mental health, aging and adult
services administration, division of children and family services, division of
vocational rehabilitation, office on AIDS, division of health, and bureau of
alcohol and substance abuse;
(7)
Encourage the development of a state-wide long-term care case management system
that effectively coordinates the plan of care and services provided to eligible
clients;
(8)
Ensure that individuals and organizations affected by or interested in
long-term care programs have an opportunity to participate in identification of
needs and priorities, policy development, planning, and development,
implementation, and monitoring of state supported long-term care programs;
(9)
Support educational institutions in Washington state to assist in the
procurement of federal support for expanded research and training in long-term
care; and
(10)
Facilitate the development of a coordinated system of long-term care education
that is clearly articulated between all levels of higher education and reflective
of both in-home care needs and institutional care needs of functionally
disabled persons.
Sec.
11. RCW
74.39.040 and 1989 c 427 s 13 are each amended to read as follows:
(((1)
A long-term care commission is created. It shall consist of:
(a)
Four legislators who shall serve on the executive committee, one from each of
the two largest caucuses in the house of representatives and the senate who
shall be selected by the president of the senate and the speaker of the house
of representatives;
(b)
Six members, to be selected by the executive committee, who shall be
authorities in gerontology, developmental disabilities, neurological
impairments, physical disabilities, mental illness, nursing, long-term care
service delivery, long-term care service financing, systems development, or
systems analysis;
(c)
Three members, to be selected by the executive committee, who represent
long-term care consumers, services providers, or advocates;
(d)
Two members, to be selected by the executive committee, who represent county
government;
(e)
One member, to be selected by the secretary of social and health services, to
represent the department of social and health services long-term care programs,
including at least developmental disabilities, mental health, aging and adult
services, AIDS, children's services, alcohol and substance abuse, and
vocational rehabilitation; and
(f)
Two members, to represent the governor, who shall serve on the executive
committee.
The
legislative members shall select a chair from the membership of the commission.
The
commission shall be staffed, to the extent possible, by staff from the
appropriate senate and house of representatives committees.
The
commission may form technical advisory committees to assist it with any
particular matters deemed necessary by the commission.
The
commission and technical advisory committee members shall receive no
compensation, but except for publicly funded agency staff, shall, to the extent
funds are available, be reimbursed for their expenses while attending any
meetings in the same manner as legislators engaged in interim committee
business as specified in RCW 44.04.120.
The
commission may receive appropriations, grants, gifts, and other payments from
any governmental or other public or private entity or person which it may use
to defray the cost of its operations or to contract for technical assistance,
with the approval of the senate committee on facilities and operations and the
house of representatives executive rules committee.
(2)
The long-term care commission shall develop legislation and recommend
administrative actions necessary to achieve the following long-term care
reforms:
(a)
The systematic coordination, planning, budgeting, and administration of long-term
care services currently administered by the department of social and health
services, division of developmental disabilities, aging and adult services
administration, division of vocational rehabilitation, office on AIDS, division
of health, and the bureau of alcohol and substance abuse;
(b))) The
legislature finds the intent of the 1989 legislature to reform statutory
provisions of long-term care for persons of all ages with chronic functional
disability, although not enacted, continues to be applicable. The need to
streamline the current bureaucratic fragmentation of chronic health services
for the person with functional disabilities and facilitate the development of
client centered, accessible, high quality, cost-effective, and appropriate
long-term care services options for persons with functional disabilities is
even more pressing today. The legislature further finds that if we are going
to meet the significant and growing chronic care needs in the next two decades,
rapid fundamental changes will need to take place in the way we finance,
organize, and provide long-term care services to the functionally disabled.
The public demands, and it is the intent of the legislature to reduce the cost
and size of government and provide efficient and effective public service to
the persons most impaired by chronic functional disability.
To
realize the need for a cost-effective, uniform, and fully integrated long-term
care system while simultaneously reducing the size and cost of government, the
legislative budget committee, in coordination with the Washington health care
policy board, shall develop a working plan for long-term care reform, including
recommendations and statutory changes, by December 12, 1995, to accomplish the
following:
(1)
Reorganize and consolidate, on a noncategorical basis, all disease or
age-specific (categorical) organizational entities of state administration and
their regional elements pertaining to chronic care services to persons with
functional mental and physical disabilities, including but not limited to: In
the department of social and health services: Health and rehabilitative
services and aging and adult services; in the department of health: Aids
chronic care and boarding homes; the department of services to the blind; in
the department of veterans affairs: Nursing facilities; and in all other state
agencies that provide chronic long-term health care services;
(2)
Implement a streamlined client centered administrative and delivery system for
long-term care services state-wide that incorporates all long-term care
services for the person with functional disabilities to include the
functionally disabled, developmentally disabled, mentally ill, traumatically
brain injured, and others with chronic functional disabilities. The system
shall be a single point entry system administered at the local level that allows
the person with functional disabilities to obtain needs determination,
eligibility screening, priority setting, and services information and
assistance. The system shall be designed so that acute health care services
are effectively coordinated with long-term care services. The system shall
recognize and respect the individuality and dignity of all functionally
disabled individuals and promote self-reliance and the preference for the
assistance and comfort provided by families, friends, and community volunteers.
It shall also recognize the importance of community organizations and the
public and private infrastructure in the delivery of care and support. All
major points of access into the long-term care system shall be identified and
integrated into the system to insure that clients are fully informed of the
most appropriate least expensive care options;
(3)
Provision of long-term care services to persons based on their functional
disabilities noncategorically and in the most independent living situation
consistent with the person's needs and preferences;
(((c)))
(4) A consistent definition of appropriate roles and responsibilities
for state and local government, regional organizations, and private
organizations in the planning, administration, financing, and delivery of
long-term care services;
(((d)))
(5) Technical assistance to enable local communities to have greater
participation and control in the planning, administration, and provision of
long-term care services;
(((e)))
(6) A case management system that coordinates an appropriate and
cost-effective plan of care and services for eligible functionally disabled
persons based on their individual needs and preferences;
(((f)))
(7) A sufficient supply of quality institutional and
noninstitutional residential alternatives for functionally disabled persons,
and supports for the providers of such services;
(((g)))
(8) Public and private alternative funding for long-term care services,
((such as federal Title XIX funding of personal care services through the
limited casualty program for the medically needy and other optional services))
that includes the promotion of affordable stand alone long-term care
insurance options or as part of overall health care insurance benefits, a
uniform fee copayment scale for client participation in state-funded,
long-term care programs, and private, long-term care insurance;
(((h)))
(9) A systematic and balanced long-term care services payment and
reimbursement system, including a case mix nursing home reimbursement,
that will provide access to needed services while controlling the rate of cost
increases for such services;
(((i)))
(10) Active involvement of volunteers and advocacy groups;
(((j)))
(11) An integrated data base that provides long-term care client tracking;
(((k)))
(12) A coordinated education system for long-term care to insure
client safety and quality of services; ((and
(l))) (13)
Administratively separate the nonmeans tested economic and social welfare and
advocacy programs of the older Americans act, 42 U.S.C. Chap 35 and 45 C.F.R.
1321 et seq. from the need and means tested programs for persons with
functional disabilities;
(14)
Review all activities mandated and expenditures authorized by the senior
citizens services act, chapter 74.38 RCW; and identify which funds are being
used for functionally disabled seniors and identify how these senior citizens
services act funds can be directed to programs serving the most disabled
elderly; and
(15)
Other issues deemed appropriate by the ((implementation team)) joint
committee on health systems oversight.
The ((commission))
legislative budget committee shall report to the legislature with its
findings, recommendations, and proposed legislation by December ((1, 1990))
12, 1995.
NEW
SECTION. Sec. 12. A new
section is added to chapter 74.39A RCW to read as follows:
The
department's system of quality improvement for long-term care services shall be
guided by the following principles, consistent with applicable federal laws and
regulations:
(1)
The system shall be consumer centered and promote privacy, independence, dignity,
choice, and a home or home-like environment for consumers.
(2)
The goal of the system is continuous quality improvement with the focus on
consumer satisfaction and outcomes for consumers.
(3)
Providers should be supported in their efforts to improve quality through
training, technical assistance, and case management.
(4)
The emphasis should be on problem prevention both in monitoring and in
screening potential providers of service.
(5)
Monitoring should be outcome based and responsive to consumer complaints.
(6)
Providers generally should be assisted in addressing identified problems
initially through consultation and technical assistance. Enforcement remedies
shall be available for problems that are serious, recurring, or that have been
uncorrected.
NEW
SECTION. Sec. 13. A new
section is added to chapter 74.39A RCW to read as follows:
(1)
The aging and adult services administration of the department shall establish
and maintain a toll-free telephone number for receiving complaints regarding a
facility that the administration licenses or with which it contracts for
long-term care services.
(2)
All facilities that are licensed by, or that contract with the aging and adult
services administration to provide long-term care services shall post in a
place and manner clearly visible to residents and visitors the department's
toll-free complaint telephone number.
(3)
The aging and adult services administration shall investigate complaints if the
subject of the complaint is within its authority unless the department
determines that: (a) The complaint is intended to willfully harass a licensee
or employee of the licensee; (b) there is no reasonable basis for
investigation; or (c) corrective action has been taken.
(4)
The aging and adult services administration shall refer complaints to
appropriate state agencies, law enforcement agencies, the attorney general, the
long-term care ombudsman, or other entities if the department lacks authority
to investigate.
(5)
The department may not provide the substance of the complaint to the licensee
or contractor before the completion of the investigation by the department. Neither
the substance of the complaint provided to the licensee or contractor nor any
copy of the complaint or related report published, released, or made otherwise
available shall disclose the name, title, or identity of any complainant, or
other person mentioned in the complaint, except that the department may
disclose the identity of the complainant if such disclosure is requested in
writing by the complainant.
(6) A
facility that provides long-term care services shall not discriminate or
retaliate in any manner against a resident on the basis or for the reason that
such resident or any other person made a complaint to the department or the
long-term care ombudsman or cooperated with the investigation of such a
complaint. The department may impose a civil penalty of not more than three
thousand dollars for a violation of this subsection and require the facility to
mitigate any damages incurred by the resident.
Sec.
14. RCW
74.39A.010 and 1993 c 508 s 3 are each amended to read as follows:
(1)
To the extent of available funding, the department of social and health
services may contract with licensed boarding homes under chapter 18.20 RCW
and tribally licensed boarding homes for assisted living services and
enhanced adult residential care. The department shall develop rules for
facilities that contract with the department for assisted living services or
enhanced adult residential care to establish:
(a)
Facility service standards consistent with the principles in section 12 of this
act and consistent with chapter 70.129 RCW;
(b)
Standards for resident living areas consistent with section 2 of this act;
(c)
Training requirements for providers and their staff.
(2)
The department's rules shall provide that ((ensure that the contracted))
services in assisted living and enhanced adult residential care:
(((1)))
(a) Recognize individual needs, privacy, and autonomy;
(((2)))
(b) Include, but not be limited to, personal care, nursing services,
medication administration, and supportive services that promote independence
and self-sufficiency;
(((3)))
(c) Are of sufficient scope to assure that each resident who chooses to
remain in the assisted living or enhanced adult residential care
may do so, ((unless nursing care needs exceed the level of care defined by
the department)) to the extent that the care provided continues to be
cost-effective and safe and promote the most appropriate level of physical,
mental, and psychosocial well-being consistent with client choice;
(((4)))
(d) Are directed first to those persons most likely, in the absence of enhanced
adult residential care or assisted living services, to need hospital,
nursing facility, or other out-of-home placement; and
(((5)))
(e) Are provided in compliance with applicable ((department of health))
facility and professional licensing laws and rules.
(3)
When a facility contracts with the department for assisted living services or
enhanced adult residential care, only services and facility standards that are
provided to or in behalf of the assisted living services or enhanced adult
residential care client shall be subject to the department's rules.
NEW
SECTION. Sec. 15. A new
section is added to chapter 74.39A RCW to read as follows:
(1) To
the extent of available funding, the department of social and health services
may contract for adult residential care and enhanced adult residential care.
(2)
The department shall, by rule, develop terms and conditions for facilities that
contract with the department for adult residential care and enhanced adult
residential care to establish:
(a)
Facility service standards consistent with the principles in section 12 of this
act and consistent with chapter 70.129 RCW; and
(b) Training requirements for providers and their staff.
(3)
The department shall, by rule, provide that services in adult residential care
and enhanced adult residential care facilities:
(a)
Recognize individual needs, privacy, and autonomy;
(b)
Include personal care and limited nursing services and other services that
promote independence and self-sufficiency and aging in place;
(c)
Are directed first to those persons most likely, in the absence of adult
residential care and enhanced adult residential care services, to need
hospital, nursing facility, or other out-of-home placement; and
(d)
Are provided in compliance with applicable facility and professional licensing
laws and rules.
(4)
When a facility contracts with the department for adult residential care and
enhanced adult residential care, only services and facility standards that are
provided to or in behalf of the adult residential care or the enhanced adult
residential care client shall be subject to the adult residential care or
enhanced adult residential care rules.
(5) To
the extent of available funding, the department may also contract under this
section with a tribally licensed boarding home for the provision of services of
the same nature as the services provided by adult residential care facilities.
The provisions of subsections (2) (a) and (b) and (3) (a) through (d) of this
section apply to such a contract.
NEW
SECTION. Sec. 16. A new
section is added to chapter 74.39A RCW to read as follows:
(1)
The department shall, by rule, establish reasonable minimum qualifications and
training requirements to assure that assisted living service, enhanced adult
residential care service, and adult residential care providers with whom the
department contracts are capable of providing services consistent with this
chapter. The rules shall apply only to residential capacity for which the
state contracts.
(2)
The department shall not contract for assisted living, enhanced adult
residential care, or adult residential care services with a provider if the
department finds that the provider or any partner, officer, director,
managerial employee, or owner of five percent or more of the provider has a
history of significant noncompliance with federal or state regulations, rules,
or laws in providing care or services to vulnerable adults or to children.
NEW
SECTION. Sec. 17. A new
section is added to chapter 74.39A RCW to read as follows:
(1)
The department is authorized to take one or more of the actions listed in
subsection (2) of this section in any case in which the department finds that a
provider of assisted living services or enhanced adult residential care
services has:
(a) Failed
or refused to comply with the requirements of this chapter or the rules adopted
under this chapter;
(b)
Operated without a license or under a revoked license;
(c)
Knowingly, or with reason to know, made a false statement of material fact on
his or her application for license or any data attached thereto, or in any
matter under investigation by the department; or
(d)
Willfully prevented or interfered with any inspection or investigation by the
department.
(2)
When authorized by subsection (1) of this section, the department may take one
or more of the following actions:
(a)
Refuse to issue a contract;
(b)
Impose reasonable conditions on a contract, such as correction within a
specified time, training, and limits on the type of clients the provider may
admit or serve;
(c)
Impose civil penalties of not more than one hundred dollars per day per
violation;
(d)
Suspend, revoke, or refuse to renew a contract; or
(e)
Suspend admissions to the facility by imposing stop placement on contracted
services.
(3)
When the department orders stop placement, the facility shall not admit any
person admitted by contract until the stop placement order is terminated. The
department may approve readmission of a resident to the facility from a
hospital or nursing home during the stop placement. The department shall
terminate the stop placement when: (a) The violations necessitating the stop
placement have been corrected; and (b) the provider exhibits the capacity to
maintain adequate care and service.
(4)
Chapter 34.05 RCW applies to department actions under this section, except that
orders of the department imposing contracts suspension, stop placement, or
conditions for continuation of a contract are effective immediately upon notice
and shall continue pending any hearing.
NEW
SECTION. Sec. 18. A new
section is added to chapter 18.20 RCW to read as follows:
(1)
The department of health is authorized to take one or more of the actions
listed in subsection (2) of this section in any case in which the department
finds that a boarding home provider has:
(a)
Failed or refused to comply with the requirements of this chapter or the rules
adopted under this chapter;
(b)
Operated a boarding home without a license or under a revoked license;
(c)
Knowingly, or with reason to know, made a false statement of material fact on
his or her application for license or any data attached thereto, or in any
matter under investigation by the department; or
(d) Willfully
prevented or interfered with any inspection or investigation by the department.
(2)
When authorized by subsection (1) of this section, the department may take one
or more of the following actions:
(a)
Refuse to issue a license;
(b)
Impose reasonable conditions on a license, such as correction within a
specified time, training, and limits on the type of clients the provider may
admit or serve;
(c)
Impose civil penalties of not more than one hundred dollars per day per
violation;
(d)
Suspend, revoke, or refuse to renew a license; or
(e)
Suspend admissions to the boarding home by imposing stop placement.
(3)
When the department orders stop placement, the facility shall not admit any new
resident until the stop placement order is terminated. The department may
approve readmission of a resident to the facility from a hospital or nursing
home during the stop placement. The department shall terminate the stop
placement when: (a) The violations necessitating the stop placement have been
corrected; and (b) the provider exhibits the capacity to maintain adequate care
and service.
(4)
Chapter 34.05 RCW applies to department actions under this section, except that
orders of the department imposing license suspension, stop placement, or
conditions for continuation of a license are effective immediately upon notice
and shall continue pending any hearing.
Sec.
19. RCW
70.128.007 and 1989 c 427 s 15 are each amended to read as follows:
The
purposes of this chapter are to:
(1)
Encourage the establishment and maintenance of adult family homes that provide
a humane, safe, and homelike environment for persons with functional
limitations who need personal and special care;
(2)
Establish standards for regulating adult family homes that adequately protect
residents((, but are consistent with the abilities and resources of an adult
family home so as not to discourage individuals from serving as adult family
home providers; and));
(3)
Encourage consumers, families, providers, and the public to become active in
assuring their full participation in development of adult family homes that
provide high quality and cost-effective care;
(4)
Provide for appropriate care of residents in adult family homes by requiring
that each resident have a care plan that promotes the most appropriate level of
physical, mental, and psychosocial well-being consistent with client choice;
and
(5)
Accord each resident the right to participate in the development of the care
plan and in other major decisions involving the resident and their care.
Sec.
20. RCW
70.128.057 and 1991 c 40 s 2 are each amended to read as follows:
Notwithstanding
the existence or use of any other remedy, the department may, in the manner
provided by law, upon the advice of the attorney general who shall represent
the department in the proceedings, maintain an action in the name of the state
for an injunction, civil penalty, or other process against a person to
restrain or prevent the operation or maintenance of an adult family home
without a license under this chapter.
NEW
SECTION. Sec. 21. A new
section is added to chapter 70.128 RCW to read as follows:
The
legislature finds that the operation of an adult family home without a license
in violation of this chapter is a matter vitally affecting the public interest
for the purpose of applying the consumer protection act, chapter 19.86 RCW.
Operation of an adult family home without a license in violation of this
chapter is not reasonable in relation to the development and preservation of
business. Such a violation is an unfair or deceptive act in trade or commerce
and an unfair method of competition for the purpose of applying the consumer
protection act, chapter 19.86 RCW.
Sec.
22. RCW
70.128.070 and 1989 c 427 s 22 are each amended to read as follows:
(1) A
license shall be valid for one year.
(2) At
least ((ninety)) sixty days prior to expiration of the license,
the provider shall submit an application for renewal of a license. The
department shall send the provider an application for renewal prior to this
time. The department shall have the authority to investigate any information
included in the application for renewal of a license.
(3)(a)
Homes applying for a license shall be inspected at the time of licensure.
(b)
Homes licensed by the department shall be inspected at least every
eighteen months, subject to available funds.
(c) ((Licensed
homes where a complaint has been received by the department may be inspected at
any time.)) The department may make an unannounced inspection of a
licensed home at any time to assure that the home and provider are in
compliance with this chapter and the rules adopted under this chapter.
(4) If
the department finds that the home is not in compliance with this chapter, it
shall require the home to correct any violations as provided in this chapter.
If the department finds that the home is in compliance with this chapter and
the rules adopted under this chapter, the department shall renew the license of
the home.
Sec.
23. RCW
70.128.080 and 1989 c 427 s 21 are each amended to read as follows:
An
adult family home shall have readily available for review by the department,
residents, and the public:
(1)
Its license to operate; and
(2) A
copy of each inspection report received by the home from the department for the
past three years.
Sec.
24. RCW
70.128.090 and 1989 c 427 s 30 are each amended to read as follows:
(1)
During inspections of an adult family home, the department shall have access
and authority to examine areas and articles in the home used to provide care or
support to residents, including residents' records, accounts, and the physical
premises, including the buildings, grounds, and equipment. The department also
shall have the authority to interview the provider and residents of an adult
family home.
(2)
Whenever an inspection is conducted, the department shall prepare a written
report that summarizes all information obtained during the inspection, and if
the home is in violation of this chapter, serve a copy of the inspection report
upon the provider at the same time as a notice of violation. If the home is
not in violation of this chapter, a copy of the inspection report shall be
mailed to the provider within ten days of the inspection of the home. All
inspection reports shall be made available to the public at the department
during business hours.
(3) ((The
inspection report shall describe any corrective measures on the part of the
provider necessary to pass a reinspection. If the department finds upon
reinspection of the home that the corrective measures have been satisfactorily
implemented, the department shall cease any actions taken against the home.
Nothing in this section shall require the department to license or renew the
license of a home where serious physical harm or death has occurred to a
resident)) The provider shall develop corrective measures for any
violations found by the department's inspection. The department may provide
consultation and technical assistance to assist the provider in developing
effective corrective measures. The department shall include a statement of the
provider's corrective measures in the department's inspection report.
NEW
SECTION. Sec. 25. A new
section is added to chapter 70.128 RCW to read as follows:
The
legislature recognizes that adult family homes located within the boundaries of
a federally recognized Indian reservation may be licensed by the Indian tribe.
The department may pay for care for persons residing in such homes, if there
has been a tribal or state criminal background check of the provider and any
staff, and the client is otherwise eligible for services administered by the
department.
Sec.
26. RCW
70.128.140 and 1989 c 427 s 27 are each amended to read as follows:
Each
adult family home shall meet applicable local licensing, zoning, building, and
housing codes, and state and local fire safety regulations as they pertain
to a single-family residence. It is the responsibility of the home to
check with local authorities to ensure all local codes are met.
Sec.
27. RCW
70.128.150 and 1989 c 427 s 28 are each amended to read as follows:
Whenever
possible adult family homes are encouraged to contact and work with local
quality assurance projects such as the volunteer ombudsman with the goal of
assuring high quality care is provided in the home.
An
adult family home may not willfully interfere with a representative of the
long-term care ombudsman program in the performance of official duties. The
department shall impose a penalty of not more than one thousand dollars for any
such willful interference.
Sec.
28. RCW
70.128.160 and 1989 c 427 s 31 are each amended to read as follows:
(1)
The department is authorized to take one or more of the actions listed in
subsection (2) of this section in any case in which the department finds that
an adult family home provider has:
(a)
Failed or refused to comply with the requirements of this chapter or the rules
adopted under this chapter;
(b)
Operated an adult family home without a license or under a revoked license;
(c)
Knowingly or with reason to know made a false statement of material fact on his
or her application for license or any data attached thereto, or in any matter
under investigation by the department; or
(d)
Willfully prevented or interfered with any inspection or investigation by the
department.
(2)
When authorized by subsection (1) of this section, the department may take one
or more of the following actions:
(a)
Refuse to issue a license;
(b) Impose
reasonable conditions on a license, such as correction within a specified time,
training, and limits on the type of clients the provider may admit or serve;
(c)
Impose civil penalties of not more than one hundred dollars per day per
violation;
(d)
Suspend, revoke, or refuse to renew a license; or
(((c)))
(e) Suspend admissions to the adult family home by imposing stop
placement.
(3)
When the department orders stop placement, the facility shall not admit any
person until the stop placement order is terminated. The department may
approve readmission of a resident to the facility from a hospital or nursing
home during the stop placement. The department shall terminate the stop
placement when: (a) The violations necessitating the stop placement have been
corrected; and (b) the provider exhibits the capacity to maintain adequate care
and service.
(4)
Chapter 34.05 RCW applies to department actions under this section, except that
orders of the department imposing license suspension, stop placement, or
conditions for continuation of a license are effective immediately upon notice
and shall continue in effect pending any hearing.
Sec.
29. RCW
70.128.175 and 1989 1st ex.s. c 9 s 815 are each amended to read as follows:
(1)
Unless the context clearly requires otherwise, these definitions shall apply
throughout this section and RCW 35.63.140, 35A.63.149, 36.70.755, 35.22.680, and
36.32.560((, and 70.128.180)):
(a)
"Adult family home" means a ((facility licensed pursuant to
chapter 70.128 RCW or the)) regular family abode of a person or persons ((who
are)) providing personal care, special care, room, and board to more
than one but not more than six adults who are not related by
blood or marriage to the person or persons providing the services.
(b)
"Residential care facility" means a facility that cares for at least
five, but not more than fifteen functionally disabled persons, that is not
licensed pursuant to chapter 70.128 RCW.
(c)
"Department" means the department of social and health services.
(2) An
adult family home shall be considered a residential use of property for zoning
purposes. Adult family homes shall be a permitted use in all areas zoned for
residential or commercial purposes, including areas zoned for single family
dwellings.
NEW
SECTION. Sec. 30. A new
section is added to chapter 70.128 RCW to read as follows:
(1)
The department shall maintain a toll-free telephone number for receiving
complaints regarding adult family homes.
(2) An
adult family home shall post in a place and manner clearly visible to residents
and visitors the department's toll-free complaint telephone number.
(3) No
adult family home shall discriminate or retaliate in any manner against a
resident on the basis or for the reason that such resident or any other person
made a complaint to the department or the long-term care ombudsman or cooperated
with the investigation of such a complaint.
NEW
SECTION. Sec. 31. RCW
70.128.180 and 1989 c 427 s 41 are each repealed.
Sec.
32. RCW
43.190.020 and 1991 sp.s. c 8 s 3 are each amended to read as follows:
As
used in this chapter, "long-term care facility" means any of the
following ((which provide services to persons sixty years of age and older
and is)):
(1) A
facility which:
(a)
Maintains and operates twenty-four hour skilled nursing services for the care
and treatment of chronically ill or convalescent patients, including mental,
emotional, or behavioral problems, mental retardation, or alcoholism;
(b)
Provides supportive, restorative, and preventive health services in conjunction
with a socially oriented program to its residents, and which maintains and
operates twenty-four hour services including board, room, personal care, and
intermittent nursing care. "Long-term health care facility" includes
nursing homes and nursing facilities, but does not include acute care hospital
or other licensed facilities except for that distinct part of the hospital or
facility which provides nursing facility services.
(2)
Any family home, group care facility, or similar facility determined by the
secretary, for twenty-four hour nonmedical care of persons in need of personal
services, supervision, or assistance essential for sustaining the activities of
daily living or for the protection of the individual.
(3)
Any swing bed in an acute care facility.
Sec.
33. RCW
43.190.060 and 1987 c 158 s 3 are each amended to read as follows:
A
long-term care ombudsman shall:
(1)
Investigate and resolve complaints made by or on behalf of ((older
individuals who are)) residents of long-term care facilities relating to
administrative action which may adversely affect the health, safety, welfare,
and rights of these individuals;
(2)
Monitor the development and implementation of federal, state, and local laws,
rules, regulations, and policies with respect to long-term care facilities in
this state;
(3)
Provide information as appropriate to public agencies regarding the problems of
individuals residing in long-term care facilities; and
(4)
Provide for training volunteers and promoting the development of citizen
organizations to participate in the ombudsman program. A volunteer long-term
care ombudsman shall be able to identify and resolve problems regarding the
care of residents in long-term care facilities and to assist such residents in
the assertion of their civil and human rights. However, volunteers shall not
be used for complaint investigations but may engage in fact-finding activities
to determine whether a formal complaint should be submitted to the department.
NEW
SECTION. Sec. 34. RCW
74.08.530, 74.08.560, 74.08.570, 74.08.545, and 74.08.550 are each recodified
in chapter 74.39A RCW.
NEW
SECTION. Sec. 35. RCW
74.08.541 and 1989 c 427 s 4, 1986 c 222 s 1, 1983 1st ex.s. c 41 s 39, &
1981 1st ex.s. c 6 s 17 are each repealed.
Sec.
36. RCW
74.08.545 and 1989 c 427 s 5 are each amended to read as follows:
It is
the intent of the legislature that chore services be provided to eligible
persons within the limits of funds appropriated for that purpose. Therefore,
the department shall provide services only to those persons identified as at
risk of being placed in a long-term care facility in the absence of such
services. The department shall not provide chore services to any individual
who is eligible for, and whose needs can be met by another community service
administered by the department. Chore services shall be provided to the
extent necessary to maintain a safe and healthful living environment. It is
the policy of the state to encourage the development of volunteer chore
services in local communities as a means of meeting chore care service needs and
directing financial resources. In determining eligibility for chore services,
the department shall consider the following:
(1)
The kind of services needed;
(2)
The degree of service need, and the extent to which an individual is dependent
upon such services to remain in his or her home or return to his or her home;
(3)
The availability of personal or community resources which may be utilized to
meet the individual's need; and
(4)
Such other factors as the department considers necessary to insure service is
provided only to those persons whose chore service needs cannot be met by
relatives, friends, nonprofit organizations, ((or)) other persons, or
by other programs or resources.
In
determining the level of services to be provided under this chapter, (([the]))
the client shall be assessed using an instrument designed by the
department to determine the level of functional disability, the need for
service and the person's risk of long-term care facility placement.
NEW
SECTION. Sec. 37. A new
section is added to chapter 74.39A RCW to read as follows:
(1)
The department shall establish a monthly dollar lid for each region on chore
services expenditures within the legislative appropriation. Priority for services
shall be given to the following situations:
(a)
People who were receiving chore personal care services as of June 30, 1995;
(b)
People for whom chore personal care services are necessary to return to the
community from a nursing home;
(c)
People for whom chore personal care services are necessary to prevent
unnecessary nursing home placement; and
(d)
People for whom chore personal care services are necessary as a protective
measure based on referrals resulting from an adult protective services
investigation.
(2)
The department shall require a client to participate in the cost of chore
services as a necessary precondition to receiving chore services paid for by
the state. The client shall retain an amount equal to one hundred percent of
the federal poverty level, adjusted for household size, for maintenance needs.
The department shall consider the remaining income as the client participation
amount for chore services except for those persons whose participation is
established under RCW 74.08.570.
(3)
The department shall establish, by rule, the maximum amount of resources a
person may retain and be eligible for chore services.
NEW
SECTION. Sec. 38. A new
section is added to chapter 74.39A RCW to read as follows:
(1)
The legislature intends that any staff reassigned by the department as a result
of shifting of the reauthorization responsibilities by contract outlined in
this section shall be dedicated for discharge planning and assisting with
discharge planning and information on existing discharge planning cases.
Discharge planning, as directed in this section, is intended for residents and
patients identified for discharge to long-term care pursuant to sections 5, 6,
and 9 of this act. The purpose of discharge planning is to protect residents
and patients from the financial incentives inherent in keeping residents or
patients in a more expensive higher level of care and shall focus on care
options that are in the best interest of the patient or resident.
(2)
The department shall contract with area agencies on aging:
(a) To
provide case management services to individuals receiving home and community
services in their own home; and
(b) To
reassess and reauthorize home and community services in home or in other
settings for individuals consistent with the intent of this section:
(i)
Who have been initially authorized by the department to receive home and
community services; and
(ii)
Who, at the time of reassessment and reauthorization, are receiving home and
community services in their own home.
(3) In
the event that an area agency on aging is unwilling to enter into or
satisfactorily fulfill a contract to provide these services, the department is
authorized to:
(a)
Obtain the services through competitive bid; and
(b)
Provide the services directly until a qualified contractor can be found.
Sec.
39. RCW
74.09.520 and 1994 c 21 s 4 are each 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) nursing facility 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 and
occupational 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) other diagnostic, screening, preventive, and rehabilitative services; and
(o) like services when furnished to a child by a school district in a manner
consistent with the requirements of this chapter. 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.
(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
and)) reviewed by a nurse.
(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.
(7)
For Title XIX personal care services administered by aging and adult services
administration of the department, the department shall contract with area
agencies on aging:
(a)
To provide case management services to individuals receiving Title XIX personal
care services in their own home; and
(b)
To reassess and reauthorize Title XIX personal care services or other home and
community services as defined in section 1 of this act in home or in other
settings for individuals consistent with the intent of this section:
(i)
Who have been initially authorized by the department to receive Title XIX
personal care services or other home and community services as defined in
section 1 of this act; and
(ii)
Who, at the time of reassessment and reauthorization, are receiving such
services in their own home.
(8)
In the event that an area agency on aging is unwilling to enter into or
satisfactorily fulfill a contract to provide these services, the department is
authorized to:
(a)
Obtain the services through competitive bid; and
(b)
Provide the services directly until a qualified contractor can be found.
Sec.
40. RCW
74.08.550 and 1989 c 427 s 6 are each amended to read as follows:
(1)
The department is authorized to develop a program to provide for ((those))
chore services ((enumerated in RCW 74.08.541)) under this
chapter.
(2)
The department may provide assistance in the recruiting of providers of the
services enumerated in ((RCW 74.08.541)) section 37 of this act
and seek to assure the timely provision of services in emergency situations.
(3)
The department shall assure that all providers of the chore services ((enumerated
in RCW 74.08.541)) under this chapter are compensated for the
delivery of the services on a prompt and regular basis.
Sec.
41. RCW
74.08.570 and 1989 c 427 s 7 are each amended to read as follows:
(1) An
otherwise eligible disabled person shall not be deemed ineligible for chore
services under this chapter if the person's gross income from employment,
adjusted downward by the cost of the chore services to be provided and the
disabled person's work expenses, does not exceed the maximum eligibility
standard established by the department for such chore services. The department
shall establish a ((sliding scale fee schedule for)) methodology for
client participation that allows such disabled persons((, taking into
consideration the person's ability to pay and work expenses)) to be
employed.
(2) If
a disabled person arranges for chore services through an individual provider
arrangement, the client's contribution shall be counted as first dollar toward
the total amount owed to the provider for chore services rendered.
(3) As
used in this section:
(a)
"Gross income" means total earned wages, commissions, salary, and any
bonus;
(b)
"Work expenses" includes:
(i)
Payroll deductions required by law or as a condition of employment, in amounts
actually withheld;
(ii)
The necessary cost of transportation to and from the place of employment by the
most economical means, except rental cars; and
(iii)
Expenses of employment necessary for continued employment, such as tools,
materials, union dues, transportation to service customers if not furnished by
the employer, and uniforms and clothing needed on the job and not suitable for
wear away from the job;
(c)
"Employment" means any work activity for which a recipient receives
monetary compensation;
(d)
"Disabled" means:
(i)
Permanently and totally disabled as defined by the department and as such
definition is approved by the federal social security administration for
federal matching funds;
(ii)
Eighteen years of age or older;
(iii)
A resident of the state of Washington; and
(iv)
Willing to submit to such examinations as are deemed necessary by the
department to establish the extent and nature of the disability.
Sec.
42. RCW
18.51.091 and 1987 c 476 s 24 are each amended to read as follows:
The
department shall make or cause to be made at least one inspection of each
nursing home ((prior to license renewal and shall inspect community-based
services as part of the licensing renewal survey)) at least every
eighteen months, except that the department may not inspect a facility that was
citation-free at the previous inspection sooner than twelve months after the
date of the previous inspection. The inspection shall be made without
providing advance notice of it. Every inspection may include an inspection of
every part of the premises and an examination of all records, methods of
administration, the general and special dietary and the stores and methods of
supply. Those nursing homes that provide community-based care shall establish
and maintain separate and distinct accounting and other essential records for
the purpose of appropriately allocating costs of the providing of such care:
PROVIDED, That such costs shall not be considered allowable costs for
reimbursement purposes under chapter 74.46 RCW. Following such inspection or
inspections, written notice of any violation of this law or the rules and
regulations promulgated hereunder, shall be given the applicant or licensee and
the department. The notice shall describe the reasons for the facility's
noncompliance. The department may prescribe by regulations that any licensee
or applicant desiring to make specified types of alterations or additions to
its facilities or to construct new facilities shall, before commencing such
alteration, addition or new construction, submit its plans and specifications
therefor to the department for preliminary inspection and approval or
recommendations with respect to compliance with the regulations and standards
herein authorized.
Sec.
43. RCW
18.51.140 and 1995 c . . . s 6 (Engrossed Substitute Senate Bill
No. 5093) are each amended to read as follows:
Standards
for fire protection and the enforcement thereof, with respect to all nursing
homes to be licensed hereunder, shall be the responsibility of the chief of the
Washington state patrol, through the director of fire protection, who shall
adopt such recognized standards as may be applicable to nursing homes for the
protection of life against the cause and spread of fire and fire hazards. The
department upon receipt of an application for a license, shall submit to the chief
of the Washington state patrol, through the director of fire protection, in
writing, a request for an inspection, giving the applicant's name and the
location of the premises to be licensed. Upon receipt of such a request, the
chief of the Washington state patrol, through the director of fire protection,
or his or her deputy, shall make an inspection of the nursing home to be
licensed, and if it is found that the premises do not comply with the required
safety standards and fire regulations as promulgated by the chief of the
Washington state patrol, through the director of fire protection, he or she
shall promptly make a written report to the nursing home and the department as
to the manner and time allowed in which the premises must qualify for a license
and set forth the conditions to be remedied with respect to fire regulations.
The department, applicant or licensee shall notify the chief of the Washington
state patrol, through the director of fire protection, upon completion of any
requirements made by him or her, and the chief of the Washington state patrol,
through the director of fire protection, or his or her deputy, shall make a
reinspection of such premises. Whenever the nursing home to be licensed meets
with the approval of the chief of the Washington state patrol, through the
director of fire protection, he or she shall submit to the department, a
written report approving same with respect to fire protection before a full
license can be issued. The chief of the Washington state patrol, through the
director of fire protection, shall make or cause to be made inspections of such
nursing homes at least ((annually)) every eighteen months.
In
cities which have in force a comprehensive building code, the provisions of
which are determined by the chief of the Washington state patrol, through the
director of fire protection, to be equal to the minimum standards of the code
for nursing homes adopted by the chief of the Washington state patrol, through
the director of fire protection, the chief of the fire department, provided the
latter is a paid chief of a paid fire department, shall make the inspection
with the chief of the Washington state patrol, through the director of fire
protection, or his or her deputy and they shall jointly approve the premises
before a full license can be issued.
Sec.
44. RCW
18.51.300 and 1981 1st ex.s. c 2 s 24 are each amended to read as follows:
Unless
specified otherwise by the department, a nursing home shall retain and preserve
all records which relate directly to the care and treatment of a patient for a
period of no less than ((ten)) eight years following the most
recent discharge of the patient; except the records of minors, which shall be
retained and preserved for a period of no less than three years following
attainment of the age of eighteen years, or ten years following such discharge,
whichever is longer.
If a
nursing home ceases operations, it shall make immediate arrangements, as
approved by the department, for preservation of its records.
The
department shall by regulation define the type of records and the information
required to be included in the records to be retained and preserved under this
section; which records may be retained in photographic form pursuant to chapter
5.46 RCW.
NEW
SECTION. Sec. 45. A new
section is added to chapter 18.88A RCW to read as follows:
The
legislature recognizes that nurses have been successfully delegating nursing
care tasks to family members and auxiliary staff for many years. The
opportunity for a nurse to delegate to nursing assistants qualifying under
section 46 of this act may enhance the viability and quality of care in
community health settings for long-term care services and to allow citizens to
live as independently as possible with maximum safeguards.
NEW
SECTION. Sec. 46. A new
section is added to chapter 18.88A RCW to read as follows:
(1) A
nurse may delegate specific care tasks to nursing assistants meeting the
requirements of this section and who provide care to individuals in community
residential programs for the developmentally disabled certified by the
department of social and health services under chapter 71A.12 RCW, to
individuals residing in adult family homes licensed under chapter 70.128 RCW,
and to individuals residing in boarding homes licensed under chapter 18.20 RCW
contracting with the department of social and health services to provide
assisted living services pursuant to RCW 74.39A.010.
(2)
For the purposes of this section, "nursing assistant" means a nursing
assistant-registered or a nursing assistant-certified. Nothing in this section
may be construed to affect the authority of nurses to delegate nursing tasks to
other persons, including licensed practical nurses, as authorized by law.
(3)
Before commencing any specific nursing care tasks authorized under this
chapter, the nursing assistant must (a) provide to the delegating nurse a
certificate of completion issued by the department of social and health
services indicating the completion of basic core training as provided in this
section, (b) be regulated by the department of health pursuant to this chapter,
subject to the uniform disciplinary act under chapter 18.130 RCW, and (c) meet any
additional training requirements identified by the nursing care quality
assurance commission and authorized by this section.
(4) A
nurse may delegate the following care tasks:
(a)
Oral and topical medications and ointments;
(b)
Nose, ear, eye drops, and ointments;
(c)
Dressing changes and catheterization using clean techniques as defined by the
nursing care quality assurance commission;
(d)
Suppositories, enemas, ostomy care;
(e)
Blood glucose monitoring;
(f)
Gastrostomy feedings in established and healed condition.
(5) On
or before September 1, 1995, the nursing care quality assurance commission, in
conjunction with the professional nursing organizations, shall develop rules
for nurse delegation protocols and by December 5, 1995, identify training
beyond the core training that is deemed necessary for the delegation of complex
tasks and patient care.
(6)
Nursing task delegation protocols are not intended to regulate the settings in
which delegation may occur but are intended to ensure that nursing care
services have a consistent standard of practice upon which the public and
profession may rely and to safeguard the authority of the nurse to make
independent professional decisions regarding the delegation of a task.
Protocols shall include at least the following:
(a)
Ensure that determination of the appropriateness of delegation of a nursing
task is at the discretion of the nurse;
(b)
Allow delegation of a nursing care task only for patients who have a stable and
predictable condition. "Stable and predictable condition" means a
situation, as defined by rule by the nursing care quality assurance commission,
in which the patient's clinical and behavioral status is known and does not
require frequent presence and evaluation of a registered nurse;
(c)
Assure that the delegations of nursing tasks pursuant to this chapter have the
written informed consent of the patient consistent with the provisions for
informed consent under chapter 7.70 RCW, as well as with the consent of the
delegating nurse and nursing assistant. The delegating nurse shall inform
patients of the level of training of all care providers in the setting;
(d)
Verify that the nursing assistant has completed the core training;
(e)
Require assessment by the nurse of the ability and willingness of the nursing
assistant to perform the delegated nursing task in the absence of direct nurse
supervision and to refrain from delegation if the nursing assistant is not able
or willing to perform the task;
(f)
Require the nurse to analyze the complexity of the nursing task that is
considered for delegation and determine the appropriate level of training and
any need of additional training for the nursing assistant;
(g)
Require the teaching of the nursing care task to the nursing assistant including
return demonstration under observation while performing the task;
(h)
Require a plan of nursing supervision and reevaluation of the delegated nursing
task. "Nursing supervision" means that the registered nurse monitors
by direct observation the skill and ability of the nursing assistant to perform
delegated nursing tasks. Frequency of supervision is at the discretion of the
registered nurse but shall occur at least every sixty days;
(i)
Require instruction to the nursing assistant that the delegated nursing task is
specific to a patient and is not transferable;
(j)
Require documentation and written instruction related to the delegated nursing
task be provided to the nursing assistant and a copy maintained in the patient
record;
(k)
Ensure that the nursing assistant is prepared to effectively deal with the
predictable outcomes of performing the nursing task;
(l)
Include in the delegation of tasks an awareness of the nature of the condition
requiring treatment, risks of the treatment, side effects, and interaction of
prescribed medications;
(m)
Require documentation in the patient's record of the rationale for delegating
or not delegating nursing tasks.
(7) A
basic core training curriculum on providing care for individuals in community
residential programs for the developmentally disabled certified by the
department of social and health services under chapter 71A.12 RCW shall be in
addition to the training requirements specified in subsection (5) of this
section. Basic core training shall be developed and adopted by rule by the
secretary of the department of social and health services. The department of
social and health services shall appoint an advisory panel to assist in the
development of core training comprised of representatives of the following:
(a)
The division of developmental disabilities;
(b)
The nursing care quality assurance commission;
(c)
Professional nursing organizations;
(d) A
state-wide organization of community residential service providers whose
members are programs certified by the department under chapter 71A.12 RCW.
(8) A
basic core training curriculum on providing care to residents in residential
settings licensed under chapter 70.128 RCW, or in assisted living pursuant to
RCW 74.39A.010 shall be mandatory for nursing assistants prior to assessment by
a nurse regarding the ability and willingness to perform a delegated nursing
task. Core training shall be developed and adopted by rule by the secretary of
the department of social and health services, in conjunction with an advisory
panel. The advisory panel shall be comprised of representatives from, at a
minimum, the following:
(a)
The nursing care quality assurance commission;
(b)
Professional nurse organizations;
(c) A
state-wide association of community residential service providers whose members
are programs certified by the department under chapter 71A.12 RCW;
(d)
Aging consumer groups;
(e)
Associations representing homes licensed under chapters 70.128 and 18.20 RCW;
and
(f)
Associations representing home health, hospice, and home care agencies licensed
under chapter 70.127 RCW.
NEW
SECTION. Sec. 47. A new
section is added to chapter 18.88A RCW to read as follows:
On or
before December 1, 1995, the department of health and the department of social
and health services, in consultation with the nursing care quality assurance
commission, shall develop and clarify program and reimbursement policies, as
well as clarify barriers to current delegation, relating to the ability and
authority of a nurse to delegate care tasks in the programs and services
operating under their authority.
The
nursing care quality assurance commission shall develop model forms that will
assist in standardizing the practice of delegation.
NEW
SECTION. Sec. 48. A new
section is added to chapter 18.88A RCW to read as follows:
(1)
The nurse and nursing assistant shall be accountable for their own individual
actions in the delegation process. Nurses acting within the protocols of their
delegation authority shall be immune from liability for any action performed in
the course of their delegation duties. Nursing assistants following written
delegation instructions from registered nurses performed in the course of their
accurately written, delegated duties shall be immune from liability.
(2) No
person may coerce a nurse into compromising patient safety by requiring the
nurse to delegate if the nurse determines it is inappropriate to do so. Nurses
shall not be subject to any employer reprisal or disciplinary action by the
Washington nursing care quality assurance commission for refusing to delegate
tasks or refusing to provide the required training for delegation if the nurse
determines delegation may compromise patient safety. Nursing assistants shall
not be subject to any employer reprisal or disciplinary action by the nursing
care quality assurance commission for refusing to accept delegation of a
nursing task. No community residential program, adult family home, or boarding
home contracting to provide assisted-living services may discriminate or
retaliate in any manner against a person because the person made a complaint or
cooperated in the investigation of a complaint.
(3)
The department of social and health services shall impose a civil fine of not
less than two hundred fifty dollars nor more than one thousand dollars on a
community residential program, adult family home, or boarding home under this
act that knowingly permits an employee to perform a nursing task except as
delegated by a nurse pursuant to this act.
NEW
SECTION. Sec. 49. A new
section is added to chapter 18.88A RCW to read as follows:
The
aging and adult services administration of the department of social and health
services shall establish a toll-free telephone number for receiving complaints
regarding delegation of specific nursing tasks to nursing assistants, in
conjunction with any other such system maintained for long-term care services.
Complaints specifically related to nurse-delegation shall be referred to the
nursing care quality assurance commission for appropriate disposition in
accordance with established procedures.
Sec.
50. RCW
18.79.040 and 1994 sp.s. c 9 s 404 are each amended to read as follows:
(1)
"Registered nursing practice" means the performance of acts requiring
substantial specialized knowledge, judgment, and skill based on the principles
of the biological, physiological, behavioral, and sociological sciences in
either:
(a)
The observation, assessment, diagnosis, care or counsel, and health teaching of
the ill, injured, or infirm, or in the maintenance of health or prevention of
illness of others;
(b)
The performance of such additional acts requiring education and training and
that are recognized by the medical and nursing professions as proper and
recognized by the commission to be performed by registered nurses licensed
under this chapter and that are authorized by the commission through its rules;
(c)
The administration, supervision, delegation, and evaluation of nursing
practice. However, nothing in this subsection affects the authority of a
hospital, hospital district, medical clinic, or office, concerning its
administration and supervision;
(d)
The teaching of nursing;
(e)
The executing of medical regimen as prescribed by a licensed physician and
surgeon, dentist, osteopathic physician and surgeon, podiatric physician and
surgeon, physician assistant, osteopathic physician assistant, or advanced
registered nurse practitioner.
(2) Nothing
in this section prohibits a person from practicing a profession for which a
license has been issued under the laws of this state or specifically authorized
by any other law of the state of Washington.
(3)
This section does not prohibit (a) the nursing care of the sick, without
compensation, by an unlicensed person who does not hold himself or herself out
to be a registered nurse, ((or)) (b) the practice of licensed practical
nursing by a licensed practical nurse, or (c) the practice of a nursing assistant,
providing delegated nursing tasks under chapter 18.88A RCW.
Sec.
51. RCW
18.79.260 and 1995 c 295 s 1 are each amended to read as follows:
A
registered nurse under his or her license may perform for compensation nursing
care, as that term is usually understood, of the ill, injured, or infirm, and
in the course thereof, she or he may do the following things that shall not be
done by a person not so licensed, except as provided in RCW 18.79.270 and
section 46 of this act:
(1) At
or under the general direction of a licensed physician and surgeon, dentist,
osteopathic physician and surgeon, naturopathic physician, podiatric physician
and surgeon, physician assistant, osteopathic physician assistant, or advanced
registered nurse practitioner acting within the scope of his or her license,
administer medications, treatments, tests, and inoculations, whether or not the
severing or penetrating of tissues is involved and whether or not a degree of
independent judgment and skill is required. Such direction must be for acts
which are within the scope of registered nursing practice;
(2)
Delegate to other persons ((engaged in nursing,)) the functions outlined
in subsection (1) of this section in accordance with chapter 18.88A RCW;
(3)
Instruct nurses in technical subjects pertaining to nursing;
(4)
Hold herself or himself out to the public or designate herself or himself as a
registered nurse.
Sec.
52. RCW
18.88A.030 and 1994 sp.s. c 9 s 709 are each amended to read as follows:
(1) A
nursing assistant may assist in the care of individuals as delegated by and
under the direction and supervision of a licensed (registered) nurse or
licensed practical nurse.
(2) A
health care facility shall not assign a nursing assistant-registered to provide
care until the nursing assistant-registered has demonstrated skills necessary
to perform competently all assigned duties and responsibilities.
(3)
Nothing in this chapter shall be construed to confer on a nursing assistant the
authority to administer medication unless delegated as a specific nursing
task pursuant to this chapter or to practice as a licensed (registered)
nurse or licensed practical nurse as defined in chapter 18.79 RCW.
(4)
Certification is voluntary for nursing assistants working in health care
facilities other than nursing homes unless otherwise required by state or
federal law or regulation.
(5)
The commission may adopt rules to implement the provisions of this chapter.
NEW
SECTION. Sec. 53. The
secretary of health in consultation with the Washington nursing care quality
assurance commission and the department of social and health services shall
monitor the implementation of sections 45 through 54 of this act and shall make
an interim report by December 31, 1996, and a final report by December 31,
1997, to the legislature with any recommendations for improvements. As part of
the monitoring process, the secretary of health and the secretary of social and
health services, in consultation with the University of Washington school of
nursing, shall conduct a study to be completed by September 30, 1997, which
shall be a part of the final report to be submitted to the legislature by
December 31, 1997. The study shall include consideration of the protection of
health and safety of persons with developmental disabilities and residents of
adult family homes and boarding homes providing assisted living services,
including the appropriateness of the tasks allowed for delegation, level and
type of training and regulation of nursing assistants. The report shall
include direct observation, documentation, and interviews, and shall
specifically include data on the following:
(1)
Patient, nurse, and nursing assistant satisfaction;
(2)
Medication errors, including those resulting in hospitalization;
(3)
Compliance with required training;
(4)
Compliance with nurse delegation protocols;
(5)
Incidence of harm to patients, including abuse and neglect;
(6)
Impact on access to care;
(7)
Impact on patient quality of life; and
(8)
Incidence of coercion in the nurse-delegation process.
NEW
SECTION. Sec. 54. A special
legislative task force is established to monitor implementation of sections 45
through 53 of this act. The task force shall consist of four members from the
house of representatives, no more than two of whom shall be members of the same
caucus, who shall be appointed by the speaker of the house of representatives,
and four members from the senate, no more than two of whom shall be members of
the same caucus, who shall be appointed by the president of the senate. The
task force shall:
(1)
Review the proposed nurse delegation protocols developed by the nursing care
quality assurance commission;
(2)
Review the proposed core and specialized training curricula developed by the
department of social and health services and by the nursing care quality
assurance commission;
(3)
Review the program and reimbursement policies, and the identified barriers to
nurse delegation, developed by the department of health and department of
social and health services;
(4)
Submit an interim report of its findings and recommendations on the above
actions to the legislature by January 1, 1996;
(5)
During 1996, conduct hearings to assess the effectiveness with which the
delegation protocols, the core training, and nurse oversight are being
implemented, and their impact on patient care and quality of life;
(6)
Review and approve the proposed study designs;
(7) By
February 1, 1997, recommend to the legislature a mechanism and time frame for
extending nurse delegation provisions similar to those described in this act to
persons residing in their own homes;
(8)
During 1997, receive interim reports on the findings of the studies conducted
in accordance with this act, and conduct additional fact-finding hearings on
the implementation and impact of the nurse delegation provisions of sections 45
through 53 of this act.
The
office of program research and senate committee services shall provide staff
support to the task force. The department of health, the department of social
and health services, and the nursing care quality assurance commission shall
provide technical support as needed. The task force shall cease to exist on
January 1, 1998, unless extended by act of the legislature.
NEW
SECTION. Sec. 55. A new
section is added to chapter 74.39A RCW to read as follows:
(1) A
person who receives an asset from an applicant for or recipient of long-term
care services for less than fair market value shall be subject to a civil fine
payable to the department if:
(a)
The applicant for or recipient of long-term care services transferred the asset
for the purpose of qualifying for state or federal coverage for long-term care
services and the person who received the asset was aware, or should have been
aware, of this purpose;
(b)
Such transfer establishes a period of ineligibility for such service under
state or federal laws or regulations; and
(c) The
department provides coverage for such services during the period of
ineligibility because the failure to provide such coverage would result in an
undue hardship for the applicant or recipient.
(2)
The civil fine imposed under this section shall be imposed in a judicial
proceeding initiated by the department and shall equal (a) up to one hundred
fifty percent of the amount the department expends for the care of the
applicant or recipient during the period of ineligibility attributable to the
amount transferred to the person subject to the civil fine plus (b) the
department's court costs and legal fees.
(3)
Transfers subject to a civil fine under this section shall be considered null
and void and a fraudulent conveyance as to the department. The department
shall have the right to petition a court to set aside such transfers and
require all assets transferred returned to the applicant or recipient.
NEW
SECTION. Sec. 56. A new
section is added to chapter 74.39A RCW to read as follows:
(1)
All payments made in state-funded long-term care shall be recoverable as if
they were medical assistance payments subject to recovery under 42 U.S.C. Sec.
1396p and chapter 43.20B RCW, but without regard to the recipient's age.
(2) In
determining eligibility for state-funded long-term care services programs, the
department shall impose the same rules with respect to the transfer of assets
for less than fair market value as are imposed under 42 U.S.C. 1396p with
respect to nursing home and home and community services.
NEW
SECTION. Sec. 57. A new
section is added to chapter 74.39A RCW to read as follows:
Notwithstanding
any other provision of law:
(1) In
order to facilitate and ensure compliance with the federal social security act,
Title XIX, as now existing or hereafter amended, later enactment to be adopted
by reference by the director by rule, and other state laws mandating recovery
of assets from estates of persons receiving long-term care services, the
secretary of the department, with the approval of the office of the attorney
general, may pay the reasonable and proper fees of attorneys admitted to
practice before courts of this state, and associated professionals such as
guardians, who are engaged in probate practice for the purpose of maintaining
actions under Title 11 RCW, to the end that assets are not wasted, but are
rather collected and preserved, and used for the care of the client or the
reimbursement of the department pursuant to this chapter or chapter 43.20B RCW.
(2)
The department may hire such other agencies and professionals on a contingency
basis or otherwise as are necessary and cost-effective to collect bad debts
owed to the department for long-term care services.
Sec.
58. RCW
11.40.010 and 1994 c 221 s 25 are each amended to read as follows:
Every
personal representative shall, after appointment and qualification, give a
notice to the creditors of the deceased, stating such appointment and
qualification as personal representative and requiring all persons having
claims against the deceased to serve the same on the personal representative or
the estate's attorney of record, and file an executed copy thereof with the
clerk of the court, within four months after the date of the first publication
of such notice described in this section or within four months after the date
of the filing of the copy of such notice with the clerk of the court, whichever
is the later, or within the time otherwise provided in RCW 11.40.013. The
four-month time period after the later of the date of the first publication of
the notice to creditors or the date of the filing of such notice with the clerk
of the court is referred to in this chapter as the "four-month time
limitation." Such notice shall be given as follows:
(1)
The personal representative shall give actual notice, as provided in RCW
11.40.013, to such creditors who become known to the personal representative
within such four-month time limitation;
(2)
The personal representative shall cause such notice to be published once in
each week for three successive weeks in the county in which the estate is being
administered; ((and))
(3)
The personal representative shall file a copy of such notice with the clerk of
the court; and
(4)
The personal representative shall mail a copy of the notice, including the
decedent's social security number, to the state of Washington, department of
social and health services, office of financial recovery.
Except
as otherwise provided in RCW 11.40.011 or 11.40.013, any claim not filed within
the four-month time limitation shall be forever barred, if not already barred
by any otherwise applicable statute of limitations. This bar is effective as
to claims against both the decedent's probate assets and nonprobate assets as
described in RCW 11.18.200. Proof by affidavit of the giving and publication
of such notice shall be filed with the court by the personal representative.
Acts
of a notice agent in complying with chapter 221, Laws of 1994 may be adopted
and ratified by the personal representative as if done by the personal
representative in complying with this chapter, except that if at the time of
the appointment and qualification of the personal representative a notice agent
had commenced nonprobate notice to creditors under chapter 11.42 RCW, the
personal representative shall give published notice as provided in RCW
11.42.180.
Sec.
59. RCW
11.42.020 and 1994 c 221 s 32 are each amended to read as follows:
(1)
The notice agent may give nonprobate notice to the creditors of the decedent
if:
(a) As
of the date of the filing of a copy of the notice with the clerk of the
superior court for the notice county, the notice agent has no knowledge of the
appointment and qualification of a personal representative in the decedent's
estate in the state of Washington or of another person becoming a notice agent;
and
(b)
According to the records of the clerk of the superior court for the notice
county as of 8:00 a.m. on the date of the filing, no personal representative of
the decedent's estate had been appointed and qualified and no cause number
regarding the decedent had been issued to any other notice agent by the clerk
under RCW 11.42.010.
(2)
The notice must state that all persons having claims against the decedent
shall: (a) Serve the same on the notice agent if the notice agent is a
resident of the state of Washington upon whom service of all papers may be
made, or on the nonprobate resident agent for the notice agent, if any, or on
the attorneys of record of the notice agent at their respective address in the
state of Washington; and (b) file an executed copy of the notice with the clerk
of the superior court for the notice county, within: (i)(A) Four months after
the date of the first publication of the notice described in this section; or
(B) four months after the date of the filing of the copy of the notice with the
clerk of the superior court for the notice county, whichever is later; or (ii)
the time otherwise provided in RCW 11.42.050. The four-month time period after
the later of the date of the first publication of the notice to creditors or
the date of the filing of the notice with the clerk of the court is referred to
in this chapter as the "four-month time limitation."
(3)
The notice agent shall declare in the notice in affidavit form or under the
penalty of perjury under the laws of the state of Washington as provided in RCW
9A.72.085 that: (a) The notice agent is entitled to give the nonprobate notice
under subsection (1) of this section; and (b) the notice is being given by the
notice agent as permitted by this section.
(4)
The notice agent shall sign the notice and file it with the clerk of the
superior court for the notice county. The notice must be given as follows:
(a)
The notice agent shall give actual notice as to creditors of the decedent who
become known to the notice agent within the four-month time limitation as
required in RCW 11.42.050;
(b)
The notice agent shall cause the notice to be published once in each week for
three successive weeks in the notice county; ((and))
(c)
The notice agent shall file a copy of the notice with the clerk of the superior
court for the notice county; and
(d)
The notice agent shall mail a copy of the notice, including the decedent's
social security number, to the state of Washington, department of social and
health services, office of financial recovery.
(5) A
claim not filed within the four-month time limitation is forever barred, if not
already barred by an otherwise applicable statute of limitations, except as
provided in RCW 11.42.030 or 11.42.050. The bar is effective to bar claims
against both the probate estate of the decedent and nonprobate assets that were
subject to satisfaction of the decedent's general liabilities immediately
before the decedent's death. If a notice to the creditors of a decedent is
published by more than one notice agent and the notice agents are not acting
jointly, the four-month time limitation means the four-month time limitation
that applies to the notice agent who first publishes the notice. Proof by
affidavit or perjury declaration made under RCW 9A.72.085 of the giving and
publication of the notice must be filed with the clerk of the superior court
for the notice county by the notice agent.
Sec.
60. RCW
11.62.010 and 1993 c 291 s 1 are each amended to read as follows:
(1) At
any time after forty days from the date of a decedent's death, any person who
is indebted to or who has possession of any personal property belonging to the
decedent or to the decedent and his or her surviving spouse as a community,
which debt or personal property is an asset which is subject to probate, shall
pay such indebtedness or deliver such personal property, or so much of either as
is claimed, to a person claiming to be a successor of the decedent upon receipt
of proof of death and of an affidavit made by said person which meets the
requirements of subsection (2) of this section.
(2) An
affidavit which is to be made pursuant to this section shall state:
(a)
The claiming successor's name and address, and that the claiming successor is a
"successor" as defined in RCW 11.62.005;
(b)
That the decedent was a resident of the state of Washington on the date of his or
her death;
(c)
That the value of the decedent's entire estate subject to probate, not
including the surviving spouse's community property interest in any assets
which are subject to probate in the decedent's estate, wherever located, less
liens and encumbrances, does not exceed sixty thousand dollars;
(d)
That forty days have elapsed since the death of the decedent;
(e)
That no application or petition for the appointment of a personal
representative is pending or has been granted in any jurisdiction;
(f)
That all debts of the decedent including funeral and burial expenses have been
paid or provided for;
(g) A
description of the personal property and the portion thereof claimed, together
with a statement that such personal property is subject to probate;
(h)
That the claiming successor has given written notice, either by personal
service or by mail, identifying his or her claim, and describing the property
claimed, to all other successors of the decedent, and that at least ten days
have elapsed since the service or mailing of such notice; and
(i)
That the claiming successor is either personally entitled to full payment or
delivery of the property claimed or is entitled to full payment or delivery
thereof on the behalf and with the written authority of all other successors who
have an interest therein.
(3) A
transfer agent of any security shall change the registered ownership of the
security claimed from the decedent to the person claiming to be the successor
with respect to such security upon the presentation of proof of death and of an
affidavit made by such person which meets the requirements of subsection (2) of
this section. Any governmental agency required to issue certificates of
ownership or of license registration to personal property shall issue a new
certificate of ownership or of license registration to a person claiming to be
a successor of the decedent upon receipt of proof of death and of an affidavit
made by such person which meets the requirements of subsection (2) of this
section.
(4) No
release from any Washington state or local taxing authority may be required
before any assets or debts are paid or delivered to a successor of a decedent
as required under this section.
(5)
A copy of the affidavit, including the decedent's social security number, shall
be mailed to the state of Washington, department of social and health services,
office of financial recovery.
Sec.
61. RCW
11.28.120 and 1994 c 221 s 23 are each amended to read as follows:
Administration
of an estate if the decedent died intestate or if the personal representative
or representatives named in the will declined or were unable to serve shall be
granted to some one or more of the persons hereinafter mentioned, and they
shall be respectively entitled in the following order:
(1)
The surviving spouse, or such person as he or she may request to have
appointed.
(2)
The next of kin in the following order: (a) Child or children; (b) father or
mother; (c) brothers or sisters; (d) grandchildren; (e) nephews or nieces.
(3)
The trustee named by the decedent in an inter vivos trust instrument,
testamentary trustee named in the will, guardian of the person or estate of the
decedent, or attorney in fact appointed by the decedent, if any such a
fiduciary controlled or potentially controlled substantially all of the
decedent's probate and nonprobate assets.
(4)
One or more of the beneficiaries or transferees of the decedent's probate or
nonprobate assets.
(5)(a)
The director of revenue, or the director's designee, for those estates having
property subject to the provisions of chapter 11.08 RCW; however, the director
may waive this right.
(b)
The secretary of the department of social and health services for those estates
owing debts for long-term care services as defined in section 1 of this act;
however the secretary may waive this right.
(6)
One or more of the principal creditors.
(7) If
the persons so entitled shall fail for more than forty days after the death of
the decedent to present a petition for letters of administration, or if it
appears to the satisfaction of the court that there is no next of kin, as above
specified eligible to appointment, or they waive their right, and there are no
principal creditor or creditors, or such creditor or creditors waive their
right, then the court may appoint any suitable person to administer such
estate.
Sec.
62. RCW
18.39.250 and 1989 c 390 s 3 are each amended to read as follows:
(1)
Any funeral establishment selling funeral merchandise or services by
prearrangement funeral service contract and accepting moneys therefore shall
establish and maintain one or more prearrangement funeral service trusts under
Washington state law with two or more designated trustees, for the benefit of
the beneficiary of the prearrangement funeral service contract or may join with
one or more other Washington state licensed funeral establishments in a
"master trust" provided that each member of the "master
trust" shall comply individually with the requirements of this chapter.
(2) Up
to ten percent of the cash purchase price of each prearrangement funeral
service contract, excluding sales tax, may be retained by the funeral
establishment unless otherwise provided in this chapter. If the prearrangement
funeral service contract is canceled within thirty calendar days of its
signing, then the purchaser shall receive a full refund of all moneys paid
under the contract.
(3) At
least ninety percent of the cash purchase price of each prearrangement funeral
service contract, paid in advance, excluding sales tax, shall be placed in the
trust established or utilized by the funeral establishment. Deposits to the
prearrangement funeral service trust shall be made not later than the twentieth
day of the month following receipt of each payment made on the last ninety
percent of each prearrangement funeral service contract, excluding sales tax.
(4)
All prearrangement funeral service trust moneys shall be deposited in an
insured account in a qualified public depositary or shall be invested in
instruments issued or insured by any agency of the federal government if these
securities are held in a public depositary. The account shall be designated as
the prearrangement funeral service trust of the funeral establishment for the
benefit of the beneficiaries named in the prearrangement funeral service
contracts. The prearrangement funeral service trust shall not be considered
as, nor shall it be used as, an asset of the funeral establishment.
(5)
After deduction of reasonable fees for the administration of the trust, taxes
paid or withheld, or other expenses of the trust, all interest, dividends,
increases, or accretions of whatever nature earned by a trust shall be kept
unimpaired and shall become a part of the trust. Adequate records shall be
maintained to allocate the share of principal and interest to each contract.
Fees deducted for the administration of the trust shall not exceed one percent
of the face amount of the prearrangement funeral service contract per annum.
In no instance shall the administrative charges deducted from the
prearrangement funeral service trust reduce, diminish, or in any other way
lessen the value of the trust so that the services or merchandise provided for
under the contract are reduced, diminished, or in any other way lessened.
(6)
Except as otherwise provided in this chapter, the trustees of a prearrangement
funeral service trust shall permit withdrawal of all funds deposited under a
prearrangement funeral service contract, plus accruals thereon, under the
following circumstances and conditions:
(a) If
the funeral establishment files a verified statement with the trustees that the
prearrangement funeral merchandise and services covered by the contract have
been furnished and delivered in accordance therewith; or
(b) If
the funeral establishment files a verified statement with the trustees that the
prearrangement funeral merchandise and services covered by the contract have
been canceled in accordance with its terms.
(7)
Subsequent to the thirty calendar day cancellation period provided for in this
chapter, any purchaser or beneficiary who has a revocable prearrangement
funeral service contract has the right to demand a refund of the amount in
trust.
(8)
Prearrangement funeral service contracts which have or should have an account
in a prearrangement funeral service trust may be terminated by the board if the
funeral establishment goes out of business, becomes insolvent or bankrupt,
makes an assignment for the benefit of creditors, has its prearrangement
funeral service certificate of registration revoked, or for any other reason is
unable to fulfill the obligations under the contract. In such event, or upon
demand by the purchaser or beneficiary of the prearrangement funeral service
contract, the funeral establishment shall refund to the purchaser or
beneficiary all moneys deposited in the trust and allocated to the contract
unless otherwise ordered by a court of competent jurisdiction. The purchaser
or beneficiary may, in lieu of a refund, elect to transfer the prearrangement
funeral service contract and all amounts in trust to another funeral
establishment licensed under this chapter which will agree, by endorsement to
the contract, to be bound by the contract and to provide the funeral
merchandise or services. Election of this option shall not relieve the
defaulting funeral establishment of its obligation to the purchaser or
beneficiary for any amounts required to be, but not placed, in trust.
(9)
Prior to the sale or transfer of ownership or control of any funeral
establishment which has contracted for prearrangement funeral service
contracts, any person, corporation, or other legal entity desiring to acquire
such ownership or control shall apply to the director in accordance with RCW
18.39.145. Persons and business entities selling or relinquishing, and persons
and business entities purchasing or acquiring ownership or control of such
funeral establishments shall each verify and attest to a report showing the
status of the prearrangement funeral service trust or trusts on the date of the
sale. This report shall be on a form prescribed by the board and shall be
considered part of the application for a funeral establishment license. In the
event of failure to comply with this subsection, the funeral establishment
shall be deemed to have gone out of business and the provisions of subsection
(8) of this section shall apply.
(10)
Prearrangement funeral service trust moneys shall not be used, directly or
indirectly, for the benefit of the funeral establishment or any director,
officer, agent, or employee of the funeral establishment including, but not
limited to, any encumbrance, pledge, or other use of prearrangement funeral
service trust moneys as collateral or other security.
(11)(a)
If, at the time of the signing of the prearrangement funeral service contract,
the beneficiary of the trust is a recipient of public assistance as defined in
RCW 74.04.005, or reasonably anticipates being so defined, the contract may
provide that the trust will be irrevocable. If after the contract is entered
into, the beneficiary becomes eligible or seeks to become eligible for public
assistance under Title 74 RCW, the contract may provide for an election by the
beneficiary, or by the purchaser on behalf of the beneficiary, to make the
trust irrevocable thereafter in order to become or remain eligible for such
assistance.
(b)
The department of social and health services shall notify the trustee of any
prearrangement service trust that the department has a claim on the estate of a
beneficiary for long-term care services. Such notice shall be renewed at least
every three years. The trustees upon becoming aware of the death of a
beneficiary shall give notice to the department of social and health services,
office of financial recovery, who shall file any claim there may be within
thirty days of the notice.
(12)
Every prearrangement funeral service contract financed through a prearrangement
funeral service trust shall contain language which:
(a)
Informs the purchaser of the prearrangement funeral service trust and the
amount to be deposited in the trust;
(b)
Indicates if the contract is revocable or not in accordance with subsection
(11) of this section;
(c)
Specifies that a full refund of all moneys paid on the contract will be made if
the contract is canceled within thirty calendar days of its signing;
(d)
Specifies that, in the case of cancellation by a purchaser or beneficiary
eligible to cancel under the contract or under this chapter, up to ten percent
of the contract amount may be retained by the seller to cover the necessary
expenses of selling and setting up the contract;
(e)
Identifies the trust to be used and contains information as to how the trustees
may be contacted.
Sec.
63. RCW
18.39.255 and 1989 c 390 s 4 are each amended to read as follows:
Prearranged
funeral service contracts funded through insurance shall contain language
which:
(1)
States the amount of insurance;
(2)
Informs the purchaser of the name and address of the insurance company through
which the insurance will be provided, the policy number, and the name of the
beneficiary; ((and))
(3)
Informs the purchaser that amounts paid for insurance may not be refundable;
(4)
Informs that any funds from the policy not used for services may be subject to
a claim for reimbursement for long-term care services paid for by the state;
and
(5)
States that for purposes of the contract, the procedures in RCW
18.39.250(11)(b) shall control such recoupment.
Sec.
64. RCW
74.42.450 and 1979 ex.s. c 211 s 45 are each amended to read as follows:
(1)
The facility shall admit as residents only those individuals whose needs can be
met by:
(a)
The facility;
(b)
The facility cooperating with community resources; or
(c)
The facility cooperating with other providers of care affiliated or under
contract with the facility.
(2) The
facility shall transfer a resident to a hospital or other appropriate facility
when a change occurs in the resident's physical or mental condition that
requires care or service that the facility cannot provide. The resident, the
resident's guardian, if any, the resident's next of kin, the attending
physician, and the department shall be consulted at least fifteen days before a
transfer or discharge unless the resident is transferred under emergency
circumstances. The department shall use casework services or other means to
insure that adequate arrangements are made to meet the resident's needs.
(3) A
resident shall be transferred or discharged only for medical reasons, the
resident's welfare or request, the welfare of other residents, or nonpayment. A
resident may not be discharged for nonpayment if the discharge would be
prohibited by the medicaid program.
(4)
If a resident chooses to remain in the nursing facility, the department shall
respect that choice, provided that if the resident is a medicaid recipient, the
resident continues to require a nursing facility level of care.
(5)
If the department determines that a resident no longer requires a nursing
facility level of care, the resident shall not be discharged from the nursing
facility until at least thirty days after written notice is given to the
resident, the resident's surrogate decision maker and, if appropriate, a family
member or the resident's representative. A form for requesting a hearing to
appeal the discharge decision shall be attached to the written notice. The
written notice shall include at least the following:
(a)
The reason for the discharge;
(b)
A statement that the resident has the right to appeal the discharge; and
(c)
The name, address, and telephone number of the state long-term care ombudsman.
(6)
If the resident appeals a department discharge decision, the resident shall not
be discharged without the resident's consent until at least thirty days after a
final order is entered upholding the decision to discharge the resident.
Sec.
65. RCW
68.46.050 and 1973 1st ex.s. c 68 s 5 are each amended to read as follows:
(1)
A bank, trust company, or savings and loan association designated as the
depository of prearrangement funds shall permit withdrawal by a cemetery
authority of all funds deposited under any specific prearrangement contract
plus interest accrued thereon, under the following circumstances and
conditions:
(((1)))
(a) If the cemetery authority files a verified statement with the
depository that the prearrangement merchandise and services covered by a
contract have been furnished and delivered in accordance therewith; or
(((2)))
(b) If the cemetery authority files a verified statement that a specific
prearrangement contract has been canceled in accordance with its terms.
(2)
The department of social and health services shall notify the cemetery
authority maintaining a prearrangement trust fund regulated by this chapter
that the department has a claim on the estate of a beneficiary for long-term
care services. Such notice shall be renewed at least every three years. The
cemetery authority upon becoming aware of the death of a beneficiary shall give
notice to the department of social and health services, office of financial
recovery, who shall file any claim there may be within thirty days of the
notice.
Sec.
66. RCW
70.129.040 and 1994 c 214 s 5 are each amended to read as follows:
(1)
The resident has the right to manage his or her financial affairs, and the
facility may not require residents to deposit their personal funds with the
facility.
(2)
Upon written authorization of a resident, if the facility agrees to manage the
resident's personal funds, the facility must hold, safeguard, manage, and
account for the personal funds of the resident deposited with the facility as
specified in this section.
(((3)))(a)
The facility must deposit a resident's personal funds in excess of one hundred
dollars in an interest-bearing account or accounts that is separate from any of
the facility's operating accounts, and that credits all interest earned on
residents' funds to that account. In pooled accounts, there must be a separate
accounting for each resident's share.
(b)
The facility must maintain a resident's personal funds that do not exceed one
hundred dollars in a noninterest-bearing account, interest-bearing account, or
petty cash fund.
(((4)))
(3) The facility must establish and maintain a system that assures a
full and complete and separate accounting of each resident's personal funds
entrusted to the facility on the resident's behalf.
(a)
The system must preclude any commingling of resident funds with facility funds
or with the funds of any person other than another resident.
(b)
The individual financial record must be available on request to the resident or
his or her legal representative.
(((5)))
(4) Upon the death of a resident with a personal fund deposited with the
facility the facility must convey within forty-five days the resident's funds,
and a final accounting of those funds, to the individual or probate
jurisdiction administering the resident's estate; but in the case of a
resident who received long-term care services paid for by the state, the funds
and accounting shall be sent to the state of Washington, department of social
and health services, office of financial recovery. The department shall
establish a release procedure for use for burial expenses.
Sec.
67. RCW
43.20B.080 and 1994 c 21 s 3 are each amended to read as follows:
(1)
The department shall file liens, seek adjustment, or otherwise effect recovery
for medical assistance correctly paid on behalf of an individual as required by
this chapter and 42 U.S.C. Sec. 1396p.
(2) Liens
may be adjusted by foreclosure in accordance with chapter 61.12 RCW.
(3)
In the case of an individual who was fifty-five years ((or [of])) of
age or older when the individual received medical assistance, the department
shall seek adjustment or recovery from the individual's estate, and from
nonprobate assets of the individual as defined by RCW 11.02.005 except property
passing through a community property agreement, but only for medical
assistance consisting of nursing facility services, home and community-based
services, other services that the department determines to be appropriate,
and related hospital and prescription drug services. Recovery from the
individual's estate, including foreclosure of liens imposed under this section,
shall be undertaken as soon as practicable, consistent with the requirements of
42 U.S.C. Sec. 1396p.
(((3)))
(4)(a) The department shall establish procedures consistent with
standards established by the federal department of health and human services
and pursuant to 42 U.S.C. Sec. 1396p to waive recovery when such recovery would
work an undue hardship.
(((4)))
(b) Recovery of medical assistance from a recipient's estate shall not
include property made exempt from claims by federal law or treaty, including
exemption for tribal artifacts that may be held by individual Native Americans.
(5)
The department is authorized to adopt rules to effect recovery under this
section. The department may adopt by rule later enactments of the federal laws
referenced in this section.
Sec.
68. RCW
74.42.020 and 1982 c 120 s 1 are each amended to read as follows:
The
standards in RCW 74.42.030 through 74.42.570 are the minimum standards for
facilities licensed under chapter 18.51 RCW: PROVIDED, HOWEVER, That RCW
74.42.040, 74.42.140 through 74.42.280, 74.42.300, 74.42.360, 74.42.370,
74.42.380, 74.42.420 (2), (4), (5), (6) and (7), 74.42.430(3), 74.42.450 (2)
and (3), 74.42.520, 74.42.530, 74.42.540, 74.42.570, and 74.42.580 shall not
apply to ((Christian Science sanatoria facilities operated and listed or
certified by The First Church of Christ, Scientist, in Boston, Massachusetts))
any nursing home or institution conducted for those who rely upon treatment
by prayer or spiritual means in accordance with the creed or tenets of any
well-recognized church or religious denomination, or for any nursing home or
institution operated for the exclusive care of members of a convent as defined
in RCW 84.36.800 or rectory, monastery, or other institution operated for the
care of members of the clergy.
NEW
SECTION. Sec. 69. A new
section is added to chapter 74.46 RCW to read as follows:
Upon
the death of a resident with a personal fund deposited with the facility, the
facility must convey within forty-five days the resident's funds, and a final
accounting of those funds, to the individual or probate jurisdiction
administering the resident's estate; but in the case of a resident who received
long-term care services, the funds and accounting shall be sent to the state of
Washington, department of social and health services, office of financial
recovery. The department shall establish a release procedure for use for
burial expenses.
Sec.
70. RCW
74.46.450 and 1993 sp.s. c 13 s 9 are each amended to read as follows:
(1)
Prospective reimbursement rates for a new contractor will be established within
sixty days following receipt by the department of the properly completed
projected budget required by RCW 74.46.670. Such reimbursement rates will
become effective as of the effective date of the contract and shall remain in
effect until adjusted or reset as provided in this chapter.
(2)
Such reimbursement rates will be based on the contractor's projected cost of
operations and on costs and payment rates of the prior contractor, if any, or
of other contractors in comparable circumstances.
(3) For
nursing facilities receiving original certificate of need approval prior to
June 30, 1988, and commencing operations on or after January 1, 1995, the
department shall base initial nursing services, food, administrative, and
operational rate components on such component rates immediately above the
median for facilities in the same county. Property and return on investment
rate components shall be established as provided in this chapter.
(4)
If a properly completed budget is not received at least sixty days prior to the
effective date of the contract, the department will establish preliminary rates
based on the other factors specified in subsection (2) of this section. These
preliminary rates will remain in effect until adjusted or reset as provided in
this chapter.
(((4)))
(5) The department is authorized to develop policies and procedures in
rule to address the computation of rates for the first and second fiscal years
of each biennium, including steps necessary to prorate rate adjustments for
economic trends and conditions as authorized in RCW 74.46.420, for contractors
having less than twelve months of cost report data for the prior calendar year.
Sec.
71. RCW
70.38.111 and 1993 c 508 s 5 are each amended to read as follows:
(1)
The department shall not require a certificate of need for the offering of an
inpatient tertiary health service by:
(a) A
health maintenance organization or a combination of health maintenance
organizations if (i) the organization or combination of organizations has, in
the service area of the organization or the service areas of the organizations
in the combination, an enrollment of at least fifty thousand individuals, (ii)
the facility in which the service will be provided is or will be geographically
located so that the service will be reasonably accessible to such enrolled
individuals, and (iii) at least seventy-five percent of the patients who can
reasonably be expected to receive the tertiary health service will be
individuals enrolled with such organization or organizations in the
combination;
(b) A
health care facility if (i) the facility primarily provides or will provide
inpatient health services, (ii) the facility is or will be controlled, directly
or indirectly, by a health maintenance organization or a combination of health
maintenance organizations which has, in the service area of the organization or
service areas of the organizations in the combination, an enrollment of at
least fifty thousand individuals, (iii) the facility is or will be
geographically located so that the service will be reasonably accessible to
such enrolled individuals, and (iv) at least seventy-five percent of the
patients who can reasonably be expected to receive the tertiary health service
will be individuals enrolled with such organization or organizations in the
combination; or
(c) A
health care facility (or portion thereof) if (i) the facility is or will be
leased by a health maintenance organization or combination of health
maintenance organizations which has, in the service area of the organization or
the service areas of the organizations in the combination, an enrollment of at
least fifty thousand individuals and, on the date the application is submitted
under subsection (2) of this section, at least fifteen years remain in the term
of the lease, (ii) the facility is or will be geographically located so that
the service will be reasonably accessible to such enrolled individuals, and
(iii) at least seventy-five percent of the patients who can reasonably be
expected to receive the tertiary health service will be individuals enrolled
with such organization;
if, with
respect to such offering or obligation by a nursing home, the department has, upon
application under subsection (2) of this section, granted an exemption from
such requirement to the organization, combination of organizations, or
facility.
(2) A
health maintenance organization, combination of health maintenance
organizations, or health care facility shall not be exempt under subsection (1)
of this section from obtaining a certificate of need before offering a tertiary
health service unless:
(a) It
has submitted at least thirty days prior to the offering of services reviewable
under RCW 70.38.105(4)(d) an application for such exemption; and
(b)
The application contains such information respecting the organization,
combination, or facility and the proposed offering or obligation by a nursing
home as the department may require to determine if the organization or
combination meets the requirements of subsection (1) of this section or the
facility meets or will meet such requirements; and
(c)
The department approves such application. The department shall approve or
disapprove an application for exemption within thirty days of receipt of a
completed application. In the case of a proposed health care facility (or
portion thereof) which has not begun to provide tertiary health services on the
date an application is submitted under this subsection with respect to such
facility (or portion), the facility (or portion) shall meet the applicable
requirements of subsection (1) of this section when the facility first provides
such services. The department shall approve an application submitted under
this subsection if it determines that the applicable requirements of subsection
(1) of this section are met.
(3) A
health care facility (or any part thereof) with respect to which an exemption
was granted under subsection (1) of this section may not be sold or leased and
a controlling interest in such facility or in a lease of such facility may not
be acquired and a health care facility described in (1)(c) which was granted an
exemption under subsection (1) of this section may not be used by any person
other than the lessee described in (1)(c) unless:
(a)
The department issues a certificate of need approving the sale, lease,
acquisition, or use; or
(b) The
department determines, upon application, that (i) the entity to which the
facility is proposed to be sold or leased, which intends to acquire the
controlling interest, or which intends to use the facility is a health
maintenance organization or a combination of health maintenance organizations
which meets the requirements of (1)(a)(i), and (ii) with respect to such
facility, meets the requirements of (1)(a) (ii) or (iii) or the requirements of
(1)(b) (i) and (ii).
(4) In
the case of a health maintenance organization, an ambulatory care facility, or
a health care facility, which ambulatory or health care facility is controlled,
directly or indirectly, by a health maintenance organization or a combination
of health maintenance organizations, the department may under the program apply
its certificate of need requirements only to the offering of inpatient tertiary
health services and then only to the extent that such offering is not exempt
under the provisions of this section.
(5)(a)
The department shall not require a certificate of need for the construction,
development, or other establishment of a nursing home, or the addition of beds
to an existing nursing home, that is owned and operated by a continuing care
retirement community that:
(i)
Offers services only to contractual members;
(ii)
Provides its members a contractually guaranteed range of services from
independent living through skilled nursing, including some assistance with
daily living activities;
(iii)
Contractually assumes responsibility for the cost of services exceeding the
member's financial responsibility under the contract, so that no third party,
with the exception of insurance purchased by the retirement community or its
members, but including the medicaid program, is liable for costs of care even
if the member depletes his or her personal resources;
(iv)
Has offered continuing care contracts and operated a nursing home continuously
since January 1, 1988, or has obtained a certificate of need to establish a
nursing home;
(v)
Maintains a binding agreement with the state assuring that financial liability
for services to members, including nursing home services, will not fall upon
the state;
(vi)
Does not operate, and has not undertaken a project that would result in a
number of nursing home beds in excess of one for every four living units
operated by the continuing care retirement community, exclusive of nursing home
beds; and
(vii)
Has obtained a professional review of pricing and long-term solvency within the
prior five years which was fully disclosed to members.
(b) A
continuing care retirement community shall not be exempt under this subsection
from obtaining a certificate of need unless:
(i) It
has submitted an application for exemption at least thirty days prior to
commencing construction of, is submitting an application for the licensure of,
or is commencing operation of a nursing home, whichever comes first; and
(ii)
The application documents to the department that the continuing care retirement
community qualifies for exemption.
(c)
The sale, lease, acquisition, or use of part or all of a continuing care
retirement community nursing home that qualifies for exemption under this
subsection shall require prior certificate of need approval to qualify for
licensure as a nursing home unless the department determines such sale, lease,
acquisition, or use is by a continuing care retirement community that meets the
conditions of (a) of this subsection.
(6) A
rural hospital, as defined by the department, reducing the number of licensed beds
to become a rural primary care hospital under the provisions of Part A Title
XVIII of the Social Security Act Section 1820, 42 U.S.C., 1395c et seq. may,
within three years of the reduction of beds licensed under chapter 70.41 RCW,
increase the number of licensed beds to no more than the previously licensed
number without being subject to the provisions of this chapter.
(7) A
rural health care facility licensed under RCW 70.175.100 formerly licensed as a
hospital under chapter 70.41 RCW may, within three years of the effective date
of the rural health care facility license, apply to the department for a
hospital license and not be subject to the requirements of RCW 70.38.105(4)(a)
as the construction, development, or other establishment of a new hospital,
provided there is no increase in the number of beds previously licensed under
chapter 70.41 RCW and there is no redistribution in the number of beds used for
acute care or long-term care, the rural health care facility has been in
continuous operation, and the rural health care facility has not been purchased
or leased.
(8)(a)
A nursing home that voluntarily reduces the number of its licensed beds to
provide assisted living, licensed boarding home care, adult day care, adult day
health, respite care, hospice, outpatient therapy services, congregate meals,
home health, or senior wellness clinic, or to reduce to one or two the number
of beds per room or to otherwise enhance the quality of life for residents
in the nursing home, may convert the original facility or portion of the
facility back, and thereby increase the number of nursing home beds to no more
than the previously licensed number of nursing home beds without ((being
subject to the provisions of this chapter except under RCW 70.38.105(4)(d)))
obtaining a certificate of need under this chapter, provided the
facility has been in continuous operation and has not been purchased or
leased. Any conversion to the original licensed bed capacity, or to any
portion thereof, shall comply with the same life and safety code requirements
as existed at the time the nursing home voluntarily reduced its licensed beds;
unless waivers from such requirements were issued, in which case the converted
beds shall reflect the conditions or standards that then existed pursuant to
the approved waivers.
(b) To
convert beds back to nursing home beds under this subsection, the nursing home
must:
(i)
Give notice of its intent to preserve conversion options to the department of
health no later than thirty days after the effective date of the license
reduction; and
(ii)
Give notice to the department of health and to the department of social and
health services of the intent to convert beds back. If construction is
required for the conversion of beds back, the notice of intent to convert beds
back must be given no later than two years prior to the effective date of
license modification reflecting the restored beds; otherwise, the notice must
be given no later than one year prior to the effective date of license
modification reflecting the restored beds.
(c)
Conversion of beds back under this subsection must be completed no later than
four years after the effective date of the license reduction. However, for
good cause shown, the four-year period for conversion may be extended by the
department of health for one additional four-year period.
(d)
Nursing home beds that have been voluntarily reduced under this section shall
be counted as available nursing home beds for the purpose of evaluating need
under RCW 70.38.115(2)(a) and (k) so long as the facility retains the ability
to convert them back to nursing home use under the terms of this section.
(e)
When a building owner has secured an interest in the nursing home beds, which
are intended to be voluntarily reduced by the licensee under (a) of this
subsection, the applicant shall provide the department with a written statement
indicating the building owner's approval of the bed reduction.
Sec.
72. RCW
70.38.115 and 1993 c 508 s 6 are each amended to read as follows:
(1)
Certificates of need shall be issued, denied, suspended, or revoked by the
designee of the secretary in accord with the provisions of this chapter and
rules of the department which establish review procedures and criteria for the
certificate of need program.
(2)
Criteria for the review of certificate of need applications, except as provided
in subsection (3) of this section for health maintenance organizations, shall
include but not be limited to consideration of the following:
(a)
The need that the population served or to be served by such services has for
such services;
(b)
The availability of less costly or more effective alternative methods of
providing such services;
(c)
The financial feasibility and the probable impact of the proposal on the cost
of and charges for providing health services in the community to be served;
(d) In
the case of health services to be provided, (i) the availability of alternative
uses of project resources for the provision of other health services, (ii) the
extent to which such proposed services will be accessible to all residents of
the area to be served, and (iii) the need for and the availability in the
community of services and facilities for osteopathic and allopathic physicians
and their patients. The department shall consider the application in terms of
its impact on existing and proposed institutional training programs for doctors
of osteopathy and medicine at the student, internship, and residency training
levels;
(e) In
the case of a construction project, the costs and methods of the proposed
construction, including the cost and methods of energy provision, and the
probable impact of the construction project reviewed (i) on the cost of
providing health services by the person proposing such construction project and
(ii) on the cost and charges to the public of providing health services by
other persons;
(f)
The special needs and circumstances of osteopathic hospitals, nonallopathic
services and children's hospitals;
(g)
Improvements or innovations in the financing and delivery of health services
which foster cost containment and serve to promote quality assurance and
cost-effectiveness;
(h) In
the case of health services proposed to be provided, the efficiency and
appropriateness of the use of existing services and facilities similar to those
proposed;
(i) In
the case of existing services or facilities, the quality of care provided by
such services or facilities in the past;
(j) In
the case of hospital certificate of need applications, whether the hospital
meets or exceeds the regional average level of charity care, as determined by
the secretary; and
(k) In
the case of nursing home applications:
(i)
The availability of other nursing home beds in the planning area to be served;
and
(ii)
The availability of other services in the community to be served. Data used to
determine the availability of other services will include but not be limited to
data provided by the department of social and health services.
(3) A
certificate of need application of a health maintenance organization or a
health care facility which is controlled, directly or indirectly, by a health maintenance
organization, shall be approved by the department if the department finds:
(a)
Approval of such application is required to meet the needs of the members of
the health maintenance organization and of the new members which such
organization can reasonably be expected to enroll; and
(b)
The health maintenance organization is unable to provide, through services or
facilities which can reasonably be expected to be available to the
organization, its health services in a reasonable and cost-effective manner
which is consistent with the basic method of operation of the organization and
which makes such services available on a long-term basis through physicians and
other health professionals associated with it.
A
health care facility, or any part thereof, with respect to which a certificate
of need was issued under this subsection may not be sold or leased and a
controlling interest in such facility or in a lease of such facility may not be
acquired unless the department issues a certificate of need approving the sale,
acquisition, or lease.
(4)
Until the final expiration of the state health plan as provided under RCW
70.38.919, the decision of the department on a certificate of need application
shall be consistent with the state health plan in effect, except in emergency
circumstances which pose a threat to the public health. The department in
making its final decision may issue a conditional certificate of need if it
finds that the project is justified only under specific circumstances. The
conditions shall directly relate to the project being reviewed. The conditions
may be released if it can be substantiated that the conditions are no longer
valid and the release of such conditions would be consistent with the purposes
of this chapter.
(5)
Criteria adopted for review in accordance with subsection (2) of this section
may vary according to the purpose for which the particular review is being
conducted or the type of health service reviewed.
(6)
The department shall specify information to be required for certificate of need
applications. Within fifteen days of receipt of the application, the
department shall request additional information considered necessary to the
application or start the review process. Applicants may decline to submit
requested information through written notice to the department, in which case
review starts on the date of receipt of the notice. Applications may be denied
or limited because of failure to submit required and necessary information.
(7)
Concurrent review is for the purpose of comparative analysis and evaluation of
competing or similar projects in order to determine which of the projects may
best meet identified needs. Categories of projects subject to concurrent
review include at least new health care facilities, new services, and expansion
of existing health care facilities. The department shall specify time periods
for the submission of applications for certificates of need subject to
concurrent review, which shall not exceed ninety days. Review of concurrent
applications shall start fifteen days after the conclusion of the time period
for submission of applications subject to concurrent review. Concurrent review
periods shall be limited to one hundred fifty days, except as provided for in
rules adopted by the department authorizing and limiting amendment during the
course of the review, or for an unresolved pivotal issue declared by the
department.
(8)
Review periods for certificate of need applications other than those subject to
concurrent review shall be limited to ninety days. Review periods may be
extended up to thirty days if needed by a review agency, and for unresolved
pivotal issues the department may extend up to an additional thirty days. A
review may be extended in any case if the applicant agrees to the extension.
(9)
The department or its designee, shall conduct a public hearing on a certificate
of need application if requested unless the review is expedited or subject to
emergency review. The department by rule shall specify the period of time
within which a public hearing must be requested and requirements related to
public notice of the hearing, procedures, recordkeeping and related matters.
(10)(a)
Any applicant denied a certificate of need or whose certificate of need has
been suspended or revoked has the right to an adjudicative proceeding. The
proceeding is governed by chapter 34.05 RCW, the Administrative Procedure Act.
(b)
Any health care facility or health maintenance organization that: (i) Provides
services similar to the services provided by the applicant and under review
pursuant to this subsection; (ii) is located within the applicant's health
service area; and (iii) testified or submitted evidence at a public hearing
held pursuant to subsection (9) of this section, shall be provided an
opportunity to present oral or written testimony and argument in a proceeding
under this subsection: PROVIDED, That the health care facility or health
maintenance organization had, in writing, requested to be informed of the
department's decisions.
(c)
If the department desires to settle with the applicant prior to the conclusion
of the adjudicative proceeding, the department shall so inform the health care
facility or health maintenance organization and afford them an opportunity to
comment, in advance, on the proposed settlement.
(11)
An amended certificate of need shall be required for the following
modifications of an approved project:
(a) A
new service requiring review under this chapter;
(b) An
expansion of a service subject to review beyond that originally approved;
(c) An
increase in bed capacity;
(d) A
significant reduction in the scope of a nursing home project without a
commensurate reduction in the cost of the nursing home project, or a cost
increase (as represented in bids on a nursing home construction project or
final cost estimates acceptable to the person to whom the certificate of need
was issued) if the total of such increases exceeds twelve percent or fifty
thousand dollars, whichever is greater, over the maximum capital expenditure
approved. The review of reductions or cost increases shall be restricted to
the continued conformance of the nursing home project with the review criteria
pertaining to financial feasibility and cost containment.
(12)
An application for a certificate of need for a nursing home capital expenditure
which is determined by the department to be required to eliminate or prevent
imminent safety hazards or correct violations of applicable licensure and
accreditation standards shall be approved.
(13)
((In the case of an application for a certificate of need to replace
existing nursing home beds, all criteria must be met on the same basis as an
application for a certificate of need for a new nursing home, except that the
need criteria shall be deemed met if the applicant is an existing licensee who
proposes to replace existing beds that the licensee has operated for at least
one year with the same or fewer number of beds in the same planning area)) (a)
Replacement of existing nursing home beds in the same planning area by an
existing licensee who has operated the beds for at least one year shall not
require a certificate of need under this chapter. The licensee shall give
written notice of its intent to replace the existing nursing home beds to the
department and shall provide the department with information as may be required
pursuant to rule. Replacement of the beds by a party other than the licensee
is subject to certificate of need review under this chapter, except as otherwise
permitted by subsection (14) of this section.
(b)
When an entire nursing home ceases operation, ((its beds shall be treated as
existing nursing home beds for purposes of replacement)) the licensee or
any other party who has secured an interest in the beds may reserve his or her
interest in the beds for eight years or until a certificate of need to
replace them is issued, whichever occurs first. However, the nursing home,
licensee, or any other party who has secured an interest in the beds must
give notice of its intent to retain the beds to the department of health no
later than thirty days after the effective date of the facility's closure. Certificate
of need review shall be required for any party who has reserved the nursing
home beds except that the need criteria shall be deemed met when the applicant
is the licensee who had operated the beds for at least one year, who has
operated the beds for at least one year immediately preceding the reservation
of the beds, and who is replacing the beds in the same planning area.
(14)
In the event that a licensee, who has provided the department with notice of
his or her intent to replace nursing home beds under subsection (13)(a) of this
section, engages in unprofessional conduct or becomes unable to practice with
reasonable skill and safety by reason of mental or physical condition, pursuant
to chapter 18.130 RCW, or dies, the building owner shall be permitted to
complete the nursing home bed replacement project, provided the building owner
has secured an interest in the beds.
Sec.
73. RCW
70.38.125 and 1989 1st ex.s. c 9 s 606 are each amended to read as follows:
(1) A
certificate of need shall be valid for two years. One six-month extension may
be made if it can be substantiated that substantial and continuing progress
toward commencement of the project has been made as defined by regulations to
be adopted pursuant to this chapter. An additional extension of up to sixty
months shall be made if the project is located in an eligible area, as defined
under RCW 82.60.020, or is located in an economically distressed area.
(2) A
project for which a certificate of need has been issued shall be commenced
during the validity period for the certificate of need.
(3)
The department shall monitor the approved projects to assure conformance with
certificates of need that have been issued. Rules and regulations adopted
shall specify when changes in the project require reevaluation of the project.
The department may require applicants to submit periodic progress reports on
approved projects or other information as may be necessary to effectuate its
monitoring responsibilities.
(4)
The secretary, in the case of a new health facility, shall not issue any
license unless and until a prior certificate of need shall have been issued by
the department for the offering or development of such new health facility.
(5)
Any person who engages in any undertaking which requires certificate of need
review without first having received from the department either a certificate
of need or an exception granted in accordance with this chapter shall be liable
to the state in an amount not to exceed one hundred dollars a day for each day
of such unauthorized offering or development. Such amounts of money shall be
recoverable in an action brought by the attorney general on behalf of the state
in the superior court of any county in which the unauthorized undertaking
occurred. Any amounts of money so recovered by the attorney general shall be
deposited in the state general fund.
(6)
The department may bring any action to enjoin a violation or the threatened
violation of the provisions of this chapter or any rules and regulations
adopted pursuant to this chapter, or may bring any legal proceeding authorized
by law, including but not limited to the special proceedings authorized in
Title 7 RCW, in the superior court in the county in which such violation occurs
or is about to occur, or in the superior court of Thurston county.
NEW
SECTION. Sec. 74. If any
part of this act is found to be in conflict with federal requirements that are
a prescribed condition to the allocation of federal funds to the state, the
conflicting part of this act is inoperative solely to the extent of the
conflict and with respect to the agencies directly affected, and this finding
does not affect the operation of the remainder of this act in its application
to the agencies concerned. The rules under this act shall meet federal
requirements that are a necessary condition to the receipt of federal funds by
the state.
NEW
SECTION. Sec. 75. The
department of social and health services shall develop and pilot, for eighteen
months, an on-line computer based information system consistent with the
information needs outlined in section 3 of this act. The department shall, by
December 1, 1996, report to the appropriations committee of the house of
representatives and the ways and means committee of the senate on the success
of the pilot in meeting the information requirements for hospitals outlined in
this section.
Sec.
76. RCW
48.85.010 and 1993 c 492 s 458 are each amended to read as follows:
The
department of social and health services shall ((from July 1, 1993, to July
1, 1998)), in conjunction with the office of the insurance commissioner,
coordinate a ((pilot)) long-term care insurance program entitled
the Washington long-term care partnership, whereby private insurance and
medicaid funds shall be used to finance long-term care. ((This program must
allow for the exclusion of an individual's assets, as approved by the federal
health care financing administration, in a determination of the individual's
eligibility for medicaid; the amount of any medicaid payment; or any subsequent
recovery by the state for a payment for medicaid services to the extent such
assets are protected by a long-term care insurance policy or contract governed
by chapter 48.84 RCW and meeting the criteria prescribed in this chapter.))
For individuals purchasing a long-term care insurance policy or contract
governed by chapter 48.84 RCW and meeting the criteria prescribed in this
chapter, and any other terms as specified by the office of the insurance
commissioner and the department of social and health services, this program
shall allow for the exclusion of some or all of the individual's assets in
determination of medicaid eligibility as approved by the federal health care
financing administration.
Sec.
77. RCW
48.85.020 and 1993 c 492 s 459 are each amended to read as follows:
The
department of social and health services shall seek approval ((and a waiver
of appropriate federal medicaid regulations)) from the federal health
care financing administration to allow the protection of an individual's
assets as provided in this chapter. The department shall adopt all rules
necessary to implement the Washington long-term care partnership program, which
rules shall permit the exclusion of all or some of an individual's
assets in a manner specified by the department in a determination of
medicaid eligibility to the extent that private long-term care insurance
provides payment or benefits for services ((that medicaid would approve or
cover for medicaid recipients)).
Sec.
78. RCW
48.85.030 and 1993 c 492 s 460 are each amended to read as follows:
(1)
The insurance commissioner shall adopt rules defining the criteria that
long-term care insurance policies must meet to satisfy the requirements of this
chapter. The rules shall provide that all long-term care insurance policies
purchased for the purposes of this chapter:
(a) Be
guaranteed renewable;
(b)
Provide coverage for ((home and community-based services and)) nursing
home care and provide coverage for an alternative plan of care benefit as
defined by the commissioner;
(c) Provide
optional coverage for home and community-based services. Such home and
community-based services shall be included in the coverage unless rejected in
writing by the applicant;
(d)
Provide automatic inflation protection or similar coverage for any
policyholder through the age of seventy-nine and made optional at age eighty
to protect the policyholder from future increases in the cost of long-term
care;
(((d)))
(e) Not require prior hospitalization or confinement in a nursing home
as a prerequisite to receiving long-term care benefits; and
(((e)))
(f) Contain at least a six-month grace period that permits reinstatement
of the policy or contract retroactive to the date of termination if the policy
or contract holder's nonpayment of premiums arose as a result of a cognitive
impairment suffered by the policy or contract holder as certified by a
physician.
(2)
Insurers offering long-term care policies for the purposes of this chapter
shall demonstrate to the satisfaction of the insurance commissioner that they:
(a) Have
procedures to provide notice to each purchaser of the long-term care consumer
education program;
(b)
Offer case management services;
(c)
Have procedures that provide for the keeping of individual policy records and
procedures for the explanation of coverage and benefits identifying those
payments or services available under the policy that meet the purposes of this
chapter;
(d)
Agree to provide the insurance commissioner, on or before September 1 of each
year, an annual report containing ((the following)) information((:
(i)
The number of policies issued and of the policies issued, that number sorted by
issue age;
(ii)
To the extent possible, the financial circumstance of the individuals covered
by such policies;
(iii)
The total number of claims paid; and
(iv)
Of the number of claims paid, the number paid for nursing home care, for home
care services, and community-based services)) derived
from the long-term care partnership long-term care insurance uniform data set
as specified by the office of the insurance commissioner.
Sec.
79. RCW
48.85.040 and 1993 c 492 s 461 are each amended to read as follows:
The
insurance commissioner((, in conjunction with)) shall, with the
cooperation of the department of social and health services and members
of the long-term care insurance industry, ((shall)) develop a
consumer education program designed to educate consumers as to the need for
long-term care, methods for financing long-term care, the availability of
long-term care insurance, and the availability and eligibility requirements of
the asset protection program provided under this chapter.
Sec.
80. RCW
48.85.050 and 1993 c 492 s 462 are each amended to read as follows:
By
January 1 of each year until 1998, the insurance commissioner, in
conjunction with the department of social and health services, shall report to
the legislature on the progress of the asset protection program. The report
shall include:
(1)
The success of the agencies in implementing the program;
(2)
The number of insurers offering long-term care policies meeting the criteria
for asset protection;
(3)
The number, age, and financial circumstances of individuals purchasing
long-term care policies meeting the criteria for asset protection;
(4)
The number of individuals seeking consumer information services;
(5)
The extent and type of benefits paid by insurers offering policies meeting the
criteria for asset protection;
(6)
Estimates of the impact of the program on present and future medicaid
expenditures;
(7)
The cost-effectiveness of the program; and
(8) A
determination regarding the appropriateness of continuing the program.
Sec.
81. RCW
74.09.585 and 1989 c 87 s 7 are each amended to read as follows:
(1)
The department shall establish standards consistent with section 1917 of the
social security act in determining the period of ineligibility for medical
assistance due to the transfer of resources.
(2) There
shall be no penalty imposed for the transfer of assets that are excluded in a
determination of the individual's eligibility for medicaid to the extent such
assets are protected by the long-term care insurance policy or contract
pursuant to chapter 48.85 RCW.
(3)
The department may waive a period of ineligibility if the department determines
that denial of eligibility would work an undue hardship.
Sec.
82. RCW
74.34.010 and 1984 c 97 s 7 are each amended to read as follows:
The
legislature finds that frail elders and vulnerable adults may be subjected to
abuse, neglect, exploitation, or abandonment. The legislature finds that
there are a number of adults sixty years of age or older who lack the ability
to perform or obtain those services necessary to maintain or establish their
well-being. The legislature finds that many frail elders and vulnerable
adults have health problems that place them in a dependent position. The
legislature further finds that a significant number of frail elders and
vulnerable adults have mental and verbal limitations that leave them vulnerable
and incapable of asking for help and protection.
It is
the intent of the legislature to prevent or remedy the abuse, neglect,
exploitation, or abandonment of persons sixty years of age or older who have a
functional, mental, or physical inability to care for or protect themselves.
It
is the intent of the legislature to assist frail elders and vulnerable adults
by providing these persons with the protection of the courts and with
the least-restrictive services, such as home care, and by
preventing or reducing inappropriate institutional care. The legislature finds
that it is in the interests of the public health, safety, and welfare of the
people of the state to provide a procedure for identifying these vulnerable
persons and providing the services and remedies necessary for their
well-being.
Sec.
83. RCW
74.34.100 and 1986 c 187 s 4 are each amended to read as follows:
The
legislature finds that frail elders and vulnerable adults((,))
who are ((physically or emotionally)) abused, neglected, abandoned,
or ((financially)) exploited may need the protection of the courts. The
legislature further finds that many of these elderly or vulnerable
persons may be homebound or otherwise may be unable to represent themselves in
court or to retain legal counsel in order to obtain the relief available to
them under this chapter.
It
is the intent of the legislature to improve access to the courts for victims of
abuse, neglect, exploitation, and abandonment in order to better protect the
state's frail elderly and vulnerable adults.
Sec.
84. RCW
74.34.020 and 1984 c 97 s 8 are each amended to read as follows:
Unless
the context clearly requires otherwise, the definitions in this section apply
throughout this chapter.
(1)
"Abandonment" means ((leaving a)) action or inaction by a
person or entity with a duty of care for a frail elder or a vulnerable adult
that leaves the vulnerable ((adult)) person without the means
or ability to obtain necessary food, clothing, shelter, or health care.
(2)
"Abuse" means ((an)) a nonaccidental act of physical or
mental mistreatment or injury, or sexual mistreatment, which harms ((or
threatens)) a person through action or inaction by another individual.
(3)
"Consent" means express written consent granted after the person has
been fully informed of the nature of the services to be offered and that the
receipt of services is voluntary.
(4)
"Department" means the department of social and health services.
(5)
"Exploitation" means the illegal or improper use of a frail elder
or vulnerable adult or that ((adult's)) person's income or
resources, including trust funds, for another person's profit or
advantage.
(6)
"Neglect" means a pattern of conduct ((resulting)) or
inaction by a person or entity with a duty of care for a frail elder or
vulnerable adult that results in the deprivation of care necessary
to maintain ((minimum)) the vulnerable person's physical ((and))
or mental health.
(7)
"Secretary" means the secretary of social and health services.
(8)
"Frail elder or vulnerable adult" means a person sixty years
of age or older who has the functional, mental, or physical inability to care
for himself or herself. "Frail elder or vulnerable adult" shall
include persons found incapacitated under chapter 11.88 RCW, or a person who
has a developmental disability under chapter 71A.10 RCW, and persons admitted
to any long-term care facility that is licensed or required to be licensed
under chapter 18.20, 18.51, 72.36, or 70.128 RCW, or persons receiving services
from home health, hospice, or home care agencies licensed or required to be
licensed under chapter 70.127 RCW.
NEW
SECTION. Sec. 85. A new
section is added to chapter 74.34 RCW to read as follows:
(1) In
addition to other remedies available under the law, a frail elder or vulnerable
adult or a person age eighteen or older who has been subjected to abuse,
neglect, exploitation, or abandonment either while residing in a long-term care
facility or in the case of a person in the care of a home health, hospice, or
home care agency, residing at home, shall have a cause of action for damages on
account of his or her injuries, pain and suffering, and loss of property
sustained thereby. This action shall be available where the defendant is or
was a corporation, trust, unincorporated association, partnership,
administrator, employee, agent, officer, partner, or director of a long-term
care facility, such as a nursing home or boarding home, that is licensed or
required to be licensed under chapter 18.20, 18.51, 72.36, or 70.128 RCW, or of
a home health, hospice, or home care agency licensed or required to be licensed
under chapter 70.127 RCW, as now or subsequently designated.
(2) It
is the intent of the legislature, however, that where there is a dispute about
the care or treatment of a frail elder or vulnerable adult, the parties should
use the least formal means available to try to resolve the dispute. Where
feasible, parties are encouraged but not mandated to employ direct discussion
with the health care provider, use of the long-term care ombudsman or other
intermediaries, and, when necessary, recourse through licensing or other
regulatory authorities.
(3) In
an action brought under this section, a prevailing plaintiff shall be awarded
his or her actual damages, together with the costs of the suit, including a
reasonable attorney's fee. The term "costs" includes, but is not
limited to, the reasonable fees for a guardian, guardian ad litem, and experts,
if any, that may be necessary to the litigation of a claim brought under this
section.
NEW
SECTION. Sec. 86. A new
section is added to chapter 74.34 RCW to read as follows:
A
petition for an order for protection or an action for damages under this
chapter may be brought by the plaintiff, or where necessary, by his or her
family members and/or guardian or legal fiduciary, or as otherwise provided
under this chapter. The death of the plaintiff shall not deprive the court of
jurisdiction over a petition or claim brought under this chapter. Upon
petition, after the death of the vulnerable person, the right to initiate or
maintain the action shall be transferred to the executor or administrator of
the deceased, for the benefit of the surviving spouse, child or children, or other
heirs set forth in chapter 4.20 RCW.
Sec.
87. RCW
74.34.070 and 1984 c 97 s 13 are each amended to read as follows:
In
responding to reports of abuse, exploitation, neglect, or abandonment under
this chapter, the department shall provide information to the ((elderly
person)) frail elder or vulnerable adult on protective services
available to the person and inform the person of the right to refuse such
services. The department shall develop cooperative agreements with
community-based agencies servicing the abused elderly and vulnerable adults.
The agreements shall cover such subjects as the appropriate roles and responsibilities
of the department and community-based agencies in identifying and responding to
reports of ((elderly)) abuse, the provision of case-management services,
standardized data collection procedures, and related coordination activities.
Sec.
88. RCW
74.34.030 and 1986 c 187 s 1 are each amended to read as follows:
Any
person, including but not limited to, financial institutions or attorneys,
having reasonable cause to believe that a vulnerable adult has suffered abuse,
exploitation, neglect, or abandonment, or is otherwise in need of protective
services may report such information to the department. Any police officer,
social worker, employee of the department, a social service, welfare, mental
health, or health agency, including but not limited to home health, hospice,
and home care agencies licensed under chapter 70.127 RCW, congregate
long-term care facility, including but not limited to adult family homes
licensed under chapter 70.128 RCW, boarding homes licensed under chapter 18.20
RCW, and nursing homes licensed under chapter 18.51 RCW, or assisted living
services pursuant to RCW 74.39A.010, or health care provider licensed under
Title 18 RCW, including but not limited to doctors, nurses, psychologists, and
pharmacists, having reasonable cause to believe that a vulnerable adult has
suffered abuse, exploitation, neglect, or abandonment, shall make an immediate
oral report of such information to the department and shall report such
information in writing to the department within ten calendar days of receiving
the information.
NEW
SECTION. Sec. 89. RCW
74.34.100 is recodified as RCW 74.34.015.
Sec.
90. RCW
74.46.020 and 1993 sp.s. c 13 s 1 are each amended to read as follows:
Unless
the context clearly requires otherwise, the definitions in this section apply
throughout this chapter.
(1)
"Accrual method of accounting" means a method of accounting in which
revenues are reported in the period when they are earned, regardless of when
they are collected, and expenses are reported in the period in which they are
incurred, regardless of when they are paid.
(2)
"Ancillary care" means those services required by the individual,
comprehensive plan of care provided by qualified therapists.
(3)
"Appraisal" means the process of estimating the fair market value or
reconstructing the historical cost of an asset acquired in a past period as
performed by a professionally designated real estate appraiser with no
pecuniary interest in the property to be appraised. It includes a systematic,
analytic determination and the recording and analyzing of property facts,
rights, investments, and values based on a personal inspection and inventory of
the property.
(4)
"Arm's-length transaction" means a transaction resulting from
good-faith bargaining between a buyer and seller who are not related
organizations and have adverse positions in the market place. Sales or
exchanges of nursing home facilities among two or more parties in which all
parties subsequently continue to own one or more of the facilities involved in
the transactions shall not be considered as arm's-length transactions for
purposes of this chapter. Sale of a nursing home facility which is
subsequently leased back to the seller within five years of the date of sale
shall not be considered as an arm's-length transaction for purposes of this
chapter.
(5)
"Assets" means economic resources of the contractor, recognized and
measured in conformity with generally accepted accounting principles.
(6)
"Bad debts" means amounts considered to be uncollectable from
accounts and notes receivable.
(7)
"Beds" means the number of set-up beds in the facility, not to exceed
the number of licensed beds.
(8)
"Beneficial owner" means:
(a)
Any person who, directly or indirectly, through any contract, arrangement,
understanding, relationship, or otherwise has or shares:
(i)
Voting power which includes the power to vote, or to direct the voting of such
ownership interest; and/or
(ii)
Investment power which includes the power to dispose, or to direct the
disposition of such ownership interest;
(b)
Any person who, directly or indirectly, creates or uses a trust, proxy, power
of attorney, pooling arrangement, or any other contract, arrangement, or device
with the purpose or effect of divesting himself of beneficial ownership of an
ownership interest or preventing the vesting of such beneficial ownership as
part of a plan or scheme to evade the reporting requirements of this chapter;
(c)
Any person who, subject to subparagraph (b) of this subsection, has the right
to acquire beneficial ownership of such ownership interest within sixty days,
including but not limited to any right to acquire:
(i)
Through the exercise of any option, warrant, or right;
(ii)
Through the conversion of an ownership interest;
(iii)
Pursuant to the power to revoke a trust, discretionary account, or similar
arrangement; or
(iv)
Pursuant to the automatic termination of a trust, discretionary account, or
similar arrangement;
except
that, any person who acquires an ownership interest or power specified in
subparagraphs (i), (ii), or (iii) of this subparagraph (c) with the purpose or
effect of changing or influencing the control of the contractor, or in
connection with or as a participant in any transaction having such purpose or
effect, immediately upon such acquisition shall be deemed to be the beneficial
owner of the ownership interest which may be acquired through the exercise or
conversion of such ownership interest or power;
(d)
Any person who in the ordinary course of business is a pledgee of ownership
interest under a written pledge agreement shall not be deemed to be the
beneficial owner of such pledged ownership interest until the pledgee has taken
all formal steps necessary which are required to declare a default and
determines that the power to vote or to direct the vote or to dispose or to
direct the disposition of such pledged ownership interest will be exercised;
except that:
(i)
The pledgee agreement is bona fide and was not entered into with the purpose
nor with the effect of changing or influencing the control of the contractor,
nor in connection with any transaction having such purpose or effect, including
persons meeting the conditions set forth in subparagraph (b) of this
subsection; and
(ii)
The pledgee agreement, prior to default, does not grant to the pledgee:
(A)
The power to vote or to direct the vote of the pledged ownership interest; or
(B)
The power to dispose or direct the disposition of the pledged ownership
interest, other than the grant of such power(s) pursuant to a pledge agreement
under which credit is extended and in which the pledgee is a broker or dealer.
(9)
"Capitalization" means the recording of an expenditure as an asset.
(10)
"Contractor" means an entity which contracts with the department to
provide services to medical care recipients in a facility and which entity is
responsible for operational decisions.
(11)
"Department" means the department of social and health services
(DSHS) and its employees.
(12)
"Depreciation" means the systematic distribution of the cost or other
basis of tangible assets, less salvage, over the estimated useful life of the
assets.
(13)
"Direct care supplies" means medical, pharmaceutical, and other
supplies required for the direct nursing and ancillary care of medical care
recipients.
(14)
"Entity" means an individual, partnership, corporation, or any other
association of individuals capable of entering enforceable contracts.
(15)
"Equity" means the net book value of all tangible and intangible
assets less the recorded value of all liabilities, as recognized and measured
in conformity with generally accepted accounting principles.
(16)
"Facility" means a nursing home licensed in accordance with chapter
18.51 RCW, excepting nursing homes certified as institutions for mental
diseases, or that portion of a hospital licensed in accordance with chapter
70.41 RCW which operates as a nursing home.
(17)
"Fair market value" means the replacement cost of an asset less
observed physical depreciation on the date for which the market value is being
determined.
(18)
"Financial statements" means statements prepared and presented in
conformity with generally accepted accounting principles including, but not
limited to, balance sheet, statement of operations, statement of changes in
financial position, and related notes.
(19)
"Generally accepted accounting principles" means accounting
principles approved by the financial accounting standards board (FASB).
(20)
"Generally accepted auditing standards" means auditing standards
approved by the American institute of certified public accountants (AICPA).
(21)
"Goodwill" means the excess of the price paid for a business over the
fair market value of all other identifiable, tangible, and intangible assets
acquired.
(22)
"Historical cost" means the actual cost incurred in acquiring and
preparing an asset for use, including feasibility studies, architect's fees,
and engineering studies.
(23)
"Imprest fund" means a fund which is regularly replenished in exactly
the amount expended from it.
(24)
"Joint facility costs" means any costs which represent resources
which benefit more than one facility, or one facility and any other entity.
(25)
"Lease agreement" means a contract between two parties for the
possession and use of real or personal property or assets for a specified
period of time in exchange for specified periodic payments. Elimination (due
to any cause other than death or divorce) or addition of any party to the
contract, expiration, or modification of any lease term in effect on January 1,
1980, or termination of the lease by either party by any means shall constitute
a termination of the lease agreement. An extension or renewal of a lease
agreement, whether or not pursuant to a renewal provision in the lease
agreement, shall be considered a new lease agreement. A strictly formal change
in the lease agreement which modifies the method, frequency, or manner in which
the lease payments are made, but does not increase the total lease payment
obligation of the lessee, shall not be considered modification of a lease term.
(26)
"Medical care program" means medical assistance provided under RCW
74.09.500 or authorized state medical care services.
(27)
"Medical care recipient" or "recipient" means an individual
determined eligible by the department for the services provided in chapter
74.09 RCW.
(28)
"Net book value" means the historical cost of an asset less
accumulated depreciation.
(29)
"Net invested funds" means the net book value of tangible fixed
assets employed by a contractor to provide services under the medical care
program, including land, buildings, and equipment as recognized and measured in
conformity with generally accepted accounting principles, plus an allowance for
working capital which shall be five percent of the product of the per patient
day rate multiplied by the prior calendar year reported total patient days of
each contractor.
(30)
"Operating lease" means a lease under which rental or lease expenses
are included in current expenses in accordance with generally accepted
accounting principles.
(31)
"Owner" means a sole proprietor, general or limited partners, and
beneficial interest holders of five percent or more of a corporation's
outstanding stock.
(32)
"Ownership interest" means all interests beneficially owned by a
person, calculated in the aggregate, regardless of the form which such
beneficial ownership takes.
(33)
"Patient day" or "((client)) resident day"
means a calendar day of care provided to a nursing facility resident,
which will include the day of admission and exclude the day of discharge;
except that, when admission and discharge occur on the same day, one day of
care shall be deemed to exist. A "client day" or "recipient
day" means a calendar day of care provided to a medical care recipient
determined eligible by the department for services provided under chapter 74.09
RCW, subject to the same conditions regarding admission and discharge
applicable to a patient day or resident day of care.
(34)
"Professionally designated real estate appraiser" means an individual
who is regularly engaged in the business of providing real estate valuation
services for a fee, and who is deemed qualified by a nationally recognized real
estate appraisal educational organization on the basis of extensive practical
appraisal experience, including the writing of real estate valuation reports as
well as the passing of written examinations on valuation practice and theory,
and who by virtue of membership in such organization is required to subscribe
and adhere to certain standards of professional practice as such organization
prescribes.
(35)
"Qualified therapist" means:
(a) An
activities specialist who has specialized education, training, or experience as
specified by the department;
(b) An
audiologist who is eligible for a certificate of clinical competence in
audiology or who has the equivalent education and clinical experience;
(c) A
mental health professional as defined by chapter 71.05 RCW;
(d) A
mental retardation professional who is either a qualified therapist or a
therapist approved by the department who has had specialized training or one
year's experience in treating or working with the mentally retarded or
developmentally disabled;
(e) A
social worker who is a graduate of a school of social work;
(f) A
speech pathologist who is eligible for a certificate of clinical competence in
speech pathology or who has the equivalent education and clinical experience;
(g) A
physical therapist as defined by chapter 18.74 RCW;
(h) An
occupational therapist who is a graduate of a program in occupational therapy,
or who has the equivalent of such education or training; and
(i) A
respiratory care practitioner certified under chapter 18.89 RCW.
(36)
"Questioned costs" means those costs which have been determined in
accordance with generally accepted accounting principles but which may
constitute disallowed costs or departures from the provisions of this chapter
or rules and regulations adopted by the department.
(37) "Rebased
rate" or "cost-rebased rate" means a facility-specific rate
assigned to a nursing facility for a particular rate period established on
desk-reviewed, adjusted costs reported for that facility covering at least six
months of a prior calendar year.
(38)
"Records" means those data supporting all financial statements and
cost reports including, but not limited to, all general and subsidiary ledgers,
books of original entry, and transaction documentation, however such data are
maintained.
(((38)))
(39) "Related organization" means an entity which is under
common ownership and/or control with, or has control of, or is controlled by,
the contractor.
(a)
"Common ownership" exists when an entity is the beneficial owner of
five percent or more ownership interest in the contractor and any other entity.
(b)
"Control" exists where an entity has the power, directly or indirectly,
significantly to influence or direct the actions or policies of an organization
or institution, whether or not it is legally enforceable and however it is
exercisable or exercised.
(((39)))
(40) "Restricted fund" means those funds the principal and/or
income of which is limited by agreement with or direction of the donor to a
specific purpose.
(((40)))
(41) "Secretary" means the secretary of the department of
social and health services.
(((41)))
(42) "Title XIX" or "Medicaid" means the 1965
amendments to the social security act, P.L. 89‑07, as amended.
(((42)))
(43) "Physical plant capital improvement" means a capitalized
improvement that is limited to an improvement to the building or the related physical
plant.
Sec.
91. RCW
74.46.105 and 1985 c 361 s 10 are each amended to read as follows:
Cost
reports and patient trust accounts of contractors shall be field audited by the
department, either by department staff or by auditors under contract to the
department, in accordance with the provisions of this chapter. The department
when it deems necessary to assure the accuracy of cost reports may review any
underlying financial statements or other records upon which the cost reports
are based. The department shall have the authority to accept or reject audits
which fail to satisfy the requirements of this section or which are performed
by auditors who violate any of the rules of this section. Department audits of
the cost reports and patient trust accounts shall be conducted as follows:
(1)
Each year the department will provide for field audit of the cost report,
statistical reports, and patient trust funds, as established by RCW 74.46.700,
of all or a sample of reporting facilities selected by profiles of costs,
exceptions, contract terminations, upon special requests or other factors
determined by the department.
(2)
Beginning with audits for calendar year ((1983, up to one hundred percent of
contractors cost reports and patient care trust fund accounts shall be
audited: PROVIDED, That each contractor shall be audited at least once in
every three-year period)) 1993, contractors' cost reports and resident
care trust fund accounts shall be audited periodically as determined necessary
by the department.
(3)
Facilities ((shall be selected for sample audits within one hundred twenty
days of submission of a correct and complete cost report, and)) shall be ((so))
informed of the department's intent to audit at least ten working days
before the commencement of an audit of a facility's cost report or resident
trust fund accounts. ((Audits so scheduled shall be completed within
one year of selection.))
(4)
Where an audit for a recent reporting or trust fund period discloses material
discrepancies, undocumented costs or mishandling of patient trust funds,
auditors may examine prior unaudited periods, for indication of similar
material discrepancies, undocumented costs or mishandling of patient trust
funds for not more than two reporting periods preceding the facility reporting
period selected in the sample.
(5)
The audit will result in a schedule summarizing appropriate adjustments to the
contractor's cost report. These adjustments will include an explanation for
the adjustment, the general ledger account or account group, and the dollar
amount. Patient trust fund audits shall be reported separately and in
accordance with RCW 74.46.700.
(6)
Audits shall meet generally accepted auditing standards as promulgated by the
American institute of certified public accountants and the standards for audit
of governmental organizations, programs, activities and functions as published
by the comptroller general of the United States. Audits shall be supervised or
reviewed by a certified public accountant.
(7) No
auditor under contract with or employed by the department to perform audits in
accordance with the provisions of this chapter shall:
(a)
Have had direct or indirect financial interest in the ownership, financing or
operation of a nursing home in this state during the period covered by the
audits;
(b)
Acquire or commit to acquire any direct or indirect financial interest in the
ownership, financing or operation of a nursing home in this state during said
auditor's employment or contract with the department;
(c)
Accept as a client any nursing home in this state during or within two years of
termination of said auditor's contract or employment with the department.
(8)
Audits shall be conducted by auditors who are otherwise independent as
determined by the standards of independence established by the American
institute of certified public accountants.
(9)
All audit rules adopted after March 31, 1984, shall be published before the
beginning of the cost report year to which they apply.
Sec.
92. RCW
74.46.115 and 1983 1st ex.s. c 67 s 6 are each amended to read as follows:
The
office of the state auditor shall ((annually)) at least once in every
three state fiscal years commencing July 1, 1995, review the performance of
the department to ensure that departmental audits are conducted in accordance
with generally accepted ((accounting principles and)) auditing
standards.
Sec.
93. RCW
74.46.160 and 1985 c 361 s 12 are each amended to read as follows:
(1)
Within one hundred twenty days after receipt of the proposed preliminary
settlement, the department shall verify the accuracy of the proposal and shall
issue a preliminary settlement report by cost center to the contractor which
fully substantiates disallowed costs, refunds, underpayments, or adjustments to
the proposed preliminary settlement.
(2)
After completion of the audit process, including exhaustion or mutual termination
of ((reviews and)) any administrative appeals ((of)) or
exception procedure used by the contractor to contest audit findings or
determinations, but not including any judicial review available to and
commenced by the contractor, the department will submit a final settlement
report by cost center to the contractor which fully substantiates disallowed
costs, refunds, underpayments, or adjustments to the contractor's cost report.
((Where the contractor is pursuing judicial or administrative review or appeal
in good faith regarding audit findings or determinations, the department may
issue a partial final settlement to recover overpayments based on audit
adjustments not in dispute.))
Sec.
94. RCW
74.46.170 and 1983 1st ex.s. c 67 s 10 are each amended to read as follows:
(1) A
contractor shall have ((thirty)) a period of days, to be
established by the department in rule, after the date the preliminary or
final settlement report is submitted to the contractor to contest a settlement
determination under the administrative appeals or exception procedure
established by the department pursuant to RCW 74.46.780. Any such
administrative review of a settlement shall be limited to calculation of the
settlement or the application of settlement principles and rules, or both, and
shall not examine or reexamine payment rate or audit issues. After the ((thirty-day))
period established by the department in rule has expired, a preliminary
or final settlement will not be subject to review.
(2) A
preliminary settlement report as issued by the department will become the final
settlement report if no audit has been scheduled within twelve calendar months
following the department's issuance of a preliminary settlement report to the
contractor.
(3) A
settlement will be reopened if necessary to make adjustments for findings
resulting from an audit performed pursuant to RCW 74.46.105(4).
Sec.
95. RCW
74.46.180 and 1993 sp.s. c 13 s 2 are each amended to read as follows:
(1)
The ((state)) department shall make payment of any underpayments to
which a contractor is entitled as determined by the department under the
provisions of this chapter within ((thirty)) sixty days after
the date the preliminary or final settlement report is submitted to the
contractor and the department shall pay interest at the rate of one percent
per month on any unpaid preliminary or final settlement balance still due the
contractor after such time, accruing from sixty days after the preliminary or
final settlement report is submitted to the contractor, and no interest shall
accrue or be paid for any period prior to this date: PROVIDED, That any
increase in a preliminary or final settlement amount due the contractor
resulting from a final administrative or judicial decision shall also bear
interest until paid at the rate of one percent per month, accruing from sixty
days after the preliminary or final settlement was submitted to the
contractor. The department shall pay no interest on amounts due a contractor
other than amounts determined by preliminary or final settlement as provided in
this subsection.
(2) A
contractor found, under a preliminary or final settlement issued by the
department, to have received either overpayments or erroneous payments ((under
a preliminary or final settlement)), to which the contractor is not
entitled as determined by the department under the provisions of this chapter,
shall refund such erroneous payments or overpayments to the ((state))
department within ((thirty)) sixty days after the date the
preliminary or final settlement report is submitted to the contractor, subject
to the provisions of subsections (3), (4), and (((7))) (6) of
this section, PROVIDED, That for all preliminary or final settlements issued
on and after July 1, 1995, regardless of what period a settlement covers,
neither a timely filed request to pursue the department's administrative
appeals or exception procedure nor commencement of judicial review, as may be
available to the contractor in law, contesting the settlement, erroneous
payments or overpayments shall delay recovery. A contractor shall pay interest
at the rate of one percent per month on any unpaid preliminary or final
settlement balance still due the department sixty days after the preliminary or
final settlement report is submitted to the contractor, accruing from this
date: PROVIDED Further, That the department shall refund interest collected
for preliminary and settlement amounts the contractor was entitled to retain as
subsequently determined by final administrative or judicial decision.
(3)
Within the cost centers of nursing services and food, all savings resulting
from the respective allowable costs being lower than the respective
reimbursement rate paid to the contractor during the report period shall be
refunded to the department. However, in computing a preliminary or final
settlement, savings in a cost center may be shifted to cover a deficit in
another cost center up to the amount of any savings. Not more than twenty
percent of the rate in a cost center may be shifted into that cost center and
no shifting may be made into the property cost center. There shall be no
shifting out of nursing services, and savings in food shall be shifted only to
cover deficits in the nursing services cost center. There shall be no shifting
from the operational to the administrative cost center.
(4)
Within the administrative and property cost centers, the contractor shall
retain at least fifty percent, but not more than seventy-five percent, of any
savings resulting from the respective audited allowable costs being lower than
the respective reimbursement rates paid to the contractor during the report
period multiplied by the number of authorized medical care client days in which
said rates were in effect, except that no savings may be retained if reported
costs in the administrative and property cost centers exceed audited allowable
costs in these cost areas by a total of ten cents or more per patient day. The
secretary, by rule, shall establish the basis for the specific percentages of
savings to the contractors. Such rules may provide for differences in the
percentages allowed for each cost center to individual facilities based on
performance measures related to administrative efficiency.
(5)
All return on investment rate payments provided by RCW 74.46.530 shall be
retained by the contractor to the extent net invested funds are substantiated
by department field audit. Any industrial insurance dividend or premium
discount under RCW 51.16.035 shall be retained by the contractor to the extent
that such dividend or premium discount is attributable to the contractor's
private patients.
(6) In
the event the contractor fails to make repayment in the time provided in
subsection (2) of this section, the department shall either:
(a)
Deduct the amount of refund due the department, plus any interest
accrued under ((RCW 43.20B.695)) subsection (2) of this section,
from payment amounts due the contractor; or
(b) In
the instance the contract has been terminated, (i) deduct the amount of refund
due the department, plus interest assessed at the rate and in the manner
provided in ((RCW 43.20B.695)) subsection (2) of this section,
from any payments due; or (ii) recover the amount due, plus any interest
assessed under ((RCW 43.20B.695,)) subsection (2) of this section
from security posted with or otherwise obtained by the department or by
any other lawful means.
(7) ((Where
the facility is pursuing timely-filed judicial or administrative remedies in
good faith regarding settlement issues, the contractor need not refund nor
shall the department withhold from the facility current payment amounts the
department claims to be due from the facility but which are specifically
disputed by the contractor.)) For all erroneous payments and
overpayments determined by preliminary or final settlements issued before July
1, 1995, and not yet recovered by the department because they are specifically
disputed by the contractor in a timely filed administrative or judicial review,
if the judicial or administrative remedy sought by the facility is not
granted after all appeals are exhausted or mutually terminated, the facility
shall make payment of such amounts due plus interest accrued from the date of
filing of the appeal, as payable on judgments, within sixty days of the date
such decision is made.
Sec.
96. RCW
74.46.190 and 1983 1st ex.s. c 67 s 12 are each amended to read as follows:
(1)
The substance of a transaction will prevail over its form.
(2)
All documented costs which are ordinary, necessary, related to care of medical
care recipients, and not expressly unallowable, are to be allowable. Costs
of providing ancillary care are allowable, subject to any applicable cost
center limit contained in this chapter, provided documentation establishes the
costs were incurred for medical care recipients and other sources of payment to
which recipients may be legally entitled, such as private insurance or
medicare, were first fully utilized.
(3)
Costs applicable to services, facilities, and supplies furnished to the
provider by related organizations are allowable but at the cost to the related
organization, provided they do not exceed the price of comparable services,
facilities, or supplies that could be purchased elsewhere.
(4)
Beginning January 1, 1985, the payment for property usage is to be independent
of ownership structure and financing arrangements.
(5)
Beginning July 1, 1995, allowable costs shall not include costs reported by a
nursing care provider for a prior period to the extent such costs, due to
statutory exemption, will not be incurred by the nursing facility in the period
to be covered by the rate.
Sec.
97. RCW
74.46.410 and 1993 sp.s. c 13 s 6 are each amended to read as follows:
(1)
Costs will be unallowable if they are not documented, necessary, ordinary, and
related to the provision of care services to authorized patients.
(2)
Unallowable costs include, but are not limited to, the following:
(a)
Costs of items or services not covered by the medical care program. Costs of
such items or services will be unallowable even if they are indirectly
reimbursed by the department as the result of an authorized reduction in
patient contribution;
(b)
Costs of services and items provided to recipients which are covered by the
department's medical care program but not included in care services established
by the department under this chapter;
(c)
Costs associated with a capital expenditure subject to section 1122 approval
(part 100, Title 42 C.F.R.) if the department found it was not consistent with
applicable standards, criteria, or plans. If the department was not given
timely notice of a proposed capital expenditure, all associated costs will be
unallowable up to the date they are determined to be reimbursable under
applicable federal regulations;
(d)
Costs associated with a construction or acquisition project requiring
certificate of need approval pursuant to chapter 70.38 RCW if such approval was
not obtained;
(e)
Interest costs other than those provided by RCW 74.46.290 on and after January
1, 1985;
(f)
Salaries or other compensation of owners, officers, directors, stockholders,
and others associated with the contractor or home office, except compensation
paid for service related to patient care;
(g)
Costs in excess of limits or in violation of principles set forth in this
chapter;
(h)
Costs resulting from transactions or the application of accounting methods
which circumvent the principles of the cost-related reimbursement system set
forth in this chapter;
(i)
Costs applicable to services, facilities, and supplies furnished by a related
organization in excess of the lower of the cost to the related organization or
the price of comparable services, facilities, or supplies purchased elsewhere;
(j)
Bad debts of non-Title XIX recipients. Bad debts of Title XIX recipients are
allowable if the debt is related to covered services, it arises from the
recipient's required contribution toward the cost of care, the provider can
establish that reasonable collection efforts were made, the debt was actually
uncollectible when claimed as worthless, and sound business judgment
established that there was no likelihood of recovery at any time in the future;
(k)
Charity and courtesy allowances;
(l)
Cash, assessments, or other contributions, excluding dues, to charitable
organizations, professional organizations, trade associations, or political
parties, and costs incurred to improve community or public relations;
(m)
Vending machine expenses;
(n) Expenses
for barber or beautician services not included in routine care;
(o)
Funeral and burial expenses;
(p)
Costs of gift shop operations and inventory;
(q)
Personal items such as cosmetics, smoking materials, newspapers and magazines,
and clothing, except those used in patient activity programs;
(r)
Fund-raising expenses, except those directly related to the patient activity
program;
(s)
Penalties and fines;
(t)
Expenses related to telephones, televisions, radios, and similar appliances in
patients' private accommodations;
(u)
Federal, state, and other income taxes;
(v)
Costs of special care services except where authorized by the department;
(w)
Expenses of key-man insurance and other insurance or retirement plans not made
available to all employees;
(x)
Expenses of profit-sharing plans;
(y)
Expenses related to the purchase and/or use of private or commercial airplanes
which are in excess of what a prudent contractor would expend for the ordinary
and economic provision of such a transportation need related to patient care;
(z)
Personal expenses and allowances of owners or relatives;
(aa)
All expenses of maintaining professional licenses or membership in professional
organizations;
(bb)
Costs related to agreements not to compete;
(cc)
Amortization of goodwill;
(dd)
Expenses related to vehicles which are in excess of what a prudent contractor
would expend for the ordinary and economic provision of transportation needs
related to patient care;
(ee)
Legal and consultant fees in connection with a fair hearing against the
department where a decision is rendered in favor of the department or where
otherwise the determination of the department stands;
(ff)
Legal and consultant fees of a contractor or contractors in connection with a
lawsuit against the department;
(gg)
Lease acquisition costs and other intangibles not related to patient care;
(hh)
All rental or lease costs other than those provided in RCW 74.46.300 on and
after January 1, 1985;
(ii)
Postsurvey charges incurred by the facility as a result of subsequent
inspections under RCW 18.51.050 which occur beyond the first postsurvey visit
during the certification survey calendar year;
(jj)
Compensation paid for any purchased nursing care services, including registered
nurse, licensed practical nurse, and nurse assistant services, obtained through
service contract arrangement in excess of the amount of compensation paid for
such hours of nursing care service had they been paid at the average hourly
wage, including related taxes and benefits, for in-house nursing care staff of
like classification at the same nursing facility, as reported in the most
recent cost report period;
(kk)
For all partial or whole rate periods after July 17, 1984, costs of land and
depreciable assets that cannot be reimbursed under the Deficit Reduction Act of
1984 and implementing state statutory and regulatory provisions;
(ll)
Costs reported by the contractor for a prior period to the extent such costs,
due to statutory exemption, will not be incurred by the contractor in the
period to be covered by the rate.
NEW
SECTION. Sec. 98. A new
section is added to chapter 74.46 RCW to read as follows:
The
legislature intends to adopt a new system for establishing nursing home payment
rates no later than July 1, 1998. Any payments to nursing homes for services
provided after June 30, 1998, shall be based on the new system. The system
shall include case-mix reimbursement methods for paying for nursing services
and shall match payments to patient care needs, while providing incentives for
cost control and efficiency. To that end:
(1) In
consultation with nursing facility provider associations, consumer groups, and
the legislative budget committee, the department of social and health services
shall design and develop alternative methods for matching nursing facility
payments to patient care needs, while providing incentives for cost control and
efficiency.
(2)
The department shall report to the fiscal and health care policy committees of
the legislature on the projected benefits and costs of these alternative
methods by October 15th of 1995, 1996, and 1997. The October 1996 report shall
additionally include a recommended time line for implementing the new payment
system no later than July 1, 1998.
(3)
The following acts or parts of acts, as now existing or hereafter amended, are
each repealed, effective June 30, 1998:
(a)
RCW 74.46.420 and 1993 sp.s. c 13 s 7, 1985 c 361 s 18, 1983 1st ex.s. c 67 s
18, & 1980 c 177 s 42;
(b)
RCW 74.46.430 and 1993 sp.s. c 13 s 8, 1987 2nd ex.s. c 1 s 2, 1987 c 476 s 2,
1983 1st ex.s. c 67 s 19, & 1980 c 177 s 43;
(c)
RCW 74.46.440 and 1989 c 372 s 16 & 1980 c 177 s 44;
(d)
RCW 74.46.450 and 1993 sp.s. c 13 s 9, 1983 1st ex.s. c 67 s 20, & 1980 c
177 s 45;
(e)
RCW 74.46.460 and 1993 sp.s. c 13 s 10, 1987 c 476 s 3, 1985 c 361 s 15, 1983
1st ex.s. c 67 s 21, 1981 1st ex.s. c 2 s 5, & 1980 c 177 s 46;
(f)
RCW 74.46.465 and 1987 c 476 s 8;
(g)
RCW 74.46.470 and 1993 sp.s. c 13 s 11, 1987 c 476 s 4, 1983 1st ex.s. c 67 s
22, & 1980 c 177 s 47;
(h)
RCW 74.46.481 and 1993 sp.s. c 13 s 12, 1991 sp.s. c 8 s 16, 1990 c 207 s 1,
1987 c 476 s 5, & 1983 1st ex.s. c 67 s 24;
(i)
RCW 74.46.490 and 1993 sp.s. c 13 s 13, 1983 1st ex.s. c 67 s 25, 1981 1st
ex.s. c 2 s 6, & 1980 c 177 s 49;
(j)
RCW 74.46.500 and 1993 sp.s. c 13 s 14, 1992 c 182 s 1, & 1980 c 177 s 50;
(k)
RCW 74.46.505 and 1993 sp.s. c 13 s 15;
(l)
RCW 74.46.510 and 1993 sp.s. c 13 s 16 & 1980 c 177 s 51;
(m)
RCW 74.46.530 and 1993 sp.s. c 13 s 17, 1991 sp.s. c 8 s 17, 1985 c 361 s 17,
1983 1st ex.s. c 67 s 28, 1981 1st ex.s. c 2 s 7, & 1980 c 177 s 53;
(n)
RCW 74.46.540 and 1980 c 177 s 54;
(o)
RCW 74.46.550 and 1983 1st ex.s. c 67 s 29 & 1980 c 177 s 55;
(p)
RCW 74.46.560 and 1983 1st ex.s. c 67 s 30 & 1980 c 177 s 56;
(q)
RCW 74.46.570 and 1983 1st ex.s. c 67 s 31 & 1980 c 177 s 57;
(r)
RCW 74.46.580 and 1983 1st ex.s. c 67 s 32 & 1980 c 177 s 58; and
(s)
RCW 74.46.590 and 1980 c 177 s 59.
Sec.
99. RCW
74.46.420 and 1993 sp.s. c 13 s 7 are each amended to read as follows:
The
following principles are inherent in RCW 74.46.430 through 74.46.590:
(1) ((Reimbursement))
Effective July 1, 1995, through June 30, 1998, nursing facility payment
rates will be set or adjusted for economic trends and conditions annually
and prospectively on a per ((patient)) resident day basis ((on
a two-year cycle corresponding to each state biennium; and)), in
accordance with the principles and methods set forth in this chapter, to take
effect July 1st of each year.
(2) ((The
rates, in the nursing services, food, administrative, and operational cost
centers, shall be adjusted downward or upward when set effective July 1 of the
first fiscal year of the two-year rate-setting cycle and adjusted again
downward or upward effective July 1 of the second fiscal year of the
rate-setting cycle for economic trends and conditions)) July 1, 1995, component
rates in the nursing services, food, administrative, and operational cost
centers shall be cost-rebased utilizing desk-reviewed and adjusted costs
reported for calendar year 1994, for all nursing facilities submitting at least
six months of cost data. Such component rates for July 1, 1995, shall also be
adjusted downward or upward for economic trends and conditions as provided in
this section. Component rates in property and return on investment (ROI) shall
be reset annually as provided in this chapter.
(3)
The July 1, 1995, component rates ((for the first year of each
biennium)) in the nursing services, food, administrative, and
operational cost centers shall be adjusted for economic trends and
conditions by the change in the implicit price deflator for personal
consumption expenditures index published by the bureau of labor statistics of
the United States department of labor (IPD index). The period used to
measure the IPD increase or decrease to be applied to these ((first
year biennial)) July 1, 1995, rate((s)) components
shall be ((the)) calendar year ((preceding the July 1 commencement of
the state biennium)) 1994.
(4) ((The
July 1 rates for the second year of each biennium shall be adjusted)) July
1, 1996, component rates in the nursing services, food, administrative, and
operational cost centers shall not be cost-rebased, but shall be the component
rates assigned to each nursing facility in effect on June 30, 1996, adjusted
downward or upward for economic trends and conditions by the change in the
nursing home input price index without capital costs published by the health
care financing administration of the department of health and human services((,))
(HCFA index((, however, any increase shall be multiplied by one and
one-half))). The period to be used to measure the HCFA index
increase ((to be multiplied by one and one-half and applied)) or
decrease to be applied to these ((second-year biennial)) June 30,
1996, component rates shall ((also)) be ((the)) calendar year
((preceding the July 1 commencement of the state biennium: PROVIDED,
However, That in the event the change in the HCFA index measured over the
following calendar year, the one terminating six months after the start of the
state biennium, is twenty-five percent greater or less than the change in the
HCFA index measured over the calendar year preceding commencement of the state
biennium, the department shall use the HCFA index increase multiplied by one
and one-half or decrease in such following calendar year to inflate or decrease
nursing facilities' nursing services, food, administrative, and operational
rates for July 1 of the second biennial year)) 1994.
(5) July
1, 1997, component rates in the nursing services, food, administrative, and
operational cost centers shall not be cost-rebased, but shall be the component
rates assigned to each nursing facility in effect on June 30, 1997, adjusted
downward or upward for economic trends and conditions by the change in the
nursing home input price index without capital costs published by the health
care financing administration of the department of health and human services
(HCFA index), multiplied by a factor of 1.25. The period to be used to measure
the HCFA increase or decrease to be applied to these rate components for July
1, 1997, rate setting shall be calendar year 1996.
(6)
If either the implicit price deflator (IPD) index or the health care
financing administration (HCFA) index specified in this section
ceases to be published in the future, the department shall select ((by rule))
and use in its place or their place one or more measures of change from the
same or an alternate source or sources ((for)) utilizing the
same or comparable time periods specified in this section.
Sec.
100. RCW
74.46.430 and 1993 sp.s. c 13 s 8 are each amended to read as follows:
(1)
The department, as provided by this chapter, will determine prospective ((cost-related
reimbursement)) payment rates for services provided to medical care
recipients. Each rate so determined shall represent the contractor's maximum
compensation within each cost center and for return on investment for
each ((patient)) resident day for such medical care recipient.
(2) ((As
required,)) The department may modify such maximum per ((patient))
resident day rates, consistent with this chapter, pursuant to the
administrative ((review provisions of)) appeals or exception
procedure authorized by RCW 74.46.780.
(3) For
July 1, 1995, and all following rates, the maximum prospective ((reimbursement))
component payment rates for the nursing services, food,
administrative, operational, and property cost centers, and the return on
investment (ROI) component rate for each nursing facility shall
be established based upon a minimum licensed bed facility occupancy
level of ((eighty-five)) ninety percent, except for rate
adjustments as provided for in RCW 74.46.460(6).
(4) The
minimum ninety percent facility occupancy shall be used to calculate individual
rates, to calculate the median cost limits (MCLs) for the metropolitan
statistical area (MSA) and nonmetropolitan statistical area (non-MSA) peer
groups, and to array facilities by costs in calculating the variable return
portion of the return on investment rate component (ROI).
(5)
All contractors shall be required to adjust and maintain wages for all
employees to a minimum hourly wage of four dollars and seventy-six cents per
hour beginning January 1, 1988, and five dollars and fifteen cents per hour
beginning January 1, 1989.
Sec.
101. RCW
74.46.450 and 1993 sp.s. c 13 s 9 are each amended to read as follows:
(1)
Prospective reimbursement rates for a new contractor, as defined by the
department in rule, will be established within sixty days following receipt
by the department of the properly completed projected budget required by RCW
74.46.670. Such reimbursement rates will become effective as of the effective
date of the contract and shall remain in effect until ((adjusted or)) the
new contractor's rate in all cost areas can be reset ((as provided in
this chapter)) effective July 1st using a cost report of that contractor
containing at least six months' data from the prior calendar year, regardless
of whether reported costs for other contractors for the prior calendar year in
question will be used to rebase their July 1st rates.
(2)
Such reimbursement rates will be based on ((the contractor's projected cost
of operations and on costs and)) payment rates of the prior contractor, if
any, or of other contractors in comparable circumstances.
(3) ((If
a properly completed budget is not received at least sixty days prior to the
effective date of the contract,)) The department will establish ((preliminary))
a new contractor's initial component rates based on the ((other))
factors specified in subsections (2) and (4) of this section.
These ((preliminary)) initial rates will remain in effect until
adjusted or reset as provided in this chapter.
(4)
The department is authorized to develop policies and procedures in rule ((to
address the computation of rates for the first and second fiscal years of each
biennium, including steps necessary to prorate rate adjustments for economic
trends and conditions as authorized in RCW 74.46.420, for contractors having
less than twelve months of cost report data for the prior calendar year)) that
comply with the policies and purposes of this chapter to establish factors by
which a new contractor's rate will be set, for example, occupancy level or
proration of rate adjustments for economic trends and conditions as authorized
in RCW 74.46.420. However, a new contractor, whose medicaid contract
was effective in calendar year 1994; and whose nursing facility occupancy
during calendar year 1994 increased by at least five percent over that of the
prior owner, shall have its July 1995 rate for nursing services, food,
administrative, operational, and property cost centers, and the return on
investment (ROI) based upon a minimum facility occupancy of eighty-five
percent.
Sec.
102. RCW
74.46.460 and 1993 sp.s. c 13 s 10 are each amended to read as follows:
(1)
Each contractor's ((reimbursement)) nursing services, food,
administrative, and operational component payment rates will be ((determined
or)) adjusted for economic trends and conditions prospectively at
least once during each calendar year, as provided in this chapter, to be
effective July 1st((.)): PROVIDED, That except
for the rates of new contractors as defined by the department, a ((contractor's))
nursing facility's cost-rebased rate for ((the first fiscal year of
each biennium)) July 1, 1995, must be established upon ((its))
the facility's own ((prior calendar period)) cost report
of at least six months of adjusted and/or audited cost data from the
calendar year 1994.
(2) Subject
to the provisions of subsections (3) through (6) of this section, rates may
be adjusted ((as determined)) by the department at the request of the
nursing facility to cover the medicaid share of incremental costs
necessary to address and take into account variations in the distribution
of all medicaid and nonmedicaid patient classifications or changes in all
medicaid or nonmedicaid patient characteristics from the prior reporting
year, program changes required by the department, or changes in staffing levels
at a facility required by the department. Rates may also be adjusted to cover
costs associated with placing a nursing home in receivership which costs are
not covered by the rate of the former contractor, including: Compensation of
the receiver, reasonable expenses of receivership and transition of control,
and costs incurred by the receiver in carrying out court instructions or rectifying
deficiencies found. Rates shall be adjusted as provided in this section
for any capitalized additions or replacements made as a condition for licensure
or certification. Rates shall be adjusted as provided in this section
for capitalized improvements done under RCW 74.46.465.
(3)
Except for rate adjustments granted for economic trends and conditions as
authorized in this chapter to be effective each July 1st, all rate adjustments
granted by the department for any other purpose, including those granted for
capitalized additions or replacements or for staffing, whether made or not made
as a condition of licensure or certification, shall be limited in total amount
each fiscal year to the total current legislative appropriation, if any,
specifically made to fund the medicaid share of such adjustments for the fiscal
year.
(4)
The department is authorized to adopt rules to ensure that funding granted for
additional staffing will be cost-effective in providing increased quantity and
quality of services to nursing facility residents and to ensure that spending
limitations will not be exceeded.
(5)
Funds disbursed representing rate adjustments granted under authority of this
section and not spent by the contractor for the purposes granted are subject to
immediate recovery by the department by means of recoupment from current
contract payments or any other means authorized by law and contractors shall
pay interest on such unused or misused funds at the rate of one percent per
month from the date of disbursal to the date of recovery. If a contractor
requests an administrative review of a department recovery action under rules
established under RCW 74.46.780, such request shall not stay recoupment from
current facility contract payments or other recovery.
(6)
All rate component adjustments to fund the medicaid share of nursing facility
new construction or refurbishing projects costing in excess of one million two
hundred thousand dollars, or projects requiring state or federal approval,
shall be based upon a minimum facility occupancy of eighty-five percent for the
nursing services, food, administrative, operational, and property cost centers,
and the return on investment (ROI), during the initial rate period in which the
adjustment is granted, and shall be based upon a minimum facility occupancy of
ninety percent for the nursing services, food, administrative, operational, and
property cost centers, and the return on investment (ROI), for all rate periods
thereafter.
Sec.
103. RCW
74.46.470 and 1993 sp.s. c 13 s 11 are each amended to read as follows:
(1) A
contractor's ((reimbursement)) nursing facility per resident day
component rates for medical care recipients ((will)) shall be
determined as provided in this chapter utilizing net invested funds and
desk-reviewed cost report data within the following cost centers:
(a)
Nursing services;
(b)
Food;
(c)
Administrative;
(d)
Operational; and
(e)
Property.
(2)
There shall be for the time period January 1988 through June 1990 only an
enhancement cost center established to reimburse contractors for specific
legislatively authorized enhancements for nonadministrative wages and benefits
to ensure that such enhancements are used exclusively for the legislatively
authorized purposes. For purposes of settlement, funds appropriated to this
cost center shall only be used for expenditures for which the legislative
authorization is granted. Such funds may be used only in the following
circumstances:
(a)
The contractor has increased expenditures for which legislative authorization
is granted to at least the highest level paid in any of the last three cost
years, plus, beginning July 1, 1987, any percentage inflation adjustment as was
granted each year under RCW 74.46.495; and
(b)
All funds shifted from the enhancement cost center are shown to have been
expended for legislatively authorized enhancements.
(3) If
the contractor does not spend the amount appropriated to this cost center in
the legislatively authorized manner, then the amounts not appropriately spent
shall be recouped at preliminary or final settlement pursuant to RCW 74.46.160.
(4)
For purposes of this section, "nonadministrative wages and benefits"
means wages and payroll taxes paid with respect to, and the employer share of
the cost of benefits provided to, employees in job classes specified in an
appropriation, which may not include administrators, assistant administrators,
or administrators in training.
(5)
Amounts expended in the enhancement cost center in excess of the minimum wage
established under RCW 74.46.430 are subject to all provisions contained in this
chapter.
Sec.
104. RCW
74.46.481 and 1993 sp.s. c 13 s 12 are each amended to read as follows:
(1)
The nursing services cost center shall include for reporting and audit purposes
all costs related to the direct provision of nursing and related care,
including fringe benefits and payroll taxes for the nursing and related care
personnel, and the cost of nursing supplies. The department shall adopt by
administrative rule a definition of "related care". For rates
effective after June 30, 1991, nursing services costs, as reimbursed within
this chapter, shall not include costs of any purchased nursing care services,
including registered nurse, licensed practical nurse, and nurse assistant
services, obtained through service contract arrangement in excess of the amount
of compensation paid for such hours of nursing care service had they been paid
at the average hourly wage, including related taxes and benefits, for in-house
nursing care staff of like classification at the same nursing facility, as
reported in the most recent cost report period.
(2)
The department shall adopt through administrative rules a method for
establishing a nursing services cost center rate consistent with the principles
stated in this section.
(3)
Utilizing regression or other statistical technique, the department shall
determine a reasonable limit on facility nursing staff taking into account
facility patient characteristics. For purposes of this section, facility
nursing staff refers to registered nurses, licensed practical nurses and
nursing assistants employed by the facility or obtained through temporary labor
contract arrangements. Effective January 1, 1988, the hours associated with
the training of nursing assistants and the supervision of that training for
nursing assistants shall not be included in the calculation of facility nursing
staff. In selecting a measure of patient characteristics, the department shall
take into account:
(a)
The correlation between alternative measures and facility nursing staff; and
(b)
The cost of collecting information for and computation of a measure.
If regression
is used, the limit shall be set at predicted nursing staff plus 1.75 regression
standard errors. If another statistical method is utilized, the limit shall be
set at a level corresponding to 1.75 standard errors above predicted staffing
computed according to a regression procedure. A regression calculated shall be
effective for the entire biennium.
(4) No
facility shall receive reimbursement for nursing staff levels in excess of the
limit. However, nursing staff levels established under subsection (3) of this
section shall not apply to the nursing services cost center reimbursement rate
only for the pilot facility especially designed to meet the needs of persons
living with AIDS as defined by RCW 70.24.017 and specifically authorized for
this purpose under the 1989 amendment to the Washington state health plan. (5)
((Every two years when rates are set at the beginning of each new biennium))
For July 1, 1995, rate setting only, the department shall divide into
two peer groups nursing facilities located in the state of Washington providing
services to medicaid residents: (a) Those facilities located within a
metropolitan statistical area as defined and determined by the United States
office of management and budget or other applicable federal office (MSA)
and (b) those not located in such an area (non-MSA). The facilities in
each peer group shall then be arrayed from lowest to highest by magnitude of
per ((patient)) resident day desk-reviewed, adjusted
nursing services cost from the ((prior)) 1994 calendar report
year, regardless of whether any such adjustments are contested by the nursing
facility, and the median or fiftieth percentile cost for each peer group shall
be determined. Nursing services component rates for facilities within
each peer group ((for the first year of the biennium)) shall be set at
the lower of the facility's desk-reviewed, adjusted per ((patient))
resident day nursing services cost from the ((prior)) 1994
report period or the median cost for the facility's peer group, utilizing
the same calendar year report data plus twenty-five percent. This rate
shall be reduced or inflated as authorized by RCW 74.46.420. However, the per
patient day peer group median cost plus twenty-five percent limit shall not
apply to the nursing services cost center reimbursement rate only for the pilot
facility especially designed to meet the needs of persons living with AIDS as
defined by RCW 70.24.017 and specifically authorized for this purpose under the
1989 amendment to the Washington state health plan.
(6) ((If
a nursing facility is impacted by the limit authorized in subsection (5) of
this section, it shall not receive a prospective rate in nursing services for
July 1, 1993, less than the same facility's prospective rate in nursing
services as of June 30, 1993, adjusted by any increase in the implicit price
deflator for personal consumption expenditures, IPD index, as measured over the
period authorized by RCW 74.46.420(3).
(7))) For
rates effective July 1, 1996, a nursing facility's noncost-rebased
component rate in nursing services ((for the second year of each
biennium)) shall be that facility's nursing services component rate
((as of July 1 of the first year of that biennium)) existing on June
30, 1996, reduced or inflated as authorized by RCW 74.46.420. ((The
alternating procedures prescribed in this section for a facility's two July 1
nursing services rates occurring within each biennium shall be followed in the
same order for each succeeding biennium.)) The July 1, 1996, nursing
services component rate used to calculate the return on investment (ROI)
component rate shall be the inflated prospective nursing services rate as of
June 30, 1996, excluding any rate increases granted pursuant to RCW 74.46.460.
(7)
For rates effective July 1, 1997, a nursing facility's noncost-rebased
component rate in nursing services shall be that facility's nursing services
component rate existing on June 30, 1997, reduced or inflated as authorized by
RCW 74.46.420. The July 1, 1997, nursing services component rate used to
calculate the return on investment (ROI) component rate shall be the inflated
prospective nursing services rate as of June 30, 1997, excluding any rate
increases granted pursuant to RCW 74.46.460.
(8)
Median cost((s)) limits for peer groups shall be calculated
initially for July 1, 1995, rate setting as provided in this chapter on
the basis of ((the most recent)) adjusted 1994 nursing services
cost report information available to the department prior to the
calculation of the new rates for July 1, 1995 ((of the first
fiscal year of each biennium)), regardless of whether the adjustments are
contested or subject to pending administrative or judicial review. Median
costs for peer groups shall be recalculated as provided in this chapter on the
basis of the most recent adjusted cost information available to the department
on October 31, 1995 ((of the first fiscal year of each biennium)),
and shall apply retroactively to ((the prior)) July 1, 1995, rates,
regardless of whether the adjustments are contested or subject to pending
administrative or judicial review. Median cost((s)) limits, once
calculated using October 31, 1995, adjusted cost information shall not be
adjusted to reflect subsequent administrative or judicial rulings, whether final
or not.
(9)
The department is authorized to determine on a systematic basis facilities with
unmet patient care service needs. The department may increase the nursing
services cost center prospective rate for a facility beyond the level
determined in accordance with subsection (6) of this section if the facility's
actual and reported nursing staffing is one standard error or more below
predicted staffing as determined according to the method selected pursuant to
subsection (3) of this section and the facility has unmet patient care service
needs: PROVIDED, That prospective rate increases authorized by this subsection
shall be funded only from legislative appropriations made for this purpose
during the periods authorized by such appropriations or other laws and the
increases shall be conditioned on specified improvements in patient care at
such facilities.
(10)
The department shall establish a method for identifying patients with
exceptional care requirements and a method for establishing or negotiating on a
consistent basis rates for such patients.
(11)
The department, in consultation with interested parties, shall adopt rules to
establish the criteria the department will use in reviewing any requests by a
contractor for a prospective rate adjustment to be used to increase the number
of nursing staff. These rules shall also specify the time period for
submission and review of staffing requests: PROVIDED, That a decision on a
staffing request shall not take longer than sixty days from the date the department
receives such a complete request. In establishing the criteria, the department
may consider, but is not limited to, the following:
(a)
Increases in debility levels of contractors' residents determined in accordance
with the department's assessment and reporting procedures and requirements
utilizing the minimum data set;
(b)
Staffing patterns for similar facilities in the same peer group;
(c)
Physical plant of contractor; and
(d)
Survey, inspection of care, and department consultation results.
Sec.
105. RCW
74.46.490 and 1993 sp.s. c 13 s 13 are each amended to read as follows:
(1)
The food cost center shall include for reporting purposes all costs for bulk
and raw food and beverages purchased for the dietary needs of medical care
recipients.
(2) ((Every
two years when rates are set at the beginning of each new biennium)) For
July 1, 1995, rate setting only, the department shall divide into two peer
groups nursing facilities located in the state of Washington providing services
to medicaid residents: (a) Those facilities located within a metropolitan
statistical area as defined and determined by the United States office of
management and budget or other applicable federal office (MSA) and (b)
those not located in such an area (non-MSA). The facilities in each
peer group shall then be arrayed from lowest to highest by magnitude of per ((patient))
resident day desk-reviewed, adjusted food cost from the ((prior))
1994 calendar report year, regardless of whether any such adjustments
are contested by the nursing facility, and the median or fiftieth percentile
cost for each peer group shall be determined. Food component rates for
facilities within each peer group ((for the first year of the biennium))
shall be set at the lower of the facility's desk-reviewed, adjusted per
((patient)) resident day food cost from the ((prior)) 1994
report period or the median cost for the facility's peer group, using the
same calendar year report data, plus twenty-five percent. This rate shall
be reduced or inflated as authorized by RCW 74.46.420.
(3) For
rates effective July 1, 1996, a nursing facility's noncost-rebased
food component rate ((for the second year of each biennium))
shall be that facility's food component rate ((as of July 1 of the
first year of that biennium)) existing on June 30, 1996, reduced or
inflated as authorized by RCW 74.46.420. ((The alternating procedures
prescribed in this section for a facility's two July 1 food rates occurring
within each biennium shall be followed in the same order for each succeeding
biennium.)) The July 1, 1996, food component rate used to calculate the
return on investment (ROI) component rate shall be the inflated prospective
food component rate as of June 30, 1996, excluding any rate increases granted
pursuant to RCW 74.46.460.
(4)
For rates effective July 1, 1997, a nursing facility's noncost-rebased food
component rate shall be that facility's food component rate existing on June
30, 1997, reduced or inflated as authorized by RCW 74.46.420. The July 1,
1997, food component rate used to calculate the return on investment (ROI)
component rate shall be the inflated prospective food component rate as of June
30, 1997, excluding any rate increases granted pursuant to RCW 74.46.460.
(((4)))
(5) Median cost((s)) limits for peer groups shall be
calculated initially for July 1, 1995, rate setting as provided in this
chapter on the basis of ((the most recent)) adjusted 1994 food
cost report information available to the department prior to the
calculation of the new rates for July 1, 1995 ((of the first
fiscal year of each biennium)), regardless of whether the adjustments are
contested or subject to pending administrative or judicial review. Median
costs for peer groups shall be recalculated as provided in this chapter on the
basis of the most recent adjusted cost information available to the department
on October 31, 1995 ((of the first fiscal year of each biennium)),
and shall apply retroactively to ((the prior)) July 1, 1995, rates,
regardless of whether the adjustments are contested or subject to pending
administrative or judicial review. Median cost((s)) limits, once
calculated utilizing October 31, 1995, adjusted cost information, shall not
be adjusted to reflect subsequent administrative or judicial rulings, whether
final or not.
Sec.
106. RCW
74.46.500 and 1993 sp.s. c 13 s 14 are each amended to read as follows:
(1)
The administrative cost center shall include for cost reporting purposes all
administrative, oversight, and management costs whether facility on-site or
allocated in accordance with a department-approved joint-cost allocation
methodology. Such costs shall be identical to the cost report line item costs
categorized under "general and administrative" in the
"administration and operations" combined cost center existing prior
to January 1, 1993, except for nursing supplies and purchased medical records.
(2) ((Every
two years when rates are set at the beginning of each new biennium)) For
July 1, 1995, rate setting only, the department shall divide into two peer
groups nursing facilities located in the state of Washington providing services
to medicaid residents: (a) Those facilities located within a metropolitan
statistical area as defined and determined by the United States office of
management and budget or other applicable federal office (MSA) and (b) those
not located in such an area (non-MSA). The facilities in each peer
group shall then be arrayed from lowest to highest by magnitude of per ((patient))
resident day desk-reviewed, adjusted administrative cost from the
((prior)) 1994 calendar report year, regardless of whether any
such adjustments are contested by the nursing facility, and the median or
fiftieth percentile cost for each peer group shall be determined.
Administrative component rates for facilities within each peer group ((for
the first year of the biennium)) shall be set at the lower of the
facility's desk-reviewed, adjusted per ((patient)) resident
day administrative cost from the ((prior)) 1994 report period or
the median cost for the facility's peer group, utilizing the same calendar
year report data, plus ten percent. This rate shall be reduced or inflated
as authorized by RCW 74.46.420.
(3) For
rates effective July 1, 1996, a nursing facility's noncost-rebased
administrative component rate ((for the second year of each biennium))
shall be that facility's administrative component rate ((as of July 1
of the first year of that biennium)) existing on June 30, 1996,
reduced or inflated as authorized by RCW 74.46.420. ((The alternating
procedures prescribed in this section for a facility's two July 1
administrative rates occurring within each biennium shall be followed in the
same order for each succeeding biennium.)) The July 1, 1996,
administrative component rate used to calculate the return on investment (ROI)
component rate shall be the inflated prospective administrative component rate
as of June 30, 1996, excluding any rate increases granted pursuant to RCW
74.46.460.
(4)
For rates effective July 1, 1997, a nursing facility's noncost-rebased
administrative component rate shall be that facility's administrative component
rate existing on June 30, 1997, reduced or inflated as authorized by RCW
74.46.420. The July 1, 1997, administrative component rate used to calculate
the return on investment (ROI) component rate shall be the inflated prospective
administrative component rate as of June 30, 1997, excluding any rate increases
granted pursuant to RCW 74.46.460.
(((4)))
(5) Median cost((s)) limits for peer groups shall be
calculated initially for July 1, 1995, rate setting as provided in this
chapter on the basis of ((the most recent)) adjusted 1994
administrative cost report information available to the department
prior to the calculation of the new rates for July 1, 1995 ((of
the first fiscal year of each biennium)), regardless of whether the
adjustments are contested or subject to pending administrative or judicial
review. Median costs for peer groups shall be recalculated as provided in this
chapter on the basis of the most recent adjusted cost information available to
the department on October 31, 1995 ((of the first fiscal year of each
biennium)), and shall apply retroactively to ((the prior)) July 1,
1995, rates, regardless of whether the adjustments are contested or
subject to pending administrative or judicial review. Median cost((s)) limits,
once calculated utilizing October 31, 1995, adjusted cost information,
shall not be adjusted to reflect subsequent administrative or judicial rulings,
whether final or not.
Sec.
107. RCW
74.46.505 and 1993 sp.s. c 13 s 15 are each amended to read as follows:
(1)
The operational cost center shall include for cost reporting purposes all
allowable costs of the daily operation of the facility not included in nursing
services and related care, food, administrative, or property costs, whether
such costs are facility on-site or allocated in accordance with a
department-approved joint-cost allocation methodology.
(2) ((Every
two years when rates are set at the beginning of each new biennium)) For
July 1, 1995, rate setting only, the department shall divide into two peer
groups nursing facilities located in the state of Washington providing services
to medicaid residents: (a) Those facilities located within a metropolitan
statistical area as defined and determined by the United States office of
management and budget or other applicable federal office (MSA) and (b)
those not located in such an area (non-MSA). The facilities in each
peer group shall then be arrayed from lowest to highest by magnitude of per ((patient))
resident day desk-reviewed, adjusted operational cost from the ((prior))
1994 calendar report year, regardless of whether any such adjustments
are contested by the nursing facility, and the median or fiftieth percentile
cost for each peer group shall be determined. Operational component
rates for facilities within each peer group ((for the first year of the
biennium)) shall be set at the lower of the facility's desk-reviewed,
adjusted per ((patient)) resident day operational cost from the
((prior)) 1994 report period or the median cost for the
facility's peer group, utilizing the same calendar year report data,
plus twenty-five percent. This rate shall be reduced or inflated as authorized
by RCW 74.46.420.
(3) For
rates effective July 1, 1996, a nursing facility's noncost-rebased
operational component rate ((for the second year of each biennium))
shall be that facility's operational component rate ((as of July 1 of
the first year of that biennium)) existing on June 30, 1996, reduced
or inflated as authorized by RCW 74.46.420. ((The alternating procedures
prescribed in this section for a facility's two July 1 operational rates
occurring within each biennium shall be followed in the same order for each
succeeding biennium.)) The July 1, 1996, operational component rate used
to calculate the return on investment (ROI) component rate shall be the
inflated prospective operational component rate as of June 30, 1996, excluding
any rate increases granted pursuant to RCW 74.46.460.
(4)
For rates effective July 1, 1997, a nursing facility's noncost-rebased
operational component rate shall be that facility's operational component rate
existing on June 30, 1997, reduced or inflated as authorized by RCW 74.46.420.
The July 1, 1997, operational component rate used to calculate the return on
investment (ROI) component rate shall be the inflated prospective operational
component rate as of June 30, 1997, excluding any rate increases granted
pursuant to RCW 74.46.460.
(((4)))
(5) Median cost((s)) limits for peer groups shall be
calculated initially for July 1, 1995, rate setting as provided in this
chapter on the basis of ((the most recent)) adjusted 1994 operational
cost report information available to the department prior to the
calculation of the new rate for July 1, 1995 ((of the first fiscal
year of each biennium)), regardless of whether the adjustments are
contested or subject to pending administrative or judicial review. Median
costs for peer groups shall be recalculated as provided in this chapter on the
basis of the most recent adjusted cost information available to the department
on October 31, 1995 ((of the first fiscal year of each biennium)),
and shall apply retroactively to ((the prior)) July 1, 1995, rates,
regardless of whether the adjustments are contested or subject to pending
administrative or judicial review. Median cost((s)) limits, once
calculated utilizing October 31, 1995, adjusted cost information, shall not
be adjusted to reflect subsequent administrative or judicial rulings, whether
final or not.
Sec.
108. RCW
74.46.510 and 1993 sp.s. c 13 s 16 are each amended to read as follows:
(1)
The property cost center rate for each facility shall be determined by dividing
the sum of the reported allowable prior period actual depreciation, subject to
RCW 74.46.310 through 74.46.380, adjusted for any capitalized additions or
replacements approved by the department, and the retained savings from such
cost center, as provided in RCW 74.46.180, by the greater of a facility's
total ((patient)) resident days for the facility in the prior
period or resident days as calculated on ninety or eighty-five percent
facility occupancy as applicable. If a capitalized addition or retirement
of an asset will result in a different licensed bed capacity during the ensuing
period, the prior period total ((patient)) resident days used in
computing the property cost center rate shall be adjusted to anticipated ((patient))
resident day level.
(2) A
nursing facility's property rate shall be rebased annually, effective July 1,
in accordance with this section and this chapter ((regardless of
whether the rate is for the first or second year of the biennium)).
(3)
When a certificate of need for a new facility is requested, the department, in
reaching its decision, shall take into consideration per-bed land and building
construction costs for the facility which shall not exceed a maximum to be
established by the secretary.
Sec.
109. RCW
74.46.530 and 1993 sp.s. c 13 s 17 are each amended to read as follows:
(1)
The department shall establish for each medicaid nursing facility a return on
investment (ROI) rate composed of two parts: A financing allowance and
a variable return allowance. The financing allowance part of a
facility's return on investment component rate shall be rebased
annually, effective July 1, in accordance with the provisions of this
section and this chapter((, regardless of whether the rate is for the
first or second year of the biennium)).
(a)
The financing allowance shall be determined by multiplying the net invested
funds of each facility by .10, and dividing by the ((contractor's)) greater
of a nursing facility's total ((patient)) resident days from
the most recent cost report period or resident days calculated on ninety
percent or eighty-five percent facility occupancy as applicable. If a
capitalized addition or retirement of an asset will result in a different
licensed bed capacity during the ensuing period, the prior period total ((patient))
resident days used in computing the financing and variable return
allowances shall be adjusted to the anticipated ((patient)) resident
day level.
(b) In
computing the portion of net invested funds representing the net book value of
tangible fixed assets, the same assets, depreciation bases, lives, and methods
referred to in RCW 74.46.330, 74.46.350, 74.46.360, 74.46.370, and 74.46.380,
including owned and leased assets, shall be utilized, except that the
capitalized cost of land upon which the facility is located and such other
contiguous land which is reasonable and necessary for use in the regular course
of providing ((patient)) resident care shall also be included.
Subject to provisions and limitations contained in this chapter, for land
purchased by owners or lessors before July 18, 1984, capitalized cost of land
shall be the buyer's capitalized cost. For all partial or whole rate periods
after July 17, 1984, if the land is purchased after July 17, 1984, capitalized
cost shall be that of the owner of record on July 17, 1984, or buyer's
capitalized cost, whichever is lower. In the case of leased facilities where
the net invested funds are unknown or the contractor is unable to provide
necessary information to determine net invested funds, the secretary shall have
the authority to determine an amount for net invested funds based on an appraisal
conducted according to RCW 74.46.360(1).
(c) In
determining the variable return allowance:
(i) ((Every
two years at the start of each new biennium)) For July 1, 1995, rate
setting only, the department, without utilizing peer groups, ((will))
shall first rank all facilities in numerical order from highest to
lowest according to their per ((patient)) resident day adjusted or
audited, or both, allowable costs for nursing services, food,
administrative, and operational costs combined for the ((previous)) 1994
calendar year cost report period.
(ii)
The department shall then compute the variable return allowance by multiplying
the appropriate percentage amounts, which shall not be less than one percent
and not greater than four percent, by the sum of the facility's nursing
services, food, administrative, and operational rate components. The
percentage amounts will be based on groupings of facilities according to the
rankings prescribed in (i) of this subsection (1)(c). The percentages
calculated and assigned will remain the same for the ((next)) variable
return allowance paid in ((the second year of the biennium)) all July
1, 1996, and July 1, 1997, rates as well. Those groups of facilities with
lower per diem costs shall receive higher percentage amounts than those with
higher per diem costs.
(d)
The sum of the financing allowance and the variable return allowance shall be
the return on investment rate for each facility, and shall be added to the
prospective rates of each contractor as determined in RCW 74.46.450 through
74.46.510.
(e) In
the case of a facility which was leased by the contractor as of January 1,
1980, in an arm's-length agreement, which continues to be leased under the same
lease agreement, and for which the annualized lease payment, plus any interest
and depreciation expenses associated with contractor-owned assets, for the
period covered by the prospective rates, divided by the contractor's total ((patient))
resident days, minus the property cost center determined according to
RCW 74.46.510, is more than the return on investment rate determined according
to subsection (1)(d) of this section, the following shall apply:
(i)
The financing allowance shall be recomputed substituting the fair market value
of the assets as of January 1, 1982, as determined by the department of general
administration through an appraisal procedure, less accumulated depreciation on
the lessor's assets since January 1, 1982, for the net book value of the assets
in determining net invested funds for the facility. A determination by the
department of general administration of fair market value shall be final unless
the procedure used to make such determination is shown to be arbitrary and
capricious.
(ii)
The sum of the financing allowance computed under subsection (1)(e)(i) of this
section and the variable allowance shall be compared to the annualized lease
payment, plus any interest and depreciation associated with contractor-owned
assets, for the period covered by the prospective rates, divided by the contractor's
total ((patient)) resident days, minus the property cost center
rate determined according to RCW 74.46.510. The lesser of the two amounts
shall be called the alternate return on investment rate.
(iii)
The return on investment rate determined according to subsection (1)(d) of this
section or the alternate return on investment rate, whichever is greater, shall
be the return on investment rate for the facility and shall be added to the
prospective rates of the contractor as determined in RCW 74.46.450 through
74.46.510.
(f) In
the case of a facility which was leased by the contractor as of January 1,
1980, in an arm's-length agreement, if the lease is renewed or extended
pursuant to a provision of the lease, the treatment provided in subsection
(1)(e) of this section shall be applied except that in the case of renewals or
extensions made subsequent to April 1, 1985, reimbursement for the annualized
lease payment shall be no greater than the reimbursement for the annualized
lease payment for the last year prior to the renewal or extension of the lease.
(2)
Each biennium, beginning in 1985, the secretary shall review the adequacy of
return on investment rates in relation to anticipated requirements for
maintaining, reducing, or expanding nursing care capacity. The secretary shall
report the results of such review to the legislature and make recommendations
for adjustments in the return on investment rates utilized in this section, if
appropriate.
Sec.
110. RCW
74.46.560 and 1983 1st ex.s. c 67 s 30 are each amended to read as follows:
The
department will notify each contractor in writing of its prospective ((reimbursement))
payment rates by the effective dates of the rates. Unless
otherwise specified at the time it is issued, ((the)) a rate will
be effective from the first day of the month in which it is issued until a new
rate becomes effective. If a rate is changed as the result of an appeals or
exception procedure established in accordance with RCW 74.46.780, it will
be effective as of the date the appealed rate became effective.
Sec.
111. RCW
74.46.570 and 1983 1st ex.s. c 67 s 31 are each amended to read as follows:
(1)
Prospective rates are subject to adjustment by the department as a result of
errors or omissions by the department or by the contractor. The department
will notify the contractor in writing of each adjustment and of the effective
date of the adjustment, and of any amount due to the department or to the
contractor as a result of the rate adjustment.
(2) If
a contractor claims an error or omission based upon incorrect cost reporting,
amended cost report pages shall be prepared and submitted by the contractor.
Amended pages shall be accompanied by a certification signed by the licensed
administrator of the nursing facility and a written justification explaining
why the amendment is necessary. The certification and justification shall meet
such criteria as are adopted by the department. Such amendments may be used to
revise a prospective rate but shall not be used to revise a settlement if
submitted after commencement of the field audit. All changes determined to be
material by the department shall be subject to field audit. If changes are
found to be incorrect or otherwise unacceptable, any rate adjustment based
thereon shall be null and void and resulting payments or payment increases
shall be subject to refund.
(3)
The contractor shall pay an amount owed the department resulting from an error
or omission as determined by the department on or after July 1, 1995, or
commence repayment in accordance with a schedule determined and agreed to in
writing by the department, within sixty days after receipt of notification
of the rate adjustment((, unless the contractor contests the department's
determination in accordance with the procedures set forth in RCW 74.46.780. If
the determination is contested, the contractor shall pay or commence repayment
within sixty days after completion of these proceedings)). If a refund as
determined by the department is not paid when due, the amount thereof may
be deducted from current payments by the department. However, neither a
timely filed request to pursue the department's administrative appeals or
exception procedure nor commencement of judicial review, as may be available to
the contractor in law, shall delay recovery.
(4)
The department shall pay any amount owed the contractor as a result of a rate
adjustment within thirty days after the contractor is notified of the rate
adjustment.
(5) No
adjustments will be made to a rate more than one hundred twenty days after the
final audit narrative and summary for the period the rate was effective is sent
to the contractor or, if no audit is held, more than one hundred twenty days
after the preliminary settlement becomes the final settlement, except when a
settlement is reopened as provided in RCW 74.46.170(3).
Sec.
112. RCW
74.46.640 and 1983 1st ex.s. c 67 s 34 are each amended to read as follows:
(1)
Payments to a contractor may be withheld by the department in each of the
following circumstances:
(a) A
required report is not properly completed and filed by the contractor within
the appropriate time period, including any approved extension. Payments will
be released as soon as a properly completed report is received;
(b)
State auditors, department auditors, or authorized personnel in the course of
their duties are refused access to a nursing ((home)) facility or
are not provided with existing appropriate records. Payments will be released
as soon as such access or records are provided;
(c) A
refund in connection with a preliminary or final settlement or rate
adjustment is not paid by the contractor when due. The amount withheld will be
limited to the unpaid amount of the refund and any accumulated interest owed
to the department as authorized by this chapter; ((and))
(d)
Payment for the final ((thirty)) sixty days of service under a
contract will be held in the absence of adequate alternate security
acceptable to the department pending final settlement when the contract is
terminated; and
(e)
Payment for services at any time during the contract period in the absence of
adequate alternate security acceptable to the department, if a contractor's net
medicaid overpayment liability for one or more nursing facilities or other debt
to the department, as determined by preliminary settlement, final settlement,
civil fines imposed by the department, third-party liabilities or other source,
reaches or exceeds fifty thousand dollars, whether subject to good faith
dispute or not, and for each subsequent increase in liability reaching or
exceeding twenty-five thousand dollars. Payments will be released as soon as
practicable after acceptable security is provided or refund to the department
is made.
(2) No
payment will be withheld until written notification of the suspension is
provided to the contractor, stating the reason ((therefor)) for the
withholding, except that neither a request to pursue the administrative appeals
or exception procedure established by the department in rule nor commencement
of judicial review, as may be available to the contractor in law, shall delay
suspension of payment.
Sec.
113. RCW
74.46.690 and 1985 c 361 s 3 are each amended to read as follows:
(1)
When a facility contract is terminated for any reason, the old contractor shall
submit final reports as required by RCW 74.46.040.
(2)
Upon notification of a contract termination, the department shall determine by
preliminary or final settlement calculations the amount of any overpayments
made to the contractor, including overpayments disputed by the contractor. If
preliminary or final settlements are unavailable for any period up to the date
of contract termination, the department shall make a reasonable estimate of any
overpayment or underpayments for such periods. The reasonable estimate shall
be based upon prior period settlements, available audit findings, the projected
impact of prospective rates, and other information available to the
department. The department shall also determine and add in the total of all
other debts owed to the department regardless of source, including, but not
limited to, interest owed to the department as authorized by this chapter,
civil fines imposed by the department, or third-party liabilities.
(3)
The old contractor shall provide security, in a form deemed adequate by the
department, ((in)) equal to the total amount of determined
and estimated overpayments and all other debts from any source, whether
or not the overpayments are the subject of good faith dispute. Security shall
consist of:
(a)
Withheld payments due the contractor; or
(b) A
surety bond issued by a bonding company acceptable to the department; or
(c) An
assignment of funds to the department; or
(d)
Collateral acceptable to the department; or
(e) A
purchaser's assumption of liability for the prior contractor's overpayment; ((or))
(f) A
promissory note secured by a deed of trust; or
(g)
Any combination of (a), (b), (c), (d), ((or)) (e), or (f) of this
subsection.
(4) A
surety bond or assignment of funds shall:
(a) Be
at least equal in amount to determined or estimated overpayments, whether or
not the subject of good faith dispute, minus withheld payments;
(b) Be
issued or accepted by a bonding company or financial institution licensed to
transact business in Washington state;
(c) Be
for a term, as determined by the department, sufficient to ensure
effectiveness after final settlement and the exhaustion of any
administrative appeals or exception procedure and judicial remedies,
as may be available to and sought by the contractor, regarding payment,
settlement, civil fine, interest assessment, or other debt issues:
PROVIDED, That the bond or assignment shall initially be for a term of at
least five years, and shall be forfeited if not renewed thereafter in an
amount equal to any remaining combined overpayment ((in dispute))
and debt liability as determined by the department;
(d)
Provide that the full amount of the bond or assignment, or both, shall be paid
to the department if a properly completed final cost report is not filed in
accordance with this chapter, or if financial records supporting this report
are not preserved and made available to the auditor; and
(e)
Provide that an amount equal to any recovery the department determines is due
from the contractor ((at)) from settlement or from any other
source of debt to the department, but not exceeding the amount of the bond
and assignment, shall be paid to the department if the contractor does not pay
the refund and debt within sixty days following receipt of written
demand ((or the conclusion of administrative or judicial proceedings to
contest settlement issues)) for payment from the department to the
contractor.
(5)
The department shall release any payment withheld as security if alternate
security is provided under subsection (3) of this section in an amount
equivalent to determined and estimated overpayments.
(6) If
the total of withheld payments, bonds, and assignments is less than the total
of determined and estimated overpayments, the unsecured amount of such
overpayments shall be a debt due the state and shall become a lien against the
real and personal property of the contractor from the time of filing by the
department with the county auditor of the county where the contractor resides
or owns property, and the lien claim has preference over the claims of all
unsecured creditors.
(7)
The contractor shall file a properly completed final cost report in accordance
with the requirements of this chapter, which shall be audited by the
department. A final settlement shall be determined within ninety days
following completion of the audit process, including completion of any
administrative appeals or exception procedure review of the audit
requested by the contractor, but not including completion of any judicial
review available to and commenced by the contractor.
(8)
Following determination of settlement for all periods, security held pursuant
to this section shall be released to the contractor after all
overpayments, erroneous payments, and debts determined in connection
with final settlement, or otherwise, including accumulated interest owed the
department, have been paid by the contractor. ((If the contractor
contests the settlement determination in accordance with RCW 74.46.170, the
department shall hold the security, not to exceed the amount of estimated
unrecovered overpayments being contested, pending completion of the
administrative appeal process.))
(9)
If, after calculation of settlements for any periods, it is determined that
overpayments exist in excess of the value of security held by the state, the
department may seek recovery of these additional overpayments as provided by
law.
(10)
((If a contract is terminated solely in order for the same owner to contract
with the department to deliver services to another classification of medical
care recipients at the same facility, the contractor is not required to submit
final cost reports, and security shall not be required)) Regardless of
whether a contractor intends to terminate its medicaid contracts, if a
contractor's net medicaid overpayments and erroneous payments for one or more
settlement periods, and for one or more nursing facilities, combined with debts
due the department, reaches or exceeds a total of fifty thousand dollars, as
determined by preliminary settlement, final settlement, civil fines imposed by
the department, third-party liabilities or by any other source, whether such
amounts are subject to good faith dispute or not, the department shall demand
and obtain security equivalent to the total of such overpayments, erroneous
payments, and debts and shall obtain security for each subsequent increase in
liability reaching or exceeding twenty-five thousand dollars. Such security
shall meet the criteria in subsections (3) and (4) of this section, except that
the department shall not accept an assumption of liability. The department
shall withhold all or portions of a contractor's current contract payments or
impose liens, or both, if security acceptable to the department is not
forthcoming. The department shall release a contractor's withheld payments or
lift liens, or both, if the contractor subsequently provides security
acceptable to the department. This subsection shall apply to all overpayments
and erroneous payments determined by preliminary or final settlements issued on
or after July 1, 1995, regardless of what payment periods the settlements may
cover and shall apply to all debts owed the department from any source,
including interest debts, which become due on or after July 1, 1995.
Sec.
114. RCW
74.46.770 and 1983 1st ex.s. c 67 s 39 are each amended to read as follows:
(1) For
all nursing facility medicaid payment rates effective on or after July 1, 1995,
and for all settlements and audits issued on or after July 1, 1995, regardless
of what periods the settlements or audits may cover, if a contractor wishes
to contest the way in which a rule ((or contract provision)) relating to
the ((prospective cost-related reimbursement)) medicaid payment rate
system was applied to the contractor by the department, it shall ((first))
pursue the ((administrative review process set forth in)) appeals or
exception procedure established by the department in rule authorized by RCW
74.46.780.
(2) ((The
administrative review and fair hearing process in RCW 74.46.780 need not be
exhausted if a contractor wishes to challenge the legal validity of a statute,
rule, or contract provision.)) If a contractor wishes to challenge the
legal validity of a statute, rule, or contract provision or wishes to bring a
challenge based in whole or in part on federal law, including but not limited
to issues of procedural or substantive compliance with the federal medicaid
minimum payment standard for long-term care facility services, the appeals or
exception procedure established by the department in rule may not be used for
these purposes. This prohibition shall apply regardless of whether the
contractor wishes to obtain a decision or ruling on an issue of validity or
federal compliance or wishes only to make a record for the purpose of
subsequent judicial review.
(3)
If a contractor wishes to challenge the legal validity of a statute, rule, or
contract provision relating to the medicaid payment rate system, or wishes to
bring a challenge based in whole or in part on federal law, it must bring such
action de novo in a court of proper jurisdiction as may be provided by law.
Sec.
115. RCW
74.46.780 and 1989 c 175 s 159 are each amended to read as follows:
(((1)
Within twenty-eight days after a contractor is notified of an action or
determination it wishes to challenge, the contractor shall request in writing
that the secretary review such determination. The request shall be signed by
the contractor or the licensed administrator of the facility, shall identify
the challenged determination and the date thereof, and shall state as specifically
as practicable the grounds for its contention that the determination was
erroneous. Copies of any documentation on which the contractor intends to rely
to support its position shall be included with the request.
(2)
After receiving a request meeting the above criteria, the secretary or his
designee will contact the contractor to schedule a conference for the earliest
mutually convenient time. The conference shall be scheduled for no later than
ninety days after a properly completed request is received unless both parties
agree in writing to a specified later date.
(3)
The contractor and appropriate representatives of the department shall attend
the conference. In addition, representatives selected by the contractor may
attend and participate. The contractor shall provide to the department in
advance of the conference any documentation on which it intends to rely to
support its contentions. The parties shall clarify and attempt to resolve the
issues at the conference. If additional documentation is needed to resolve the
issues, a second session of the conference shall be scheduled for not later
than twenty-eight days after the initial session unless both parties agree in
writing to a specific later date.
(4)
A written decision by the secretary will be furnished to the contractor within
sixty days after the conclusion of the conference.
(5)
If the contractor desires review of an adverse decision of the secretary, it
shall within twenty-eight days following receipt of such decision file a
written application for an adjudicative proceeding. The proceeding is governed
by chapter 34.05 RCW, the Administrative Procedure Act.)) For
all nursing facility medicaid payment rates effective on or after July 1, 1995,
and for all audits completed and settlements issued on or after July 1, 1995,
regardless of what periods the payment rates, audits, or settlements may cover,
the department shall establish in rule, consistent with federal requirements
for nursing facilities participating in the medicaid program, an appeals or
exception procedure that allows individual nursing care providers an
opportunity to submit additional evidence and receive prompt administrative
review of payment rates with respect to such issues as the department deems
appropriate.
Sec.
116. 1995 c
260 s 12 (uncodified) is amended to read as follows:
Sections
7 through 11 of this act shall take effect ((January)) July 1,
1996.
Sec.
117. RCW
70.128.120 and 1995 c 260 s 5 are each amended to read as follows:
An
adult family home provider shall have the following minimum qualifications:
(1)
Twenty-one years of age or older;
(2)
Good moral and responsible character and reputation;
(3)
Literacy;
(4)
Management and administrative ability to carry out the requirements of this
chapter;
(5)
Satisfactory completion of department-approved initial training and continuing
education training as specified by the department in rule;
(6)
Satisfactory completion of department-approved, or equivalent, special care
training before a provider may provide special care services to a resident;
(7)
Not been convicted of any crime listed in RCW 43.43.830 and 43.43.842; and
(8) Effective
July 1, 1996, registered with the department of health.
NEW
SECTION. Sec. 118. If any
part of this act is found to be in conflict with federal requirements that are
a prescribed condition to the allocation of federal funds to the state, the
conflicting part of this act is inoperative solely to the extent of the
conflict and with respect to the agencies directly affected, and this finding
does not affect the operation of the remainder of this act in its application
to the agencies concerned. The rules under this act shall meet federal requirements
that are a necessary condition to the receipt of federal funds by the state.
NEW
SECTION. Sec. 119. 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. 120. This act
is necessary for the immediate preservation of the public peace, health, or
safety, or support of the state government and its existing public
institutions, and shall take effect July 1, 1995.
