2410

2410.E AMS HEA S5462.1

EHB 2410 - S COMM AMD

By Committee on Health & Long-Term Care

Strike everything after the enacting clause and insert the following:

"NEW SECTION. Sec. 1. A new section is added to chapter 18.20 RCW to read as follows:

(1) Powers and duties regarding boarding homes, previously assigned under this chapter to the department of health and to the secretary of health, are by this section transferred to the department of social and health services and to the secretary of social and health services, respectively. This section further provides that, regarding boarding homes, all references within the Revised Code of Washington to the department of health and to the secretary of health mean the department of social and health services and the secretary of social and health services, respectively.

(2)(a) The department of health shall deliver to the department of social and health services all reports, documents, surveys, books, records, data, files, papers, and written material pertaining to boarding homes and the powers, functions, and duties transferred by this section. The department of health shall make available to the department of social and health services all cabinets, furniture, office equipment, motor vehicles, and other tangible property employed by the department of health in carrying out the powers, functions, and duties transferred by this section. The department of health shall assign to the department of social and health services all funds, credits, and other assets that the department of health possesses in connection with the power, functions, and duties transferred by this section.

(b) On the effective date of this section, the department of health shall transfer to the department of social and health services any appropriations and license fees made to or possessed by the department of health for carrying out the powers, functions, and duties transferred by this section.

(c) When a question arises regarding the transfer of personnel, funds, books, documents, records, papers, files, equipment, or other tangible property used or held in the exercise of the powers, functions, and duties transferred by this section, the director of financial management shall determine the proper allocation and shall certify that determination to the state agencies concerned.

(3) The department of social and health services shall continue and shall act upon all rules and pending business before the department of health pertaining to the powers, functions, and duties transferred by this section.

(4) The transfer of powers, functions, duties, and personnel from the department of health to the department of social and health services, as mandated by this section, will not affect the validity of any act performed by the department of health regarding boarding homes before the effective date of this section.

(5) If apportionments of budgeted funds are required because of the transfers mandated by this section, the director of financial management shall certify the apportionments to the agencies affected, the state auditor, and the state treasurer. Each of these shall make the necessary transfers and adjustments in funds, appropriation accounts, and equipment records in accordance with the certification.

(6) Nothing contained in this section alters any existing collective bargaining unit or the provisions of any existing collective bargaining agreement until the agreement expires or until the bargaining unit is modified by action of the personnel board as provided by law.

Sec. 2. RCW 18.20.020 and 1991 c 3 s 34 are each amended to read as follows:

As used in this chapter:

(1) "Aged person" means a person of the age sixty-five years or more, or a person of less than sixty-five years who by reason of infirmity requires domiciliary care.

(2) "Boarding home" means any home or other institution, however named, which is advertised, announced or maintained for the express or implied purpose of providing board and domiciliary care to three or more aged persons not related by blood or marriage to the operator. It shall not include facilities certified as group training homes pursuant to RCW 71A.22.040, nor any home, institution or section thereof which is otherwise licensed and regulated under the provisions of state law providing specifically for the licensing and regulation of such home, institution or section thereof. Nor shall it include any independent senior housing, independent living units in continuing care retirement communities, or other similar living situations including those subsidized by the department of housing and urban development.

(3) "Person" means any individual, firm, partnership, corporation, company, association, or joint stock association, and the legal successor thereof.

(4) "Secretary" means the secretary of social and health services.

(5) "Department" means the state department of social and health services.

(6) "Authorized department" means any city, county, city-county health department or health district authorized by the secretary ((~~of health~~)) to carry out the provisions of this chapter.

Sec. 3. RCW 18.20.190 and 1995 1st sp.s. c 18 s 18 are each amended to read as follows:

(1) The department of social and health services 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;

(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.

NEW SECTION. Sec. 4. A new section is added to chapter 18.20 RCW to read as follows:

The secretary may adopt rules and policies as necessary to entitle the state to participate in federal funding programs and opportunities and to facilitate state and federal cooperation in programs under the department's jurisdiction. The secretary shall ensure that any internal reorganization carried out under the terms of this chapter complies with prerequisites for the receipt of federal funding for the various programs under the department's control. When interpreting any department-related section or provision of law susceptible to more than one interpretation, the secretary shall construe that section or provision in the manner most likely to comply with federal laws and rules entitling the state to receive federal funds for the various programs of the department. If any law or rule dealing with the department is ruled to be in conflict with federal prerequisites to the allocation of federal funding to the state, the department, or its agencies, the secretary shall declare that law or rule inoperative solely to the extent of the conflict.

NEW SECTION. Sec. 5. (1) The governor shall establish a joint legislative and executive task force on long-term care, safety, quality, and oversight. The joint task force shall consist of seven members. The governor shall appoint three members that include: (a) The secretary of the department of social and health services or his or her designee; (b) the secretary of the department of health or his or her designee; and (c) the state long-term care ombudsman. Four legislative members shall serve on the joint task force as ex officio members and include: Two members of the senate appointed by the president of the senate, one of whom shall be a member of the majority caucus and one whom shall be a member of the minority caucus; and two members of the house of representatives appointed by the speaker of the house of representatives, one of whom shall be a member of the majority caucus and one whom shall be a member of the minority caucus. Primary staff assistance to the joint task force shall be provided by the office of financial management with assistance, as directed by legislative members, by the health care committee of the house of representatives office of program research and the senate health and long-term care committee of senate committee services.

(2) The joint task force shall elect a chair and vice-chair. The chair shall serve a one-year term as the chair of the joint task force. The following year, the previously elected vice-chair shall serve as the chair of the joint task force and a new vice-chair shall be elected by the members of the joint task force.

(3) The joint task force shall have the ability to create advisory committees and appoint individuals from a variety of disciplines and perspectives including but not limited to patient and resident advocates and representatives of provider organizations, to assist the joint task force with specific issues related to chapter . . ., Laws of 1998 (this act).

(4) The joint task force may hold meetings, including hearings, to receive public testimony, which shall be open to the public in accordance with law. Records of the joint task force shall be subject to public disclosure in accordance with law. Members shall not receive compensation, but may be reimbursed for travel expenses as authorized under RCW 43.03.050 and 43.03.060. Advisory committee members, if appointed, shall not receive compensation or reimbursement for travel or expenses.

(5) The joint task force shall:

(a) Review all long-term care quality and safety standards for all long-term care facilities and services developed, revised, and enforced by the department of social and health services;

(b) In cooperation with aging and adult services, the division of developmental disabilities, and the division of mental health and the department of health, develop recommendations to simplify, strengthen, reduce, or eliminate rules, procedures, and burdensome paperwork that prove to be barriers to providing the highest standard of client safety, effective quality of care, effective client protections, and effective coordination of direct services;

(c) Review the need for reorganization and reform of long-term care administration and service delivery, including administration and services provided for the aged, for those with mental health needs, and for the developmentally disabled, and recommend the establishment of a single long-term care department or a division of long-term care within the department of social and health services;

(d) Suggest cost-effective methods for reallocating funds to unmet needs in direct services;

(e) List all nonmeans tested programs and activities funded by the federal older Americans act and state-funded senior citizens act or other such state-funded programs, and recommend methods for integrating such services into existing long-term care programs for the functionally disabled;

(f) Suggest methods to establish a single point of entry for service eligibility and delivery for all functionally disabled persons;

(g) Evaluate the need for long-term care training and review all long-term care training and education programs conducted by the department of social and health services, and suggest modifications to enhance client safety, to create greater access to training through the use of innovative technology, to reduce training costs, to improve coordination of training between the appropriate divisions and departments and, to enhance the overall uniformity of the long-term care training system;

(h) Evaluate the current system used by the department of social and health services for placement of functionally disabled clients, including aging, mentally ill, and developmentally disabled persons, into long-term care settings and services and assess the capacity of each long-term care service or setting to appropriately meet the health and safety needs of functionally disabled clients or residents referred to each service or setting;

(i) Evaluate the need for uniform client assessments for determining functional long-term care needs of all persons who receive state-funded, long-term care services;

(j) Evaluate the success of the transfer of boarding home responsibilities outlined in chapter . . ., Laws of 1998 (this act) and recommend if any further administrative changes should be made; and

(k) Evaluate the need to establish a dementia and Alzheimer's certification requirement for long-term care facilities who choose to provide care to persons who have been diagnosed with Alzheimer's or a related dementia. The evaluation shall also identify the level of disability a resident or client must have before the resident or client is considered for care in a certified long-term care Alzheimer's facility.

(6) The joint task force shall report its initial findings and recommendations to the governor and appropriate committees of the legislature by January 1, 1999. The joint task force shall report its final findings and recommendations to the governor and appropriate committees of the legislature by December 12, 1999.

Sec. 6. RCW 18.20.160 and 1985 c 297 s 2 are each amended to read as follows:

(1) No person operating a boarding home licensed under this chapter shall admit to or retain in the boarding home any aged person requiring nursing or medical care of a type provided by institutions licensed under chapters 18.51, 70.41 or 71.12 RCW, except that when registered nurses are available, and upon a doctor's order that a supervised medication service is needed, it may be provided. Supervised medication services, as defined by the department, may include an approved program of self-medication or self-directed medication. Such medication service shall be provided only to boarders who otherwise meet all requirements for residency in a boarding home.

(2)(a) Notwithstanding any provision contained in this section, in no case shall a resident be bedbound, as a result of illness or disease, for any continuous period of time exceeding one hundred twenty hours, unless the resident's attending physician has seen the resident and assessed the resident's medical condition, prescribed a plan of care, and determined that a continued stay in the boarding home is appropriate.

(b) Residents who continue to be bedbound for more than nine consecutive days shall be seen by their attending physician at least every thirty days, counting from the date of the initial bedbound-related physician visit, for as long as the resident continues to be bedbound.

(c) The physician and the boarding home shall document each visit and the physician shall, at each visit, prescribe a plan of care and redetermine the appropriateness of the resident's continued stay in the boarding home.

(3) For the purposes of this section, an illness or disease does not include any illness or disease for which the resident has elected to receive hospice care and chooses to remain in the boarding home. When the resident elects to receive hospice care, an outside licensed agency is responsible for performing timely and appropriate visits and for developing a plan of care.

Sec. 7. RCW 70.128.060 and 1995 c 260 s 4 are each amended to read as follows:

(1) An application for license shall be made to the department upon forms provided by it and shall contain such information as the department reasonably requires.

(2) The department shall issue a license to an adult family home if the department finds that the applicant and the home are in compliance with this chapter and the rules adopted under this chapter, unless (a) the applicant has prior violations of this chapter relating to the adult family home subject to the application or any other adult family home, or of any other law regulating residential care facilities within the past five years that resulted in revocation or nonrenewal of a license; or (b) the applicant has a history of significant noncompliance with federal, state, or local laws, rules, or regulations relating to the provision of care or services to vulnerable adults or to children.

(3) The license fee shall be submitted with the application.

(4) The department shall serve upon the applicant a copy of the decision granting or denying an application for a license. An applicant shall have the right to contest denial of his or her application for a license as provided in chapter 34.05 RCW by requesting a hearing in writing within twenty-eight days after receipt of the notice of denial.

(5) The department shall not issue a license to a provider if the department finds that the provider or any partner, officer, director, managerial employee, or owner of five percent or more if 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.

(6)(a) The department shall license an adult family home for the maximum level of care that the adult family home may provide. However, in no case shall the adult family home admit or retain residents who are bedbound, as a result of illness or disease, for any continuous period of time exceeding one hundred twenty hours, unless the resident's attending physician has seen the resident to assess their medical condition, prescribed a plan of care, and determined that a continued stay in the adult family home is appropriate.

(c) The physician and adult family home shall document each visit and the physician shall, at each visit, prescribe a plan of care and redetermine the continued appropriateness of the resident remaining in the adult family home.

(d) The department shall further define, in rule, license levels based upon the education, training, and caregiving experience of the licensed provider or staff.

(e) For the purposes of this section, an illness or disease does not include any illness or disease for which the resident has elected to receive hospice care and chooses to remain in the adult family home. When the resident elects to receive hospice care, an outside licensed agency is responsible for performing timely and appropriate visits and for developing a plan of care.

(7) The department shall establish, by rule, standards used to license nonresident providers and multiple facility operators.

(8) The department shall establish, by rule, for multiple facility operators educational standards substantially equivalent to recognized national certification standards for residential care administrators.

(9) The license fee shall be set at fifty dollars per year for each home. A fifty dollar processing fee shall also be charged each home when the home is initially licensed.

NEW SECTION. Sec. 8. The sum of fifty thousand dollars, or as much thereof as may be necessary, is appropriated for the fiscal year ending June 30, 1999, from the general fund to the office of financial management solely for the purposes of implementing section 5 of this act.

NEW SECTION. Sec. 9. 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 takes effect immediately.

NEW SECTION. Sec. 10. (1) Sections 1 through 4 of this act expire July 1, 2000, unless reauthorized by the legislature.

(2) Section 5 of this act expires December 12, 1999.

NEW SECTION. Sec. 11. 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."

EHB 2410 - S COMM AMD

By Committee on Health & Long-Term Care

On page 1, line 1 of the title, after "homes;" strike the remainder of the title and insert "amending RCW 18.20.020, 18.20.190, 18.20.160, and 70.128.060; adding new sections to chapter 18.20 RCW; creating a new section; making an appropriation; providing a contingent expiration date; providing an expiration date; and declaring an emergency."