6544-S2 AMC CONF H5586

6544-S2 AMC CONF H5586.1

2SSB 6544 - CONF REPT

By Conference Committee

ADOPTED 3/12/98

Strike everything after the enacting clause and insert the following:

"NEW SECTION. Sec. 1. The legislature finds that many residents of long-term care facilities and recipients of in-home personal care services are exceptionally vulnerable and their health and well-being are heavily dependent on their caregivers. The legislature further finds that the quality of staff in long-term care facilities is often the key to good care. The need for well-trained staff and well-managed facilities is growing as the state's population ages and the acuity of the health care problems of residents increases. In order to better protect and care for residents, the legislature directs that the minimum training standards be reviewed for management and caregiving staff, including those serving residents with special needs, such as mental illness, dementia, or a developmental disability, that management and caregiving staff receive appropriate training, and that the training delivery system be improved.

NEW SECTION. Sec. 2. A new section is added to chapter 18.20 RCW to read as follows:

(1) The department of social and health services shall review, in coordination with the department of health, the nursing care quality assurance commission, adult family home providers, boarding home providers, in-home personal care providers, and long-term care consumers and advocates, training standards for administrators and resident caregiving staff. The departments and the commission shall submit to the appropriate committees of the house of representatives and the senate by December 1, 1998, specific recommendations on training standards and the delivery system, including necessary statutory changes and funding requirements. Any proposed enhancements shall be consistent with this section, shall take into account and not duplicate other training requirements applicable to boarding homes and staff, and shall be developed with the input of boarding home and resident representatives, health care professionals, and other vested interest groups. Training standards and the delivery system shall be relevant to the needs of residents served by the boarding home and recipients of long-term in-home personal care services and shall be sufficient to ensure that administrators and caregiving staff have the skills and knowledge necessary to provide high quality, appropriate care.

(2) The recommendations on training standards and the delivery system developed under subsection (1) of this section shall be based on a review and consideration of the following: Quality of care; availability of training; affordability, including the training costs incurred by the department of social and health services and private providers; portability of existing training requirements; competency testing; practical and clinical course work; methods of delivery of training; standards for management and caregiving staff training; and necessary enhancements for special needs populations and resident rights training. Residents with special needs include, but are not limited to, residents with a diagnosis of mental illness, dementia, or developmental disability.

(3) The department of social and health services shall report to the appropriate committees of the house of representatives and the senate by December 1, 1998, on the cost of implementing the proposed training standards for state-funded residents, and on the extent to which that cost is covered by existing state payment rates.

NEW SECTION. Sec. 3. A new section is added to chapter 70.128 RCW to read as follows:

(1) The department of social and health services shall review, in coordination with the department of health, the nursing care quality assurance commission, adult family home providers, boarding home providers, in-home personal care providers, and long-term care consumers and advocates, training standards for providers, resident managers, and resident caregiving staff. The departments and the commission shall submit to the appropriate committees of the house of representatives and the senate by December 1, 1998, specific recommendations on training standards and the delivery system, including necessary statutory changes and funding requirements. Any proposed enhancements shall be consistent with this section, shall take into account and not duplicate other training requirements applicable to adult family homes and staff, and shall be developed with the input of adult family home and resident representatives, health care professionals, and other vested interest groups. Training standards and the delivery system shall be relevant to the needs of residents served by the adult family home and recipients of long-term in-home personal care services and shall be sufficient to ensure that providers, resident managers, and caregiving staff have the skills and knowledge necessary to provide high quality, appropriate care.

(2) The recommendations on training standards and the delivery system developed under subsection (1) of this section shall be based on a review and consideration of the following: Quality of care; availability of training; affordability, including the training costs incurred by the department of social and health services and private providers; portability of existing training requirements; competency testing; practical and clinical course work; methods of delivery of training; standards for management; uniform caregiving staff training; necessary enhancements for special needs populations; and resident rights training. Residents with special needs include, but are not limited to, residents with a diagnosis of mental illness, dementia, or developmental disability. Development of training recommendations for developmental disabilities services shall be coordinated with the study requirements in section 6 of this act.

Sec. 4. RCW 70.128.070 and 1995 1st sp.s. c 18 s 22 are each amended to read as follows:

(1) ((~~A license shall be valid for one year.~~

(2) At least 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 license shall remain valid unless voluntarily surrendered, suspended, or revoked in accordance with this chapter.

(2)(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) 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)~~)) (3) 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. 5. RCW 70.129.030 and 1997 c 386 s 31 are each amended to read as follows:

(1) The facility must inform the resident both orally and in writing in a language that the resident understands of his or her rights and all rules and regulations governing resident conduct and responsibilities during the stay in the facility. The notification must be made prior to or upon admission. Receipt of the information must be acknowledged in writing.

(2) The resident or his or her legal representative has the right:

(a) Upon an oral or written request, to access all records pertaining to himself or herself including clinical records within twenty-four hours; and

(b) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or portions of them upon request and two working days' advance notice to the facility.

(3) The facility shall only admit or retain individuals whose needs it can safely and appropriately serve in the facility with appropriate available staff and through the provision of reasonable accommodations required by state or federal law. Except in cases of genuine emergency, the facility shall not admit an individual before obtaining a thorough assessment of the resident's needs and preferences. The assessment shall contain, unless unavailable despite the best efforts of the facility, the resident applicant, and other interested parties, the following minimum information: Recent medical history; necessary and contraindicated medications; a licensed medical or other health professional's diagnosis, unless the individual objects for religious reasons; significant known behaviors or symptoms that may cause concern or require special care; mental illness, except where protected by confidentiality laws; level of personal care needs; activities and service preferences; and preferences regarding other issues important to the resident applicant, such as food and daily routine.

(4) The facility must inform each resident in writing in a language the resident or his or her representative understands before((~~, or at the time of~~)) admission, and at least once every twenty-four months thereafter of: (a) Services, items, and activities customarily available in the facility or arranged for by the facility as permitted by the facility's license; (b) charges for those services, items, and activities including charges for services, items, and activities not covered by the facility's per diem rate or applicable public benefit programs; and (c) the rules of facility operations required under RCW 70.129.140(2). Each resident and his or her representative must be informed in writing in advance of changes in the availability or the charges for services, items, or activities, or of changes in the facility's rules. Except in emergencies, thirty days' advance notice must be given prior to the change. However, for facilities licensed for six or fewer residents, if there has been a substantial and continuing change in the resident's condition necessitating substantially greater or lesser services, items, or activities, then the charges for those services, items, or activities may be changed upon fourteen days' advance written notice.

((~~(4)~~)) (5) The facility must furnish a written description of residents rights that includes:

(a) A description of the manner of protecting personal funds, under RCW 70.129.040;

(b) A posting of names, addresses, and telephone numbers of the state survey and certification agency, the state licensure office, the state ombudsmen program, and the protection and advocacy systems; and

(c) A statement that the resident may file a complaint with the appropriate state licensing agency concerning alleged resident abuse, neglect, and misappropriation of resident property in the facility.

((~~(5)~~)) (6) Notification of changes.

(a) A facility must immediately consult with the resident's physician, and if known, make reasonable efforts to notify the resident's legal representative or an interested family member when there is:

(i) An accident involving the resident which requires or has the potential for requiring physician intervention;

(ii) A significant change in the resident's physical, mental, or psychosocial status (i.e., a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications).

(b) The facility must promptly notify the resident or the resident's representative shall make reasonable efforts to notify an interested family member, if known, when there is:

(i) A change in room or roommate assignment; or

(ii) A decision to transfer or discharge the resident from the facility.

(c) The facility must record and update the address and phone number of the resident's representative or interested family member, upon receipt of notice from them.

NEW SECTION. Sec. 6. The division of developmental disabilities in the department of social and health services, in coordination with advocacy, self-advocacy, and provider organizations, shall review administrator and resident caregiver staff training standards for agency contracted supported living services, including intensive tenant support, tenant support, supportive living, and in-home personal care services for children. The division and the advocates shall coordinate specialty training recommendations with the larger study group referenced in sections 2(1) and 3(1) of this act and submit specific recommendations on training standards, including necessary statutory changes and funding requirements to the appropriate committees of the house of representatives and the senate by December 1, 1998.

NEW SECTION. Sec. 7. A new section is added to chapter 18.48 RCW to read as follows:

Adult family homes have developed rapidly in response to the health and social needs of the aging population in community settings, especially as the aging population has increased in proportion to the general population. The growing demand for elder care with a new focus on issues affecting senior citizens, including persons with developmental disabilities, mental illness, or dementia, has prompted a growing professionalization of adult family home providers to address quality care and quality of life issues consistent with standards of accountability and regulatory safeguards for the health and safety of the residents. The establishment of an advisory committee to the department of health and the department of social and health services under section 8 of this act formalizes a stable process for discussing and considering these issues among residents and their advocates, regulatory officials, and adult family home providers. The dialogue among all stakeholders interested in maintaining a healthy option for the aging population in community settings assures the highest regard for the well-being of these residents within a benign and functional regulatory environment.

NEW SECTION. Sec. 8. A new section is added to chapter 18.48 RCW to read as follows:

(1) The secretary, in consultation with the secretary of social and health services, shall appoint an advisory committee on matters relating to the regulation, administrative rules, enforcement process, staffing, and training requirements of adult family homes. The advisory committee shall be composed of six members, of which two members shall be resident advocates, three members shall represent adult family home providers, and one member shall represent the public and serve as chair. The members shall generally represent the interests of aging residents, residents with dementia, residents with mental illness, and residents with developmental disabilities respectively. Members representing adult family home providers must have at least two years' experience as licensees. The membership must generally reflect urban and rural areas and western and eastern parts of the state. A member may not serve more than two consecutive terms.

(2) The secretary may remove a member of the advisory committee for cause as specified by rule adopted by the department. If there is a vacancy, the secretary shall appoint a member to serve for the remainder of the unexpired term.

(3) The advisory committee shall meet at the times and places designated by the secretary and shall hold meetings during the year as necessary to provide advice to the secretary on matters relating to the regulation of adult family homes. A majority of the members may request a meeting of the committee for any express purpose directly related to the regulation of adult family homes. A majority of members currently serving shall constitute a quorum.

(4) Establishment of the advisory committee shall not prohibit the department of health from utilizing other advisory activities that the department of health deems necessary for program development.

(5) Each member of the advisory committee shall serve without compensation but may be reimbursed for travel expenses as authorized in RCW 43.03.060.

(6) The secretary, members of the advisory committee, or individuals acting on their behalf are immune from civil liability for official acts performed in the course of their duties.

NEW SECTION. Sec. 9. A new section is added to chapter 70.128 RCW to read as follows:

Establishment of the advisory committee shall not prohibit the department of social and health services from utilizing other advisory activities that the department of social and health services deems necessary for program development.

Sec. 10. RCW 18.88A.210 and 1995 1st sp.s. c 18 s 46 are each amended 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)) initial delegating nurse obtains written consent to the nurse delegation process from the patient or a person authorized under RCW 7.70.065. Written consent is only necessary at the initial use of the nurse delegation process for each patient and is not necessary for task additions or changes or if a different nurse or nursing assistant will be participating in the process. The written consent must include at a minimum the following:

(i) A list of the tasks that could potentially be delegated per RCW 18.88A.210; and

(ii) A statement that a nursing assistant through the nurse delegation process will be performing a task that would previously have been performed by a registered or licensed practical nurse;

(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~~)) utilizing one or more of the following: (i) Verification of competency via return demonstration ((~~under observation while performing the task~~)); (ii) other methods for verification of competency to perform the nursing task; or (iii) assurance that the nursing assistant is competent to perform the nursing task as a result of systems in place in the community residential program for the developmentally disabled, adult family home, or boarding home providing assisted living services;

(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 or by whatever means is deemed appropriate by the registered nurse 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;

(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.

Sec. 11. RCW 18.88A.230 and 1997 c 275 s 6 are each amended 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 based on patient safety issues. 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~~)) may 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 chapter 18, Laws of 1995 1st sp. sess. that knowingly permits an employee to perform a nursing task except as delegated by a nurse pursuant to chapter 18, Laws of 1995 1st sp. sess.

Sec. 12. 1995 1st sp.s. c 18 s 54 (uncodified) is amended to read as follows:

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~~)) 1998, 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~~)) 1999, unless extended by act of the legislature.

NEW SECTION. Sec. 13. 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. 14. 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. 15. 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. 16. 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. 17. (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; and

(l) Evaluate the effect of requiring regular visits to bedbound patients of boarding homes and adult family homes by licensed practitioners.

(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. 18. 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 ten days, unless a licensed practitioner 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 ten consecutive days shall be seen by a licensed practitioner at least every thirty days, counting from the date of the initial bedbound-related licensed practitioner visit, for as long as the resident continues to be bedbound.

(c) The licensed practitioner and the boarding home shall document each visit and the licensed practitioner 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.

NEW SECTION. Sec. 19. A new section is added to chapter 18.20 RCW to read as follows:

For the purposes of RCW 18.20.160, "licensed practitioner" includes a physician licensed under chapter 18.71 RCW, a registered nurse licensed under chapter 18.79 RCW, an osteopathic physician and surgeon licensed under chapter 18.57 RCW, an advanced registered nurse practitioner licensed under chapter 18.79 RCW, or a physician assistant licensed under chapter 18.71A RCW.

Sec. 20. 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 ten days, unless a licensed practitioner 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 licensed practitioner and adult family home shall document each visit and the licensed practitioner 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. The licensing fee is due each year within thirty days of the anniversary date of the license. A fifty dollar processing fee shall also be charged each home when the home is initially licensed.

NEW SECTION. Sec. 21. A new section is added to chapter 70.128 RCW to read as follows:

For the purposes of RCW 70.128.060, "licensed practitioner" includes a physician licensed under chapter 18.71 RCW, a registered nurse licensed under chapter 18.79 RCW, an osteopathic physician and surgeon licensed under chapter 18.57 RCW, an advanced registered nurse practitioner licensed under chapter 18.79 RCW, or a physician assistant licensed under chapter 18.71A RCW.

NEW SECTION. Sec. 22. 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 17 of this act.

NEW SECTION. Sec. 23. Section 5 of this act takes effect July 1, 1998.

NEW SECTION. Sec. 24. (1) Sections 13 through 16 of this act expire July 1, 2000, unless reauthorized by the legislature.

(2) Section 17 of this act expires December 12, 1999.

NEW SECTION. Sec. 25. 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. 26. Except for section 5 of this act, 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."

2SSB 6544 - CONF REPT

By Conference Committee

ADOPTED 3/12/98

On page 1, line 1 of the title, after "care;" strike the remainder of the title and insert "amending RCW 70.128.070, 70.129.030, 18.88A.210, 18.88A.230, 18.20.020, 18.20.190, 18.20.160, and 70.128.060; amending 1995 1st sp.s. c 18 s 54 (uncodified); adding new sections to chapter 18.20 RCW; adding new sections to chapter 70.128 RCW; adding new sections to chapter 18.48 RCW; creating new sections; making an appropriation; providing an effective date; providing an expiration date; providing a contingent expiration date; and declaring an emergency."