H-2419

AN ACT Relating to the long-term care reorganization and standards of care reform act; amending RCW 70.129.030, 70.129.110, 70.129.150, 74.39A.030, 74.39A.040, 74.39A.050, 74.39A.060, 70.129.105, 74.42.030, 43.20B.080, 74.34.010, 74.39A.170, 18.20.040, and 70.128.175; reenacting and amending RCW 18.130.040; adding a new section to chapter 43.20A RCW; adding a new section to chapter 18.20 RCW; adding a new section to chapter 70.124 RCW; adding new sections to chapter 74.34 RCW; adding a new section to chapter 43.20B RCW; adding a new chapter to Title 43 RCW; adding a new chapter to Title 18 RCW; creating new sections; repealing RCW 74.39.001, 74.39.005, 74.39.030, 74.39.040, 74.39A.005, 74.39A.007, and 74.39A.008; prescribing penalties; providing expiration dates; and declaring an emergency.

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

PART I

CREATING THE DIVISION OF LONG-TERM CARE SERVICES

NEW SECTION. Sec. 101. This act shall be known and may be cited as the Clara act.

NEW SECTION. Sec. 102. FINDINGS AND INTENT. The legislature finds and declares that the state's current fragmented categorical system for administering services to persons with disabilities and the elderly is not client and family-centered and has created significant organizational barriers to providing high quality, safe, and effective care and support. The present fragmented system results in uncoordinated enforcement of regulations designed to protect the health and safety of disabled persons, lacks accountability due to the absence of management information systems' client tracking data, and perpetuates difficulty in matching client needs and services to multiple categorical funding sources.

The legislature further finds that Washington's chronically functionally disabled population of all ages is growing at a rapid pace due to a population of the very old and increased incidence of disability due in large measure to technological improvements in acute care causing people to live longer. Further, to meet the significant and growing long-term care needs into the near future, rapid, fundamental changes must take place in the way we finance, organize, and provide long-term care services to the chronically functionally disabled.

The legislature further finds that the public demands that long‑term care services be safe, client and family-centered, and designed to encourage individual dignity, autonomy, and development of the fullest human potential at home or in other residential settings, whenever practicable. To accomplish this, the legislature recognizes the immediate need to administer long-term care services for persons with functional disabilities through a separate, integrated, and comprehensive long-term care division.

It is the intent of this chapter to establish a new division within the department of social and health services, known as the division of long‑term care services, which is mandated to coordinate client-centered, long-term care services in a way that increases safety, accountability, and quality, minimizes administrative cost, eliminates unnecessarily complex administrative barriers, minimizes program and service duplication, and maximizes the use of financial resources in directly meeting the needs of persons of all ages with chronic functional limitations.

NEW SECTION. Sec. 103. DEFINITIONS. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Adult family home" means a home 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 RCW 74.39A.020.

(3) "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.

(4) "Boarding home" means a facility licensed under chapter 18.20 RCW.

(5) "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.

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

(7) "Division" means the division of long-term care services in the department of social and health services.

(8) "Enhanced adult residential care" means services provided by a boarding home that is licensed under chapter 18.20 RCW and that has a contract with the department under RCW 74.39A.010.

(9) "Functionally disabled person" is synonymous with chronic functionally disabled and means a person who because of a recognized chronic physical or mental condition or disease is impaired to the extent of being dependent upon others for direct care, support, supervision, or monitoring to perform activities of daily living. "Activities of daily living", in this context, means self-care abilities related to personal care such as bathing, eating, using the toilet, dressing, and transfer. Instrumental activities of daily living may also be used to assess a person's functional abilities as they are related to the mental capacity to perform activities in the home and the community such as cooking, shopping, house cleaning, doing laundry, working, and managing personal finances.

(10) "Home and community services" means adult family homes, group homes, intensive tenant support, boarding homes, in-home services, and other services administered by the department directly or through contract with area agencies on aging or similar services provided by facilities and agencies licensed by the department.

(11) "Long-term care" is synonymous with chronic care and means care and supports delivered indefinitely, intermittently, or over a sustained time to persons of any age disabled by chronic mental or physical illness, disease, or a medical condition that is permanent, not reversible or curable, or is long-lasting and severely limits their mental or physical capacity for self-care. The use of this definition is not intended to expand the scope of services, care, or assistance by any individuals, groups, residential care settings, or professions unless otherwise expressed by law.

(12) "Nursing home" means a facility licensed under chapter 18.51 RCW.

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

(14) "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. 104. DUTIES AND RESPONSIBILITIES. The division has, but is not limited to, the following duties and responsibilities:

(1) Provide long-term care services to functionally disabled persons within available funding, in the most safe, cost-effective, and appropriate residential environment consistent with the person's measurable needs, exceptional or special care needs, and individual preferences;

(2) Establish and implement a consistent definition of appropriate and integrated roles and responsibilities for state and local government, regional organizations, provider groups, families, and private volunteers in the planning, administration, financing, and delivery of long-term care services;

(3) Continually develop, implement, and monitor safety and quality standards for all levels of care and assistance;

(4) Provide, to the extent funding is available, accessible and affordable technical assistance that will enable persons who are disabled, their families, and local communities to have greater participation and control in the planning, administration, and provision of long-term care services;

(5) Promote the active and meaningful involvement of families, volunteers, and advocacy groups throughout all levels of care;

(6) Promote the development of a coordinated education and training system for long-term care that is relevant to the needs of the client, and includes special care needs resulting from Alzheimer and other dementia disorders, Parkinson's, Huntington's, chemical addiction, multiple sclerosis, developmental disabilities, spinal cord injuries, traumatic head injury, and incontinence. It should be accessible and affordable for all providers and designed to improve client safety and the highest quality of services in accordance with the intent of this chapter and recommendations provided by the stakeholder committee established in section 107 of this act. In an effort to improve access to training and education, especially for rural communities, and reduce costs, the coordinated system of long-term care education should include the use of distance learning using satellite technology coordinated through community colleges or other entities, as defined by the department, and the development and use of other innovative types of learning strategies;

(7) Promote options for seeking and obtaining public and private alternative funding for long-term care services, such as federal waivers and demonstration projects that will allow for the most effective use of federal medicaid and medicare funding, long-term care insurance options as part of overall health care insurance benefits, innovative social health maintenance organization models or other managed care models that are designed to encourage economic efficiencies and better coordinate care between acute and chronic long-term care, and a uniform fee copayment scale collected by the department for client participation in state-funded, long-term care programs for the elderly, which does not include clients of the subdivisions of developmental disabilities and mental health; and

(8) Consider other issues deemed appropriate by the governor, legislature, secretary, or the committee established in section 107 of this act that are consistent with the objectives set forth in this chapter and allocated in the budget.

NEW SECTION. Sec. 105. (1) No additional state employees shall be hired as a result of establishing the division, however the department may hire or assign additional employees to monitor facilities licensed under chapter 18.20 RCW and shall maintain sufficient employees to adequately monitor all long-term care facilities if funds are allocated.

(2) Any funds saved because of the elimination of management level positions within the new division shall be redirected to direct long-term care services and quality assurance and complaint investigations provided by the department.

NEW SECTION. Sec. 106. GUIDING PRINCIPLES. The division shall provide leadership and coordination in identifying and resolving barriers to receiving safe, client and family-centered, long-term care services in accordance with the following principles:

(1) Clear lines of balanced authority and coordination that avoid duplications and fragmentation within and between subelements of the department for service delivery, financing, and quality assurance;

(2) A simplified organizational design promoting accessibility, responsiveness, and accountability to persons receiving services and their families, the legislature, and the general public;

(3) A coordinated organizational structure for managing the division's programs and activities that is client-centered and encourages consistent joint working agreements with and between all long-term care programs;

(4) Decentralized authority and responsibility, with clear accountability;

(5) Effective strategies for implementing and enforcing long-term care quality standards and educational and training standards;

(6) Expert advice and information on chronic long-term care issues to families, providers, and the executive and legislative branches of state government;

(7) Uniform, active, and fair enforcement of rules;

(8) Effective coordination, cooperation, and innovation by facilitating the meaningful participation of persons with functional disabilities and their families, employees, vendors, elements of the civil society, community advocates, and other federal, state, and local governmental agencies in the planning, development, and implementation of programs and services consistent with the intent of this chapter;

(9) A fair and realistic system for measuring both short-range and long-range progress; and

(10) Continually striving to simplify, reduce, or eliminate unnecessary rules, procedures, and burdensome paperwork that prove to be barriers to providing effective coordination or high quality direct services.

NEW SECTION. Sec. 107. DEPARTMENTAL COMMITTEE ON LONG-TERM CARE REORGANIZATION. A departmental committee on long-term care reorganization, hereafter referred to in this section as the committee, shall be appointed by the secretary as soon as practical, but not later than July 1, 1997.

The committee shall be composed of high-ranking administrators of departmental programs that are being transferred to the division to be selected by the secretary and a related direct service employee, who shall be nominated to the secretary by the appropriate employee organizations. The assistant secretary of the division shall be the chair of the committee.

The committee shall establish technical advisory panels composed of balanced representation of all types of persons served by the division to provide expert technical assistance on matters necessary to implement this act.

The committee has the following duties:

(1) Ensure that all appropriate interests participate in the departmental reorganization activities;

(2) Oversee the development, revision, implementation, and enforcement of all quality assurance measures;

(3) Report the following to the appropriate committees of the legislature, no later than December 1, 1997:

(a) Methods of cost-efficiencies that can be used to reallocate funds to unmet needs in direct services;

(b) 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 how to integrate such services into the new division to conform with the intent of chapter . . ., Laws of 1997 (this act);

(d) An analysis of the desirability and feasibility of establishing a voucher-type, pilot project;

(e) Present recommendations provided by the department of community, trade, and economic development to establish a long-term care ombudsman program that will cover all persons who are functionally disabled;

(f) Necessary modifications of the case management system and management information systems to fully implement chapter . . ., Laws of 1997 (this act);

(g) Federal waivers necessary to implement chapter . . ., Laws of 1997 (this act); and

(h) Recommend legislation necessary to implement changes proposed by the committee to the joint legislative committee on long-term care oversight;

(4) The department shall make the committee recommendations available to the public in a timely manner and report quarterly to the joint legislative committee on long-term care oversight established in section 108 of this act.

This section expires March 1, 2001.

NEW SECTION. Sec. 108. JOINT LEGISLATIVE COMMITTEE ON LONG-TERM CARE OVERSIGHT. (1) There is created a joint legislative committee on long-term care oversight. The committee shall consist of: (a) Three members of the senate appointed by the president of the senate, two of whom shall be members of the majority party and one of whom shall be a member of the minority party; and (b) three members of the house of representatives, two of whom shall be members of the majority party and one of whom shall be a member of the minority party.

(2) The committee shall elect a chair and vice-chair. The chair shall be a member of the senate in even-numbered years and a member of the house of representatives in odd-numbered years. The vice-chair shall be a member of the senate in odd-numbered years and a member of the house of representatives in even-numbered years.

(3) The committee shall:

(a) Review all reorganization and reform activities necessary to implement chapter . . ., Laws of 1997 (this act);

(b) Review all quality standards developed, revised, and enforced by the department;

(c) Initiate or review studies relevant to the issues of administration, delivery, and quality of long-term care services;

(d) Review all rules proposed by the department to ensure consistency with the intent, guiding principles, and duties and responsibilities of the division;

(e) Report to the legislature the progress on reorganization and reform consistent with chapter . . ., Laws of 1997 (this act);

(f) Act upon the recommendations of the reorganization and oversight stakeholders committee; and

(g) Prepare legislation necessary to implement the intent of chapter . . ., Laws of 1997 (this act).

(4) This section expires March 1, 2001.

PART II

FUNCTIONS TRANSFERRED TO THE DIVISION OF LONG-TERM CARE SERVICES

NEW SECTION. Sec. 201. A new section is added to chapter 43.20A RCW to read as follows:

The department shall establish a division of long-term care services. The department shall transfer the following programs and services, and the programs and services related to boarding homes under chapter 18.20 RCW that were transferred to the department under section 202 of this act, and related management and support services to the division of long-term care services:

Title 71 RCW - Mental illness programs;

Title 71A RCW - Developmental disabilities;

Chapter 72.06 RCW - Mental health;

Chapter 72.23 RCW - Public and private facilities for mentally ill;

Chapter 72.25 RCW - Nonresident mentally ill, sexual psychopaths, and psychopathic delinquents‑-Deportation transportation;

Chapter 72.27 RCW - Interstate compact on mental health;

Chapter 72.29 RCW - Multi-use facilities for the mentally or physically handicapped or the mentally ill;

Chapter 70.10 RCW - Comprehensive community health centers;

Chapter 70.82 RCW - Cerebral palsy program;

Chapter 70.124 RCW - Abuse of patients‑-Nursing homes, state hospitals;

Chapter 70.128 RCW - Adult family homes;

Chapter 70.129 RCW - Long-term care resident rights;

Chapter 74.26 RCW - Services for children with multiple handicaps;

Chapter 74.34 RCW - Abuse of vulnerable adults;

Chapter 74.36 RCW - Funding for community programs for the aging;

Chapter 74.39 RCW - Long-term care service options;

Chapter 74.41 RCW - Respite care services;

Chapter 74.42 RCW - Nursing homes‑-Resident care, operating standards;

Chapter 74.46 RCW - Nursing home auditing and cost reimbursement act of 1980;

Chapter 74.39A RCW - Long-term care services options‑-Expansion;

Chapter 18.48 RCW - Adult family homes;

Chapter 18.51 RCW - Nursing homes; and

Chapter 10.77 RCW - Criminally insane.

NEW SECTION. Sec. 202. A new section is added to chapter 18.20 RCW to read as follows:

(1) All powers, duties, and functions of the department of health pertaining to boarding homes are transferred to the department of social and health services. All references to the secretary or the department of health in the Revised Code of Washington shall be construed to mean the secretary or the department of social and health services when referring to the functions transferred in this section.

(2)(a) All reports, documents, surveys, books, records, files, papers, or written material in the possession of the department of health pertaining to the powers, functions, and duties transferred shall be delivered to the custody of 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 shall be made available to the department of social and health services. All funds, credits, or other assets held in connection with the powers, functions, and duties transferred shall be assigned to the department of social and health services.

(b) Any appropriations made to the department of health for carrying out the powers, functions, and duties transferred shall, on the effective date of this section, be transferred and credited to the department of social and health services.

(c) Whenever any question arises as to the transfer of any personnel, funds, books, documents, records, papers, files, equipment, or other tangible property used or held in the exercise of the powers and the performance of the duties and functions transferred, the director of financial management shall make a determination as to the proper allocation and certify the same to the state agencies concerned.

(3) All employees of the department of health engaged in performing the powers, functions, and duties transferred are transferred to the jurisdiction of the department of social and health services. All employees classified under chapter 41.06 RCW, the state civil service law, are assigned to the department of social and health services to perform their usual duties upon the same terms as formerly, without any loss of rights, subject to any action that may be appropriate thereafter in accordance with the laws and rules governing state civil service.

(4) All rules and all pending business before the department of health pertaining to the powers, functions, and duties transferred shall be continued and acted upon by the department of social and health services. All existing contracts and obligations shall remain in full force and shall be performed by the department of social and health services.

(5) The transfer of the powers, duties, functions, and personnel of the department of health shall not affect the validity of any act performed before the effective date of this section.

(6) If apportionments of budgeted funds are required because of the transfers directed 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 appropriate transfer and adjustments in funds and appropriation accounts and equipment records in accordance with the certification.

(7) Nothing contained in this section may be construed to alter any existing collective bargaining unit or the provisions of any existing collective bargaining agreement until the agreement has expired or until the bargaining unit has been modified by action of the personnel board as provided by law.

PART III

QUALITY STANDARDS AND COMPLAINT ENFORCEMENT

NEW SECTION. Sec. 301. A new section is added to chapter 70.124 RCW to read as follows:

(1) An employee who is a whistleblower and who as a result of being a whistleblower has been subjected to workplace reprisal or retaliatory action, has the remedies provided under chapter 49.60 RCW. RCW 4.24.500 through 4.24.520, providing certain protection to persons who communicate to government agencies, apply to complaints made under this section. The identity of a whistleblower who complains, in good faith, to the department about suspected abuse, neglect, financial exploitation, or abandonment by any person in a nursing home, state hospital, boarding home, or adult family home may remain confidential if requested. The identity of the whistleblower shall subsequently remain confidential unless the department determines that the complaint was not made in good faith.

(2)(a) An attempt to discharge a resident from a nursing home, state hospital, adult family home, or boarding home, or any type of discriminatory treatment of a resident by whom, or upon whose behalf, a complaint substantiated by the department has been submitted to the department or any proceeding instituted under or related to this chapter within one year of the filing of the complaint or the institution of the action, raises a rebuttable presumption that the action was in retaliation for the filing of the complaint.

(b) The presumption is rebutted by credible evidence establishing the alleged retaliatory action was initiated prior to the complaint.

(c) The presumption is rebutted by a functional assessment conducted by the department that shows that the resident's needs cannot be met by the reasonable accommodations of the facility due to the increased needs of the resident.

(3) For the purposes of this section:

(a) "Whistleblower" means a resident or employee of a nursing home, state hospital, boarding home, or adult family home, or any person licensed under Title 18 RCW, who in good faith reports alleged abuse or neglect to the department or to a law enforcement agency; and

(4) This section does not prohibit a nursing home, state hospital, boarding home, or adult family home from exercising its authority to terminate, suspend, or discipline an employee who engages in workplace reprisal or retaliatory action against a whistleblower. The protections provided to whistleblowers under this chapter shall not prevent a nursing home, state hospital, boarding home, or adult family home from: (a) Terminating, suspending, or disciplining a whistleblower for other lawful purposes; or (b) for facilities with fewer than six residents, reducing the hours of employment or terminating employment as a result of the demonstrated inability to meet payroll requirements. The department shall determine if the facility cannot meet payroll in cases where a whistleblower has been terminated or had hours of employment reduced due to the inability of a facility to meet payroll.

(5) The department shall adopt rules to implement procedures for filing, investigation, and resolution of whistleblower complaints that are integrated with complaint procedures under this chapter.

(6) The department shall develop remedies that discourage whistleblowers who report complaints that are made in bad faith or for retaliatory purposes.

NEW SECTION. Sec. 302. A new section is added to chapter 74.34 RCW to read as follows:

(1) An employee who is a whistleblower and who as a result of being a whistleblower has been subjected to workplace reprisal or retaliatory action, has the remedies provided under chapter 49.60 RCW. RCW 4.24.500 through 4.24.520, providing certain protection to persons who communicate to government agencies, apply to complaints made under this section. The identity of a whistleblower who complains, in good faith, to the department about suspected abuse, neglect, exploitation, or abandonment by any person in a boarding home licensed or required to be licensed pursuant to chapter 18.20 RCW may remain confidential if requested. The identity of the whistleblower shall subsequently remain confidential unless the department determines that the complaint was not made in good faith.

(2)(a) An attempt to expel a resident from a boarding home, or any type of discriminatory treatment of a resident by whom, or upon whose behalf, a complaint substantiated by the department has been submitted to the department or any proceeding instituted under or related to this chapter within one year of the filing of the complaint or the institution of the action, raises a rebuttable presumption that the action was in retaliation for the filing of the complaint.

(b) The presumption is rebutted by credible evidence establishing the alleged retaliatory action was initiated prior to the complaint.

(3) For the purposes of this section:

(a) "Whistleblower" means a resident or employee of a boarding home, or any person licensed under Title 18 RCW, who in good faith reports alleged abuse or neglect to the department or to a law enforcement agency; and

(b) "Workplace reprisal or retaliatory action" means, but is not limited to: Denial of adequate staff to perform duties; frequent staff changes; frequent and undesirable office changes; refusal to assign meaningful work; unwarranted and unsubstantiated report of misconduct under Title 18 RCW; letters of reprimand or unsatisfactory performance evaluations; demotion; denial of employment; or a supervisor or superior encouraging coworkers to behave in a hostile manner toward the whistleblower. The protections provided to whistleblowers under this chapter shall not prevent a nursing home, state hospital, boarding home, or adult family home from: (i) Terminating, suspending, or disciplining a whistleblower for other lawful purposes; or (ii) for facilities with fewer than six residents, reducing the hours of employment or terminating employment as a result of the demonstrated inability to meet payroll requirements. The department shall determine if the facility cannot meet payroll in cases in which a whistleblower has been terminated or had hours of employment reduced because of the inability of a facility to meet payroll.

(4) This section does not prohibit a boarding home from exercising its authority to terminate, suspend, or discipline any employee who engages in workplace reprisal or retaliatory action against a whistleblower. The protections provided to whistleblowers under this chapter shall not prevent a whistleblower from being terminated, suspended, or disciplined for other lawful purposes.

(5) The department shall adopt rules to implement procedures for filing, investigation, and resolution of whistleblower complaints that are integrated with complaint procedures under this chapter.

(6) No frail elder or vulnerable person who relies upon and is being provided spiritual treatment in lieu of medical treatment in accordance with the tenets and practices of a well-recognized religious denomination shall for that reason alone be considered abandoned, abused, or neglected, nor shall anything in this chapter be construed to authorize, permit, or require medical treatment contrary to the stated or clearly implied objection of such a person.

Sec. 303. RCW 70.129.030 and 1994 c 214 s 4 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 maintain individuals whose needs it can safely and appropriately serve in the facility with current staff or through the provision of reasonable accommodations within the scope of its license or contract and required by state or federal law. Except in cases of emergency, facilities shall not admit a medicaid eligible individual before obtaining a comprehensive assessment of the resident's needs and preferences. The assessment shall contain, unless unavailable despite the best efforts of the facility and other interested parties and with existing funds, the following information: Recent medical history; necessary and prohibited medications; a medical professional's diagnosis; 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 issues important to the potential resident, such as food and daily routine. 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; (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 unusual circumstances, 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) 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 resident abuse, neglect, and misappropriation of resident property in the facility.

(5) 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.

(6) This section applies to long-term care facilities covered under this chapter.

Sec. 304. RCW 70.129.110 and 1994 c 214 s 12 are each amended to read as follows:

(1) The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless:

(a) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;

(b) The safety of individuals in the facility is endangered;

(d) The resident has failed to make the required payment for his or her stay; or

(e) The facility ceases to operate.

(2) All long-term care facilities shall fully disclose to potential residents who are medicaid eligible or their legal representative the service capabilities of the facility prior to admission to the facility. If the care needs of the potential resident are in excess of the facility's service capabilities, the department shall identify other care settings or residential care options consistent with federal law.

(3) Before a long-term care facility transfers or discharges a resident, the facility must:

(a) First attempt through reasonable accommodations, within the scope of its license or contract, to avoid the transfer or discharge, unless agreed to by the resident;

(b) Notify the resident and representative and make a reasonable effort to notify, if known, an interested family member of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand;

((~~(b)~~)) (c) Record the reasons in the resident's record; and

((~~(c)~~)) (d) Include in the notice the items described in subsection ((~~(4)~~)) (5) of this section.

((~~(3)~~)) (4)(a) Except when specified in this subsection, the notice of transfer ((~~of [or]~~)) or discharge required under subsection ((~~(2)~~)) (3) of this section must be made by the facility at least thirty days before the resident is transferred or discharged.

(b) Notice may be made as soon as practicable before transfer or discharge when:

(i) The safety of individuals in the facility would be endangered;

(ii) The health of individuals in the facility would be endangered;

(iii) An immediate transfer or discharge is required by the resident's urgent medical needs; or

(iv) A resident has not resided in the facility for thirty days.

((~~(4)~~)) (5) The written notice specified in subsection ((~~(2)~~)) (3) of this section must include the following:

(a) The reason for transfer or discharge;

(b) The effective date of transfer or discharge;

(d) The name, address, and telephone number of the state long-term care ombudsman;

(e) For residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled individuals established under part C of the developmental disabilities assistance and bill of rights act; and

(f) For residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals established under the protection and advocacy for mentally ill individuals act.

((~~(5)~~)) (6) A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.

((~~(6)~~)) (7) A resident discharged in violation of this section has the right to be readmitted immediately upon the first availability of a gender-appropriate bed in the facility.

Sec. 305. RCW 70.129.150 and 1994 c 214 s 16 are each amended to read as follows:

(1) Prior to admission, all long-term care facilities or nursing facilities licensed under chapter 18.51 RCW that require payment of an admissions fee, deposit, advance notice before transferring from the facility, or a minimum stay fee, by or on behalf of a person seeking ((~~admissions [admission]~~)) admission to the long-term care facility or nursing facility, shall provide the resident, or his or her representative, full disclosure in writing ((~~of the long-term care facility or nursing facility's schedule of charges for items and services provided by the facility and~~)) in a language the resident or his or her representative understands, a statement of the amount of any admissions fees, deposits, prepaid charges, or minimum stay fees. In addition, the long-term care facility or nursing facility shall also fully disclose in writing prior to admission what portion of the deposits, admissions fees, prepaid charges, or minimum stay fees will be refunded to the resident or his or her representative if the resident leaves the long-term care facility or nursing facility. Receipt of the disclosures required under this subsection must be acknowledged in writing. If the facility does not provide these disclosures, the deposits, admissions fees, prepaid charges, or minimum stay fees may not be kept by the facility. If a resident((~~, during the first thirty days of residence,~~)) dies or is hospitalized or is transferred to another facility for more appropriate care and does not return to the original facility, the facility shall refund any deposit or charges already paid less the facility's per diem rate for the days the resident actually resided or reserved or retained a bed in the facility notwithstanding any minimum stay policy or discharge notice requirements, except that the facility may retain an additional amount to cover its reasonable, actual expenses incurred as a result of a resident's move, not to exceed five days' per diem charges. All long-term care facilities or nursing facilities covered under this section are required to refund any and all refunds due the resident or ((~~their~~)) his or her representative within thirty days from the resident's date of discharge from the facility. Nothing in this section applies to provisions in contracts negotiated between a nursing facility or long-term care facility and a certified health plan, health or disability insurer, health maintenance organization, managed care organization, or similar entities.

(2) Where a long-term care facility or nursing facility requires the execution of an admission contract by or on behalf of an individual seeking admission to the facility, the terms of the contract shall be consistent with the requirements of this section, and the terms of an admission contract by a long-term care facility shall be consistent with the requirements of this chapter.

Sec. 306. RCW 74.39A.030 and 1995 1st sp.s. c 18 s 2 are each amended 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, neither the department nor the department of health 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 or an enhanced adult residential care 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 or enhanced adult residential care services.

Sec. 307. RCW 74.39A.040 and 1995 1st sp.s. c 18 s 6 are each amended to read as follows:

The department shall work in partnership with hospitals, who choose to participate, in assisting patients and their families to find long-term care services of their choice according to subsections (1) through (4) of this section. 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

Sec. 308. RCW 74.39A.050 and 1995 1st sp.s. c 18 s 12 are each amended 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~~)) client-centered and promote privacy, independence, dignity, choice, and a home or home-like environment for consumers consistent with chapter . . ., Laws of 1997 (this act).

(2) The goal of the system is continuous quality improvement with the focus on consumer satisfaction and outcomes for consumers. This includes that when conducting licensing inspections, the department shall interview an appropriate percentage of residents, family members, resident managers, and advocates in addition to interviewing providers and staff.

(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 and a clear set of health, quality of care, and safety standards that are easily understandable and have been made available to providers.

(6) Providers ((~~generally~~)) at all levels of care should be assisted in addressing identified problems initially through consultation and technical assistance, unless the safety, health, or well-being of a resident is seriously and immediately endangered. Prompt and specific enforcement remedies shall also be ((~~available~~)) implemented for providers found to have delivered care or failed to deliver care resulting in problems that are serious, recurring, or that have been uncorrected. These enforcement remedies must include, when appropriate, reasonable conditions on a contract or license.

(7) To the extent funding is available, providers at all levels and their staff should be screened through background checks in a uniform and timely manner to ensure that they do not have a criminal history that would disqualify them from working with vulnerable adults. Employees may be provisionally hired pending the results of the background check if they have been given three positive references.

(8) The department shall promote the development of a training system that is practical and relevant to the needs of residents, providers, and staff. To improve access to training, especially for rural communities, the training system may include, but is not limited to, the use of satellite technology distance learning that is coordinated through community colleges.

(9) No provider or staff, or prospective provider or staff, with a stipulated finding of fact, conclusion of law, and agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into the state registry finding him or her guilty of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW shall be employed in the care of and have unsupervised access to vulnerable adults.

(10) Under existing funds the department shall establish a quality improvement standards committee to review and implement the principles set forth in chapter . . ., Laws of 1997 (this act).

Sec. 309. RCW 74.39A.060 and 1995 1st sp.s. c 18 s 13 are each amended to read as follows:

(1) The ((~~aging and adult services administration~~)) long-term care division of the department shall establish and maintain a toll-free telephone number for receiving complaints regarding a facility that the ((~~administration~~)) department 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~~)) long-term care division to provide chronic 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 and the toll-free number and program description of the long-term care ombudsman as provided by RCW 43.190.050.

(3) The ((~~aging and adult services administration~~)) long-term care division 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; or (b) there is no reasonable basis for investigation; or (c) corrective action has been taken as determined by the ombudsman or the department.

(4) The ((~~aging and adult services administration~~)) long-term care division 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 or if its investigation reveals that a follow-up referral to one or more of these entities is appropriate.

(5) The department shall adopt rules that include the following complaint investigation protocols:

(a) Upon receipt of a complaint, the department shall make a preliminary review of the complaint, assess the severity of the complaint, and assign an appropriate response time. Complaints involving imminent danger to the health, safety, or well-being of a resident must be responded to within two days. When appropriate, the department shall make an on-site investigation within a reasonable time after receipt of the complaint or otherwise ensure that complaints are responded to.

(b) The complainant must be: Promptly contacted by the department and informed of the right to meet the inspector at the site of the alleged violations, unless the inspector determines that the privacy of residents would be violated or compromised thereby or the investigator determines that imminent danger to the resident necessitates an initial response before the complainant is available; informed of the department's proposed course of action; and informed of the right to receive a written copy of the investigation report.

(c) In conducting the investigation, the department shall interview the complainant, unless anonymous, and shall use its best efforts to interview the resident or residents allegedly harmed by the violations, and, in addition to facility staff, any available independent sources of relevant information, including if appropriate the family members of the resident.

(d) Substantiated complaints involving harm to residents may be sanctioned according to RCW 74.39A.080 or 18.20.190 or chapter 18.51 RCW. Whenever appropriate, the department shall also give consultation and technical assistance to the provider.

(e) In the best practices of total quality management and continuous quality improvement, after a department finding of a violation that is serious, recurring, or uncorrected following a previous citation, the department shall make an on-site revisit of the facility to ensure correction of the violation.

(f) Substantiated complaints of neglect, abuse, exploitation, or abandonment of residents, or suspected criminal violations, shall also be referred by the department to the appropriate law enforcement agencies, the attorney general, and appropriate professional disciplinary boards.

(6) The department may ((~~not~~)) provide the substance of the complaint to the licensee or contractor before the completion of the investigation by the department unless such disclosure would reveal the identity of a complainant, witness, or resident who chooses to remain anonymous. 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, or reasonably lead to the disclosure of, the name, title, or identity of any complainant, or other person mentioned in the complaint, except that the name of the provider and the name or names of any officer, employee, or agent of the department conducting the investigation shall be disclosed after the investigation has been closed and the complaint has been substantiated. The department may disclose the identity of the complainant if such disclosure is requested in writing by the complainant. Nothing in this subsection shall be construed to interfere with the obligation of the long-term care ombudsman program to monitor the department's licensing, contract, and complaint investigation files for long-term care facilities.

((~~(6)~~)) (7) The resident has the right to be free of interference, coercion, discrimination, and reprisal from a facility in exercising his or her rights, including the right to voice grievances about treatment furnished or not furnished. A facility that provides long-term care services shall not discriminate or retaliate in any manner against a resident, employee, or any other person on the basis or for the reason that such resident or any other person made a complaint to the department, the attorney general, law enforcement agencies, or the long-term care ombudsman, provided information, or otherwise cooperated with the investigation of such a complaint. Any attempt to discharge a resident against the resident's wishes, or any type of retaliatory treatment of a resident by whom or upon whose behalf a complaint substantiated by the department has been made to the department, the attorney general, law enforcement agencies, or the long-term care ombudsman, within six months of the filing of the complaint, raises a rebuttable presumption that such action was in retaliation for the filing of the complaint. "Retaliatory treatment" means, but is not limited to, monitoring a resident's phone, mail, or visits; involuntary seclusion or isolation; transferring a resident to a different room unless requested or based upon legitimate management reasons; withholding or threatening to withhold food or treatment; or persistently delaying responses to a resident's request for service or assistance. A facility that provides long-term care services shall not willfully interfere with the performance of official duties by a long-term care ombudsman. The department shall sanction and 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. 310. RCW 70.129.105 and 1994 c 214 s 17 are each amended to read as follows:

No long-term care facility or nursing facility licensed under chapter 18.51 RCW shall require or request residents to sign waivers of potential liability for losses of personal property or injury, or to sign waivers of residents' rights set forth in this chapter or in the applicable licensing or certification laws.

Sec. 311. RCW 74.42.030 and 1979 ex.s. c 211 s 3 are each amended to read as follows:

Each resident or guardian or legal representative, if any, shall be fully informed and receive in writing, in a language the resident or his or her representative understands, the following information:

(1) The resident's rights and responsibilities in the facility;

(2) Rules governing resident conduct;

(3) Services, items, and activities available in the facility; and

(4) Charges for services, items, and activities, including those not included in the facility's basic daily rate or not paid by medicaid.

The facility shall provide this information before ((~~or at the time of~~)) admission and as changes occur during the resident's stay. The resident and his or her representative must be informed in writing in advance of changes in the availability or charges for services, items, or activities, or of changes in the facility's rules. Except in unusual circumstances, thirty days' advance notice must be given prior to the change. The resident or legal guardian shall acknowledge in writing receipt of this information ((~~and any changes in the information~~)).

The written information provided by the facility pursuant to this section, and the terms of any admission contract executed between the facility and an individual seeking admission to the facility, must be consistent with the requirements of this chapter and chapter 18.51 RCW and, for facilities certified under medicaid or medicare, with the applicable federal requirements.

PART IV

ESTATE RECOVERY CONSUMER DISCLOSURE

NEW SECTION. Sec. 401. A new section is added to chapter 43.20B RCW to read as follows:

(1) It is the intent of the legislature to ensure that needy individuals have access to basic long-term care without requiring them to sell their homes. In the face of rising medical costs and limited funding for social welfare programs, however, the state's medicaid and state-funded long-term care programs have placed an increasing financial burden on the state. By balancing the interests of individuals with immediate and future unmet medical care needs, surviving spouses and dependent children, adult nondependent children, more distant heirs, and the state, the estate recovery provisions of RCW 43.20B.080 and 74.39A.170 provide an equitable and reasonable method of easing the state's financial burden while ensuring the continued viability of the medicaid and state-funded long-term care programs.

(2) It is further the intent of the legislature to confirm that chapter 21, Laws of 1994, effective July 1, 1994, repealed and substantially reenacted the state's medicaid estate recovery laws and did not eliminate the department's authority to recover the cost of medical assistance paid prior to October 1, 1993, from the estates of deceased recipients regardless of whether they died before, on, or after July 1, 1994.

Sec. 402. RCW 43.20B.080 and 1995 1st sp.s. c 18 s 67 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~~)) consistent with 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 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.

(4) The provision that relates to the elimination of the community property agreement exemption to recovery made by chapter . . ., Laws of 1997 (this act) applies as follows:

(a) If a recipient received assistance subject to estate recovery on or after the effective date of this section, the department may recover from the estate or nonprobate assets of a deceased recipient the cost of all the assistance received, whenever received, in accordance with the law in effect at the time the benefit was received; and

(b) If a recipient does not receive assistance subject to estate recovery on or after the effective date of this section, but did receive the assistance before the effective date of this section, the department may recover from the estate or nonprobate assets of a deceased recipient the cost of all the assistance received, whenever received, in accordance with the law in effect at the time of the last assistance payment made by the department on the recipient's behalf.

(5)(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.

(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)~~)) (6) A lien authorized under subsections (1) through (5) of this section relates back to attach to any real property that the decedent had an ownership interest in immediately before death and is effective as of that date.

(7) 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. 403. RCW 74.34.010 and 1995 1st sp.s. c 18 s 82 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.

It is further the intent of the legislature that the cost of protective services rendered to a frail elder or vulnerable adult under this chapter that are paid with state funds only not be subject to recovery from the recipient or the recipient's estate, whether by lien, adjustment, or any other means of recovery, regardless of the income or assets of the recipient of the services. In making this exemption the legislature recognizes that receipt of such services is voluntary and incentives to decline services or delay permission must be kept to a minimum. There may be a need to act or intervene quickly to protect the assets, health, or well-being of a frail elder or vulnerable adult; to prevent or halt the exploitation, neglect, abandonment, or abuse of the person or assets of a frail elder or vulnerable adult; or to prevent or limit inappropriate placement or retention in an institution providing long-term care. The delivery of such services is less likely to be impeded, and consent to such services will be more readily obtained, if the cost of these services is not subject to recovery. The legislature recognizes that there will be a cost in not seeking financial recovery for such services, but that this cost may be offset by preventing costly and inappropriate institutional placement.

NEW SECTION. Sec. 404. A new section is added to chapter 74.34 RCW to read as follows:

The cost of benefits and services provided to a frail elder or vulnerable adult under this chapter with state funds only does not constitute an obligation or lien and is not recoverable from the recipient of the services or from the recipient's estate, whether by lien, adjustment, or any other means of recovery.

Sec. 405. RCW 74.39A.170 and 1995 1st sp.s. c 18 s 56 are each amended 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, except the cost of state-funded adult protective services provided under chapter 74.34 RCW to frail elders and vulnerable adults.

(2) In determining eligibility for state-funded long-term care services programs, except for protective services provided to frail elders and vulnerable adults, 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.

(3) It is the responsibility of the department to fully disclose in advance verbally and in writing, in easy to understand language, the terms and conditions of estate recovery. The disclosure must include billing and recovery and copayment procedures to all persons offered long‑term care services subject to recovery of payments.

(4) In disclosing estate recovery costs to potential clients and their family members, the department shall provide a written description of the community service options. The description must include supervision, wages, and the full direct and indirect costs associated with each care option offered.

(5) To the extent funds are available and in compliance with federal law, the department is responsible for also notifying the client, or his or her advocate, quarterly of the types of services used, charges for services, credit amount of copayment, and the difference (debt) that will be charged against the estate.

PART V

BOARDING HOME UNIFORM DISCIPLINARY ACT

NEW SECTION. Sec. 501. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Secretary" means the secretary of the department of health.

(2) "Boarding home" means a facility licensed under chapter 18.20 RCW.

(3) "Boarding home provider" means any individual, partnership, corporation, association, or limited liability company that is licensed under chapter 18.20 RCW to operate a boarding home.

(4) "Boarding home operator" means a person who is employed or otherwise is contracted with by the provider to manage a boarding home, or a provider who acts as a manager of the boarding home.

NEW SECTION. Sec. 502. (1) The secretary shall register boarding home operators and providers.

(2) The secretary, by policy or rule, shall define terms and establish forms and procedures for registration applications, including the payment of registration fees pursuant to RCW 43.70.250. An application for boarding home operator or provider registration must include at least the following information:

(a) Name and address;

(b) If the provider is a corporation, copies of its articles of incorporation and current bylaws, together with the names and addresses of its officers and directors; and

(3) The secretary shall adopt policies or rules to establish the registration periods, fees, and procedures. If the boarding home is sold or ownership or management is transferred, the registration is voided and the provider and operator must apply for a new registration.

NEW SECTION. Sec. 503. The uniform disciplinary act, chapter 18.130 RCW, governs the issuance and denial of registration and the discipline of persons registered under this chapter. The secretary is the disciplinary authority under this chapter.

NEW SECTION. Sec. 504. A provider who operates more than one boarding home must register for each separate location.

Sec. 505. RCW 18.20.040 and 1957 c 253 s 4 are each amended to read as follows:

(1) An application for a license shall be made to the department or authorized department upon forms provided by either of said departments and shall contain such information as the department reasonably requires, which shall include affirmative evidence of ability to comply with such rules and regulations as are lawfully promulgated by the board.

(2) Boarding home operators and boarding home providers, as defined in section 501 of this act, must register with the department of health under section 502 of this act.

Sec. 506. RCW 18.130.040 and 1996 c 200 s 32 and 1996 c 81 s 5 are each reenacted and amended to read as follows:

(1) This chapter applies only to the secretary and the boards and commissions having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.

(2)(a) The secretary has authority under this chapter in relation to the following professions:

(i) Dispensing opticians licensed under chapter 18.34 RCW;

(ii) Naturopaths licensed under chapter 18.36A RCW;

(iii) Midwives licensed under chapter 18.50 RCW;

(iv) Ocularists licensed under chapter 18.55 RCW;

(v) Massage operators and businesses licensed under chapter 18.108 RCW;

(vi) Dental hygienists licensed under chapter 18.29 RCW;

(vii) Acupuncturists licensed under chapter 18.06 RCW;

(viii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;

(ix) Respiratory care practitioners certified under chapter 18.89 RCW;

(x) Persons registered or certified under chapter 18.19 RCW;

(xi) Persons registered as nursing pool operators under chapter 18.52C RCW;

(xii) Nursing assistants registered or certified under chapter ((~~18.79~~)) 18.88A RCW;

(xiii) Health care assistants certified under chapter 18.135 RCW;

(xiv) Dietitians and nutritionists certified under chapter 18.138 RCW;

(xv) Sex offender treatment providers certified under chapter 18.155 RCW;

(xvi) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;

(xvii) Persons registered as adult family home providers and resident managers under RCW 18.48.020; ((~~and~~))

(xviii) Denturists licensed under chapter 18.30 RCW; and

(xix) Boarding home operators and providers registered under chapter 18.-- RCW (sections 501 through 504 of this act).

(b) The boards and commissions having authority under this chapter are as follows:

(i) The podiatric medical board as established in chapter 18.22 RCW;

(ii) The chiropractic quality assurance commission as established in chapter 18.25 RCW;

(iii) The dental quality assurance commission as established in chapter 18.32 RCW;

(iv) The board of hearing and speech as established in chapter 18.35 RCW;

(v) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;

(vi) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;

(vii) The board of osteopathic medicine and surgery as established in chapter 18.57 RCW governing licenses issued under chapters 18.57 and 18.57A RCW;

(viii) The board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;

(ix) The medical quality assurance commission as established in chapter 18.71 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;

(x) The board of physical therapy as established in chapter 18.74 RCW;

(xi) The board of occupational therapy practice as established in chapter 18.59 RCW;

(xii) The nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses issued under that chapter;

(xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW; and

(xiv) The veterinary board of governors as established in chapter 18.92 RCW.

(3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses based on the conditions and criteria established in this chapter and the chapters specified in subsection (2) of this section. This chapter also governs any investigation, hearing, or proceeding relating to denial of licensure or issuance of a license conditioned on the applicant's compliance with an order entered pursuant to RCW 18.130.160 by the disciplining authority.

(4) All disciplining authorities shall adopt procedures to ensure substantially consistent application of this chapter, the Uniform Disciplinary Act, among the disciplining authorities listed in subsection (2) of this section.

NEW SECTION. Sec. 507. The department of social and health services shall develop a plan for implementing a pilot program for accrediting boarding homes licensed under RCW 18.20.020 with a recognized national nongovernmental accreditation organization or an organization with experience in developing and implementing accreditation programs in at least two states. The pilot plan shall be developed with the input of residents, provider representatives, and other vested interest groups. The plan shall review the overall feasibility of implementation, cost or savings to the department of health, impact on client health and safety, and financial and other impacts to the boarding industry. The pilot boarding home accreditation plan shall be presented to the appropriate committees of the house of representatives and the senate by January 5, 1998.

PART VI

ADULT FAMILY HOMES

Sec. 601. RCW 70.128.175 and 1995 1st sp.s. c 18 s 29 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:

(a) "Adult family home" means a regular family abode ((of)) in which a person or persons ((~~providing~~)) provides 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.

(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. 602. The department of social and health services shall implement a limited moratorium on the authorization of adult family home licenses until December 12, 1997, or until the advisory committee has determined that all adult family home and group home safety and quality of care standards have been reviewed by the department, determined by the secretary to reasonably protect the life, safety, and health of residents, and has notified all adult family home and group home operators of the standards of care or any modifications to the existing standards. This limited moratorium shall in no way prevent a person eligible to receive services from receiving the same or equivalent chronic long‑term care services. In the event of a need for such services, the department shall develop a process for determining the availability of chronic long‑term care residential services on a case‑by‑case basis to determine if an adult family home license should be granted to accommodate the needs of a particular geographical or ethnic community. The secretary shall make the final determination on individual case licensure until December 12, 1997, or until the moratorium has been removed.

PART VII

MISCELLANEOUS PROVISIONS

NEW SECTION. Sec. 701. The department of community, trade, and economic development, in collaboration with the organizations designated by state or federal law to provide protection and advocacy and ombuds services for older Americans and people with disabilities using publicly funded long-term care residential services, shall conduct a study, make recommendations, and draft legislation necessary to implement changes that will result in a single coordinating umbrella for ombuds and advocacy services that maximizes efficiency, minimizes duplication, and allows for specialization in target populations such as developmental disabilities, older Americans, and mental illness, and assures that the providers of ombuds services have sufficient expertise and experience with target populations and the systems that serve them. The study shall include review of all relevant federal and state laws and regulations, including but not limited to the older Americans act, 42 U.S.C. 3001 as amended, the developmental disabilities assistance and bill of rights act as amended, 42 U.S.C. 6000, the protection and advocacy for persons with mental illness act as amended, 42 U.S.C. 10801, the rehabilitation act of 1973 as amended, 29 U.S.C. 701, the long-term care ombudsman statute chapter 43.190 RCW, developmental disabilities statute, Title 71A RCW, and the community mental health services regulations, chapter 275-57 WAC. The study shall identify the gaps in current ombuds and advocacy services, and develop a cost assessment for implementation of a comprehensive umbrella of ombuds and advocacy services. The department of community, trade, and economic development shall report to the appropriate committees of the house of representatives and the senate by January 10, 1998.

NEW SECTION. Sec. 702. The department of social and health services shall review the cost and feasibility of implementing developmental disabilities certification standards for community residential alternatives to ensure that services are adequate for the health, safety, care, treatment, and support of persons with developmental disabilities. The community residential alternatives shall include, but not be limited to, entities that contract or directly provide services with the division of developmental disabilities such as group homes, agency alternative living, intensive and other tenant support services, adult family homes, or boarding homes. Certification standards shall review at a minimum the following areas. Administrative and financial capabilities of the provider, health and safety practices, the opportunities for the individuals served by the programs to have power and choice in their lives, opportunities to develop friendships and relationships, and opportunities to develop self-respect and to gain respect from others, to participate in the community, and to gain independent living skills. The department shall also recommend whether adult family homes that choose to provide services only to persons with developmental disabilities should receive special certification or licensure apart from or in place of the existing adult family home license. The review shall also recommend the type and amount of provider training necessary to appropriately support persons with developmental disabilities in community residential alternatives. The department shall include the assistance of other departments, vested interest groups, and family members in the development of recommendations. The department shall report to the appropriate committees of the house of representatives and the senate by January 30, 1998.

NEW SECTION. Sec. 703. The following acts or parts of acts are each repealed:

(1) RCW 74.39.001 and 1989 c 427 s 1;

(2) RCW 74.39.005 and 1995 1st sp.s. c 18 s 10 & 1989 c 427 s 2;

(3) RCW 74.39.030 and 1989 c 427 s 11;

(4) RCW 74.39.040 and 1989 c 427 s 13;

(5) RCW 74.39A.005 and 1993 c 508 s 1;

(6) RCW 74.39A.007 and 1993 c 508 s 2; and

(7) RCW 74.39A.008 and 1995 1st sp.s. c 18 s 1.

NEW SECTION. Sec. 704. (1) Sections 102 through 108 of this act constitute a new chapter in Title 43 RCW.

(2) Sections 501 through 504 of this act constitute a new chapter in Title 18 RCW.

NEW SECTION. Sec. 705. Sections 107, 108, 401 through 405, 507, 602, 701, and 702 of this act are necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and take effect immediately.

NEW SECTION. Sec. 706. Part headings and captions used in this act are not part of the law.