BP BHEAD INT S [atlas:bill]

AN ACT Relating to the long-term care reorganization and standards of care reform act; amending RCW 9A.42.010, 9A.42.050, 9A.42.020, 9A.42.030, 9A.44.010, 9A.44.050, 9A.44.100, 18.130.200, 43.43.842, 70.124.020, 70.124.030, 70.124.040, 70.124.070, 70.129.030, 70.129.110, 70.129.150, 43.190.030, 43.190.070, 74.39A.030, 74.39A.040, 74.39A.050, 74.39A.060, 74.39A.080, 43.20B.080, 74.34.010, 74.39A.170, 18.20.040, 70.128.175, and 43.17.020; reenacting and amending RCW 18.130.040, 18.130.040, and 43.17.010; adding a new section to chapter 9A.42 RCW; adding a new section to chapter 70.124 RCW; adding new sections to chapter 74.34 RCW; adding new sections to chapter 43.20B RCW; adding a new section to chapter 41.06 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 an effective date; providing expiration dates; and declaring an emergency.

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

PART I

CREATING THE DEPARTMENT 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. If we are going 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 department.

It is the intent of this chapter to establish a new department, known as the department 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 facility licensed under chapter 70.128 RCW.

(2) "Adult residential care" means personal care services provided by a boarding home that is licensed under chapter 18.20 RCW and that has a contract with the department under 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 long-term care services.

(7) "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.

(8) "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.

(9) "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.

(10) "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.

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

(12) "Secretary" means the secretary of long-term care services.

(13) "Tribally licensed boarding home" means a boarding home licensed by a federally recognized Indian tribe which home provides services similar to boarding homes licensed under chapter 18.20 RCW.

NEW SECTION. Sec. 104. DEPARTMENT OF LONG-TERM CARE SERVICES. There is created a department of state government to be known as the department of long-term care services. The department is vested with all powers and duties transferred to it under this chapter and such other powers and duties as may be authorized by law. The main administrative office of the department must be located in the city of Olympia. The secretary may establish administrative facilities in other locations, if deemed necessary for the efficient operation of the department, and if consistent with the principles set forth in section 107 of this act.

NEW SECTION. Sec. 105. DUTIES AND RESPONSIBILITIES. The department 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 114 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 114 of this act that are consistent with the objectives set forth in this chapter and allocated in the budget.

NEW SECTION. Sec. 106. APPOINTMENT OF SECRETARY. The executive head and appointing authority of the department is the secretary. The secretary shall be appointed by the governor, with the consent of the senate, and shall serve at the pleasure of the governor. The secretary shall be paid a salary to be fixed by the governor in accordance with RCW 43.03.040.

NEW SECTION. Sec. 107. GUIDING PRINCIPLES. The department 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 department'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. 108. RULES REVIEW. In accordance with the administrative procedure act, chapter 34.05 RCW, the department shall ensure an opportunity for consultation, review, and comment by the department's clients and their families and other interested members of the public before the adoption of standards, guidelines, and rules.

NEW SECTION. Sec. 109. AUTHORITY OF THE SECRETARY. Consistent with the principles set forth in section 107 of this act, the secretary may create such administrative divisions, offices, bureaus, and programs within the department as necessary. The secretary has complete charge of, and supervisory powers over, the department, except where the secretary's authority is specifically limited by law.

NEW SECTION. Sec. 110. PERSONNEL. (1) The secretary shall appoint such personnel as are necessary to carry out the duties of the department in accordance with chapter 41.06 RCW.

(2) The secretary shall appoint the deputy secretaries, assistant secretaries, and other administrative positions as necessary and consistent with the principles set forth in this chapter. All persons who administer the necessary divisions, offices, bureaus, and programs and no more than five additional employees are exempt from the provisions of chapter 41.06 RCW. The officers and employees appointed under this section shall be paid salaries to be fixed by the governor in accordance with the procedure established by law for the fixing of salaries for officers exempt from the state civil service law.

NEW SECTION. Sec. 111. DELEGATION OF AUTHORITY. Any power or duty vested in or transferred to the secretary by law or executive order may be delegated by the secretary to the deputy secretary or to any other assistant or subordinate; but the secretary shall be responsible for the official acts of the officers and employees of the department.

NEW SECTION. Sec. 112. APPOINTMENT OF ADVISORY COMMITTEES OR COUNCILS BY THE SECRETARY. The secretary shall appoint advisory committees as required for receipt of federal funds by the department. The secretary may also appoint advisory committees, as deemed necessary, on subject matters within the department's responsibilities. The committees must have balanced representation of clients, private and public providers, and public employees.

Members of such state advisory committees may be paid their travel expenses in accordance with RCW 43.03.050 and 43.03.060.

NEW SECTION. Sec. 113. DEPARTMENT JURISDICTION IN RELATION TO FEDERAL LAW. In furtherance of the policy of the state to cooperate with the federal government in all of the programs under the jurisdiction of the department, such rules as may become necessary to entitle the state to participate in federal funds may be adopted, unless expressly prohibited by law. Any internal reorganization carried out under the terms of this chapter shall meet federal requirements that are a necessary condition to state receipt of federal funds. Any section or provision of law dealing with the department that may be susceptible to more than one construction shall be interpreted in favor of the construction most likely to comply with federal laws entitling this state to receive federal funds for the various programs of the department. If any law dealing with the department is ruled to be in conflict with federal requirements that are a prescribed condition of the allocation of federal funds to the state, or to any departments or agencies thereof, the conflicting part is declared to be inoperative solely to the extent of the conflict.

NEW SECTION. Sec. 114. 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 of social and health services 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 department of long-term care 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 secretary of social and health services shall be the chair of the committee; however, effective July 1, 1998, the secretary of long-term care shall assume all responsibilities of the secretary of social and health services as set forth in this section.

The committee shall establish technical advisory panels composed of balanced representation of all types of persons served by the department of long-term care and consistent with section 112 of this act 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 department 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, cash and counsel pilot project;

(e) Recommendations 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) Draft legislation necessary to implement changes proposed by the committee;

(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 115 of this act.

This section expires March 1, 2001.

NEW SECTION. Sec. 115. 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 department;

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

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

(4) This section expires March 1, 2001.

PART II

FUNCTIONS TRANSFERRED FROM DEPARTMENT OF SOCIAL AND

HEALTH SERVICES AND DEPARTMENT OF HEALTH

NEW SECTION. Sec. 201. (1) The powers and duties of the department of social and health services, the secretary of social and health services, the department of health, and the secretary of health under the following statutes, programs, and services, and related management and support services, presently administered by the department of social and health services or the department of health are hereby transferred to the department 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 18.20 RCW - Boarding homes;

Chapter 18.48 RCW - Adult family homes; and

Chapter 18.51 RCW - Nursing homes.

All references to the secretary of social and health services, the secretary of health, the department of social and health services, or the department of health in the Revised Code of Washington shall be construed to mean the secretary of long-term care services or the department of long-term care 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 social and health services or the department of health pertaining to the powers, functions, and duties transferred shall be delivered to the custody of the department of long-term care services. All cabinets, furniture, office equipment, motor vehicles, and other tangible property employed by the department of social and health services or the department of health in carrying out the powers, functions, and duties transferred shall be made available to the department of long-term care services. All funds, credits, or other assets held in connection with the powers, functions, and duties transferred shall be assigned to the department of long-term care services.

(b) Any appropriations made to the department of social and health services or 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 long-term care 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 social and health services or the department of health engaged in performing the powers, functions, and duties transferred are transferred to the jurisdiction of the department of long-term care services. All employees classified under chapter 41.06 RCW, the state civil service law, are assigned to the department of long-term care 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 social and health services or the department of health pertaining to the powers, functions, and duties transferred shall be continued and acted upon by the department of long-term care services. All existing contracts and obligations shall remain in full force and shall be performed by the department of long-term care services.

(5) The transfer of the powers, duties, functions, and personnel of the department of social and health services or 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

Sec. 301. RCW 9A.42.010 and 1996 c 302 s 1 are each amended to read as follows:

As used in this chapter:

(1) "Basic necessities of life" means food, water, shelter, clothing, and health care, including but not limited to health-related treatment or activities, hygiene, oxygen, and medication, but does not include the withholding or withdrawal of life-support treatment authorized by a terminally ill patient pursuant to law.

(2)(a) "Bodily injury" means physical pain or injury, illness, or an impairment of physical condition;

(b) "Substantial bodily harm" means bodily injury which involves a temporary but substantial disfigurement, or which causes a temporary but substantial loss or impairment of the function of any bodily part or organ, or which causes a fracture of any bodily part;

(c) "Great bodily harm" means bodily injury which creates a high probability of death, or which causes serious permanent disfigurement, or which causes a permanent or protracted loss or impairment of the function of any bodily part or organ.

(3) "Child" means a person under eighteen years of age.

(4) "Dependent person" means a person who, because of physical or mental disability, or because of extreme advanced age, is dependent upon another person to provide the basic necessities of life. A frail elder or vulnerable adult is presumed to be a dependent person for purposes of this chapter and includes any person admitted to any long-term care facility that is licensed or is required to be licensed under chapter 18.20, 18.51, 72.36, or 70.128 RCW and any person who is receiving services from home health, hospice, or home care agencies licensed or required to be licensed under chapter 70.127 RCW.

(5) "Employed" means hired by a dependent person, another person acting on behalf of a dependent person, or by an organization or governmental entity, to provide to a dependent person any of the basic necessities of life. A person may be "employed" regardless of whether the person is paid for the services or, if paid, regardless of who pays for the person's services.

(6) "Parent" has its ordinary meaning and also includes a guardian and the authorized agent of a parent or guardian.

(7) "Abandons" means leaving a child or other dependent person without the means or ability to obtain one or more of the basic necessities of life.

Sec. 302. RCW 9A.42.050 and 1986 c 250 s 5 are each amended to read as follows:

In any prosecution for criminal mistreatment, it shall be a defense that the withholding of the basic necessities of life is due to financial inability only if the person charged has made a reasonable effort to obtain adequate assistance. This defense is not available to persons in the business of providing care who have been paid for the delivery of such care.

Sec. 303. RCW 9A.42.020 and 1986 c 250 s 2 are each amended to read as follows:

(1) A parent of a child ((or)), the person entrusted with the physical custody of a child or dependent person, or a person employed to provide to the child or dependent person the basic necessities of life is guilty of criminal mistreatment in the first degree if he or she recklessly causes great bodily harm to a child or dependent person by withholding any of the basic necessities of life.

(2) Criminal mistreatment in the first degree is a class B felony.

Sec. 304. RCW 9A.42.030 and 1986 c 250 s 3 are each amended to read as follows:

(1) A parent of a child ((or)), the person entrusted with the physical custody of a child or dependent person, or a person employed to provide to the child or dependent person the basic necessities of life is guilty of criminal mistreatment in the second degree if he or she recklessly either (a) creates an imminent and substantial risk of death or great bodily harm, or (b) causes substantial bodily harm by withholding any of the basic necessities of life.

(2) Criminal mistreatment in the second degree is a class C felony.

NEW SECTION. Sec. 305. A new section is added to chapter 9A.42 RCW to read as follows:

(1) A person is guilty of the crime of criminal mistreatment in the third degree if the person is the parent of a child, is a person entrusted with the physical custody of a child or other dependent person, or is a person employed to provide to the child or dependent person the basic necessities of life, and either:

(a) With criminal negligence the person creates an imminent and substantial risk of bodily injury to a child or dependent person by withholding any of the basic necessities of life; or

(b) With criminal negligence the person causes bodily injury to a child or dependent person by withholding any of the basic necessities of life.

(2) Criminal mistreatment in the third degree is a gross misdemeanor.

Sec. 306. RCW 9A.44.010 and 1994 c 271 s 302 are each amended to read as follows:

As used in this chapter:

(1) "Sexual intercourse" (a) has its ordinary meaning and occurs upon any penetration, however slight, and

(b) Also means any penetration of the vagina or anus however slight, by an object, when committed on one person by another, whether such persons are of the same or opposite sex, except when such penetration is accomplished for medically recognized treatment or diagnostic purposes, and

(c) Also means any act of sexual contact between persons involving the sex organs of one person and the mouth or anus of another whether such persons are of the same or opposite sex.

(2) "Sexual contact" means any touching of the sexual or other intimate parts of a person done for the purpose of gratifying sexual desire of either party or a third party.

(3) "Married" means one who is legally married to another, but does not include a person who is living separate and apart from his or her spouse and who has filed in an appropriate court for legal separation or for dissolution of his or her marriage.

(4) "Mental incapacity" is that condition existing at the time of the offense which prevents a person from understanding the nature or consequences of the act of sexual intercourse whether that condition is produced by illness, defect, the influence of a substance or from some other cause.

(5) "Physically helpless" means a person who is unconscious or for any other reason is physically unable to communicate unwillingness to an act.

(6) "Forcible compulsion" means physical force which overcomes resistance, or a threat, express or implied, that places a person in fear of death or physical injury to herself or himself or another person, or in fear that she or he or another person will be kidnapped.

(7) "Consent" means that at the time of the act of sexual intercourse or sexual contact there are actual words or conduct indicating freely given agreement to have sexual intercourse or sexual contact.

(8) "Significant relationship" means a situation in which the perpetrator is:

(a) A person who undertakes the responsibility, professionally or voluntarily, to provide education, health, welfare, or organized recreational activities principally for minors; ((or))

(b) A person who in the course of his or her employment supervises minors; or

(c) A person who professionally or voluntarily provides welfare, health or residential assistance, personal care, or organized recreational activities to frail elders or vulnerable adults, including a provider, employee, temporary employee, volunteer, or independent contractor who supplies services to long-term care facilities licensed or required to be licensed under chapter 18.20, 18.51, 72.36, or 70.128 RCW, and home health, hospice, or home care agencies licensed or required to be licensed under chapter 70.127 RCW.

(9) "Abuse of a supervisory position" means a direct or indirect threat or promise to use authority to the detriment or benefit of a minor.

(10) "Developmentally disabled," for purposes of RCW 9A.44.050(1)(c) and 9A.44.100(1)(c), means a person with a developmental disability as defined in RCW 71A.10.020.

(11) "Person with supervisory authority," for purposes of RCW 9A.44.050(1) (c) or (e) and 9A.44.100(1) (c) or (e), means any proprietor or employee of any public or private care or treatment facility who directly supervises developmentally disabled, mentally disordered, or chemically dependent persons at the facility.

(12) "Mentally disordered person" for the purposes of RCW 9A.44.050(1)(e) and 9A.44.100(1)(e) means a person with a "mental disorder" as defined in RCW 71.05.020(2).

(13) "Chemically dependent person" for purposes of RCW 9A.44.050(1)(e) and 9A.44.100(1)(e) means a person who is "chemically dependent" as defined in RCW 70.96A.020(4).

(14) "Health care provider" for purposes of RCW 9A.44.050 and 9A.44.100 means a person who is, holds himself or herself out to be, or provides services as if he or she were: (a) A member of a health care profession under chapter 18.130 RCW; or (b) registered or certified under chapter 18.19 RCW, regardless of whether the health care provider is licensed, certified, or registered by the state.

(15) "Treatment" for purposes of RCW 9A.44.050 and 9A.44.100 means the active delivery of professional services by a health care provider which the health care provider holds himself or herself out to be qualified to provide.

(16) "Frail elder or vulnerable adult" means a person sixty years of age or older who has the functional, mental, or physical inability to care for himself or herself. "Frail elder or vulnerable adult" also includes a person found incapacitated under chapter 11.88 RCW, a person over eighteen years of age who has a developmental disability under chapter 71A.10 RCW, a person admitted to a long-term care facility that is licensed or required to be licensed under chapter 18.20, 18.51, 72.36, or 70.128 RCW, and a person receiving services from a home health, hospice, or home care agency licensed or required to be licensed under chapter 70.127 RCW.

Sec. 307. RCW 9A.44.050 and 1993 c 477 s 2 are each amended to read as follows:

(1) A person is guilty of rape in the second degree when, under circumstances not constituting rape in the first degree, the person engages in sexual intercourse with another person:

(a) By forcible compulsion;

(b) When the victim is incapable of consent by reason of being physically helpless or mentally incapacitated;

(c) When the victim is developmentally disabled and the perpetrator is a person who is not married to the victim and who has supervisory authority over the victim;

(d) When the perpetrator is a health care provider, the victim is a client or patient, and the sexual intercourse occurs during a treatment session, consultation, interview, or examination. It is an affirmative defense that the defendant must prove by a preponderance of the evidence that the client or patient consented to the sexual intercourse with the knowledge that the sexual intercourse was not for the purpose of treatment; ((or))

(e) When the victim is a resident of a facility for mentally disordered or chemically dependent persons and the perpetrator is a person who is not married to the victim and has supervisory authority over the victim; or

(f) When the victim is a frail elder or vulnerable adult and the perpetrator is a person who is not married to the victim and who has a significant relationship with the victim.

(2) Rape in the second degree is a class A felony.

Sec. 308. RCW 9A.44.100 and 1993 c 477 s 3 are each amended to read as follows:

(1) A person is guilty of indecent liberties when he knowingly causes another person who is not his spouse to have sexual contact with him or another:

(a) By forcible compulsion; ((or))

(b) When the other person is incapable of consent by reason of being mentally defective, mentally incapacitated, or physically helpless;

(c) When the victim is developmentally disabled and the perpetrator is a person who is not married to the victim and who has supervisory authority over the victim;

(d) When the perpetrator is a health care provider, the victim is a client or patient, and the sexual contact occurs during a treatment session, consultation, interview, or examination. It is an affirmative defense that the defendant must prove by a preponderance of the evidence that the client or patient consented to the sexual contact with the knowledge that the sexual contact was not for the purpose of treatment; ((or))

(f) When the victim is a frail elder or vulnerable adult and the perpetrator is a person who is not married to the victim and who has a significant relationship with the victim.

(2) Indecent liberties is a class B felony.

Sec. 309. 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.

(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.

Sec. 310. RCW 18.130.200 and 1986 c 259 s 12 are each amended to read as follows:

A person who attempts to obtain ((or)), obtains, or attempts to maintain a license by willful misrepresentation or fraudulent representation is guilty of a gross misdemeanor.

Sec. 311. RCW 43.43.842 and 1992 c 104 s 1 are each amended to read as follows:

(1)(a) The secretary of social and health services, the secretary of long-term care services, and the secretary of health shall adopt additional requirements for the licensure or relicensure of agencies ((or)), facilities ((~~which~~)), and licensed individuals who provide care and treatment to vulnerable adults. These additional requirements shall ensure that any person associated with a licensed agency or facility having direct contact with a vulnerable adult shall not have been: ((~~(a)~~)) (i) Convicted of a crime against persons as defined in RCW 43.43.830, except as provided in this section; ((~~(b)~~)) (ii) convicted of crimes relating to financial exploitation as defined in RCW 43.43.830, except as provided in this section; ((~~(c)~~)) (iii) found in any disciplinary board final decision to have abused a vulnerable adult under RCW 43.43.830; or ((~~(d)~~)) (iv) the subject in a protective proceeding under chapter 74.34 RCW.

(b) A person associated with a licensed agency or facility who has direct contact with a vulnerable adult shall make the disclosures specified in RCW 43.43.834(2). The person shall make the disclosures in writing, sign, and swear to the contents under penalty of perjury. The person shall, in the disclosures, specify all crimes against children or other persons, and all crimes relating to financial exploitation as defined in RCW 43.43.830, committed by the person.

(2) The rules adopted under this section shall permit the licensee to consider the criminal history of an applicant for employment in a licensed facility when the applicant has one or more convictions for a past offense and:

(a) The offense was simple assault, assault in the fourth degree, or the same offense as it may be renamed, and three or more years have passed between the most recent conviction and the date of application for employment;

(b) The offense was prostitution, or the same offense as it may be renamed, and three or more years have passed between the most recent conviction and the date of application for employment;

(c) The offense was theft in the third degree, or the same offense as it may be renamed, and three or more years have passed between the most recent conviction and the date of application for employment;

(d) The offense was theft in the second degree, or the same offense as it may be renamed, and five or more years have passed between the most recent conviction and the date of application for employment;

(e) The offense was forgery, or the same offense as it may be renamed, and five or more years have passed between the most recent conviction and the date of application for employment.

The offenses set forth in (a) through (e) of this subsection do not automatically disqualify an applicant from employment by a licensee. Nothing in this section may be construed to require the employment of any person against a licensee's judgment.

In consultation with law enforcement personnel, the secretary of social and health services and the secretary of health shall investigate the conviction record and the protection proceeding record information under this chapter ((~~43.43 RCW~~)) of each agency or facility and its staff under their respective jurisdictions seeking licensure or relicensure. The individual responding to criminal background inquiry requests by the individual's employer or potential employer shall disclose the information about the individual's criminal history under penalty of perjury. The secretaries shall use the information solely for the purpose of determining eligibility for licensure or relicensure. Criminal justice agencies shall provide the secretaries such information as they may have and that the secretaries may require for such purpose.

Sec. 312. RCW 70.124.020 and 1996 c 178 s 24 are each amended to read as follows:

Unless the context requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Court" means the superior court of the state of Washington.

(2) "Law enforcement agency" means the police department, the director of public safety, or the office of the sheriff.

(3) "Practitioner of the healing arts" or "practitioner" means a person licensed by this state to practice podiatric medicine and surgery, optometry, pharmacy, physical therapy, chiropractic, nursing, dentistry, osteopathic medicine and surgery, or medicine and surgery. The term "practitioner" shall include a nurses aide, a nursing home administrator licensed under chapter 18.52 RCW, and a duly accredited Christian Science practitioner: PROVIDED, HOWEVER, That a nursing home patient who is being furnished Christian Science treatment by a duly accredited Christian Science practitioner shall not be considered, for that reason alone, a neglected patient for the purposes of this chapter.

(4) "Department" means the state department of ((~~social and health~~)) long-term care services.

(5) "Nursing home" has the meaning prescribed by RCW 18.51.010.

(6) "Social worker" means anyone engaged in a professional capacity during the regular course of employment in encouraging or promoting the health, welfare, support, or education of nursing home patients, or providing social services to nursing home patients, whether in an individual capacity or as an employee or agent of any public or private organization or institution.

(7) "Psychologist" means any person licensed to practice psychology under chapter 18.83 RCW, whether acting in an individual capacity or as an employee or agent of any public or private organization or institution.

(8) "Pharmacist" means any registered pharmacist under chapter 18.64 RCW, whether acting in an individual capacity or as an employee or agent of any public or private organization or institution.

(9) "Abuse or neglect" or "patient abuse or neglect" means the nonaccidental physical injury or condition, sexual abuse, or negligent treatment of a nursing home, adult family home, boarding home, or state hospital patient under circumstances which indicate that the patient's health, welfare, ((~~and~~)) or safety is harmed thereby.

(10) "Negligent treatment" means an act or omission which evinces a serious disregard of consequences of such magnitude as to constitute a clear and present danger to the patient's health, welfare, ((~~and~~)) or safety.

(11) "State hospital" means any hospital operated and maintained by the state for the care of the mentally ill under chapter 72.23 RCW.

(12) "Adult family home" has the meaning set forth in RCW 70.128.010.

(13) "Boarding home" has the meaning set forth in RCW 18.20.020.

Sec. 313. RCW 70.124.030 and 1981 c 174 s 3 are each amended to read as follows:

(1) When any practitioner, social worker, psychologist, pharmacist, employee of a nursing home, employee of an adult family home, employee of a boarding home, employee of a state hospital, or employee of the department has reasonable cause to believe that a nursing home, adult family home, boarding home, or state hospital patient has suffered abuse or neglect, the person shall report such incident, or cause a report to be made, to either a law enforcement agency or to the department as provided in RCW 70.124.040.

(2) Any other person who has reasonable cause to believe that a nursing home, adult family home, boarding home, or state hospital patient has suffered abuse or neglect may report such incident to either a law enforcement agency or to the department as provided in RCW 70.124.040.

(3) The department or any law enforcement agency receiving a report of an incident of abuse or neglect involving a nursing home, adult family home, boarding home, or state hospital patient who has died or has had physical injury or injuries inflicted other than by accidental means or who has been subjected to sexual abuse shall report the incident to the proper county prosecutor for appropriate action.

Sec. 314. RCW 70.124.040 and 1981 c 174 s 4 are each amended to read as follows:

(1) Where a report is ((~~deemed warranted~~)) required under RCW 70.124.030, an immediate oral report shall be made by telephone or otherwise to either a law enforcement agency or to the department and, upon request, shall be followed by a report in writing. The reports shall contain the following information, if known:

(a) The name and address of the person making the report;

(b) The name and address of the nursing home, adult family home, boarding home, or state hospital patient;

(d) The nature and extent of the injury or injuries;

(e) The nature and extent of the neglect;

(f) The nature and extent of the sexual abuse;

(g) Any evidence of previous injuries, including their nature and extent; and

(h) Any other information which may be helpful in establishing the cause of the patient's death, injury, or injuries, and the identity of the perpetrator or perpetrators.

(2) Each law enforcement agency receiving such a report shall, in addition to taking the action required by RCW 70.124.050, immediately relay the report to the department, and to other law enforcement agencies, including the medicaid fraud control unit of the office of the attorney general, as appropriate. For any report it receives, the department shall likewise take the required action and in addition relay the report to the appropriate law enforcement agency or agencies. The appropriate law enforcement agency or agencies shall receive immediate notification when the department, upon receipt of such report, has reasonable cause to believe that a criminal act has been committed.

Sec. 315. RCW 70.124.070 and 1979 ex.s. c 228 s 7 are each amended to read as follows:

A person who is required to make or to cause to be made a report pursuant to RCW 70.124.030 or 70.124.040 and who knowingly fails to make such report or fails to cause such report to be made is guilty of a gross misdemeanor.

NEW SECTION. Sec. 316. 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 expel 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 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 nursing home, state hospital, 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

(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.

(4) This section does not prohibit a nursing home, state hospital, 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 terminating, suspending, or disciplining a whistleblower 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.

NEW SECTION. Sec. 317. A new section is added to chapter 74.34 RCW to read as follows:

A person who is required to make or cause to be made a report under RCW 74.34.030 or 74.34.040 and who knowingly fails to make the report or fails to cause the report to be made is guilty of a gross misdemeanor.

NEW SECTION. Sec. 318. 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 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

(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.

(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.

Sec. 319. 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 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.

(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 and nursing facilities licensed under chapter 18.51 RCW.

Sec. 320. 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) The long-term care facility shall only accept individuals whose needs they can safely and appropriately serve in the facility with current staff or through the provision of reasonable accommodations as described in the written service plan completed by the department and submitted to the provider in advance of placement. The service plan may include, but is not limited to, a medical history, necessary and prohibited medications, special dietary requirements, a medical professional's diagnosis or prognosis as to why the resident needs long-term care residential placement, significant behavioral patterns that may cause concern, history of mental illness, and level of personal care needs. All long-term care facilities shall fully disclose to potential residents 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 facilities' service capabilities, the department shall review the placement order and if the department concurs with the facility, 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 as defined by the department 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. 321. 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~~)) chapter.

Sec. 322. RCW 43.190.030 and 1995 c 399 s 105 are each amended to read as follows:

There is created the office of the state long-term care ombudsman. The department of community, trade, and economic development shall contract with a private nonprofit organization to provide long-term care ombudsman services as specified under, and consistent with, the federal older Americans act as amended, federal mandates, the goals of the state, and the needs of its citizens. The department of community, trade, and economic development shall ensure that all program and staff support necessary to enable the ombudsman to effectively protect the interests of residents, patients, and clients of all long-term care facilities is provided by the nonprofit organization that contracts to provide long-term care ombudsman services. The department of community, trade, and economic development shall adopt rules to carry out this chapter and the long-term care ombudsman provisions of the federal older Americans act, as amended. The long-term care ombudsman program shall have the following powers and duties:

(1) To provide services for coordinating the activities of long-term care ombudsmen throughout the state;

(2) Carry out such other activities as the department of community, trade, and economic development deems appropriate;

(3) Establish procedures consistent with RCW 43.190.110 for appropriate access by long-term care ombudsmen to long-term care facilities and patients' records, including procedures to protect the confidentiality of the records and ensure that the identity of any complainant or resident will not be disclosed without the written consent of the complainant or resident, or upon court order;

(4) Establish a state-wide uniform reporting system to collect and analyze data relating to complaints and conditions in long-term care facilities for the purpose of identifying and resolving significant problems, with provision for submission of such data to the department of social and health services and to the federal department of health and human services, or its successor agency, on a regular basis; and

(5) Establish procedures to assure that any files maintained by ombudsman programs shall be disclosed only at the discretion of the ombudsman having authority over the disposition of such files, except that the identity of any complainant or resident of a long-term care facility shall not be disclosed by such ombudsman unless:

(a) Such complainant or resident, or the complainant's or resident's legal representative, consents in writing to such disclosure; or

(b) Such disclosure is required by court order.

Sec. 323. RCW 43.190.070 and 1983 c 290 s 7 are each amended to read as follows:

(1) The office of the state long-term care ombudsman shall develop referral procedures for all long-term care ombudsman programs to refer any complaint to any appropriate state or local government agency. The department of ((~~social and health~~)) long-term care services shall act as quickly as possible on any complaint referred to them by a long-term care ombudsman.

(2) The department of ((~~social and health~~)) long-term care services shall respond to any complaint against a long-term care facility which was referred to it by a long-term care ombudsman and shall forward to that ombudsman a summary of the results of the investigation and action proposed or taken.

Sec. 324. 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 services.

Sec. 325. 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. 326. 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, strict, and specific enforcement remedies shall 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. Screening should reasonably ensure that potential employees also possess adequate skills, education, and training to provide the highest quality of care consistent with the chronic health care needs of the client, including when appropriate additional training, to include, but not limited to, specialized care needs for persons with dementia, traumatic head injury, mental illness, and developmental disabilities.

(8) 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. 327. 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 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~~)) department 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~~)) department 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~~)) department 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, the family members of these residents, and, in addition to facility staff, any available independent sources of relevant information.

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

(e) After a department finding of a violation that is serious, recurring, or uncorrected following a previous citation, the department shall, if funds are available, 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 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 substantiated serious complaint has been made to the department, the attorney general, law enforcement agencies, or the long-term care ombudsman, within one year 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 ((~~may~~)) shall 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, employee, or other person.

Sec. 328. RCW 74.39A.080 and 1996 c 193 s 1 are each amended to read as follows:

(1) The department is authorized to take one or more of the actions listed in subsection (2) of this section in any case in which the department finds that a provider of assisted living services, adult residential care services, adult family home, or enhanced adult residential care services has:

(a) Failed or refused to comply with the requirements of this chapter or the rules adopted under this chapter;

(b) Operated without a license or under a revoked license;

(c) Knowingly, or with reason to know, made a false statement of material fact on his or her application for license or any data attached thereto, or in any matter under investigation by the department; or

(d) Willfully prevented or interfered with any inspection or investigation by the department.

(2) When authorized by subsection (1) of this section, the department may take one or more of the following actions:

(a) Refuse to issue a contract;

(b) Impose reasonable conditions on a contract, such as correction within a specified time, training, and limits on the type of clients the provider may admit or serve;

(d) Suspend, revoke, or refuse to renew a contract; or

(e) Suspend admissions to the facility by imposing stop placement on contracted services.

(3) When the department orders stop placement, the facility shall not admit any person admitted by contract until the stop placement order is terminated. The department may approve readmission of a resident to the facility from a hospital or nursing home during the stop placement. The department shall terminate the stop placement when: (a) The violations necessitating the stop placement have been corrected; and (b) the provider exhibits the capacity to maintain adequate care and service.

(4) Chapter 34.05 RCW applies to department actions under this section, except that orders of the department imposing contracts suspension, stop placement, or conditions for continuation of a contract are effective immediately upon notice and shall continue pending any hearing.

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 medical 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.

NEW SECTION. Sec. 402. A new section is added to chapter 43.20B RCW to read as follows:

People with developmental disabilities and their families who support them are exempt from this chapter.

Sec. 403. 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 of the recipient's death; 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. 404. 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. 405. 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. 406. 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 person who 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.

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; and

(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.

(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: