5499 AMH HC H2599.1

                                           By Representative Pflug

SB 5499 - H COMM AMD ADOPTED 04/09/99

By Committee on Health Care

    Strike everything after the enacting clause and insert the following:

    "Sec. 1.  RCW 70.127.010 and 1993 c 42 s 1 are each amended to read as follows:

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

    (1) (("Branch office" means a location or site from which a home health, hospice, or home care agency provides services within a portion of the total geographic area served by the parent agency.  The branch office is part of the agency and is located sufficiently close to share administration, supervision, and services.

    (2))) "Department" means the department of health.

    (((3))) (2) "Home care agency" means a private or public agency or organization that administers or provides home care services directly or through a contract arrangement to ill, disabled, or infirm persons in places of temporary or permanent residence.

    (((4))) (3) "Home care services" means personal care services, homemaker services, respite care services, or any other nonmedical services provided to ill, disabled, or infirm persons which services enable these persons to remain in their own residences consistent with their desires, abilities, and safety.

    (((5))) (4) "Home health agency" means a private or public agency or organization that administers or provides home health aide services or two or more home health services directly or through a contract arrangement to ill, disabled, or infirm persons in places of temporary or permanent residence.  A private or public agency or organization that administers or provides nursing services only may elect to be designated a home health agency for purposes of licensure.

    (((6))) (5) "Home health services" means health or medical services provided to ill, disabled, or infirm persons.  These services may be of an acute or maintenance care nature, and include but are not limited to nursing services, home health aide services, physical therapy services, occupational therapy services, speech therapy services, respiratory therapy services, nutritional services, medical social services, and medical supplies or equipment services.

    (((7))) (6) "Home health aide services" means services provided by a home health agency or a hospice agency under the supervision of a registered nurse, physical therapist, occupational therapist, or speech therapist.  Such care includes ambulation and exercise, assistance with self-administered medications, reporting changes in patients' conditions and needs, completing appropriate records, and personal care or homemaker services.

    (((8))) (7) "Homemaker services" means services that assist ill, disabled, or infirm persons with household tasks essential to achieving adequate household and family management.

    (((9))) (8) "Hospice agency" means a private or public agency or organization administering or providing hospice care directly or through a contract arrangement to terminally ill persons in places of temporary or permanent residence by using an interdisciplinary team composed of at least nursing, social work, physician, and pastoral or spiritual counseling.

    (((10))) (9) "Hospice care" means:  (a) Palliative care provided to a terminally ill person in a place of temporary or permanent residence that alleviates physical symptoms, including pain, as well as alleviates the emotional and spiritual discomfort associated with dying; and (b) bereavement care provided to the family of a terminally ill person that alleviates the emotional and spiritual discomfort associated with the death of a family member.  Hospice care may include health and medical services and personal care, respite, or homemaker services.  Family means individuals who are important to and designated by the patient, and who need not be relatives.

    (((11))) (10) "Ill, disabled, or infirm persons" means persons who need home health, hospice, or home care services in order to maintain themselves in their places of temporary or permanent residence.

    (((12))) (11) "Personal care services" means services that assist ill, disabled, or infirm persons with dressing, feeding, and personal hygiene to facilitate self-care.

    (((13))) (12) "Public or private agency or organization" means an entity that employs or contracts with two or more persons who provide care in the home.

    (((14))) (13) "Respite care services" means services that assist or support the primary care giver on a scheduled basis.

(14) "Service area" means the geographic area in which the department has given prior approval to a licensee to provide home health, hospice, or home care services.

    Sec. 2.  RCW 70.127.080 and 1993 c 42 s 4 are each amended to read as follows:

    (1) An applicant for a home health, hospice, or home care agency license shall:

    (a) File a written application on a form provided by the department;

    (b) Demonstrate ability to comply with this chapter and the rules adopted under this chapter;

    (c) Cooperate with on-site review conducted by the department prior to licensure or renewal except as provided in RCW 70.127.085;

    (d) Provide evidence of and maintain professional liability insurance in the amount of one hundred thousand dollars per occurrence or adequate self-insurance as approved by the department.  This subsection shall not apply to hospice agency applicants that provide hospice care without receiving compensation for delivery of services;

    (e) Provide evidence of and maintain public liability and property damage insurance coverage in the sum of fifty thousand dollars for injury or damage to property per occurrence and fifty thousand dollars for injury or damage, including death, to any one person and one hundred thousand dollars for injury or damage, including death, to more than one person, or evidence of adequate self-insurance for public liability and property damage as approved by the department.  This subsection shall not apply to hospice agency applicants that provide hospice care without receiving compensation for delivery of services;

    (f) Provide such proof as the department may require concerning organizational structure, and the identity of the applicant, officers, directors, partners, managing employees, or owners of ten percent or more of the applicant's assets;

    (g) File with the department for approval a ((list of the counties)) description of the service area in which the applicant will operate and a description of how the applicant intends to provide management and supervision of services throughout the service area.  The department shall adopt rules necessary to establish criteria for approval that are related to appropriate management and supervision of services throughout the service area.  In developing the rules, the department may not establish criteria that:

(i) Limit the number or type of agencies in any service area; or

(ii) Limit the number of persons any agency may serve within its service area unless the criteria are related to the need for trained and available staff to provide services within the service area;

    (h) File with the department a list of the services offered;

    (i) Pay to the department a license fee as provided in RCW 70.127.090; and

    (j) Provide any other information that the department may reasonably require.

    (2) A certificate of need under chapter 70.38 RCW is not required for licensure.

    (3) A license or renewal shall not be granted pursuant to this chapter if the applicant, officers, directors, partners, managing employees, or owners of ten percent or more of the applicant's assets, within the last five years have been found in a civil or criminal proceeding to have committed any act which reasonably relates to the person's fitness to establish, maintain, or administer an agency or to provide care in the home of another.

    (((4) A separate license is not required for a branch office.))

    Sec. 3.  RCW 70.127.090 and 1993 c 42 s 5 are each amended to read as follows:

    An application for a license or any renewal shall be accompanied by a fee as established by the department under RCW 43.70.250.  The department shall adopt by rule licensure fees ((shall be)) based on a sliding scale using such factors as the number of agency full-time equivalents, ((with agencies with the highest number of full-time equivalents paying the highest fee.  Full-time equivalent is a measurement based on a forty-hour work week and is applicable to paid agency employees or contractors)) geographic area served, number of locations, or type and volume of services provided.  For agencies receiving a licensure survey that requires more than ((one)) two on-site reviews by the department per licensure period, an additional fee ((of fifty percent of the base licensure fee)) as determined by the department by rule shall be charged for each additional on-site review.  The department shall charge a reasonable fee for processing changes in ownership.  The department may set different licensure fees for each licensure category.

    Sec. 4.  RCW 70.127.110 and 1988 c 245 s 12 are each amended to read as follows:

    The department shall adopt rules providing for the combination of applications and licenses, and the reduction of individual license fees if an applicant applies for more than one category of license under this chapter.  The department shall provide for combined licensure inspections and audits for licensees holding more than one license under this chapter.  The department may prorate licensure fees to facilitate combined licensure inspections and audits.

NEW SECTION. Sec. 5.  The department of health shall submit a report to the health care committees of the legislature with recommendations for any changes needed to the home health, hospice, and home care licensure law, chapter 70.127 RCW, in order to allow the department to regulate this fast-growing and evolving industry.  The report, at a minimum, shall specifically address the following questions:

    (1) Does the scope of the licensure law need to be revised in order to enhance protection for persons receiving home health, hospice, and home care services?

    (2) Does the department of health need additional compliance strategies in order to provide protection for persons receiving home health, hospice, and home care services?

    (3) Does chapter 70.126 RCW need to be retained in statute, or is it simply duplicative and confusing?

    A report shall be submitted by November 1, 1999, together with any recommendations for legislation necessary to implement the findings and recommendations of the department of health.  The department of health shall prepare the report with existing funds."

    Correct the title.

EFFECT:  Clarifies that department rules concerning approval of an agency's service area are only related to assuring appropriate management and supervision of services in the service area and that it is not the intent of the bill to expand or disallow the number or types of home health care services unless related to the need for trained and available staff.

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