2380-S.E AAS 3/1/00 S5001.1

ESHB 2380 - S COMM AMD

By Committee on Health & Long-Term Care

                                                    ADOPTED 3/1/00

    Strike everything after the enacting clause and insert the following:

    "Sec. 1.  RCW 18.20.020 and 1998 c 272 s 14 are each amended to read as follows:

    As used in this chapter:

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

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

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

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

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

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

    Sec. 2.  RCW 18.20.040 and 1957 c 253 s 4 are each amended to read as follows:

    An application for a license shall be made to the department ((or authorized department)) upon forms provided by ((either of said departments)) the department 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)) adopted by the ((board)) department.

    Sec. 3.  RCW 18.20.050 and 1987 c 75 s 3 are each amended to read as follows:

    Upon receipt of an application for license, if the applicant and the boarding home facilities meet the requirements established under this chapter, the department ((or the department and the authorized health department jointly,)) shall issue a license.  If there is a failure to comply with the provisions of this chapter or the standards((,)) and rules((, and regulations promulgated)) adopted pursuant thereto, the department((, or the department and authorized health department,)) may in its discretion issue to an applicant for a license, or for the renewal of a license, a provisional license which will permit the operation of the boarding home for a period to be determined by the department, ((or the department and authorized health department,)) but not to exceed twelve months, which provisional license shall not be subject to renewal.  At the time of the application for or renewal of a license or provisional license the licensee shall pay a license fee as established by the department under RCW 43.20B.110.  ((When the license or provisional license is issued jointly by the department and authorized health department, the license fee shall be paid to the authorized health department.))  All licenses issued under the provisions of this chapter shall expire on a date to be set by the department, but no license issued pursuant to this chapter shall exceed twelve months in duration((:  PROVIDED, That)).  However, when the annual license renewal date of a previously licensed boarding home is set by the department on a date less than twelve months prior to the expiration date of a license in effect at the time of reissuance, the license fee shall be prorated on a monthly basis and a credit be allowed at the first renewal of a license for any period of one month or more covered by the previous license.  All applications for renewal of a license shall be made not later than thirty days prior to the date of expiration of the license.  Each license shall be issued only for the premises and persons named in the application, and no license shall be transferable or assignable.  Licenses shall be posted in a conspicuous place on the licensed premises.

    Sec. 4.  RCW 18.20.110 and 1985 c 213 s 7 are each amended to read as follows:

    The department ((or authorized health department)) shall make or cause to be made at least a yearly inspection and investigation of all boarding homes.  Every inspection shall focus primarily on actual or potential resident outcomes, and may include an inspection of every part of the premises and an examination of all records (other than financial records), methods of administration, the general and special dietary, and the stores and methods of supply.  Following such an inspection or inspections, written notice of any violation of this law or the rules ((and regulations promulgated)) adopted hereunder((,)) shall be given to the applicant or licensee and the department.  The department may prescribe by ((regulations)) rule that any licensee or applicant desiring to make specified types of alterations or additions to its facilities or to construct new facilities shall, before commencing such alteration, addition, or new construction, submit plans and specifications therefor to the ((department or to the authorized department)) agencies responsible for plan reviews for preliminary inspection and approval or recommendations with respect to compliance with the ((regulations)) rules and standards herein authorized.

    Sec. 5.  RCW 18.20.120 and 1994 c 214 s 25 are each amended to read as follows:

    All information received by the department ((or authorized health department)) through filed reports, inspections, or as otherwise authorized under this chapter((,)) shall not be disclosed publicly in any manner as to identify individuals or boarding homes, except at the specific request of a member of the public and disclosure is consistent with RCW 42.17.260(1).

    Sec. 6.  RCW 18.20.130 and 1995 c 369 s 4 are each amended to read as follows:

    Standards for fire protection and the enforcement thereof, with respect to all boarding homes to be licensed hereunder, shall be the responsibility of the chief of the Washington state patrol, through the director of fire protection, who shall adopt such recognized standards as may be applicable to boarding homes for the protection of life against the cause and spread of fire and fire hazards.  The department, upon receipt of an application for a license, shall submit to the chief of the Washington state patrol, through the director of fire protection, in writing, a request for an inspection, giving the applicant's name and the location of the premises to be licensed.  Upon receipt of such a request, the chief of the Washington state patrol, through the director of fire protection, or his or her deputy, shall make an inspection of the boarding home to be licensed, and if it is found that the premises do not comply with the required safety standards and fire ((regulations)) rules as ((promulgated)) adopted by the chief of the Washington state patrol, through the director of fire protection, he or she shall promptly make a written report to the boarding home and the department ((or authorized department)) as to the manner and time allowed in which the premises must qualify for a license and set forth the conditions to be remedied with respect to fire ((regulations)) rules.  The department, ((authorized department,)) applicant, or licensee shall notify the chief of the Washington state patrol, through the director of fire protection, upon completion of any requirements made by him or her, and the chief of the Washington state patrol, through the director of fire protection, or his or her deputy, shall make a reinspection of such premises.  Whenever the boarding home to be licensed meets with the approval of the chief of the Washington state patrol, through the director of fire protection, he or she shall submit to the department ((or authorized department,)) a written report approving same with respect to fire protection before a full license can be issued.  The chief of the Washington state patrol, through the director of fire protection, shall make or cause to be made inspections of such homes at least annually.

    In cities which have in force a comprehensive building code, the provisions of which are determined by the chief of the Washington state patrol, through the director of fire protection, to be equal to the minimum standards of the code for boarding homes adopted by the chief of the Washington state patrol, through the director of fire protection, the chief of the fire department, provided the latter is a paid chief of a paid fire department, shall make the inspection with the chief of the Washington state patrol, through the director of fire protection, or his or her deputy, and they shall jointly approve the premises before a full license can be issued.

    Sec. 7.  RCW 18.20.190 and 1998 c 272 s 15 are each amended to read as follows:

    (1) The department of social and health services is authorized to take one or more of the actions listed in subsection (2) of this section in any case in which the department finds that a boarding home provider has:

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

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

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

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

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

    (a) Refuse to issue a license;

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

    (c) Impose civil penalties of not more than one hundred dollars per day per violation;

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

    (e) Suspend admissions to the boarding home by imposing stop placement.

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

    (4) RCW 43.20A.205 governs notice of a license denial, revocation, suspension, or modification.  Chapter 34.05 RCW applies to department actions under this section, except that orders of the department imposing license suspension, stop placement, or conditions for continuation of a license are effective immediately upon notice and shall continue pending any hearing.

NEW SECTION. Sec. 8.  A new section is added to chapter 18.20 RCW to read as follows:

    (1) In an effort to ensure a cooperative process among the department, boarding home provider representatives, and resident and family representatives on matters pertaining to the boarding home program, the secretary, or his or her designee, shall designate an advisory board.  The advisory board must include representatives of the state-wide boarding home associations, the state long-term care ombudsman program, the state-wide resident council program, consumers, and family representatives.  Depending on the topic to be discussed, the department may invite other representatives in addition to the named members of the advisory board.  The secretary, or his or her designee, shall periodically, but not less than quarterly, convene a meeting of the advisory board to encourage open dialogue on matters affecting the boarding home program.  It is, minimally, expected that the department will discuss with the advisory board the department's inspection, enforcement, and quality improvement activities, in addition to seeking their comments and recommendations on matters described under subsection (2) of this section.

    (2) The secretary, or his or her designee, shall seek comments and recommendations from the advisory board prior to the adoption of rules and standards, implementation of boarding home provider programs, or development of methods and rates of payment.

    (3) For the purpose of implementing this section, "department" means either the department of health or the department of social and health services, depending on which department has the licensing authority under this chapter.

    Sec. 9.  1998 c 272 s 24 (uncodified) is amended to read as follows:

    (1) Section((s)) 13 ((through 16)) of this act expires July 1, 2000((, unless reauthorized by the legislature)).

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

NEW SECTION. Sec. 10.  A new section is added to chapter 18.20 RCW to read as follows:

    (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.

    (a) "Caregiver" includes any person who provides residents with hands-on personal care on behalf of a boarding home, except volunteers who are directly supervised.

    (b) "Direct supervision" means oversight by a person who has demonstrated competency in the core areas or has been fully exempted from the training requirements pursuant to this section, is on the premises, and is quickly and easily available to the caregiver.

    (2) Training must have the following components:  Orientation, basic training, specialty training as appropriate, and continuing education.  All boarding home employees or volunteers who routinely interact with residents shall complete orientation.  Boarding home administrators, or their designees, and caregivers shall complete orientation, basic training, specialty training as appropriate, and continuing education.

    (3) Orientation consists of introductory information on residents' rights, communication skills, fire and life safety, and universal precautions.  Orientation must be provided at the facility by appropriate boarding home staff to all boarding home employees before the employees have routine interaction with residents.

    (4) Basic training consists of modules on the core knowledge and skills that caregivers need to learn and understand to effectively and safely provide care to residents.  Basic training must be outcome-based, and the effectiveness of the basic training must be measured by demonstrated competency in the core areas through the use of a competency test.  Basic training must be completed by caregivers within one hundred twenty days of the date on which they begin to provide hands-on care or within one hundred twenty days of March 1, 2002, whichever is later.  Until competency in the core areas has been demonstrated, caregivers shall not provide hands-on personal care to residents without direct supervision.  Boarding home administrators, or their designees, must complete basic training and demonstrate competency within one hundred twenty days of employment or within one hundred twenty days of March 1, 2002, whichever is later.

    (5) For boarding homes that serve residents with special needs such as dementia, developmental disabilities, or mental illness, specialty training is required of administrators, or designees, and caregivers.  Specialty training consists of modules on the core knowledge and skills that caregivers need to effectively and safely provide care to residents with special needs.  Specialty training should be integrated into basic training wherever appropriate.  Specialty training must be outcome-based, and the effectiveness of the specialty training measured by demonstrated competency in the core specialty areas through the use of a competency test.  Specialty training must be completed by caregivers within one hundred twenty days of the date on which they begin to provide hands-on care to a resident having special needs or within one hundred twenty days of March 1, 2002, whichever is later.  However, if specialty training is not integrated with basic training, the specialty training must be completed within ninety days of completion of basic training.  Until competency in the core specialty areas has been demonstrated, caregivers shall not provide hands-on personal care to residents with special needs without direct supervision.  Boarding home administrators, or their designees, must complete specialty training and demonstrate competency within one hundred twenty days of March 1, 2002, if the boarding home serves one or more residents with special needs.

    (6) Continuing education consists of ongoing delivery of information to caregivers on various topics relevant to the care setting and care needs of residents.  Competency testing is not required for continuing education.  Continuing education is not required during the first year following completion of the basic training.  If specialty training is completed, the specialty training applies toward any continuing education requirement for up to two years following the completion of the specialty training.

    (7) Persons who successfully challenge the competency test for basic training are fully exempt from the basic training requirements of this section.  Persons who successfully challenge the specialty training competency test are fully exempt from the specialty training requirements of this section.

    (8) Licensed persons who perform the tasks for which they are licensed are fully or partially exempt from the training requirements of this section, as specified by the department in rule.

    (9) In an effort to improve access to training and education and reduce costs, especially for rural communities, the coordinated system of long-term care training and education must include the use of innovative types of learning strategies such as internet resources, videotapes, and distance learning using satellite technology coordinated through community colleges or other entities, as defined by the department.

    (10) The community long-term care training and education steering committee established under section 11 of this act shall develop criteria for the approval of orientation, basic training, and specialty training programs.

    (11) Boarding homes that desire to deliver facility-based training with facility designated trainers, or boarding homes that desire to pool their resources to create shared training systems, must be encouraged by the department in their efforts.  The community long-term care training and education steering committee shall develop criteria for reviewing and approving trainers and training materials that are substantially similar to or better than the materials developed by the steering committee.

    (12) The department shall adopt rules by March 1, 2002, for the implementation of this section based on the recommendations of the community long-term care training and education steering committee established in section 11 of this act.

    (13) The orientation, basic training, specialty training, and continuing education requirements of this section take effect March 1, 2002, and shall be applied prospectively.  However, nothing in this section affects the current training requirements under RCW 74.39A.010.

NEW SECTION. Sec. 11.  A new section is added to chapter 74.39A RCW to read as follows:

    (1) The secretary shall appoint a steering committee for community long-term care training and education to advise the department on the development and approval of criteria for training materials, the development of competency tests, the development of criteria for trainers, and the development of exemptions from training.  The community long-term care training and education steering committee shall also review the effectiveness of the training program or programs, including the qualifications and availability of the trainers.  The steering committee shall also review the appropriateness of the adopted rules implementing this section.  The steering committee shall advise the department on flexible and innovative learning strategies that accomplish the training goals, such as competency and outcome-based models and distance learning.  The steering committee shall review and recommend the most appropriate length of time between an employee's date of first hire and the start of the employee's basic training.

    (2) The steering committee shall, at a minimum, consist of a representative from each of the following:  Each of the state-wide boarding home associations, two adult family home associations, each of the state-wide home care associations, the long-term care ombudsman program, the area agencies on aging, the department of health representing the nursing care quality assurance commission, and a consumer, or their nonprovider designee, from a boarding home, adult family home, home care served by an agency, and home care served by an individual provider.  A majority of the members currently serving constitute a quorum.

    (3) Nothing in this chapter shall prevent the adult family home advisory committee from enhancing training requirements for adult family providers and resident managers, regulated under chapter 18.48 RCW, at the cost of those providers and resident managers.

    (4) Establishment of the steering committee does not prohibit the department from utilizing other advisory activities that the department deems necessary for program development.  However, when the department obtains input from other advisory sources, the department shall present the information to the steering committee for review and approval.

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

    (6) The steering committee recommendations must implement the intent of RCW 74.39A.050(14) to create training that includes skills and competencies that are transferable to nursing assistant training.

    (7) The steering committee shall cease to exist on July 1, 2004.

NEW SECTION. Sec. 12.  A new section is added to chapter 74.39A RCW to read as follows:

    All training curricula and material, except competency testing material, developed by the department and used in part or in whole to improve provider and caregiver knowledge and skill are in the public domain and are subject to public disclosure under chapter 42.17 RCW.  Any training curricula and material developed by a private entity and used under contract or by agreement with the department are also considered part of the public domain and shall be shared subject to any copyright restrictions.  It is the department's responsibility when making training materials available to the public, to identify which material has copyright or other legal restrictions on its use, and which does not.  Any proprietary curricula and material developed by a private entity for training purposes in facilities licensed under chapter 18.20 or 70.128 RCW or individual providers and home care agency providers under this chapter and approved for training by the department are not part of the public domain.

NEW SECTION. Sec. 13.  The following acts or parts of acts are each repealed:

(1) RCW 18.20.060 (Actions against license) and 1991 c 3 s 35, 1989 c 175 s 60, 1985 c 213 s 5, & 1957 c 253 s 6; and

(2) RCW 18.20.100 (Enforcement by local authorities--Authorization) and 1979 c 141 s 26 & 1957 c 253 s 10.

NEW SECTION. Sec. 14.  This act takes effect July 1, 2000."

ESHB 2380 - S COMM AMD

By Committee on Health & Long-Term Care

                                                    ADOPTED 3/1/00

    On page 1, line 1 of the title, after "homes;" strike the remainder of the title and insert "amending RCW 18.20.020, 18.20.040, 18.20.050, 18.20.110, 18.20.120, 18.20.130, and 18.20.190; amending 1998 c 272 s 24 (uncodified); adding new sections to chapter 18.20 RCW; adding new sections to chapter 74.39A RCW; repealing RCW 18.20.060 and 18.20.100; and providing an effective date."

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