BP BHEAD INT H [atlas:bill]

AN ACT Relating to the long-term care integration reform act; adding a new section to chapter 43.20A RCW; adding a new chapter to Title 43 RCW; creating a new section; repealing RCW 74.39.001, 74.39.005, 74.39.030, 74.39A.005, and 74.39A.007; providing expiration dates; and declaring an emergency.

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

NEW SECTION. Sec. 1. FINDINGS AND INTENT. The legislature 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.

The legislature further finds that the public demands that long‑term care services be client and family-centered, safe, economically effective and efficient, 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 and provide long-term care services for persons with chronic functional disabilities through a separate, integrated, and comprehensive long-term care division.

It is the intent of this chapter to establish a new division within the department of social and health services, known as the division of long‑term care and rehabilitation services, which is directed 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, including persons with acute episodic mental illness.

NEW SECTION. Sec. 2. DEFINITIONS. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "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.

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

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

(4) "Functionally disabled person" is synonymous with chronic functionally disabled and means a person who because of a recognized chronic physical or acute or chronic 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.

(5) "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.

(6) "Long-term care" is synonymous with chronic care and means care and support delivered indefinitely, intermittently, or over a sustained time to persons of any age disabled by an acute or chronic mental illness, physical illness, disease, or medical condition that is permanent, is 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.

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

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

NEW SECTION. Sec. 3. DUTIES AND RESPONSIBILITIES. The division has, but is not limited to, the following duties and responsibilities:

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

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

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

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

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

(6) Promote the development of an integrated and 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, incontinence, and multiple diagnoses. 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 6 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 internet resources, 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, and apply appropriate testing of skills and comprehension;

(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 6 of this act that are consistent with the objectives set forth in this chapter and allocated in the budget.

NEW SECTION. Sec. 4. (1) No additional state employees may be hired as a result of establishing the division.

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

NEW SECTION. Sec. 5. GUIDING PRINCIPLES. The division shall provide leadership and coordination in identifying and resolving barriers to receiving safe and 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, integrated organizational design promoting accessibility, responsiveness, and accountability to persons receiving services and their families, the legislature, and the general public;

(3) A coordinated, integrated organizational structure for managing the division's programs and activities that is client-centered and encourages consistent and seamless 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 test-based educational and training standards across all programs and levels of care;

(6) Expert advice and information on chronic long-term care issues to families including unpaid family caregivers, 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 and high-quality direct services.

NEW SECTION. Sec. 6. DEPARTMENTAL COMMITTEE ON LONG-TERM CARE INTEGRATION. The secretary shall appoint, as soon as practical, but not later than July 1, 2000, a departmental committee on long-term care integration, hereafter referred to in this section as the committee.

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

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

The committee has the following duties:

(1) Ensure that all appropriate interests participate in the departmental integration 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 12, 2001:

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

(b) The possibility of establishing a single point of entry for service eligibility and delivery for functionally disabled persons;

(c) An analysis of the desirability and feasibility of establishing an integrated long-term care pilot project that will streamline accessability of services and integrate acute and long-term care funding to enhance program flexibility;

(d) A review of the need to establish an integrated long-term care ombudsman program that will cover all persons who are functionally disabled;

(e) Necessary modifications of the case management system and management information systems to fully implement chapter . . ., Laws of 2000 (this act);

(f) Federal waivers necessary to implement chapter . . ., Laws of 2000 (this act); and

(g) Recommended legislation necessary to implement changes proposed by the committee to the joint legislative committee on long-term care and rehabilitation oversight.

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 and rehabilitation oversight established in section 7 of this act.

This section expires March 1, 2004.

NEW SECTION. Sec. 7. JOINT LEGISLATIVE COMMITTEE ON LONG-TERM CARE AND REHABILITATION OVERSIGHT. (1) There is created a joint legislative committee on long-term care and rehabilitation 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. In the event of no majority, each house shall select an equal number of members.

(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 2000 (this act);

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

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

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

(e) Report to the legislature the progress on reorganization and reform consistent with chapter . . ., Laws of 2000 (this act);

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

(g) Prepare legislation necessary to implement the intent of chapter . . ., Laws of 2000 (this act); and

(h) Review the need to develop a geographically balanced matrix of designated service areas.

(4) This section expires March 1, 2004.

NEW SECTION. Sec. 8. A new section is added to chapter 43.20A RCW to read as follows:

FUNCTIONS TRANSFERRED TO THE DIVISION OF LONG-TERM CARE AND REHABILITATION SERVICES. The department shall establish a division of long-term care and rehabilitation services. The department shall transfer the following programs and services and related management and support services to the division of long-term care and rehabilitation 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 70.96A RCW - Treatment for alcoholism, intoxication, and drug addiction;

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 facility medicaid payment system;

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

Chapter 18.48 RCW - Adult family homes;

Chapter 18.51 RCW - Nursing homes; and

Chapter 10.77 RCW - Criminally insane.

NEW SECTION. Sec. 9. The following acts or parts of acts are each repealed:

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

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

(3) RCW 74.39.030 (Community options program entry system--Waiver--Respite services) and 1989 c 427 s 11;

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

(5) RCW 74.39A.007 (Purpose and intent) and 1993 c 508 s 2.

NEW SECTION. Sec. 10. Sections 1 through 7 of this act constitute a new chapter in Title 43 RCW.

NEW SECTION. Sec. 11. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately.

NEW SECTION. Sec. 12. Captions used in this act are not part of the law.