[atlas:bill]

AN ACT Relating to enhancing the wages and benefits of long-term care paraprofessional workers providing care to the elderly and disabled; amending RCW 70.47.020, 70.47.060, and 28B.15.558; adding new sections to chapter 74.39A RCW; adding a new section to chapter 43.20A RCW; and creating a new section.

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

NEW SECTION. Sec. 1. The legislature finds that long-term care providers in the state of Washington are reporting unprecedented labor vacancies, particularly for those paraprofessionals who provide direct hands-on care to some of the most medically vulnerable citizens of our state.

It is the intent of this act to increase the stability of long-term care paraprofessional employment by supporting enhanced wages and benefits for those long-term care paraprofessional workers who provide direct hands-on care for state-funded clients in nursing homes, boarding homes, adult family homes, community residential settings for the developmentally disabled or mentally ill, or clients' own homes.

NEW SECTION. Sec. 2. A new section is added to chapter 74.39A RCW to read as follows:

As used in sections 3 and 4 of this act:

(1) "Long-term care paraprofessional worker" means:

(a) A nonlicensed worker providing direct hands-on care to a medicaid client in a nursing home under chapter 18.51 RCW, boarding home under chapter 18.20 RCW, adult family home under chapter 70.128 RCW, or developmental disability residential program under chapter 71.12 RCW; or

(b) A nonlicensed worker providing direct hands-on care to a functionally disabled person in the person's own home through medicaid personal care as described in RCW 74.09.520, community options program entry system waiver services as described in RCW 74.39A.030, or chore services as described in RCW 74.39A.110 as an individual provider or employee of a home care agency under chapter 70.127 RCW.

(2) "Long-term care para professional worker" does not include janitorial staff, food service staff, or any other nondirect care staff working in a nursing home, group home, or boarding home facility, or an owner, operator, or manager of a nursing home, group home, boarding home, or adult family home.

NEW SECTION. Sec. 3. A new section is added to chapter 74.39A RCW to read as follows:

(1) The department of social and health services shall establish a wage enhancement program to enhance the wages of long-term care paraprofessional workers. Facilities, organizations, and agencies that employ or contract with long-term care paraprofessional workers may voluntarily participate in the program. Under the program, the department of social and health services shall provide participating facilities, organizations, and agencies with funds to enhance the wages of long-term care paraprofessional workers based on the proportion of worker hours that may be reasonably apportioned to the care of medicaid clients compared to the total number of hours of care for all clients of the facility or home. Wage enhancement funds shall be available for both current workers and additional long-term care paraprofessional workers. Participating facilities, organizations, and agencies shall provide worker and medicaid client data as determined necessary by the department of social and health services. The department shall develop standards for determining how the wage enhancement funds are to be distributed to participating facilities, organizations, and agencies, and reporting requirements needed to determine how wage enhancement funds provided under this act shall be distributed to each long-term care paraprofessional worker. Facilities, organizations, and agencies participating in the wage enhancement program shall report to the department retrospectively on how the funds were distributed. All funds provided to a participating facility, organization, or agency must be used only to directly enhance the wages of long-term care paraprofessional workers. Participating facilities, organizations, and agencies are prohibited from arbitrarily reducing the wages of any long-term care paraprofessional worker on or after July 1, 2001, through July 2, 2002. Any funds received under this act that are not expended for the purposes of this act must be returned to the department.

(a) On July 1, 2001, participating facilities, organizations, and agencies shall increase by one dollar per hour, plus an amount equal to mandatory federal and state payroll taxes, the wages paid to each long-term care paraprofessional worker employed or contracted with by the facility, organization, or agency.

(b) On July 1, 2002, participating facilities, organizations, and agencies shall increase the wages paid to all long-term care paraprofessional workers by an average amount of one dollar per hour, plus an amount equal to mandatory federal and state payroll taxes. Participating facilities, organizations, and agencies shall determine the amount of the wage enhancement for each eligible long-term care paraprofessional worker in accordance with wage increase criteria guidelines adopted by each participating facility, organization, or agency. The wage increase criteria guidelines must include consideration of tenure, shift, and technical performance of duties, unless otherwise established by contract or bargaining agreement and consistent with existing state and federal law.

(2) The department shall determine the wage increase amount for persons working in the individual provider program. The department shall distribute the funding for the July 1, 2002, wage increase so that each participating employer receives an amount equal to the cost of providing a wage increase of one dollar per hour to each long-term care paraprofessional worker, plus an amount equal to mandatory federal and state payroll taxes.

NEW SECTION. Sec. 4. A new section is added to chapter 43.20A RCW to read as follows:

The department of social and health services shall distribute to all long-term care paraprofessional workers as defined in section 2 of this act information regarding the federal earned income tax credit program. The department's efforts must include outreach and technical assistance designed to allow all long-term care paraprofessional workers who are qualified to receive assistance through the earned income tax credit program.

Sec. 5. RCW 70.47.020 and 2000 c 79 s 43 are each amended to read as follows:

As used in this chapter:

(1) "Washington basic health plan" or "plan" means the system of enrollment and payment for basic health care services, administered by the plan administrator through participating managed health care systems, created by this chapter.

(2) "Administrator" means the Washington basic health plan administrator, who also holds the position of administrator of the Washington state health care authority.

(3) "Managed health care system" means: (a) Any health care organization, including health care providers, insurers, health care service contractors, health maintenance organizations, or any combination thereof, that provides directly or by contract basic health care services, as defined by the administrator and rendered by duly licensed providers, to a defined patient population enrolled in the plan and in the managed health care system; or (b) a self-funded or self-insured method of providing insurance coverage to subsidized enrollees provided under RCW 41.05.140 and subject to the limitations under RCW 70.47.100(7).

(4)(a) "Subsidized enrollee" means an individual, or an individual plus the individual's spouse or dependent children: ((~~(a)~~)) (i) Who is not eligible for medicare; ((~~(b)~~)) (ii) who is not confined or residing in a government-operated institution, unless he or she meets eligibility criteria adopted by the administrator; ((~~(c)~~)) (iii) who resides in an area of the state served by a managed health care system participating in the plan; ((~~(d)~~)) (iv) whose gross family income at the time of enrollment does not exceed two hundred percent of the federal poverty level as adjusted for family size and determined annually by the federal department of health and human services; and ((~~(e)~~)) (v) who chooses to obtain basic health care coverage from a particular managed health care system in return for periodic payments to the plan. To the extent that state funds are specifically appropriated for this purpose, with a corresponding federal match, "subsidized enrollee" also means an individual, or an individual's spouse or dependent children, who meets the requirements in (a)(i) through ((~~(c)~~)) (iii) and ((~~(e)~~)) (v) of this subsection and whose gross family income at the time of enrollment is more than two hundred percent, but less than two hundred fifty-one percent, of the federal poverty level as adjusted for family size and determined annually by the federal department of health and human services.

(b) "Subsidized enrollee" also means a long-term care paraprofessional worker as defined in section 2 of this act.

(5) "Nonsubsidized enrollee" means an individual, or an individual plus the individual's spouse or dependent children: (a) Who is not eligible for medicare; (b) who is not confined or residing in a government-operated institution, unless he or she meets eligibility criteria adopted by the administrator; (c) who resides in an area of the state served by a managed health care system participating in the plan; (d) who chooses to obtain basic health care coverage from a particular managed health care system; and (e) who pays or on whose behalf is paid the full costs for participation in the plan, without any subsidy from the plan.

(6) "Subsidy" means the difference between the amount of periodic payment the administrator makes to a managed health care system on behalf of a subsidized enrollee plus the administrative cost to the plan of providing the plan to that subsidized enrollee, and the amount determined to be the subsidized enrollee's responsibility under RCW 70.47.060(2).

(7) "Premium" means a periodic payment, based upon gross family income which an individual, their employer or another financial sponsor makes to the plan as consideration for enrollment in the plan as a subsidized enrollee or a nonsubsidized enrollee.

(8) "Rate" means the amount, negotiated by the administrator with and paid to a participating managed health care system, that is based upon the enrollment of subsidized and nonsubsidized enrollees in the plan and in that system.

Sec. 6. RCW 70.47.060 and 2000 c 79 s 34 are each amended to read as follows:

The administrator has the following powers and duties:

(1) To design and from time to time revise a schedule of covered basic health care services, including physician services, inpatient and outpatient hospital services, prescription drugs and medications, and other services that may be necessary for basic health care. In addition, the administrator may, to the extent that funds are available, offer as basic health plan services chemical dependency services, mental health services and organ transplant services; however, no one service or any combination of these three services shall increase the actuarial value of the basic health plan benefits by more than five percent excluding inflation, as determined by the office of financial management. All subsidized and nonsubsidized enrollees in any participating managed health care system under the Washington basic health plan shall be entitled to receive covered basic health care services in return for premium payments to the plan. The schedule of services shall emphasize proven preventive and primary health care and shall include all services necessary for prenatal, postnatal, and well-child care. However, with respect to coverage for subsidized enrollees who are eligible to receive prenatal and postnatal services through the medical assistance program under chapter 74.09 RCW, the administrator shall not contract for such services except to the extent that such services are necessary over not more than a one-month period in order to maintain continuity of care after diagnosis of pregnancy by the managed care provider. The schedule of services shall also include a separate schedule of basic health care services for children, eighteen years of age and younger, for those subsidized or nonsubsidized enrollees who choose to secure basic coverage through the plan only for their dependent children. In designing and revising the schedule of services, the administrator shall consider the guidelines for assessing health services under the mandated benefits act of 1984, RCW 48.47.030, and such other factors as the administrator deems appropriate.

(2)(a) To design and implement a structure of periodic premiums due the administrator from subsidized enrollees that is based upon gross family income, giving appropriate consideration to family size and the ages of all family members. The enrollment of children shall not require the enrollment of their parent or parents who are eligible for the plan. The structure of periodic premiums shall be applied to subsidized enrollees entering the plan as individuals pursuant to subsection (9) of this section and to the share of the cost of the plan due from subsidized enrollees entering the plan as employees pursuant to subsection (10) of this section.

(b) To the extent funds are specifically appropriated for this purpose, to enroll in the basic health plan long-term care paraprofessional workers as defined in section 2 of this act who are not otherwise enrolled. Premiums due from long-term care paraprofessional workers shall be set at ten dollars per covered worker per month.

(c) To determine the periodic premiums due the administrator from nonsubsidized enrollees. Premiums due from nonsubsidized enrollees shall be in an amount equal to the cost charged by the managed health care system provider to the state for the plan plus the administrative cost of providing the plan to those enrollees and the premium tax under RCW 48.14.0201.

((~~(c)~~)) (d) An employer or other financial sponsor may, with the prior approval of the administrator, pay the premium, rate, or any other amount on behalf of a subsidized or nonsubsidized enrollee, by arrangement with the enrollee and through a mechanism acceptable to the administrator.

(3) To design and implement a structure of enrollee cost-sharing due a managed health care system from subsidized and nonsubsidized enrollees. The structure shall discourage inappropriate enrollee utilization of health care services, and may utilize copayments, deductibles, and other cost-sharing mechanisms, but shall not be so costly to enrollees as to constitute a barrier to appropriate utilization of necessary health care services.

(4) To limit enrollment of persons who qualify for subsidies so as to prevent an overexpenditure of appropriations for such purposes. Whenever the administrator finds that there is danger of such an overexpenditure, the administrator shall close enrollment until the administrator finds the danger no longer exists.

(5) To limit the payment of subsidies to subsidized enrollees, as defined in RCW 70.47.020. The level of subsidy provided to persons who qualify may be based on the lowest cost plans, as defined by the administrator.

(6) To adopt a schedule for the orderly development of the delivery of services and availability of the plan to residents of the state, subject to the limitations contained in RCW 70.47.080 or any act appropriating funds for the plan.

(7) To solicit and accept applications from managed health care systems, as defined in this chapter, for inclusion as eligible basic health care providers under the plan for either subsidized enrollees, or nonsubsidized enrollees, or both. The administrator shall endeavor to assure that covered basic health care services are available to any enrollee of the plan from among a selection of two or more participating managed health care systems. In adopting any rules or procedures applicable to managed health care systems and in its dealings with such systems, the administrator shall consider and make suitable allowance for the need for health care services and the differences in local availability of health care resources, along with other resources, within and among the several areas of the state. Contracts with participating managed health care systems shall ensure that basic health plan enrollees who become eligible for medical assistance may, at their option, continue to receive services from their existing providers within the managed health care system if such providers have entered into provider agreements with the department of social and health services.

(8) To receive periodic premiums from or on behalf of subsidized and nonsubsidized enrollees, deposit them in the basic health plan operating account, keep records of enrollee status, and authorize periodic payments to managed health care systems on the basis of the number of enrollees participating in the respective managed health care systems.

(9) To accept applications from individuals residing in areas served by the plan, on behalf of themselves and their spouses and dependent children, for enrollment in the Washington basic health plan as subsidized or nonsubsidized enrollees, to establish appropriate minimum-enrollment periods for enrollees as may be necessary, and to determine, upon application and on a reasonable schedule defined by the authority, or at the request of any enrollee, eligibility due to current gross family income for sliding scale premiums. Funds received by a family as part of participation in the adoption support program authorized under RCW 26.33.320 and 74.13.100 through 74.13.145 shall not be counted toward a family's current gross family income for the purposes of this chapter. When an enrollee fails to report income or income changes accurately, the administrator shall have the authority either to bill the enrollee for the amounts overpaid by the state or to impose civil penalties of up to two hundred percent of the amount of subsidy overpaid due to the enrollee incorrectly reporting income. The administrator shall adopt rules to define the appropriate application of these sanctions and the processes to implement the sanctions provided in this subsection, within available resources. No subsidy may be paid with respect to any enrollee whose current gross family income exceeds twice the federal poverty level or, subject to RCW 70.47.110, who is a recipient of medical assistance or medical care services under chapter 74.09 RCW. If a number of enrollees drop their enrollment for no apparent good cause, the administrator may establish appropriate rules or requirements that are applicable to such individuals before they will be allowed to reenroll in the plan.

(10) To accept applications from business owners on behalf of themselves and their employees, spouses, and dependent children, as subsidized or nonsubsidized enrollees, who reside in an area served by the plan. The administrator may require all or the substantial majority of the eligible employees of such businesses to enroll in the plan and establish those procedures necessary to facilitate the orderly enrollment of groups in the plan and into a managed health care system. The administrator may require that a business owner pay at least an amount equal to what the employee pays after the state pays its portion of the subsidized premium cost of the plan on behalf of each employee enrolled in the plan. Enrollment is limited to those not eligible for medicare who wish to enroll in the plan and choose to obtain the basic health care coverage and services from a managed care system participating in the plan. The administrator shall adjust the amount determined to be due on behalf of or from all such enrollees whenever the amount negotiated by the administrator with the participating managed health care system or systems is modified or the administrative cost of providing the plan to such enrollees changes.

(11) To determine the rate to be paid to each participating managed health care system in return for the provision of covered basic health care services to enrollees in the system. Although the schedule of covered basic health care services will be the same or actuarially equivalent for similar enrollees, the rates negotiated with participating managed health care systems may vary among the systems. In negotiating rates with participating systems, the administrator shall consider the characteristics of the populations served by the respective systems, economic circumstances of the local area, the need to conserve the resources of the basic health plan trust account, and other factors the administrator finds relevant.

(12) To monitor the provision of covered services to enrollees by participating managed health care systems in order to assure enrollee access to good quality basic health care, to require periodic data reports concerning the utilization of health care services rendered to enrollees in order to provide adequate information for evaluation, and to inspect the books and records of participating managed health care systems to assure compliance with the purposes of this chapter. In requiring reports from participating managed health care systems, including data on services rendered enrollees, the administrator shall endeavor to minimize costs, both to the managed health care systems and to the plan. The administrator shall coordinate any such reporting requirements with other state agencies, such as the insurance commissioner and the department of health, to minimize duplication of effort.

(13) To evaluate the effects this chapter has on private employer-based health care coverage and to take appropriate measures consistent with state and federal statutes that will discourage the reduction of such coverage in the state.

(14) To develop a program of proven preventive health measures and to integrate it into the plan wherever possible and consistent with this chapter.

(15) To provide, consistent with available funding, assistance for rural residents, underserved populations, and persons of color.

(16) In consultation with appropriate state and local government agencies, to establish criteria defining eligibility for persons confined or residing in government-operated institutions.

(17) To administer the premium discounts provided under RCW 48.41.200(3)(a) (i) and (ii) pursuant to a contract with the Washington state health insurance pool.

(18) In consultation with the department of social and health services and to the extent funds are specifically appropriated for this purpose, to provide subsidized coverage in the basic health plan to long-term care paraprofessional workers as defined in section 2 of this act.

Sec. 7. RCW 28B.15.558 and 1997 c 211 s 1 are each amended to read as follows:

(1) The governing boards of the state universities, the regional universities, The Evergreen State College, and the community colleges may waive all or a portion of the tuition and services and activities fees for state employees as defined under subsection (2) of this section and members of the Washington national guard. The enrollment of these persons is pursuant to the following conditions:

(a) Such persons shall register for and be enrolled in courses on a space available basis and no new course sections shall be created as a result of the registration;

(b) Enrollment information on persons registered pursuant to this section shall be maintained separately from other enrollment information and shall not be included in official enrollment reports, nor shall such persons be considered in any enrollment statistics that would affect budgetary determinations; and

(2) For the purposes of this section, "state employees" means persons employed half‑time or more in one or more of the following employee classifications:

(a) Permanent employees in classified service under chapter 41.06 RCW;

(b) Permanent employees governed by chapter 41.56 RCW pursuant to the exercise of the option under RCW 41.56.201;

(d) Faculty, counselors, librarians, and exempt professional and administrative employees at institutions of higher education as defined in RCW 28B.10.016; and

(e) Long-term care paraprofessional workers as defined in section 2 of this act.

(3) In awarding waivers, an institution of higher education may award waivers to eligible persons employed by the institution before considering waivers for eligible persons who are not employed by the institution.

(4) If an institution of higher education exercises the authority granted under this section, it shall include all eligible state employees and members of the Washington national guard in the pool of persons eligible to participate in the program.

(5) In establishing eligibility to receive waivers, institutions of higher education may not discriminate between full‑time employees and employees who are employed half‑time or more.