BILL REQ. #: H-3611.1

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HOUSE BILL 2528
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State of Washington

58th Legislature

2004 Regular Session

By Representatives Darneille and Benson

Read first time 01/15/2004. Referred to Committee on Health Care.

AN ACT Relating to boarding homes; amending RCW 18.20.020, 18.20.090, 18.20.160, 18.20.290, 74.39A.009, 74.39A.020, and 70.129.110; adding new sections to chapter 18.20 RCW; providing an effective date; and declaring an emergency.

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

Sec. 1   RCW 18.20.020 and 2003 c 231 s 2 are each amended to read as follows:
     As used in this chapter:
     (1) "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~~)) housing and assuming general responsibility for the safety and well-being of the residents, consistent with RCW 18.20.280, and may also provide domiciliary care, consistent with section 2 of this act, to seven or more residents after July 1, 2000. However, a boarding home that is licensed to provide ((~~board and~~)) housing and assume general responsibility for the safety and well-being of the residents consistent with RCW 18.20.280, and which may also provide domiciliary care, consistent with section 2 of this act, to three to six residents on July 1, 2000, 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.
     (2) "Person" means any individual, firm, partnership, corporation, company, association, or joint stock association, and the legal successor thereof.
     (3) "Secretary" means the secretary of social and health services.
     (4) "Department" means the state department of social and health services.
     (5) "Designated representative" means a person under RCW 7.70.065, or a person appointed by the resident to act on the resident's behalf and at the direction of the resident. The designated representative may not be an employee of the boarding home.
     (6) "Domiciliary care" means: Assistance with activities of daily living provided by the boarding home either directly or indirectly; or ((~~assuming general responsibility for the safety and well-being of the resident~~)) health support services, if provided directly or indirectly by the boarding home; or intermittent nursing services, if provided directly or indirectly by the boarding home. (("Domiciliary care" does not include general observation or preadmission assessment for the purposes of transitioning to a licensed care setting.
     (6))) (7) "General responsibility for the safety and well-being of the resident" includes the provision of: Meals, nutritious snacks, laundry, emergency assistance, activities, housekeeping services, and observation of residents for changes in overall functioning. However, observation of residents for changes in overall functioning shall not be construed to include systems or methods employed by 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, to monitor the well-being of nonresident individuals.
     (8) "General responsibility for the safety and well-being of the resident" does not include: (a) Emergency assistance provided on an intermittent or nonroutine basis to any nonresident individual; ((or)) (b) blood pressure checks for nonresident individuals; (c) nurse consultation services provided at the request of a nonresident individual to determine whether referral to an outside health care provider is recommended; (d) making health care appointments at the request of nonresident individuals; (e) reminding nonresident individuals of scheduled outside health care appointments; (f) one-time or short term treatment, including but not limited to removing sutures or staples for nonresident individuals or applying eye drops following eye surgery for nonresident individuals when performed pursuant to an outside health care provider's instructions and the treatment is performed at the request of any nonresident individual, and the activity is within the scope of practice of the available licensed nurse; (g) periodic observation or preadmission assessment for the purposes of transitioning to a licensed care setting; or (h) services customarily provided under landlord tenant agreements governed by the residential landlord-tenant act, chapter 59.18 RCW. Such services do not include continual care or supervision for any nonresident individual.
     ((~~(7)~~)) (9) "Nonresident individual" means a person who resides in independent senior housing, independent living units in continuing care retirement communities, or in other similar living environments including those subsidized by the department of housing and urban development.
     (10) "Resident" means an individual who((~~: Lives in a boarding home, including those receiving respite care;~~)) is not related by blood or marriage to the operator of the boarding home((;)), and by reason of age or disability, resides in the boarding home and may receive((s)) domiciliary care, respite care, or hospice care provided either directly or indirectly by the boarding home.
     (11) "Resident applicant" means an individual who has completed and signed an application for admission to a licensed boarding home.

NEW SECTION.  Sec. 2   A new section is added to chapter 18.20 RCW to read as follows:
     (1) A boarding home licensed under this chapter may select the level and scope of care or services that it chooses to provide from the list of domiciliary care services described in subsection (2), (3), or (4) of this section. In addition to the care and services described in subsections (2), (3), and (4) of this section, the boarding home licensee may provide additional care and services, as long as the resident does not require medical or nursing care, and as long as such additional care or services are disclosed in accordance with this section.
     (a) The boarding home licensee shall disclose the level and scope of care or services that it chooses to provide to the department, residents or a resident's designated representative, and interested consumers upon request.
     (b) If the boarding home licensee changes the level or scope of services that it chooses to provide, the licensee shall provide a minimum of thirty days' notice to the department and to residents before the effective date of any change in the level or scope of care or services provided.
     (c) The disclosure of any services or care that a boarding home licensee offers to provide may include exceptions to allow the licensee to, on a limited basis, meet the needs of residents pending discharge. Providing care or services to one or more residents on a limited basis, pending discharge, shall not be construed to mean that the licensee can or will reasonably accommodate other residents' similar needs throughout their boarding home stay.
     (d) Even though the boarding home licensee may disclose that it can provide certain care or services to residents or resident applicants, the licensee reserves the right to deny admission to a resident applicant or to discharge any resident when the licensee determines that the needs of the resident applicant or the resident cannot be met based upon the cumulative need for care or services of all residents or the medical complexity of the resident or the resident applicant. The licensee may immediately discharge a resident when the licensee determines that it can no longer meet the residents' needs or when the resident requires care or services that are beyond those that the licensee has disclosed. The department shall, at the request of the licensee, secure an alternative placement for the resident.
     (e) The boarding home licensee shall use the following form, or one that is substantially similar, to disclose the care or services that the licensee may choose to provide:

Boarding Home Name: . . . . . . . . . . . .
Address: . . . . . . . . . . . .
Telephone: . . . . . . . . . . . .		Web Address, if applicable: . . . . . . . . . . . .
Boarding Home License Number: . . . . . . . . . . . .		Number of License Boarding Home Beds: . . . . . . . . . . . .
This boarding home	□ does not accept Medicaid as a source of payment
	□ may accept Medicaid payments, with the following conditions/limitations:
	. . . . . . . . . . . .

     This Disclosure Statement is not intended to take the place of visiting the boarding home, communicating with boarding home staff, or understanding the boarding home's fee schedule for services outlined below, and other offered services.
     This licensed boarding home has selected the level and scope of care or services that it chooses to provide from the list of domiciliary care services outlined below. Should the boarding home change the level or scope of services that it chooses to provide, the provider shall provide a minimum of 30 days' notice to the Department of Social and Health Services and to residents before the effective date of any change in the level or scope of care or services provided.
     The disclosure of any services or care that a boarding home offers to provide may include exceptions to allow the provider to, on a limited basis, meet the needs of residents pending discharge. Providing care or services to one or more residents on a limited basis, pending discharge, shall not be construed to mean that the provider can or will reasonably accommodate other residents' similar needs throughout their boarding home stay.

This boarding home provides assistance with one or more of the following Activities of Daily Living:

□ Bathing:

     □ Minimal assistance - The resident requires oversight or reminding only. The resident is capable of bathing without assistance or supervision, but must be reminded occasionally or cannot get into the tub or shower alone. Help is limited to standby assistance only.
     □ Substantial assistance - The resident requires physical assistance with a significant part of the bathing activity, for example, to lather, wash and/or rinse the resident's hair or body, or physical assistance into a tub or shower is needed.
     □ Total assistance - The resident is dependent upon caregivers to provide a complete bath.
     □ Clarification/Other Comments: . . . . . . . . . . . .

□ Dressing:

     □ Minimal assistance - The resident can dress and undress but may need clothing laid out and/or needs to be reminded or supervised on occasion.
     □ Substantial assistance - The resident can assist in dressing or undressing but frequently or most of the time needs some physical assistance.
     □ Total assistance - The resident is dependent upon caregivers to do all dressing and undressing.
     □ Clarification/Other Comments: . . . . . . . . . . . .

□ Eating:

     □ Minimal assistance - The resident may need assistance cutting or preparing food or beverages for consumption.
     □ Substantial assistance - The resident can self-feed but needs standby assistance for occasional gagging, choking, or swallowing difficulty. The resident may need reminding or assistance with adaptive feeding equipment.
     □ Total assistance - The resident must be fed some or all food by a caregiver and/or frequently gags or chokes due to difficulty in swallowing.
     □ Clarification/Other Comments: . . . . . . . . . . . .

□ Personal hygiene:

     □ Minimal assistance - The resident can manage personal hygiene and grooming tasks but must be reminded, supervised, or have personal grooming items set out, at least some of the time. The resident may require occasional assistance with both personal hygiene and grooming.
     □ Substantial assistance - The resident regularly requires assistance with personal hygiene and grooming.
     □ Total assistance - The resident is dependent upon caregivers to provide all personal hygiene and grooming.
     □ Clarification/Other Comments: . . . . . . . . . . . .

□ Transferring:

     □ Minimal assistance - The resident occasionally requires verbal cuing or standby assistance for transfers.
     □ Substantial assistance - The resident occasionally requires a light touch to guide or steady the resident in transferring.
     □ Total assistance - The resident requires physical assistance with some or all transfers.
     □ Clarification/Other Comments: . . . . . . . . . . . .

□ Toileting:

     □ Minimal assistance - The resident needs reminding to toilet or to change a protective garment.
     □ Substantial assistance - The resident needs occasional assistance with parts of the toileting tasks.
     □ Total assistance - The resident needs physical assistance to use the toilet on a scheduled toileting or incontinence program which may include management of a closed drainage system if the resident has a catheter or sheath.
     □ Clarification/Other Comments: . . . . . . . . . . . .

□ Ambulation and Mobility:

     □ Minimal assistance - The resident is ambulatory or mobile, with or without assistive devices, but requires verbal cuing some of the time.
     □ Substantial assistance - The resident is ambulatory or mobile but needs occasional standby light touch assistance to guide or steady the resident during ambulation or mobility.
     □ Total assistance - The resident is only ambulatory or mobile, with or without assistive devices, with the physical assistance of a caregiver.
     □ Clarification/Other Comments: . . . . . . . . . . . .

□ This boarding home provides one or more of the following Health Support Services:

□ Medication assistance	Clarification/Other Comments: . . . . . . . . . . . .
□ Assistance with treatments	Clarification/Other Comments: . . . . . . . . . . . .
□ Blood glucose testing	Clarification/Other Comments: . . . . . . . . . . . .
□ Low sodium diets	Clarification/Other Comments: . . . . . . . . . . . .
□ General diabetic diets	Clarification/Other Comments: . . . . . . . . . . . .
□ Puree diets	Clarification/Other Comments: . . . . . . . . . . . .
□ Mechanical soft diets	Clarification/Other Comments: . . . . . . . . . . . .
□ Calorie-controlled diabetic diets	Clarification/Other Comments: . . . . . . . . . . . .
□ Other diets	Clarification/Other Comments: . . . . . . . . . . . .

□ Arrangement of health care appointments with outside health care providers
	Clarification/Other Comments: . . . . . . . . . . . .
□ Coordination of health care services with outside health care providers
	Clarification/Other Comments: . . . . . . . . . . . .
□ Assistance with obtaining and maintaining glasses, hearing aids, dentures, canes, crutches, walkers, wheelchairs,
and assistive communication devices	Clarification/Other Comments: . . . . . . . . . . . .
□ Other Health Support Services: . . . . . . . . . . . .

□ This boarding home provides one or more of the following Intermittent Nursing Services:
□ Medication administration	Clarification/Other Comments: . . . . . . . . . . . .
□ Administration of health care treatments	Clarification/Other Comments: . . . . . . . . . . . .
□ Blood glucose monitoring	Clarification/Other Comments: . . . . . . . . . . . .
□ Ostomy care	Clarification/Other Comments: . . . . . . . . . . . .
□ Tube feeding	Clarification/Other Comments: . . . . . . . . . . . .
□ Insertion of indwelling urinary catheter	Clarification/Other Comments: . . . . . . . . . . . .
□ Other Intermittent Nursing Services: . . . . . . . . . . . .

Admission/Discharge/Transfer

Even though the licensee may disclose that it can provide certain care or services to residents or resident applicants, the licensee may deny admission to a resident applicant or to discharge a resident when the licensee determines that the needs of the resident applicant or the resident cannot be met based upon the cumulative need for care or services of all residents or the medical complexity of the resident or the resident applicant. Notwithstanding RCW 70.129.110 (1)(a) and (4)(a), the licensee may immediately discharge a resident when the licensee determines that it can no longer meet the residents' needs or when the resident requires care or services that are beyond those that the licensee has disclosed. The licensee and the resident otherwise retain all other rights of transfer and discharge under RCW 70.129.110. The department of social and health services shall, at the request of the licensee, secure an alternative placement for the resident.

Optional Services/Amenities:

□	This boarding home
	□ Does permit residents' designated representatives to administer or assist with medications or treatments, with the following limitations and/or conditions: . . . . . . . . . . . .
	□ Does not permit residents' designated representatives to administer or assist with medications or treatments.
□	This boarding home has the capacity to assist with the use of oxygen, with the following limitations or conditions: . . . . . . . . . . . .
□	This boarding home
	□ Does permit smoking, with the following limitations or conditions: . . . . . . . . . . . .
	□ Does not permit smoking
□	This boarding home
	□ Does permit pets, with the following limitations or conditions: . . . . . . . . . . . .
	□ Does not permit pets
□	Religious/Spiritual support services		Clarification/Other Comments: . . . . . . . . . . . .
□	Barber/Beauty Shop services		Clarification/Other Comments: . . . . . . . . . . . .
□	Facility transportation,		Clarification/Other Comments: . . . . . . . . . . . .
□	Housekeeping (...... day/week)		Clarification/Other Comments: . . . . . . . . . . . .
□	This boarding home has the ability to assist with management of wandering behavior:
	□ Indoor	□ Outdoor	Clarification/Other Comments: . . . . . . . . . . . .
			. . . . . . . . . . . .
□	Other: . . . . . . . . . . . .
□	Other: . . . . . . . . . . . .
□	Other: . . . . . . . . . . . .

Phone number to call for more information on this boarding home, or to schedule an appointment to visit the boarding home: . . . . . . . . . . . .

This Disclosure Statement was completed by:	Name: . . . . . . . . . . . .
	Title: . . . . . . . . . . . .
	Company: . . . . . . . . . . . .
	Email: . . . . . . . . . . . .
	Phone No.: . . . . . . . . . . . .	Date: . . . . . . . . . . . .

	Signature: . . . . . . . . . . . .

     (2) Activities of daily living assistance may include one or more of the following:

     (a) Bathing:

     (i) Minimal assistance. The resident requires oversight or reminding only. The resident is capable of bathing without assistance or supervision, but must be reminded occasionally or cannot get into the tub or shower alone. Help is limited to standby assistance only.
     (ii) Substantial assistance. The resident requires physical assistance with a significant part of the bathing activity, for example, to lather, wash and/or rinse the resident's hair or body, or physical assistance into a tub or shower is needed.
     (iii) Total assistance. The resident is dependent upon caregivers to provide a complete bath.

     (b) Dressing:

     (i) Minimal assistance. The resident can dress and undress but may need clothing laid out and/or needs to be reminded or supervised on occasion.
     (ii) Substantial assistance. The resident can assist in dressing or undressing but frequently or most of the time needs some physical assistance.
     (iii) Total assistance. The resident is dependent upon caregivers to do all dressing and undressing.

     (c) Eating:

     (i) Minimal assistance. The resident may need assistance cutting or preparing food or beverages for consumption.
     (ii) Substantial assistance. The resident can self-feed but needs standby assistance for occasional gagging, choking, or swallowing difficulty. The resident may need reminding or assistance with adaptive feeding equipment.
     (iii) Total assistance. The resident must be fed some or all food by a caregiver and/or frequently gags or chokes due to difficulty in swallowing.

     (d) Personal Hygiene:

     (i) Minimal assistance. The resident can manage personal hygiene and grooming tasks but must occasionally be reminded, supervised, or have personal grooming items set out. The resident may require occasional assistance with both personal hygiene and grooming.
     (ii) Substantial assistance. The resident regularly requires assistance with personal hygiene and grooming.
     (iii) Total assistance. The resident is dependent upon caregivers to provide all personal hygiene and grooming.

     (e) Transferring:

     (i) Minimal assistance. The resident occasionally requires verbal cuing or standby assistance for transfers.
     (ii) Substantial assistance. The resident occasionally requires light touch to guide or steady the resident in transferring.
     (iii) Total assistance. The resident requires physical assistance with some or all transfers.

     (f) Toileting:

     (i) Minimal assistance. The resident needs reminding to toilet or to change a protective garment.
     (ii) Substantial assistance. The resident needs occasional assistance with parts of the toileting tasks.
     (iii) Total assistance. The resident needs physical assistance to use the toilet on a scheduled toileting, or incontinence program which may include management of a closed drainage system if the resident has a catheter or sheath.

     (g) Ambulation and Mobility:

     (i) Minimal assistance. The resident is ambulatory or mobile, with or without assistive devices, but requires occasional verbal cuing.
     (ii) Substantial assistance. The resident is ambulatory or mobile but needs occasional standby assistance or light touch assistance to guide or steady during ambulation or mobility.
     (iii) Total assistance. The resident is only ambulatory or mobile, with or without assistive devices, with the physical assistance of a caregiver.

     (3) Health support services may include one or more of the following:

     (a) Medication assistance;
     (b) Assistance with treatments;
     (c) Blood glucose testing;
     (d) Low sodium diets;
     (e) General diabetic diets;
     (f) Puree diets;
     (g) Mechanical soft foods;
     (h) Calorie-controlled diabetic diets;
     (i) Arrangement of health care appointments with outside health care providers;
     (j) Coordination of health care services with outside health care providers; and
     (k) Assistance with obtaining and maintaining glasses, hearing aids, dentures, canes, crutches, walkers, wheelchairs, and assistive communication devices.

     (4) Intermittent nursing services may include one or more of the following:

     (a) Medication administration;
     (b) Administration of health care treatments;
     (c) Blood glucose monitoring;
     (d) Ostomy care;
     (e) Tube feeding; and
     (f) Insertion of indwelling urinary catheters.

NEW SECTION.  Sec. 3   A new section is added to chapter 18.20 RCW to read as follows:
     (1) A boarding home licensee may permit residents' designated representatives to administer medications or treatments or to provide medication or treatment assistance to residents. If the licensee permits this, the licensee may establish conditions under which such assistance may occur. The licensee shall disclose to the department, residents, and each resident's designated representative, and to interested consumers upon request, information describing whether the licensee permits assistance with or permits the administration of medications or treatments and, if so, whether there are any limitations or conditions and the extent thereof.
     (2) A resident's designated representative may only administer or provide assistance with medications or treatments on behalf of the resident who has granted the designated representative the authority to so act.
     (3) If a licensee permits residents' designated representatives to administer medications or treatments or to provide medication or treatment assistance, the licensee shall request that each designated representative submit to the licensee a written medication or treatment plan. At a minimum, the written medication or treatment plan shall identify:
     (a) By name, the designated representative who will administer the medication or treatment or provide assistance therewith;
     (b) The primary medication or treatment administration or assistance that the designated representative will provide consistent with subsection (1) of this section. This will be referred to as the primary plan;
     (c) An alternate plan that will meet the resident's medication or treatment needs if the designated representative is unable to fulfill his or her duties as specified in the primary plan; and
     (d) An emergency contact person and telephone number if the boarding home licensee observes changes in the resident's functioning or condition that may relate to the medication or treatment plan.
     (4) The boarding home licensee may require that the primary or alternate medication or treatment plan include other information in addition to that specified in subsection (3) of this section.
     (5) The medication or treatment plan shall be signed and dated by the resident, the resident's designated representative, and the boarding home licensee.
     (6) The designated representative shall immediately notify the boarding home licensee of any change in the primary or alternate medication or treatment plan.
     (7) When a boarding home licensee permits residents' designated representatives to assist with or administer medications or treatments, the licensee must observe the resident for changes in overall functioning consistent with RCW 18.20.280. The licensee's duty of care under this section, and any negligence that may be attributed thereto, is limited to the licensee's failure to observe the resident for a change in overall functioning, and then to the extent that such change in overall functioning would have been observed by a reasonable person having the same skill and knowledge as the licensee.

Sec. 4 RCW 18.20.090 and 1985 c 213 s 6 are each amended to read as follows:
The department shall adopt, amend, and promulgate such rules, regulations, and standards with respect to all boarding homes and operators thereof to be licensed hereunder as may be designed to further the accomplishment of the purposes of this chapter in promoting safe and adequate care of individuals in boarding homes and the sanitary, hygienic and safe conditions of the boarding home in the interest of public health, safety, and welfare. However, the department may not adopt or amend rules, with respect to matters pertaining to chapter 18.79 RCW, or any other health professional licensing matters that are under the purview of the department of health. The department may, by reference, incorporate any such rules adopted under chapter 18.79 RCW.

NEW SECTION.  Sec. 5   A new section is added to chapter 18.20 RCW to read as follows:
     (1) The boarding home licensee shall conduct an initial assessment for each resident applicant. The initial assessment shall include the following minimum information:
     (a) Medical history;
     (b) Necessary and contraindicated medications;
     (c) A licensed medical or health professional's diagnosis, unless the individual objects for religious reasons;
     (d) Significant known behaviors or symptoms that may cause concern or require special care. The licensee shall complete the initial assessment before admission unless there is an emergency. In an emergency admission, the initial assessment must be completed within five days of the date of admission. For purposes of this section, an emergency includes, but is not limited to, evenings, weekends, or Friday afternoons and the resident applicant would otherwise need to remain in a licensed hospital, nursing facility, adult family home, an unsafe home environment, or be without adequate and safe housing.
     (e) Mental illness diagnosis, except where protected by confidentiality laws;
     (f) Level of personal care needs;
     (g) Activities and service preferences; and
     (h) Preferences regarding other issues important to the resident applicant, such as food and daily routine.
     (2) The boarding home licensee shall complete an initial resident service plan upon move-in to identify the resident's immediate needs and to provide direction to staff and caregivers relating to the resident's immediate needs.
     (3) The boarding home licensee shall complete a negotiated service agreement involving the resident and the resident's designated representative, within thirty days of a resident's move-in date. The resident's designated representative will not be included in the development of the negotiated service agreement if the resident objects to his or her involvement. If the resident is a Medicaid client, the department's case manager shall also be involved. However, if the case manager is not available, the completion of the negotiated service agreement shall not be delayed but shall be sent to the case manager for review.

NEW SECTION. Sec. 6 A new section is added to chapter 18.20 RCW to read as follows:
By December 12, 2005, the department shall report on the payment system for licensed boarding homes to the chairs of the senate and house of representatives health care committees. The department shall include in the report findings regarding the average costs of providing care and services for the nonmetropolitan statistical areas, metropolitan statistical areas, and King county to determine whether the rates of payment within the designated areas are, on average, reasonably related to the identified average costs. To protect the confidentiality of the cost data, the department shall work in collaboration with the three statewide associations representing boarding home providers, so that the department does not possess individual provider identifiable cost data. This cost-to-rate comparison study shall assess any cost impacts that may be attributed to the implementation of new boarding home rules occurring between September 1, 2004, and June 30, 2005. If the department adopts new boarding home rules after June 30, 2005, the report to the chairs of the senate and house of representatives health care committees will instead be due by December 12, 2006.

Sec. 7 RCW 18.20.160 and 1985 c 297 s 2 are each amended to read as follows:
Because boarding homes are engaged in the rental or leasing of real property to residents, no person operating a boarding home licensed under this chapter shall admit to or retain in the boarding home any aged person requiring nursing or medical care of a type provided by institutions licensed under chapters 18.51, 70.41 or 71.12 RCW, except that when registered nurses are available, and upon a doctor's order that a supervised medication service is needed, it may be provided. Supervised medication services, as defined by the department but not exceeding that which is permitted under chapters 69.41 and 18.79 RCW, may include an approved program of self-medication or self-directed medication. Such medication service shall be provided only to boarders who otherwise meet all requirements for residency in a boarding home. No boarding home shall admit or retain a person requiring twenty-four hours of continuous skilled nursing care or supervision, excluding persons who are receiving hospice care or persons who have a short-term illness that is expected to be resolved within fourteen days.

Sec. 8   RCW 18.20.290 and 2003 c 231 s 11 are each amended to read as follows:
     (1) When a boarding home contracts with the department to provide adult residential care services, enhanced adult residential care services, or assisted living services under chapter 74.39A RCW, the boarding home must hold a medicaid eligible resident's room or unit when short-term care is needed in a nursing home or hospital, the resident is likely to return to the boarding home, and payment is made under subsection (2) of this section.
     (2) The medicaid resident's bed or unit shall be held for up to twenty days. The per day bed or unit hold compensation amount shall be seventy percent of the daily rate paid for the first seven days the bed or unit is held for the resident who needs short-term nursing home care or hospitalization. The rate for the eighth through the twentieth day a bed is held shall be established in rule, but shall be no lower than ten dollars per day the bed or unit is held.
     (3) The boarding home may seek third-party payment to hold a bed or unit for twenty-one days or longer. The third-party payment shall not exceed eighty-five percent of the average daily private pay and Medicaid rate paid to the facility, and as determined by the facility. If third-party payment is not available, the medicaid resident may return to the first available and appropriate bed or unit, if the resident continues to meet the admission criteria under this chapter.
     (4) The department shall monitor the use and impact of the policy established under this section and shall report its findings to the appropriate committees of the senate and house of representatives by December 31, 2005.
     (5) This section expires June 30, 2006.

Sec. 9   RCW 74.39A.009 and 1997 c 392 s 103 are each amended to read as follows:
     Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
     (1) "Adult family home" means a home licensed under chapter 70.128 RCW.
     (2) "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.020 to provide personal care services.
     (3) "Assisted living services" means services provided by a boarding home that has a contract with the department under RCW 74.39A.010 to provide personal care services, intermittent nursing services, and medication administration services, 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 social and health 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 to provide personal care services, intermittent nursing services, and medication administration services.
     (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, including chemical dependency, 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, in-home services, and other services administered or provided by contract 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, chemical dependency, 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 social and health 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.

Sec. 10   RCW 74.39A.020 and 1995 1st sp.s. c 18 s 15 are each amended to read as follows:
     (1) To the extent of available funding, the department of social and health services may contract for adult residential care ((~~and enhanced adult residential care~~)).
     (2) The department shall, by rule, develop terms and conditions for facilities that contract with the department for adult residential care ((~~and enhanced adult residential care~~)) to establish:
     (a) Facility service standards consistent with the principles in RCW 74.39A.050 and consistent with chapter 70.129 RCW; and
     (b) Training requirements for providers and their staff.
     (3) The department shall, by rule, provide that services in adult residential care ((~~and enhanced adult residential care~~)) facilities:
     (a) Recognize individual needs, privacy, and autonomy;
     (b) Include personal care ((~~and limited nursing services~~)) and other services that promote independence and self-sufficiency and aging in place;
     (c) Are directed first to those persons most likely, in the absence of adult residential care ((~~and enhanced adult residential care~~)) services, to need hospital, nursing facility, or other out-of-home placement; and
     (d) Are provided in compliance with applicable facility and professional licensing laws and rules.
     (4) When a facility contracts with the department for adult residential care ((~~and enhanced adult residential care~~)), only services and facility standards that are provided to or in behalf of the adult residential care ((~~or the enhanced adult residential care~~)) client shall be subject to the adult residential care ((~~or enhanced adult residential care~~)) rules.
     (5) To the extent of available funding, the department may also contract under this section with a tribally licensed boarding home for the provision of services of the same nature as the services provided by adult residential care facilities. The provisions of subsections (2)(a) and (b) and (3)(a) through (d) of this section apply to such a contract.

NEW SECTION. Sec. 11 A new section is added to chapter 18.20 RCW to read as follows:
When the department performs assessments of Medicaid eligible clients to determine whether such persons are eligible for boarding home placement, the department shall not adjust the assessment method, including the algorithms used to categorize clients into assessment categories, for the sole purpose of remaining within the funding amount appropriated by the legislature for boarding homes.

Sec. 12   RCW 70.129.110 and 1997 c 392 s 205 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) Except as provided in section 2 of this act, 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;
     (c) The health of individuals in the facility would otherwise be endangered;
     (d) The resident has failed to make the required payment for his or her stay; or
     (e) The facility ceases to operate.
     (2) 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 applicant who is medicaid eligible are in excess of the facility's service capabilities, 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 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;
     (c) Record the reasons in the resident's record; and
     (d) Include in the notice the items described in subsection (5) of this section.
     (4)(a) Except when specified in this subsection and as provided in section 2 of this act, the notice of transfer or discharge required under subsection (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.
     (5) The written notice specified in subsection (3) of this section must include the following:
     (a) The reason for transfer or discharge;
     (b) The effective date of transfer or discharge;
     (c) The location to which the resident is transferred or discharged;
     (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.
     (6) A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.
     (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.

NEW SECTION. Sec. 13 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, except that sections 2, 3, and 5 of this act take effect September 1, 2004.

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