BILL REQ. #:  S-0771.1 

Read first time 01/28/2003.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to creating a license for assisted living facilities; adding a new chapter to Title 18 RCW; and prescribing penalties.

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

NEW SECTION.  Sec. 1   The purpose of this chapter is to provide for the development, establishment, and enforcement of standards for the maintenance and operation of assisted living facilities. Assisted living is a housing option in long-term care that maximizes residents' independence and dignity in combining personal care and possibly health-related services in a residential setting. An assisted living residence is not a nursing home. The distinguishing characteristic of assisted living is its philosophy of supporting the particular and changing needs of the individual, supporting lifestyle choices, and minimizing the need to move. Taking into account the advancing knowledge in the care of the aged, assisted living facilities promote safe and adequate care as well as accommodate individual resident's changing needs and preferences; protect residents' rights; maximize residents' dignity, autonomy, privacy, independence, choice, safety, quality of life, and quality of care and encourage family and community involvement of the individuals who have chosen to make an assisted living facility their home.
     It is further the intent of the legislature that assisted living facilities be available to meet the needs of those for whom they care by recognizing the capabilities of individuals to direct their self-medication or to use supervised self-medication techniques when ordered and approved by a physician licensed under chapter 18.57 or 18.71 RCW or a podiatric physician and surgeon licensed under chapter 18.22 RCW.
     The legislature finds that many residents of community-based long-term care facilities are vulnerable, and their health and well-being are dependent on their caregivers. The quality, skills, and knowledge of their caregivers are often the key to good care. The legislature finds that the need for well-trained caregivers is growing as the state's population ages and residents' needs increase. The legislature intends that current training standards be enhanced without unduly creating impediments for those who wish to become caregivers.

NEW SECTION.  Sec. 2   The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Aged person" means a person of age sixty-five years or more, or a person of less than sixty-five years who by reason of infirmity requires assistance with the activities of daily living.
     (2) "Assisted living facility" means any residential setting that provides twenty-four-hour response to assistance with the activities of daily living on a scheduled and unscheduled basis determined by a negotiated service plan, and that may provide or coordinate health-related services. Other services provided include, but are not limited to: Social and recreational services, meals, housekeeping, and laundry. "Assisted living facility" does not include facilities certified as group training homes pursuant to RCW 71A.22.040, boarding homes licensed under RCW 18.20.030, 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 does 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 department of social and health services.

NEW SECTION.  Sec. 3   After January 1, 2004, no person may operate or maintain an assisted living facility within this state without a license under this chapter.

NEW SECTION.  Sec. 4   An application for a license must be made to the department upon forms provided by the department and must contain such information as the department reasonably requires, which includes affirmative evidence of ability to comply with rules adopted by the department.

NEW SECTION.  Sec. 5   Upon receipt of an application for a license, if the applicant and the assisted living facilities meet the requirements established under this chapter and the facilities are approved under section 11 of this act, the department shall issue a license. If there is a failure to comply with the provisions of this chapter or the standards and rules adopted under this chapter, the department may in its discretion issue to an applicant for a license, or for the renewal of a license, a provisional license that permits the operation of the assisted living facility for a period to be determined by the department, but not to exceed twelve months. The provisional license is not 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. All licenses issued under this chapter expire on a date to be set by the department, but no license issued pursuant to this chapter may exceed twelve months in duration. However, when the annual license renewal date of a previously licensed assisted living facility 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 must be prorated on a monthly basis and a credit 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 must be made not later than thirty days prior to the date of expiration of the license. Each license must be issued only for the premises and persons named in the application, and no license is transferable or assignable. Licenses must be posted in a conspicuous place on the licensed premises.
     A licensee who receives notification of the department's initiation of a denial, suspension, nonrenewal, or revocation of an assisted living facility license may, in lieu of appealing the department's action, surrender or relinquish the license. The department shall not issue a new license to or contract with the licensee, for the purposes of providing care to vulnerable adults or children, for a period of twenty years following the surrender or relinquishment of the former license. The licensing record must indicate that the licensee relinquished or surrendered the license, without admitting the violations, after receiving notice of the department's initiation of a denial, suspension, nonrenewal, or revocation of a license.

NEW SECTION.  Sec. 6   The department shall adopt rules with respect to all assisted living facilities and operators to be licensed under this chapter designed to further the accomplishment of the purposes of this chapter to promote safe and adequate care; respect resident's rights; and maximize residents' dignity, autonomy, privacy, independence, choice, safety, quality of life, and the interest of public health, safety, and welfare. These rules may not restrict the ability of individuals to negotiate their care with the assisted living providers.

NEW SECTION.  Sec. 7   The department shall make or cause to be made at least a yearly inspection of all assisted living facilities. Every inspection must focus primarily on actual or potential resident outcomes and satisfaction, 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. The focus of the inspection shall not be on physical plant, procedural, and documentations standards. Following such an inspection, written notice of any violation of this chapter or the rules adopted under this chapter must be given to the applicant or licensee and the department. The written notice must include specific statutes or rules violated, the specific facts of the violation, and the rationale for any remedy or punitive action imposed on the assisted living facility, including any department policies, procedures, interpretative guidelines, or advisory letters. The department may require by 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 to the agencies responsible for plan reviews for preliminary inspection and approval or recommendations with respect to compliance with state and local building codes. After the final approval of the alterations or additions to facilities or the construction of new facilities has been granted, the department shall no longer inspect the physical plant for compliance, unless a substantial change to the physical plant is noticed by the inspector during an inspection or compliance investigation. Oversight of the housing component is a function of local health and safety enforcement agencies.

NEW SECTION.  Sec. 8   The department shall develop and make available to assisted living facilities a quality improvement consultation program using the following principles:
     (1) The program must be resident-centered and promote privacy, independence, dignity, choice, and a home or home-like environment for residents consistent with chapter 70.129 RCW.
     (2) The goal of the program is continuous quality improvement with the focus on resident satisfaction and outcomes for residents. The quality improvement consultation program must be offered to assisted living facilities on a voluntary basis. Based on requests for the services of the quality improvement consultation program, the department may establish a process for prioritizing service availability.
     (3) Assisted living facilities should be supported in their efforts to improve quality and address problems, as identified by the licensee, initially through training, consultation, and technical assistance. At a minimum, the department may, within available funding, at the request of the assisted living facility, conduct on-site visits and telephone consultations.
     (4) To facilitate collaboration and trust between the assisted living facility and the department's quality improvement consultation program staff, the consultation program staff shall not simultaneously serve as department licensors, complaint investigators, or participants in any enforcement-related decisions, within the region in which they perform consultation activities; except such staff may investigate, on an emergency basis, complaints anywhere in the state when the complaint indicates high risk to resident health or safety. Any records or information gained as a result of quality improvement consultation program work may not be disclosed to or shared with nonmanagerial department licensing or complaint investigation staff, unless necessary to carry out duties described under chapter 74.34 RCW. The emphasis should be on problem prevention. Nothing in this section limits or interferes with the consultant's mandated reporting duties under chapter 74.34 RCW.
     (5) The department shall promote the development of a training system that is practical and relevant to the needs of residents and staff. To improve access to training, especially for rural communities, the training system may include, but is not limited to, the use of satellite technology distance learning that is coordinated through community colleges or other appropriate organizations.

NEW SECTION.  Sec. 9   Information received by the department through filed reports or inspections, or as otherwise authorized under this chapter, may not be disclosed publicly in any manner that identifies individuals or assisted living facilities, except at the specific request of a member of the public if disclosure is consistent with RCW 42.17.260(1).

NEW SECTION.  Sec. 10   (1) Monitoring must be outcome-based and responsive to resident complaints and a clear set of health, quality of care, and safety standards that are easily understandable and have been made available to facilities. When conducting licensing inspections, the department shall interview an appropriate percentage of residents, family members, and advocates in addition to interviewing appropriate staff.
     (2) Prompt and specific enforcement remedies must be implemented without delay, consistent with section 18 of this act, for facilities found to have delivered care or failed to deliver care resulting in problems that are serious, recurring, or uncorrected, or that create a hazard that is causing or likely to cause death or serious harm to one or more residents. Enforcement remedies may also include, when appropriate, reasonable conditions on a license. In the selection of remedies, the safety, health, and well-being of residents must be of paramount importance.
     (3) To the extent funding is available, the licensee, administrator, and their staff must be screened through background checks in a uniform and timely manner to ensure that they do not have a criminal history that would disqualify them from working with vulnerable adults. Employees may be provisionally hired pending the results of the background check if they have been given three positive references.
     (4) No licensee, administrator, or staff, or prospective licensee, administrator, or staff, with a stipulated finding of fact, conclusion of law, and agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into the state registry, finding him or her guilty of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW may be employed in the care of and have unsupervised access to vulnerable adults.

NEW SECTION.  Sec. 11   Standards for fire protection and their enforcement, with respect to all assisted living facilities to be licensed under this chapter, is the responsibility of the chief of the Washington state patrol, through the director of fire protection, who shall adopt standards applicable to assisted living facilities 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 the 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 assisted living facility to be licensed. If it is found that the premises do not comply with the required safety standards and fire rules, the chief of the Washington state patrol, through the director of fire protection, shall promptly make a written report to the assisted living facility and the department as to the manner and time allowed for the premises to qualify for a license and the conditions to be remedied with respect to fire rules. The department, applicant, or licensee shall notify the chief of the Washington state patrol, through the director of fire protection, upon completion of any requirements, and the chief of the Washington state patrol, through the director of fire protection, or his or her deputy, shall make a reinspection of the premises. The chief of the Washington state patrol, through the director of fire protection, shall submit to the department a written report when the assisted living facility is approved with respect to fire protection. The chief of the Washington state patrol, through the director of fire protection, shall make or cause to be made inspections of assisted living facilities at least annually.
     In cities which have a paid chief of a paid fire department and 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 assisted living facilities adopted by the chief of the Washington state patrol, through the director of fire protection, the chief of the 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 must jointly approve the premises.

NEW SECTION.  Sec. 12   Any person operating or maintaining an assisted living facility without a license under this chapter is guilty of a misdemeanor. Each day of a continuing violation is to be considered a separate offense.

NEW SECTION.  Sec. 13   Notwithstanding the existence or use of any other remedy, the department may, in the manner provided by law, upon the advice of the attorney general who shall represent the department in the proceedings, maintain an action in the name of the state for an injunction or other process against any person to restrain or prevent the operation or maintenance of an assisted living facility without a license under this chapter.

NEW SECTION.  Sec. 14   No person operating an assisted living facility licensed under this chapter shall admit to or retain in the assisted living facility any aged person requiring nursing or medical care of a type provided by institutions licensed under chapter 18.51, 70.41, or 71.12 RCW, except that supervised medication service may be provided when registered nurses are available and upon a doctor's order that a supervised medication service is needed. Supervised medication services, as defined by the department, may include an approved program of self-medication or self-directed medication. Such medication service may be provided only to residents who otherwise meet all requirements for residency in an assisted living facility.

NEW SECTION.  Sec. 15   Nothing in this chapter or the rules adopted under this chapter are to be construed as authorizing the supervision, regulation, or control of the remedial care or treatment of residents in any assisted living facility conducted for those who rely upon treatment by prayer or spiritual means in accordance with the creed or tenets of any well-recognized church or religious denomination.

NEW SECTION.  Sec. 16   RCW 70.129.005 through 70.129.030, 70.129.040(1), and 70.129.050 through 70.129.170 apply to this chapter and persons regulated under this chapter.

NEW SECTION.  Sec. 17   (1) The department shall establish and maintain a toll-free telephone number for receiving complaints regarding a facility that the department licenses.
     (2) All facilities that are licensed under this chapter shall post in a place and manner clearly visible to residents and visitors the department's toll-free complaint telephone number and the toll-free number and program description of the long-term care ombudsman as provided by RCW 43.190.050.
     (3) The department shall investigate complaints if the subject of the complaint is within its authority unless the department determines that: (a) The complaint is intended to willfully harass a licensee or employee of the licensee; or (b) there is no reasonable basis for investigation; or (c) corrective action has been taken as determined by the ombudsman or the department.
     (4) The department shall refer complaints to appropriate state agencies, law enforcement agencies, the attorney general, the long-term care ombudsman, or other entities if the department lacks authority to investigate or if its investigation reveals that a follow-up referral to one or more of these entities is appropriate.
     (5) The department shall adopt rules that include the following complaint investigation protocols:
     (a) Upon receipt of a complaint, the department shall make a preliminary review of the complaint, assess the severity of the complaint, and assign an appropriate response time. Complaints involving imminent danger to the health, safety, or well-being of a resident must be responded to within two days. When appropriate, the department shall make an on-site investigation within a reasonable time after receipt of the complaint or otherwise ensure that complaints are responded to.
     (b) The complainant must be: Promptly contacted by the department, unless anonymous or unavailable despite several attempts by the department, and informed of the right to discuss alleged violations with the inspector and to provide other information the complainant believes will assist the inspector; informed of the department's course of action; and informed of the right to receive a written copy of the investigation report.
     (c) In conducting the investigation, the department shall interview the complainant, unless anonymous, and shall use its best efforts to interview the resident or residents allegedly harmed by the violations, and, in addition to facility staff, any available independent sources of relevant information, including if appropriate the family members of the resident.
     (d) Substantiated complaints involving harm to a resident, if an applicable law or rule has been violated, are subject to one or more of the actions provided in Section 18 of this act. Whenever appropriate, the department shall also give consultation and technical assistance to the facility.
     (e) After a department finding of a violation for which a stop placement has been ordered, the department shall make an on-site revisit of the provider within fifteen working days from request for revisit to ensure correction of the violation. For violations that are serious or recurring or uncorrected following a previous citation, and create actual or threatened harm to one or more residents' well-being, including violations of residents' rights, the department shall make an on-site revisit as soon as appropriate to ensure correction of the violation. Verification of correction of all other violations may be made by either a department on-site revisit or by written or photographic documentation found by the department to be credible. This subsection does not prevent the department from enforcing license suspensions or revocations. Nothing in this subsection interferes with or diminishes the department's authority and duty to ensure that the provider adequately cares for residents, including departmental on-site revisits as needed to ensure that the provider protects residents and to enforce compliance with this chapter.
     (f) Substantiated complaints of neglect, abuse, exploitation, or abandonment of residents, or suspected criminal violations, must also be referred by the department to the appropriate law enforcement agencies, the attorney general, and appropriate professional disciplining authority.
     (6) The department may provide the substance of the complaint to the licensee before the completion of the investigation by the department unless such disclosure would reveal the identity of a complainant, witness, or resident, who chooses to remain anonymous. Neither the substance of the complaint provided to the licensee or contractor nor any copy of the complaint or related report published, released, or made otherwise available may disclose, or reasonably lead to the disclosure of, the name, title, or identity of any complainant, or other person mentioned in the complaint, except that the name of the provider and the name or names of any officer, employee, or agent of the department conducting the investigation must be disclosed after the investigation has been closed and the complaint has been substantiated. The department may disclose the identity of the complainant if such disclosure is requested in writing by the complainant. Nothing in this subsection is to be construed to interfere with the obligation of the long-term care ombudsman program to monitor the department's licensing, contract, and complaint investigation files for long-term care facilities.
     (7) A resident has the right to be free of interference, coercion, discrimination, and reprisal from a facility in exercising his or her rights, including the right to voice grievances about treatment furnished or not furnished. A facility licensed under this chapter shall not discriminate or retaliate in any manner against a resident, employee, or any other person on the basis or for the reason that such resident or any other person made a complaint to the department, the attorney general, law enforcement agencies, or the long-term care ombudsman, provided information, or otherwise cooperated with the investigation of such a complaint. Any attempt to discharge a resident against the resident's wishes, or any type of retaliatory treatment of a resident by whom or upon whose behalf a complaint substantiated by the department has been made to the department, the attorney general, law enforcement agencies, or the long-term care ombudsman, within one year of the filing of the complaint, raises a rebuttable presumption that such action was in retaliation for the filing of the complaint. "Retaliatory treatment" means, but is not limited to, monitoring a resident's phone, mail, or visits; involuntary seclusion or isolation; transferring a resident to a different room unless requested or based upon legitimate management reasons; withholding or threatening to withhold food or treatment unless authorized by a terminally ill resident or his or her representative pursuant to law; or persistently delaying responses to a resident's request for service or assistance. A facility licensed under this chapter shall not willfully interfere with the performance of official duties by a long-term care ombudsman. The department shall sanction and may impose a civil penalty of not more than three thousand dollars for a violation of this subsection.

NEW SECTION.  Sec. 18   (1) The department may take one or more of the actions listed in subsection (2) of this section in any case in which the department finds that an assisted living facility provider has:
     (a) Failed or refused to comply with the requirements of this chapter or the rules adopted under this chapter;
     (b) Operated an assisted living facility 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 attached data, 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 assisted living facility by ordering 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 correction of the violations previously found deficient. However, if upon the revisit the department finds new violations that the department reasonably believes will result in a new stop placement, the previous stop placement remains in effect until the new stop placement is imposed.
     (4) After a department finding of a violation for which a stop placement has been ordered, the department shall make an on-site revisit of the provider within fifteen working days from a request for revisit to ensure correction of the violation. For violations that are serious or recurring or uncorrected following a previous citation, and create actual or threatened harm to one or more residents' well-being, including violations of residents' rights, the department shall make an on-site revisit as soon as appropriate to ensure correction of the violation. Verification of correction of all other violations may be made by either a department on-site revisit or by written or photographic documentation found by the department to be credible. This subsection does not prevent the department from enforcing license suspensions or revocations. Nothing in this subsection interferes with or diminishes the department's authority and duty to ensure that the provider adequately cares for residents, including departmental on-site revisits as needed to ensure that the provider protects residents and to enforce compliance with this chapter.
     (5) 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 continue pending any hearing.

NEW SECTION.  Sec. 19   (1) The licensee or its designee has the right to an informal dispute resolution process to dispute any violation found or enforcement remedy imposed by the department during a licensing inspection or complaint investigation. The purpose of the informal dispute resolution process is to provide an opportunity for an exchange of information that may lead to the modification, deletion, or removal of a violation, or parts of a violation, or enforcement remedy imposed by the department.
     (2) The informal dispute resolution process provided by the department must include, but is not necessarily limited to, an opportunity for review by a department employee who did not participate in, or oversee, the determination of the violation or enforcement remedy under dispute. The department shall develop, or further develop, an informal dispute resolution process consistent with this section.
     (3) A request for an informal dispute resolution must be made to the department within ten working days from the receipt of a written finding of a violation or enforcement remedy. The request must identify the violation or violations and enforcement remedy or remedies being disputed. The department shall convene a meeting, when possible, within ten working days of receipt of the request for informal dispute resolution, unless by mutual agreement a later date is agreed upon.
     (4) If the department determines that a violation or enforcement remedy should not be cited or imposed, the department shall delete the violation or immediately rescind or modify the enforcement remedy. Upon request, the department shall issue a clean copy of the revised report, statement of deficiencies, or notice of enforcement action.
     (5) The request for informal dispute resolution does not delay the effective date of an enforcement remedy imposed by the department, except that civil monetary fines are not payable until the exhaustion of any formal hearing and appeal rights provided under this chapter. The licensee shall submit to the department, within the time period prescribed by the department, a plan of correction to address any undisputed violations, and including any violations that still remain following the informal dispute resolution.

NEW SECTION.  Sec. 20   The secretary shall suspend the license of any person who has been certified by a lending agency and reported to the secretary for nonpayment or default on a federally or state-guaranteed educational loan or service-conditional scholarship. Prior to the suspension, the lending agency shall provide the person an opportunity for a brief adjudicative proceeding under RCW 34.05.485 through 34.05.494 and issue a finding of nonpayment or default on a federally or state-guaranteed educational loan or service-conditional scholarship. The person's license may not be reissued until the person provides the secretary a written release issued by the lending agency stating that the person is making payments on the loan in accordance with a repayment agreement approved by the lending agency. If the person has continued to meet all other requirements for licensure during the suspension, reinstatement is automatic upon receipt of the notice and payment of any reinstatement fee the secretary may impose.

NEW SECTION.  Sec. 21   The department shall immediately suspend the license of a person who has been certified pursuant to RCW 74.20A.320 by the department as a person who is not in compliance with a support order or visitation order. If the person has continued to meet all other requirements for reinstatement during the suspension, reissuance of the license is automatic upon the department's receipt of a release issued by the department stating that the licensee is in compliance with the order.

NEW SECTION.  Sec. 22   (1) The department shall review training standards for administrators and resident caregiving staff in coordination with the department of health, the nursing care quality assurance commission, adult family home providers, assisted living facility providers, in-home personal care providers, and long-term care consumers and advocates. Any proposed enhancements must be consistent with this section, take into account and not duplicate other training requirements applicable to assisted living facilities and staff, and be developed with the input of assisted living facilities and resident representatives, health care professionals, and other vested interest groups. Training standards and the delivery system must be relevant to the needs of residents served by the assisted living facilities and recipients of long-term in-home personal care services and must be sufficient to ensure that administrators and caregiving staff have the skills and knowledge necessary to provide high quality, appropriate care.
     (2) The recommendations on training standards and the delivery system developed under subsection (1) of this section must be based on a review and consideration of the following: Quality of care; availability of training; affordability, including the training costs incurred by the department and private providers; portability of existing training requirements; competency testing; practical and clinical coursework; methods of delivery of training; standards for management and caregiving staff training; and necessary enhancements for special needs populations and resident rights training. Residents with special needs include, but are not limited to, residents with a diagnosis of mental illness, dementia, or developmental disability.

NEW SECTION.  Sec. 23   The secretary may adopt rules and policies as necessary to entitle the state to participate in federal funding programs and opportunities and to facilitate state and federal cooperation in programs under the department's jurisdiction. The secretary shall ensure that any internal reorganization carried out under the terms of this chapter complies with prerequisites for the receipt of federal funding for the various programs under the department's control. When interpreting any department-related section or provision of law susceptible to more than one interpretation, the secretary shall construe that section or provision in the manner most likely to comply with federal laws and rules entitling the state to receive federal funds for the various programs of the department. If any law or rule dealing with the department is ruled to be in conflict with federal prerequisites to the allocation of federal funding to the state, the department, or its agencies, the secretary shall declare that law or rule inoperative solely to the extent of the conflict.

NEW SECTION.  Sec. 24   (1) In an effort to ensure a cooperative process among the department, assisted living facility provider representatives, and resident and family representatives on matters pertaining to the assisted living program, the secretary, or his or her designee, shall designate an advisory board. The advisory board must include representatives of the statewide associations representing assisted living facilities, the state long-term care ombudsman program, the statewide 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 assisted living facility 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 assisted living facility provider programs, or development of methods and rates of payment.

NEW SECTION.  Sec. 25   (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 an assisted living facility, 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 assisted living facility employees or volunteers who routinely interact with residents shall complete orientation. Assisted living facility 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 assisted living facility staff to all assisted living facility 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 September 1, 2003, 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. Assisted living 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 September 1, 2003, whichever is later.
     (5) For assisted living facilities 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 September 1, 2003, 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. Assisted living administrators, or their designees, must complete specialty training and demonstrate competency within one hundred twenty days of September 1, 2003, or one hundred twenty days from the date on which the administrator or his or her designee is hired, whichever is later, if the assisted living facility 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 in the same calendar year in which basic or modified basic training is successfully completed. Continuing education is required in each calendar year thereafter. 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 department shall develop criteria for the approval of orientation, basic training, and specialty training programs.
     (11) Assisted living facilities that desire to deliver facility-based training with facility designated trainers, or assisted living facilities that desire to pool their resources to create shared training systems, must be encouraged by the department in their efforts. The department shall develop criteria for reviewing and approving trainers and training materials that are substantially similar to or better than the materials developed by the department. The department may approve a curriculum based upon attestation by an assisted living facility administrator that the assisted living facility's training curriculum addresses basic and specialty training competencies identified by the department. The department shall review a curriculum to verify that it meets these requirements. The department may conduct the review as part of the next regularly scheduled yearly inspection and investigation required under section 7 of this act. The department shall rescind approval of any curriculum if it determines that the curriculum does not meet these requirements.
     (12) The department shall adopt rules by September 1, 2003, for the implementation of this section.
     (13) The orientation, basic training, specialty training, and continuing education requirements of this section commence September 1, 2003, or one hundred twenty days from the date of employment, whichever is later, and shall be applied to (a) employees hired subsequent to September 1, 2003; and (b) existing employees that on September 1, 2003, have not successfully completed the training requirements under RCW 74.39A.010 or 74.39A.020 and this section. Existing employees who have not successfully completed the training requirements under RCW 74.39A.010 or 74.39A.020 are subject to all applicable requirements of this section. However, prior to September 1, 2003, nothing in this section affects the current training requirements under RCW 74.39A.010.

NEW SECTION.  Sec. 26   If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.

NEW SECTION.  Sec. 27   Sections 1 through 26 of this act constitute a new chapter in Title 18 RCW.