BILL REQ. #:  S-4308.2 

Read first time 01/24/08.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to discharge of long-term care residents; amending RCW 74.42.450 and 70.129.110; and adding a new section to chapter 18.20 RCW.

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

NEW SECTION.  Sec. 1   A new section is added to chapter 18.20 RCW to read as follows:
     (1) A boarding home's voluntary withdrawal from participation in the medicaid program for residential care and services, while continuing to provide services of the type provided by boarding homes, is not an acceptable basis for the transfer or discharge of persons who were residing in the boarding home on the day before the effective date of the withdrawal.
     (a) The persons who are protected from transfer or discharge after the boarding home's withdrawal from participation in the medicaid program include persons who were residing in the boarding home on the day before the effective date of the withdrawal but who were not yet entitled to medicaid assistance on that date.
     (b) The provisions of this section continue to apply to persons who were residing in the boarding home on the day before the effective date of the withdrawal until the date of their transfer or discharge from the facility.
     (2)(a) A boarding home that voluntarily withdraws from participation in the medicaid program for residential care and services must provide notice to any person who begins residence in the boarding home on or after the effective date of the medicaid withdrawal that:
     (i) The boarding home will not participate in the medicaid program with respect to that person; and
     (ii) The boarding home may transfer or discharge the person, following notice, if the person is unable to pay the charges of the facility, even if the person becomes eligible for medicaid assistance for boarding home services while residing at the boarding home.
     (b) The boarding home shall provide notice orally and in writing in a prominent manner on a separate page before the person begins residence, and must obtain the person's signed, written acknowledgement of receipt of the information.
     (c) Nothing in this subsection shall be construed as affecting any requirement that a boarding home provide advance notice to the department of its intention to voluntarily terminate the facility's medicaid contract with the department.
     (3) Notwithstanding any other provision of this section, a medicaid contract between the department and a boarding home is deemed to continue in effect after the effective date of the facility's voluntary withdrawal from participation in the medicaid program for purposes of:
     (a) Receiving payments under the medicaid program for boarding home services provided to persons who were residing in the boarding home on the day before the effective date of the withdrawal;
     (b) Maintaining compliance with all requirements of the medicaid contract between the department and the facility; and
     (c) Continuing to apply the oversight and enforcement authority provided under the department's contract, regulations, and the law.

Sec. 2   RCW 74.42.450 and 1997 c 392 s 216 are each amended to read as follows:
     (1) The facility shall admit as residents only those individuals whose needs can be met by:
     (a) The facility;
     (b) The facility cooperating with community resources; or
     (c) The facility cooperating with other providers of care affiliated or under contract with the facility.
     (2) The facility shall transfer a resident to a hospital or other appropriate facility when a change occurs in the resident's physical or mental condition that requires care or service that the facility cannot provide. The resident, the resident's guardian, if any, the resident's next of kin, the attending physician, and the department shall be consulted at least fifteen days before a transfer or discharge unless the resident is transferred under emergency circumstances. The department shall use casework services or other means to insure that adequate arrangements are made to meet the resident's needs.
     (3) A resident shall be transferred or discharged only for medical reasons, the resident's welfare or request, the welfare of other residents, or nonpayment. A resident may not be discharged for nonpayment if the discharge would be prohibited by the medicaid program.
     (4) If a resident chooses to remain in the nursing facility, the department shall respect that choice, provided that if the resident is a medicaid recipient, the resident continues to require a nursing facility level of care.
     (5) If the department determines that a resident no longer requires a nursing facility level of care, the resident shall not be discharged from the nursing facility until at least thirty days after written notice is given to the resident, the resident's surrogate decision maker and, if appropriate, a family member or the resident's representative. A form for requesting a hearing to appeal the discharge decision shall be attached to the written notice. The written notice shall include at least the following:
     (a) The reason for the discharge;
     (b) A statement that the resident has the right to appeal the discharge; and
     (c) The name, address, and telephone number of the state long-term care ombudsman.
     (6) If the resident appeals a department discharge decision, the resident shall not be discharged without the resident's consent until at least thirty days after a final order is entered upholding the decision to discharge the resident.
     (7) Before the facility transfers or discharges a resident, the facility must first attempt through reasonable accommodations to avoid the transfer or discharge unless the transfer or discharge is agreed to by the resident. The facility shall admit or retain only individuals whose needs it can safely and appropriately serve in the facility with available staff or through the provision of reasonable accommodations required by state or federal law. "Reasonable accommodations" has the meaning given to this term under the federal Americans with disabilities act of 1990, 42 U.S.C. Sec. 12101 et seq. and other applicable federal or state antidiscrimination laws and regulations.
     (8) If a resident is transferred or discharged by the facility for treatment in a hospital and is subsequently cleared for readmittance to the facility by a physician, the facility shall readmit the resident to the first available gender-appropriate bed. If the facility thereafter issues a notice of transfer or discharge stating the facility is no longer able to meet the resident's needs following the resident's hospital stay, the resident is entitled to contest the proposed transfer or discharge in a fair hearing, provided the resident or resident's representative files a request for an administrative hearing with the office of administrative hearings within ten days of receipt of the notice of transfer or discharge.

Sec. 3   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) 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, 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)) persons who are developmentally disabled 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)) persons with a mental illness 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.
     (8) If a resident is transferred or discharged by the facility for treatment in a hospital and is subsequently cleared for readmittance to the facility by a physician, the facility shall readmit the resident to the first available gender-appropriate bed. If the facility thereafter issues a notice of transfer or discharge stating the facility is no longer able to meet the resident's needs following the resident's hospital stay, the resident is entitled to contest the proposed transfer or discharge in a fair hearing, provided the resident or resident's representative files a request for an administrative hearing with the office of administrative hearings within ten days of receipt of the notice of transfer or discharge.