BILL REQ. #:  H-0495.1 

Read first time 01/19/09.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to supporting care for the elderly; amending RCW 74.38.040, 74.41.050, and 74.09.710; adding a new section to chapter 74.39A RCW; and creating new sections.

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

NEW SECTION.  Sec. 1   The legislature finds that Washingtonians sixty-five years of age and older will nearly double in the next twenty years, from eleven percent of our population today to almost twenty percent of our population in 2025. Younger people with disabilities will also require supportive long-term care services. Nationally, young people with a disability account for thirty-seven percent of the total number of people who need long-term care.
     The legislature further finds that to address this increasing need, the long-term care system should support autonomy and self-determination, and support the role of informal caregivers and families. It should promote personal planning and savings combined with public support, when needed. It should also include culturally appropriate, high quality information, services, and supports delivered in a cost-effective and efficient manner.
     The legislature further finds that the long-term care system should utilize evidence-based practices for the prevention and management of chronic disease to improve the general health of Washingtonians over their lifetime and reduce health care and long-term care costs related to ineffective chronic care management.
     The legislature further finds that investments in family caregiver support, aging and disability resource centers, adult day care and chronic care management, have the potential to both improve the quality of life for individuals who require long-term care and also to result in long-term savings through home diversion and reduced emergency room use.

Sec. 2   RCW 74.38.040 and 1983 c 290 s 14 are each amended to read as follows:
     The community-based services for low-income eligible persons provided by the department or the respective area agencies may include:
     (1) Access services designed to provide identification of eligible persons, assessment of individual needs, reference to the appropriate service, and follow-up service where required. These services shall include information and referral, outreach, transportation, and counseling. They must also include long-term care planning and options counseling, information and crisis intervention, and streamlined assistance to access a wide array of public and private community-based services. Services must be available to individuals, concerned families or friends, or professionals working with issues related to aging, disabilities, and caregivers. Services must be made available through aging and disability resource centers that shall be established in every area agency on aging. For the purposes of this section "aging and disability resource center" means a single, coordinated system of information and access for all persons seeking long-term support to minimize confusion, enhance individual choice, and support informed decision making;
     (2) Day care offered on a regular, recurrent basis. General nursing, rehabilitation, personal care, nutritional services, social casework, mental health as provided pursuant to chapter 71.24 RCW and/or limited transportation services may be made available within this program;
     (3) In-home care for persons, including basic health care; performance of various household tasks and other necessary chores, or, a combination of these services;
     (4) Counseling on death for the terminally ill and care and attendance at the time of death; except, that this is not to include reimbursement for the use of life-sustaining mechanisms;
     (5) Health services which will identify health needs and which are designed to avoid institutionalization; assist in securing admission to medical institutions or other health related facilities when required; and, assist in obtaining health services from public or private agencies or providers of health services. These services shall include health screening and evaluation, in-home services, health education, and such health appliances which will further the independence and well-being of the person;
     (6) The provision of low cost, nutritionally sound meals in central locations or in the person's home in the instance of incapacity. Also, supportive services may be provided in nutritional education, shopping assistance, diet counseling and other services to sustain the nutritional well-being of these persons;
     (7) The provisions of services to maintain a person's home in a state of adequate repair, insofar as is possible, for their safety and comfort. These services shall be limited, but may include housing counseling, minor repair and maintenance, and moving assistance when such repair will not attain standards of health and safety, as determined by the department;
     (8) Civil legal services, as limited by RCW 2.50.100, for counseling and representation in the areas of housing, consumer protection, public entitlements, property, and related fields of law;
     (9) Long-term care ombudsman programs for residents of all long-term care facilities.

Sec. 3   RCW 74.41.050 and 2008 c 146 s 4 are each amended to read as follows:
     The department shall contract with area agencies on aging or other appropriate agencies to conduct family caregiver long-term care information and support services to the extent ((of available funding)) necessary to sufficiently meet demand in each area agency on aging and support nursing home diversion. The responsibilities of the agencies shall include but not be limited to: (1) Administering a program of family caregiver long-term care information and support services; (2) negotiating rates of payment, administering sliding-fee scales to enable eligible participants to participate in paying for respite care, and arranging for respite care information, training, and other support services, including family caregiver support and respite care services; and (3) developing an evidence-based tailored caregiver assessment and referral tool. In evaluating the need for respite services, consideration shall be given to the mental and physical ability of the caregiver to perform necessary caregiver functions.

Sec. 4   RCW 74.09.710 and 2007 c 259 s 4 are each amended to read as follows:
     (1) The department of social and health services, in collaboration with the department of health, shall:
     (a) Design and implement medical homes for its aged, blind, and disabled clients in conjunction with chronic care management programs to improve health outcomes, access, and cost-effectiveness. Programs must be evidence based, facilitating the use of information technology to improve quality of care, must acknowledge the role of primary care providers and include financial and other supports to enable these providers to effectively carry out their role in chronic care management, and must improve coordination of primary, acute, and long-term care for those clients with multiple chronic conditions. The department shall ((consider expansion of)) expand existing medical home and chronic care management programs and build on the Washington state collaborative initiative. The department shall use best practices in identifying those clients best served under a chronic care management model using predictive modeling through claims or other health risk information; and
     (b) Evaluate the effectiveness of current chronic care management efforts in the health and recovery services administration and the aging and disability services administration, comparison to best practices, and recommendations for future efforts and organizational structure to improve chronic care management.
     (2) For purposes of this section:
     (a) "Medical home" means a site of care that provides comprehensive preventive and coordinated care centered on the patient needs and assures high quality, accessible, and efficient care.
     (b) "Chronic care management" means the department's program that provides care management and coordination activities for medical assistance clients determined to be at risk for high medical costs. "Chronic care management" provides education and training and/or coordination that assist program participants in improving self-management skills to improve health outcomes and reduce medical costs by educating clients to better utilize services.

NEW SECTION.  Sec. 5   A new section is added to chapter 74.39A RCW to read as follows:
     Within funds appropriated for this specific purpose, the department shall develop a challenge grant program to assist communities and organizations in efforts to plan and establish additional adult day service programs throughout the state. The challenge grant program shall provide financial grants, not to exceed fifty thousand dollars for each grant, for the purpose of helping to meet the costs of planning, development, and start-up of new adult day service programs in underserved communities. Recipients of these grants must provide matching resources, in funds or in-kind, of equal value to any grant received. Any adult day services program developed after receiving a challenge grant must agree to serve people whose care is paid for by the state on a first-come, first-served basis, regardless of the source of payment.

NEW SECTION.  Sec. 6   If specific funding for the purposes of sections 2 through 5 of this act, referencing sections 2 through 5 of this act by bill or chapter number and section number, is not provided by June 30, 2009, in the omnibus appropriations act, sections 2 through 5 of this act are null and void.