BILL REQ. #:  H-3238.1 

Read first time 04/15/09.   Referred to Committee on Ways & Means.

     AN ACT Relating to long-term care worker training and credentialing; amending RCW 74.39A.009, 74.39A.073, 18.88B.040, 74.39A.050, and 74.39A.340; and repealing RCW 74.39.070.

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

Sec. 1   RCW 74.39A.009 and 2009 c 2 s 2 (Initiative Measure No. 1029) 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) "Core competencies" means basic training topics, including but not limited to, communication skills, worker self-care, problem solving, maintaining dignity, consumer directed care, cultural sensitivity, body mechanics, fall prevention, skin and body care, long-term care worker roles and boundaries, supporting activities of daily living, and food preparation and handling.
     (6) "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.
     (7) "Department" means the department of social and health services.
     (8) "Developmental disability" has the same meaning as defined in RCW 71A.10.020.
     (9) "Direct care worker" means a paid caregiver who provides direct, hands-on personal care services to persons with disabilities or the elderly requiring long-term care.
     (10) "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.
     (11) "Functionally disabled person" or "person who is functionally disabled" is synonymous with chronic functionally disabled and means a person who because of a recognized chronic physical or mental condition or disease, or developmental disability, 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.
     (12) "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.
     (13) "Home care aide" means a long-term care worker who has obtained certification as a home care aide by the department of health.
     (14) "Individual provider" is defined according to RCW 74.39A.240.
     (15) "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.
     (16)(a) "Long-term care workers for the elderly or persons with disabilities" or "long-term care workers" includes all persons who are ((long-term care workers for)) paid by the state, or who are employed by state-licensed or certified private agencies or facilities that are paid by the state, to provide personal care services to the elderly or persons with functional disabilities, including but not limited to individual providers of home care services, direct care employees of home care agencies, providers of home care services to persons with developmental disabilities under Title 71 RCW, all direct care workers in state-licensed boarding homes, assisted living facilities, and adult family homes, respite care providers, community residential service providers, and any other direct care worker providing home ((or community-based)) and community services to the elderly or persons with functional disabilities or developmental disabilities.
     (b) "Long-term care workers" do not include((: (i))) persons employed in nursing homes subject to chapter 18.51 RCW, hospitals or other acute care settings, hospice agencies subject to chapter 70.127 RCW, adult day care centers, and adult day health care centers((; or (ii) persons who are not paid by the state or by a private agency or facility licensed by the state to provide personal care services)).
     (17) "Nursing home" means a facility licensed under chapter 18.51 RCW.
     (18) "Personal care services" means physical or verbal assistance with activities of daily living and instrumental activities of daily living provided because of a person's functional disability.
     (19) "Population specific competencies" means basic training topics unique to the care needs of the population the long-term care worker is serving, including but not limited to, mental health, dementia, developmental disabilities, young adults with physical disabilities, and older adults.
     (20) "Qualified instructor" means a registered nurse or other person with specific knowledge, training, and work experience in the provision of direct, hands-on personal care and other assistance services to the elderly or persons with disabilities requiring long-term care.
     (21) "Secretary" means the secretary of social and health services.
     (22) "Secretary of health" means the secretary of health or the secretary's designee.
     (23) "Training partnership" means a joint partnership or trust that includes the office of the governor and the exclusive bargaining representative of individual providers under RCW 74.39A.270 with the capacity to provide training, peer mentoring, and workforce development, or other services to individual providers.
     (24) "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. 2   RCW 74.39A.073 and 2009 c 2 s 5 (Initiative Measure No. 1029) are each amended to read as follows:
     (1) Effective January 1, 2010, except as provided in RCW 18.88B.040, all persons ((employed)) hired as long-term care workers for the elderly or persons with disabilities must meet the minimum training requirements in this section within one hundred twenty calendar days of employment.
     (2) All persons ((employed)) hired as long-term care workers must obtain seventy-five hours of entry-level training approved by the department. A long-term care worker must accomplish five of these seventy-five hours before becoming eligible to provide care.
     (3) ((Training required by subsection (4)(c) of this section will be applied towards)) A long-term care worker exempt under RCW 18.88B.040(3) who elects to become certified as a home care aide under chapter 18.88B RCW may apply the training required under RCW 18.20.270 ((or)), 70.128.230 ((as well as)), or 74.39A.050 or any statutory or regulatory training requirements for long-term care workers employed by ((supportive)) supported living providers toward the training requirements under subsection (4)(c) of this section.
     (4) Only training curriculum approved by the department may be used to fulfill the training requirements specified in this section. The seventy-five hours of entry-level training required shall be as follows:
     (a) Before a long-term care worker is eligible to provide care, he or she must complete two hours of orientation training regarding his or her role as caregiver and the applicable terms of employment;
     (b) Before a long-term care worker is eligible to provide care, he or she must complete three hours of safety training, including basic safety precautions, emergency procedures, and infection control; and
     (c) All long-term care workers must complete seventy hours of long-term care basic training, including training related to core competencies and population specific competencies.
     (5) The department shall only approve training curriculum that:
     (a) Has been developed with input from consumer and worker representatives; and
     (b) Requires comprehensive instruction by qualified instructors on the competencies and training topics in this section.
     (6) Individual providers under RCW 74.39A.270 shall be compensated for training time required by this section.
     (7) The department of health shall adopt rules by August 1, 2009, to implement subsections (1), (2), and (3) of this section.
     (8) The department shall adopt rules by August 1, 2009, to implement subsections (4) and (5) of this section.

Sec. 3   RCW 18.88B.040 and 2009 c 2 s 7 (Initiative Measure No. 1029) are each amended to read as follows:
     The following long-term care workers are not required to become a certified home care aide pursuant to this chapter.
     (1) Registered nurses, licensed practical nurses, certified nursing assistants, medicare-certified home health aides, or other persons who hold a similar health credential, as determined by the secretary of health, or persons with special education training and an endorsement granted by the superintendent of public instruction, as described in RCW 28A.300.010, if the secretary of health determines that the circumstances do not require certification. Individuals exempted by this subsection may obtain certification as a home care aide from the department of health without fulfilling the training requirements in RCW 74.39A.073 but must successfully complete a certification examination pursuant to RCW 18.88B.030.
     (2) A person ((already employed)) initially hired as a long-term care worker prior to January 1, 2010, who completes all of his or her training requirements in effect as of the date he or she was hired, is not required to obtain certification. Individuals exempted by this subsection may obtain certification as a home care aide from the department of health without fulfilling the training requirements in RCW 74.39A.073 but must successfully complete a certification examination pursuant to RCW 18.88B.030.
     (3) All long-term care workers employed by in-home services agencies licensed under chapter 70.127 RCW, boarding homes licensed under chapter 18.20 RCW, adult family homes licensed under chapter 70.128 RCW, and assisted living facilities, community residential service providers, and supported living providers approved or certified pursuant to programs authorized under chapter 74.39A or 71A.12 RCW are not required to obtain certification under this chapter. Individuals initially hired on or after January 1, 2010, and exempted by this subsection may obtain certification as a home care aide from the department of health by fulfilling the training requirements in RCW 74.39A.073 and successfully completing a certification examination pursuant to RCW 18.88B.030.
     (4) An individual provider caring only for his or her biological, step, or adoptive child or parent is not required to obtain certification under this chapter.
     (5) Prior to June 30, 2014, a person hired as an individual provider who provides twenty hours or less of care for one person in any calendar month is not required to obtain certification under this chapter.
     (6) A long-term care worker exempted from certification by this section is also exempt from the training requirements contained in RCW 74.39A.073 ((may not be prohibited)). However, this subsection does not prohibit an exempt long-term care worker from enrolling in training pursuant to that section.
     (7) The department of health shall adopt rules by August 1, 2009, to implement this section.

Sec. 4   RCW 74.39A.050 and 2009 c 2 s 14 (Initiative Measure No. 1029) are each amended to read as follows:
     The department's system of quality improvement for long-term care services shall use the following principles, consistent with applicable federal laws and regulations:
     (1) The system shall be client-centered and promote privacy, independence, dignity, choice, and a home or home-like environment for consumers consistent with chapter 392, Laws of 1997.
     (2) The goal of the system is continuous quality improvement with the focus on consumer satisfaction and outcomes for consumers. This includes that when conducting licensing or contract inspections, the department shall interview an appropriate percentage of residents, family members, resident case managers, and advocates in addition to interviewing providers and staff.
     (3) Providers should be supported in their efforts to improve quality and address identified problems initially through training, consultation, technical assistance, and case management.
     (4) The emphasis should be on problem prevention both in monitoring and in screening potential providers of service.
     (5) Monitoring should be outcome based and responsive to consumer complaints and based on a clear set of health, quality of care, and safety standards that are easily understandable and have been made available to providers, residents, and other interested parties.
     (6) Prompt and specific enforcement remedies shall also be implemented without delay, pursuant to RCW 74.39A.080, RCW 70.128.160, chapter 18.51 RCW, or chapter 74.42 RCW, for providers 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. These enforcement remedies may also include, when appropriate, reasonable conditions on a contract or license. In the selection of remedies, the safety, health, and well-being of residents shall be of paramount importance.
     (7) All long-term care workers shall 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 persons. This information will be shared with the department of health to advance the purposes of chapter 2, Laws of 2009.
     (8) No provider or long-term care worker, or prospective provider or long-term care worker, with a stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into a 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 shall be employed in the care of and have unsupervised access to vulnerable adults.
     (9) The department shall establish, by rule, a state registry which contains identifying information about long-term care workers identified under this chapter who have substantiated findings of abuse, neglect, financial exploitation, or abandonment of a vulnerable adult as defined in RCW 74.34.020. The rule must include disclosure, disposition of findings, notification, findings of fact, appeal rights, and fair hearing requirements. The department shall disclose, upon request, substantiated findings of abuse, neglect, financial exploitation, or abandonment to any person so requesting this information. This information will also be shared with the department of health to advance the purposes of chapter 2, Laws of 2009.
     (10) ((Until December 31, 2009)) Except as provided in RCW 74.39A.073 and 74.39A.075, individual providers and home care agency providers must satisfactorily complete department-approved orientation, basic training, and continuing education within the time period specified by the department in rule. The department shall adopt rules by March 1, 2002, for the implementation of this section. The department shall deny payment to an individual provider or a home care provider who does not complete the training requirements within the time limit specified by the department by rule.
     (11) ((Until December 31, 2009)) Except as provided in RCW 74.39A.073 and 74.39A.075, 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.
     (12) The department shall create an approval system by March 1, 2002, for those seeking to conduct department-approved training.
     (13) The department shall establish, by rule, background checks and other quality assurance requirements for long-term care workers who provide in-home services funded by medicaid personal care as described in RCW 74.09.520, community options program entry system waiver services as described in RCW 74.39A.030, or chore services as described in RCW 74.39A.110 that are equivalent to requirements for individual providers.
     (14) Under existing funds the department shall establish internally a quality improvement standards committee to monitor the development of standards and to suggest modifications.
     (15) Within existing funds, the department shall design, develop, and implement a long-term care training program that is flexible, relevant, and qualifies towards the requirements for a nursing assistant certificate as established under chapter 18.88A RCW. This subsection does not require completion of the nursing assistant certificate training program by providers or their staff. The long-term care teaching curriculum must consist of a fundamental module, or modules, and a range of other available relevant training modules that provide the caregiver with appropriate options that assist in meeting the resident's care needs. Some of the training modules may include, but are not limited to, specific training on the special care needs of persons with developmental disabilities, dementia, mental illness, and the care needs of the elderly. No less than one training module must be dedicated to workplace violence prevention. The nursing care quality assurance commission shall work together with the department to develop the curriculum modules. The nursing care quality assurance commission shall direct the nursing assistant training programs to accept some or all of the skills and competencies from the curriculum modules towards meeting the requirements for a nursing assistant certificate as defined in chapter 18.88A RCW. A process may be developed to test persons completing modules from a caregiver's class to verify that they have the transferable skills and competencies for entry into a nursing assistant training program. The department may review whether facilities can develop their own related long-term care training programs. The department may develop a review process for determining what previous experience and training may be used to waive some or all of the mandatory training. The department of social and health services and the nursing care quality assurance commission shall work together to develop an implementation plan by December 12, 1998.

Sec. 5   RCW 74.39A.340 and 2009 c 2 s 9 (Initiative Measure No. 1029) are each amended to read as follows:
     (1) ((The department of health shall ensure that)) (a) Except as provided in (b) of this subsection, all long-term care workers shall complete ((twelve)) ten hours of continuing education training in advanced training topics each year.
     (b) All individual providers shall complete twelve hours of continuing education in advanced training topics each year. This requirement applies beginning on January 1, 2010.
     (2) Completion of continuing education as required in this section is a prerequisite to maintaining home care aide certification under ((chapter 2, Laws of 2009)) chapter 18.88B RCW.
     (3) Unless voluntarily certified as a home care aide under ((chapter 2, Laws of 2009)) chapter 18.88B RCW, subsection (1) of this section does not apply to:
     (a) An individual provider caring only for his or her biological, step, or adoptive child; and
     (b) Before June 30, 2014, a person hired as an individual provider who provides twenty hours or less of care for one person in any calendar month.
     (4) Only training curriculum approved by the department may be used to fulfill the training requirements specified in this section. The department shall only approve training curriculum that:
     (a) Has been developed with input from consumer and worker representatives; and
     (b) Requires comprehensive instruction by qualified instructors.
     (5) Individual providers under RCW 74.39A.270 shall be compensated for training time required by this section.
     (6) The department of health shall adopt rules by August 1, 2009, to implement subsections (1), (2), and (3) of this section.
     (7) The department shall adopt rules by August 1, 2009, to implement subsection (4) of this section.

NEW SECTION.  Sec. 6   RCW 74.39.070 (Personal aide -- Qualification exemptions) and 1999 c 336 s 8 are each repealed.