BILL REQ. #:  H-4045.2 

Read first time 01/25/10.   Referred to Committee on Health & Human Services Appropriations.

     AN ACT Relating to modifying state payments for in-home care; amending RCW 74.39A.326; creating a new section; repealing RCW 74.39A.325; and repealing 2009 c 571 s 3 (uncodified).

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

NEW SECTION.  Sec. 1   (1) The intent of this act is to specify the manner and circumstances under which family members are paid by the department when they are employed by an agency licensed under chapter 70.127 RCW for in-home personal care services provided under the medicaid in-home personal care program.
     (2) The legislature recognizes that:
     (a) Some clients receiving in-home care are best served by having their own caregivers receive the oversight, monitoring, and support provided by a home care agency;
     (b) A recent financial analysis conducted by an independent analyst found that payments by the state for agency employed family member caregivers are much less than the previously calculated five dollars per hour differential and could be a net amount less for family member caregivers employed by agencies than for family member independent providers;
     (c) Clients for whom English is not a native language often require extensive translation services which is better and more cost-effective when provided by a family member supervised by an agency rather than by a translator paid for by the state;
     (d) Clients for whom English is not a native language and Native American tribal members often have cultural needs that are best served by family members who have the oversight, monitoring, and support of a home care agency; and
     (e) Clients of in-home services should have the ability to choose whether their family member caregivers are employed by home care agencies under certain circumstances.
     (3) The legislature finds that:
     (a) In-home care can be provided by family members employed by a licensed agency in a cost-efficient manner, as compared to in-home care provided by family member independent providers;
     (b) The resources of the state are best and most cost-effectively spent by allowing family members to be paid as employees of home care agencies when the client has identifiable language or cultural needs or when the client is unable to supervise his or her paid provider, has poor decision-making skills with no understanding of consequences, or is unable to make decisions;
     (c) In those circumstances, in-home care provided by family member agency employees can be the best option for the health care needs of the clients; and
     (d) Clients should have the ability to choose to have their family member caregivers employed by a home care agency.

Sec. 2   RCW 74.39A.326 and 2009 c 571 s 1 are each amended to read as follows:
     (1)(a) The department shall not pay a home care agency licensed under chapter 70.127 RCW for in-home personal care or respite services provided under this chapter, Title 71A RCW, or chapter 74.39 RCW if the care is provided to a client by a family member of the client. To the extent permitted under federal law, the provisions of this subsection shall not apply if the family member providing care is older than the client.
     (b) The department may, on a case-by-case basis based on the client's health and safety, make exceptions to (a) of this subsection to authorize payment or to provide for payment during a transition period of up to three months.
     (2) The department shall pay for a home care agency licensed under chapter 70.127 RCW for in-home personal care services provided under the medicaid in-home personal care program if the care is provided to a client by a family member of the client if:
     (a) The client chooses care from a family member caregiver employed by a licensed home care agency; and
     (b)(i) The client's native language is a language other than English;
     (ii) The client is a registered member of a Native American tribe; or
     (iii) The client has been determined based on his or her annual state assessment to have a cognitive performance scale score of two or more or had decision making coded as poor decision making or unaware of consequences of his or her decisions.
     (3) The department shall take appropriate enforcement action against a home care agency found to have charged the state for hours of service for which the department is not authorized to pay under this section, including requiring recoupment of any payment made for those hours and, under criteria adopted by the department by rule, terminating the contract of an agency that violates a recoupment requirement.
     (((3))) (4) For purposes of this section:
     (a) "Client" means a person who has been deemed eligible by the department to receive in-home personal care or respite services.
     (b) "Family member" shall be liberally construed to include, but not be limited to, a parent, child, sibling, aunt, uncle, cousin, grandparent, grandchild, grandniece, or grandnephew, or such relatives when related by marriage.
     (((4))) (5) The department shall adopt rules to implement this section. The rules shall not result in affecting the amount, duration, or scope of the personal care or respite services benefit to which a client may be entitled pursuant to RCW 74.09.520 or Title XIX of the federal social security act.

NEW SECTION.  Sec. 3   The following acts or parts of acts are each repealed:
     (1) RCW 74.39A.325 (In-home personal care or respite services--Electronic timekeeping) and 2009 c 571 s 2; and
     (2) 2009 c 571 s 3 (uncodified).