BILL REQ. #:  S-4832.2 

Read first time 02/24/12.   Referred to Committee on Ways & Means.

     AN ACT Relating to the medicaid personal care services program; and amending RCW 74.09.520.

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

Sec. 1   RCW 74.09.520 and 2011 1st sp.s. c 15 s 27 are each amended to read as follows:
     (1) The term "medical assistance" may include the following care and services subject to rules adopted by the authority or department: (a) Inpatient hospital services; (b) outpatient hospital services; (c) other laboratory and X-ray services; (d) nursing facility services; (e) physicians' services, which shall include prescribed medication and instruction on birth control devices; (f) medical care, or any other type of remedial care as may be established by the secretary or director; (g) home health care services; (h) private duty nursing services; (i) dental services; (j) physical and occupational therapy and related services; (k) prescribed drugs, dentures, and prosthetic devices; and eyeglasses prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the individual may select; (l) personal care services, as provided in this section; (m) hospice services; (n) other diagnostic, screening, preventive, and rehabilitative services; and (o) like services when furnished to a child by a school district in a manner consistent with the requirements of this chapter. For the purposes of this section, neither the authority nor the department may cut off any prescription medications, oxygen supplies, respiratory services, or other life-sustaining medical services or supplies.
     "Medical assistance," notwithstanding any other provision of law, shall not include routine foot care, or dental services delivered by any health care provider, that are not mandated by Title XIX of the social security act unless there is a specific appropriation for these services.
     (2) The department shall adopt, amend, or rescind such administrative rules as are necessary to ensure that Title XIX personal care services are provided to eligible persons in conformance with federal regulations.
     (a) These administrative rules shall include financial eligibility indexed according to the requirements of the social security act providing for medicaid eligibility.
     (b) The rules shall require clients be assessed as having a medical condition requiring assistance with personal care tasks. Plans of care for clients requiring health-related consultation for assessment and service planning may be reviewed by a nurse.
     (c) The department shall determine by rule which clients have a health-related assessment or service planning need requiring registered nurse consultation or review. This definition may include clients that meet indicators or protocols for review, consultation, or visit.
     (3)(a) The department shall design and implement a means to assess the level of functional disability of persons eligible for personal care services under this section. ((The personal care services benefit shall be provided to the extent funding is available according to the assessed level of functional disability.)) The department shall operate the medicaid personal care services program within the amounts specifically appropriated in the biennial appropriations act. Any reductions in services made necessary for funding reasons should be accomplished in a manner that assures that priority for maintaining services is given to persons with the greatest need as determined by the assessment of functional disability.
     (b) The personal care services benefit for child clients shall be provided according the most current medicaid state plan.
     (c) The personal care services benefit for adult clients must be provided under section 1915(i) of the social security act, exclusively using the option that allows for client self-direction of an individualized budget.
     (i) The department shall establish a matrix that provides an array of client acuity levels.
     (ii) The assessed level of functional disability must result in the client's placement in an acuity level on the acuity matrix.
     (iii) The department shall establish a budget amount that is associated with each acuity level and must be used to assist the client in securing services and supports to address their assessed needs.
     (iv) This section does not require the department to establish the per-client budget amount at a level that sufficiently meets all assessed needs. Subject to any limits established by the department, clients shall prioritize the use of their budget amount.
     (v) The department shall establish the value of the per-client budget amounts associated with each acuity level using a methodology that:
     (A) Is objective and evidence-based and uses valid, reliable cost data;
     (B) Includes a calculation of the expected cost of each service available under this option; and
     (C) Can be applied consistently to individuals.
     (vi) Nothing in this section may be construed as creating a legal right or entitlement of any individual to a prior personal care services budget amount in the event individual budget amounts are adjusted so the department can remain within the amounts specifically appropriated in the biennial appropriations act.
     (d) The department shall provide, or contract to have provided, client care case management services to assist the client in developing and executing a plan of care that allocates their personal care services budget to appropriate providers, support services and therapies, and equipment or other expenditures as necessary to address the client's health and safety.
     (e) The department shall contract for financial intermediary services to assist adult clients in executing their spending plan and managing their personal care services budget. The department may deduct up to five percent from the value of each individual budget to cover the associated costs.
     (4) Effective July 1, 1989, the authority shall offer hospice services in accordance with available funds.
     (5) For Title XIX personal care services administered by aging and disability services administration of the department, the department shall contract with area agencies on aging:
     (a) To provide case management services to individuals receiving Title XIX personal care services in their own home; and
     (b) To reassess and reauthorize Title XIX personal care services or other home and community services as defined in RCW 74.39A.009 in home or in other settings for individuals consistent with the intent of this section:
     (i) Who have been initially authorized by the department to receive Title XIX personal care services or other home and community services as defined in RCW 74.39A.009; and
     (ii) Who, at the time of reassessment and reauthorization, are receiving such services in their own home.
     (6) In the event that an area agency on aging is unwilling to enter into or satisfactorily fulfill a contract or an individual consumer's need for case management services will be met through an alternative delivery system, the department is authorized to:
     (a) Obtain the services through competitive bid; and
     (b) Provide the services directly until a qualified contractor can be found.
     (7) Subject to the availability of amounts appropriated for this specific purpose, the authority may offer medicare part D prescription drug copayment coverage to full benefit dual eligible beneficiaries.