BILL REQ. #:  H-1131.1 

Read first time 02/06/13.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to raising licensure limits to allow assisted living facilities to serve a higher acuity resident population; amending RCW 18.20.330 and 18.20.160; and adding a new section to chapter 18.20 RCW.

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

Sec. 1   RCW 18.20.330 and 2012 c 10 s 22 are each amended to read as follows:
     (1) Assisted living facilities are not required to provide intermittent nursing services. The assisted living facility licensee may choose to provide any of the following intermittent nursing services through appropriately licensed and credentialed staff, however, the facility may or may not need to provide additional intermittent nursing services to comply with the reasonable accommodation requirements in federal or state law:
     (a) Medication administration;
     (b) Administration of health care treatments;
     (c) Diabetic management;
     (d) Nonroutine ostomy care;
     (e) Tube feeding; and
     (f) Nurse delegation consistent with chapter 18.79 RCW.
     (2) The licensee shall clarify on the disclosure form any limitations, additional services, or conditions that may apply under this section.
     (3) In providing intermittent nursing services, the assisted living facility shall observe the resident for changes in overall functioning and respond appropriately when there are observable or reported changes in the resident's physical, mental, or emotional functioning.
     (4) The assisted living facility may provide intermittent nursing services to ((the extent permitted by RCW 18.20.160)) residents who do not require the frequent presence and supervision of a licensed nurse.

NEW SECTION.  Sec. 2   A new section is added to chapter 18.20 RCW to read as follows:
     (1) In addition to the intermittent nursing services that may be provided under RCW 18.20.330, the licensee may, but is not required to, provide extensive and continuing nursing services, as defined by the department in rule, to meet the needs of more medically complex residents.
     (2) The licensee shall clarify on the disclosure form any limitations, additional services, or conditions that may apply under this section.
     (3) In providing extensive and continuing nursing services, the assisted living facility shall observe the resident for changes in overall functioning and respond appropriately when there are observable or reported changes in the resident's physical, mental, or emotional functioning that exceed the licensee's licensure limitations and any limitations described in the disclosure form.
     (4) The assisted living facility may provide extensive and continuing nursing services to the extent permitted by RCW 18.20.160.

Sec. 3   RCW 18.20.160 and 2012 c 10 s 11 are each amended to read as follows:
     ((No person operating an assisted living facility licensed under this chapter shall admit to or retain in the assisted living facility any aged person requiring nursing or medical care of a type provided by institutions licensed under chapters 18.51, 70.41 or 71.12 RCW, except that when registered nurses are available, and upon a doctor's order that a supervised medication service is needed, it may be provided. Supervised medication services, as defined by the department and consistent with chapters 69.41 and 18.79 RCW, may include an approved program of self-medication or self-directed medication. Such medication service shall be provided only to residents who otherwise meet all requirements for residency in an assisted living facility. No assisted living facility shall admit or retain a person who requires the frequent presence and frequent evaluation of a registered nurse, excluding persons who are receiving hospice care or persons who have a short-term illness that is expected to be resolved within fourteen days.)) The assisted living facility must assume general responsibility for each resident and must promote each resident's health, safety, and well-being consistent with the resident negotiated care plan. In addition, the assisted living facility may provide assistance with activities of daily living, health support services, intermittent nursing services and extensive nursing services, as defined by the department in rule, and consistent with the care and services included in the disclosure form required under RCW 18.20.300. The assisted living facility must assure that sufficient numbers and appropriately qualified and trained staff are available to provide care and services consistent with this chapter.