BILL REQ. #:  S-0765.3 

Read first time 02/01/13.   Referred to Committee on Health Care .

     AN ACT Relating to enacting planning measures to provide for the future long-term care services and supports needs of the aging population; amending RCW 74.41.050; creating new sections; and providing expiration dates.

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

NEW SECTION.  Sec. 1   The legislature makes the following findings:
     (1) By 2030 nearly twenty percent or one out of every five people in our state will be age sixty-five or older and by 2060 the population of people who are age eighty-five or older in our state will more than triple. This will affect every area of state government;
     (2) There is a need for increased focus and a planning to support the growing number of seniors and people with disabilities with Washington state. Planning is necessary across a broad range of policy areas including health, long-term services and supports, housing, transportation, financial security, and protections for vulnerable adults;
     (3) To address the growing demand for long-term services and supports, Washington state must do more to leverage private resources, support families so they can take care of their loved ones without having to resort to medicaid and help people plan for potential future costs;
     (4) In the past few decades, a number of initiatives have been undertaken to reform Washington's system of supports for seniors to emphasize home and community based options. These efforts have saved millions of dollars by preventing expensive institutional placements;
     (5) Washington must begin planning for the future long-term services and supports needs of its residents by taking steps to grow its workforce, resources, and quality long-term services and supports, and identify alternative long-term care financing options to help families and reduce the rate of growth in medicaid;
     (6) It is necessary to explore public and private sector approaches to support payment for long-term services and supports to support full integration of people with disabilities and assist elders to age in place; and
     (7) The family caregiver support program and the four existing aging and disability resource centers have proven potential in delaying medicaid utilization and helping families manage and plan for the cost of long-term services and support.

Sec. 2   RCW 74.41.050 and 2008 c 146 s 4 are each amended to read as follows:
     (1) 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)) with a goal of reaching ten thousand caregivers by the end of fiscal year 2014. The responsibilities of the agencies shall include but not be limited to: (((1))) (a) Administering a program of family caregiver long-term care information and support services; (((2))) (b) 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; ((and (3))) (c) developing an evidence-based tailored caregiver assessment and referral tool; and (d) conducting outreach activities in order to reach people in the community who would benefit from family caregiver long-term care information and support services. 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.
     (2) By July 1, 2014, the aging and disability services administration of the department of social and health services must report to the appropriate committees of the legislature on a phased expansion plan to meet the demands of an aging society and extend caregiver support to a greater percentage of caregivers in need. The report should include evaluation of the program's potential to: (a) Delay or divert medicaid utilization rates; and (b) improve the health and well-being of family caregivers including, but not limited to, reducing rates of depression and other health or mental health issues. In developing the plan, the aging and disability services administration must consult with stakeholders, including individuals with developmental disabilities, physical disabilities, behavioral health needs, and long-term care needs.

NEW SECTION.  Sec. 3   By July 1, 2014, the aging and disability services administration of the department of social and health services, in consultation with stakeholders, including individuals with developmental disabilities, physical disabilities, behavioral health needs, and long-term care needs, must report to the appropriate committees of the legislature on:
     (1) The existing funding of the following aging and disability resource centers: (a) The northwest regional council in Skagit and Whatcom counties; (b) Pierce county community connections; (c) southeast Washington aging and disability resource centers in Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Yakima, and Walla Walla counties; and (d) aging and long-term care of eastern Washington in Ferry, Pend Oreille, Spokane, Stevens, and Whitman counties;
     (2) The level of funding necessary to achieve the full complement of aging and disability resource center functions statewide by December 1, 2017. The full complement of services includes five core functions: (a) Information and assistance; (b) options counseling; (c) streamlines access; (d) person-centered care transitions; (e) quality assurance and evaluation; and (f) care coordination. This proposal must include ways to maximize opportunities to leverage federal dollars and requirements to establish local partnerships to draw in additional funding;
     (3) Preliminary results of evaluations underway on the aging and disability resource centers as of the effective date of this section and a proposal for ongoing evaluations and assessments; and
     (4) The roles and responsibilities of the aging and disability resource centers, how they serve different populations including individuals with developmental disabilities, individuals with physical disabilities, and individuals with behavioral health needs, and how they interact with existing information and assistance programs such as 211, parent to parent, and regional support networks.
     This section expires December 15, 2014.

NEW SECTION.  Sec. 4   (1) The office of financial management must evaluate the following options to support families as they prepare for the cost of long-term services and supports needs:
     (a) Tax incentives or other measures to encourage individuals to purchase private long-term care insurance and to encourage employers to offer private long-term care insurance to their employees;
     (b) Options to incentivize state workers to participate in employer offered private long-term care insurance;
     (c) Options to increase take-up rate of long-term care partnership policies, including a public option;
     (d) Regulatory changes necessary to encourage the use of life insurance to finance long-term services and supports;
     (e) A public insurance option financed through voluntary contributions; and
     (f) A public insurance option financed through mandatory contributions.
     (2) Each of the options listed in subsection (1) of this section should be evaluated based on how it meets the following goals:
     (a) Delay or divert medicaid long-term care utilization and provide relief for family caregivers;
     (b) Support individuals with functional or cognitive limitations or both so that they are able to remain in the community by purchasing nonmedical services and supports such as home care and adult day health services and avoid institutional care;
     (c) Expand long-term coverage and supports for the greatest number of people;
     (d) Address direct care workforce recruitment and retention issues to ensure access to long-term services and supports;
     (e) Be affordable for families and include comprehensive benefits;
     (f) Reduce inequality and promote economic security for middle class families; and
     (g) Include a minimal impact on the state general fund and bring additional funds into the long-term care system.
     (3) The office of financial management must select one or more of the options in subsection (1) of this section and provide a proposal and implementation plan for the preferred option to start in 2015.
     (4) The office of financial management must consult with the joint legislative executive committee on aging and disability issues created in section 5 of this act on the study design as well as on the draft and final report.
     (5) The office of financial management must also consult with stakeholders, including advocates for people with disabilities or area aging, labor representatives, area agencies on aging, long-term services and supports providers, and the office of the insurance commissioner on the study design as well as on the draft and final report.
     (6) The office of financial management must provide a draft report to the joint legislative executive committee on aging and disability issues for review and feedback by October 15, 2014. The office of financial management must deliver a final report to the legislature by December 10, 2014, that includes an implementation plan to the ways and means committees of the senate and the house of representatives.
     (7) This section expires December 15, 2014.

NEW SECTION.  Sec. 5   (1) A joint legislative executive committee on aging and disability issues is established, with members as provided in this subsection.
     (a) The president of the senate shall appoint the chair of the senate committee with jurisdiction over long-term care policy as well as one additional member from each of the two largest caucuses of the senate;
     (b) The speaker of the house of representatives shall appoint the chair of the house committee with jurisdiction over long-term care policy as well as one additional member from each of the two largest caucuses of the house of representatives;
     (c) The governor shall appoint one member to service as a liaison to the committee;
     (d) The secretary of the department of social and health services or his or her designee; and
     (e) The director of the health care authority or his or her designee.
     (2) The joint committee must be convened by September 1, 2013. At the first meeting, the members of the joint committee shall select cochairs from among the committee members. The joint committee shall establish advisory committees, consisting of at least three stakeholders and chaired by a member of the joint committee, to focus on specific topic areas. All meetings of the joint committee and the advisory committees are open to the public.
     (3) The joint committee shall consult with the office of the insurance commissioner, the caseload forecast council, and other appropriate entities with specialized knowledge of the growing needs of the aging and disability populations.
     (4) The joint committee shall conduct the following activities:
     (a)(i) Establish a profile of Washington's current elderly and disabled population and its needs;
     (ii) Establish an inventory of the services and supports currently available to the elderly and disabled, including health care providers and facilities, long-term care providers and facilities, caregiver supports, public and private financing, transportation services, and housing;
     (iii) Assess the areas of the current system where the additional support is needed for Washington's current elderly population;
     (b)(i) Establish a profile of Washington's expected elderly and disabled population in 2025 and evaluate its anticipated needs;
     (ii) Establish an anticipated inventory of future services and supports that will be required to meet the needs of the elderly and disabled population in 2025;
     (c) Develop a strategy of actions that the state may take to prepare for the future demographic trends in the elderly and disabled populations and build the necessary capacity to meet these demands, including the identification of:
     (i) Statutory and regulatory changes to promote the most efficient use of resources, such as simplifying administrative procedures, facilitating points of entry into the long-term care services and supports system, and improving transitions between care settings;
     (ii) Practices for promoting the use of technology, chronic care management, and disability prevention programs to maintain the independence of the elderly and disabled populations;
     (iii) Caregiver supports;
     (iv) Specialized resources for populations with special needs, such as chronic conditions and dementia; and
     (v) Housing and transportation programs to help individuals who are elderly or disabled to maintain their independence;
     (d) Consult with and provide direction to the office of financial management in completing the study under section 4 of this act.
     (5) Staff support for the joint committee must be provided by the senate committee services, the office of program research, and the office of financial management. The office of financial management shall designate staff of the department of social and health services to provide additional support to the joint committee.
     (6) The joint committee members may be reimbursed for travel expenses as authorized under RCW 43.03.050 and 43.03.060, and chapter 44.04 RCW as appropriate. Advisory committee members may not receive compensation or reimbursement for travel and expenses.
     (7) The expenses of the joint committee must be paid jointly by the senate, the house of representatives, and the office of financial management. Joint committee expenditures are subject to approval by the senate facilities and operations committee and the house of representatives executive rules committee, or their successor committees.
     (8) The joint committee shall report its findings and recommendations to the governor and the appropriate committees of the legislature by December 10, 2014.
     (9) This section expires December 15, 2014.