BILL REQ. #:  S-4478.1 

READ FIRST TIME 02/11/14.   

     AN ACT Relating to reducing the number of individuals with developmental disabilities who have requested a service but the provision of a specific service would exceed program capacity; amending RCW 71A.10.020 and 71A.16.050; and creating new sections.

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

NEW SECTION.  Sec. 1   In conjunction with recent findings from the Washington state auditor's office, the legislature finds that there are thousands of state citizens who have been determined eligible for services through the department of social and health services' developmental disability administration. For those who have asked for help but are waiting for services, families may experience financial or emotional hardships. The legislature intends to clarify and make transparent the process for accessing publicly funded services for individuals with developmental disabilities and their families. The legislature intends to significantly reduce the number of eligible individuals who are waiting for services by funding additional slots and by implementing new programs that better utilize federal funding partnerships.

Sec. 2   RCW 71A.10.020 and 2011 1st sp.s. c 30 s 3 are each amended to read as follows:
     As used in this title, the following terms have the meanings indicated unless the context clearly requires otherwise.
     (1) "Assessment" means an evaluation is provided by the department to determine:
     (a) If the individual meets functional and financial criteria for medicaid services; and
     (b) The individual's support needs for service determination.
     (2) "Community residential support services," or "community support services," and "in-home services" means one or more of the services listed in RCW 71A.12.040.
     (((2))) (3) "Crisis stabilization services" means services provided to persons with developmental disabilities who are experiencing behaviors that jeopardize the safety and stability of their current living situation. Crisis stabilization services include:
     (a) Temporary intensive services and supports, typically not to exceed sixty days, to prevent psychiatric hospitalization, institutional placement, or other out-of-home placement; and
     (b) Services designed to stabilize the person and strengthen their current living situation so the person may continue to safely reside in the community during and beyond the crisis period.
     (((3))) (4) "Department" means the department of social and health services.
     (((4))) (5) "Developmental disability" means a disability attributable to intellectual disability, cerebral palsy, epilepsy, autism, or another neurological or other condition of an individual found by the secretary to be closely related to an intellectual disability or to require treatment similar to that required for individuals with intellectual disabilities, which disability originates before the individual attains age eighteen, which has continued or can be expected to continue indefinitely, and which constitutes a substantial limitation to the individual. By January 1, 1989, the department shall promulgate rules which define neurological or other conditions in a way that is not limited to intelligence quotient scores as the sole determinant of these conditions, and notify the legislature of this action.
     (((5))) (6) "Eligible person" means a person who has been found by the secretary under RCW 71A.16.040 to be eligible for services.
     (((6))) (7) "Habilitative services" means those services provided by program personnel to assist persons in acquiring and maintaining life skills and to raise their levels of physical, mental, social, and vocational functioning. Habilitative services include education, training for employment, and therapy.
     (((7))) (8) "Legal representative" means a parent of a person who is under eighteen years of age, a person's legal guardian, a person's limited guardian when the subject matter is within the scope of the limited guardianship, a person's attorney-at-law, a person's attorney-in-fact, or any other person who is authorized by law to act for another person.
     (((8))) (9) "Notice" or "notification" of an action of the secretary means notice in compliance with RCW 71A.10.060.
     (((9))) (10) "Residential habilitation center" means a state-operated facility for persons with developmental disabilities governed by chapter 71A.20 RCW.
     (((10))) (11) "Respite services" means relief for families and other caregivers of people with disabilities, typically not to exceed ninety days, to include both in-home and out-of-home respite care on an hourly and daily basis, including twenty-four hour care for several consecutive days. Respite care workers provide supervision, companionship, and personal care services temporarily replacing those provided by the primary caregiver of the person with disabilities. Respite care may include other services needed by the client, including medical care which must be provided by a licensed health care practitioner.
     (((11))) (12) "Secretary" means the secretary of social and health services or the secretary's designee.
     (((12))) (13) "Service" or "services" means services provided by state or local government to carry out this title.
     (((13))) (14) "State-operated living alternative" means programs for community residential services which may include assistance with activities of daily living, behavioral, habilitative, interpersonal, protective, medical, nursing, and mobility supports to individuals who have been assessed by the department as meeting state and federal requirements for eligibility in home and community-based waiver programs for individuals with developmental disabilities. State-operated living alternatives are operated and staffed with state employees.
     (((14))) (15) "Supported living" means community residential services and housing which may include assistance with activities of daily living, behavioral, habilitative, interpersonal, protective, medical, nursing, and mobility supports provided to individuals with disabilities who have been assessed by the department as meeting state and federal requirements for eligibility in home and community-based waiver programs for individuals with developmental disabilities. Supported living services are provided under contracts with private agencies or with individuals who are not state employees.
     (((15))) (16) "Vacancy" means an opening at a residential habilitation center, which when filled, would not require the center to exceed its biennially budgeted capacity.
     (17) "Service request list" means a list of eligible persons who have received an assessment for service determination and their assessment shows that they meet the eligibility requirements for the requested service but were denied access due to funding limits.

Sec. 3   RCW 71A.16.050 and 1988 c 176 s 405 are each amended to read as follows:
     The determination made under this chapter is only as to whether a person is eligible for services. After the secretary has determined under this chapter that a person is eligible for services, the individual may request an assessment for eligibility for medicaid programs and specific services administered by the developmental disabilities administration. The secretary shall make a determination as to what services are appropriate for the person. The secretary shall prioritize services to medicaid eligible clients. Services may be made available to nonmedicaid eligible clients based on available funding. Services available through the state medicaid plan must be provided to those individuals who meet the eligibility criteria. The department shall establish and maintain a service request list database for individuals who are found to be eligible and have an assessed and unmet need for programs and services offered under a home and community-based services waiver, but the provision of a specific service would exceed the biennially budgeted capacity.

NEW SECTION.  Sec. 4   The department of social and health services shall develop and implement a medicaid program to replace the individual and family services program for medicaid-eligible clients no later than May 1, 2015. The new medicaid program must offer services that closely resemble the services offered in fiscal year 2014 through the individual and family services program. The department shall expand the client caseload beginning June 1, 2015. By June 30, 2017, the department shall increase the number of clients served in the new medicaid program by four thousand additional individuals from the numbers served in the 2014 individual and family support program. The department is authorized in fiscal year 2015 to use general fund--state dollars previously provided for the individual and family services program to cover the costs of increasing the number of clients served in the new medicaid program. To the extent possible, the department shall use general fund--state savings from section 6 of this act to offset costs for the increased client caseloads in fiscal years 2016, 2017, 2018, and 2019.

NEW SECTION.  Sec. 5   The department of social and health services shall expand the home and community-based services basic plus waiver client caseload beginning June 30, 2015. By June 30, 2017, the department of social and health services shall increase the number served on the home and community-based services basic plus waiver program by one thousand additional individuals from the numbers served in fiscal year 2014. The department is authorized in fiscal year 2015 to use general fund--state dollars previously provided for the individual and family services program to cover the costs of increasing the number of clients served in the basic plus waiver program. To the extent possible, the department shall use general fund--state savings from section 6 of this act to offset costs for the increased client caseloads in fiscal years 2016, 2017, 2018, and 2019.

NEW SECTION.  Sec. 6   The department of social and health services shall refinance medicaid personal care services under the community first choice option. Beginning July 1, 2014, the department shall seek stakeholder input on program and system design prior to the submission of a proposal to the center for medicaid and medicare services. The community first choice option shall be designed in such a way to meet the federal minimum maintenance of effort requirements and all service requirements as specified in federal rule. Without express legislative authorization, the per capita cost of all services offered in the new community first choice benefit design, to include required and optional services, shall not exceed a three percent increase over the per capita cost of the services provided to this population prior to the refinance to the community first choice option. The community first choice option must be fully implemented no later than August 30, 2015. In fiscal year 2015, the department shall use general fund--state savings from section 4 of this act to cover the fiscal year 2015 general fund--state costs of this section. For the 2015-2017 biennium and the 2017-2019 biennium, the department shall use general fund--state savings from the refinance in this section to offset costs related to sections 4 and 5 of this act.