H-1143.1

HOUSE BILL 1784


State of Washington	64th Legislature	2015 Regular Session

By Representatives Tharinger, Cody, Van De Wege, Riccelli, Jinkins, and Moeller

Read first time 01/28/15. Referred to Committee on Health Care & Wellness.

AN ACT Relating to promoting quality in nursing homes; amending RCW 74.42.360; adding a new section to chapter 74.46 RCW; creating a new section; and prescribing penalties.

NEW SECTION. Sec. 1. The legislature finds that Washington's nursing facilities provide important long-term care services for tens of thousands of seniors. However, according to recent reports by AARP and the SCAN foundation, Washington state ranks poorly compared to other states in nursing home quality and certified nursing assistant turnover measures. Washington is one of only a few states without minimum certified nursing assistant direct care staffing requirements. These minimum staffing requirements have linked to improved quality care for residents. With the age wave dramatically increasing the number of seniors needing long-term services and supports, it is the intent of the legislature to put in place policies that promote high quality care and reductions in direct care staff turnover in our state's licensed nursing facilities.

(1) The facility shall have staff on duty twenty-four hours daily sufficient in number and qualifications to carry out the provisions of RCW 74.42.010 through 74.42.570 and the policies, responsibilities, and programs of the facility. Each facility must have at least one registered nurse present and on duty at the facility twenty-four hours daily.

(2)(a) By January 1, 2017, each facility must have adequate staff on duty to provide 2.4 hours per resident per day, as adjusted by an acuity factor determined by the department.

(b) By January 1, 2018, each facility must have adequate staff on duty to provide 3.3 hours per resident per day, as adjusted by an acuity factor determined by the department.

(c) By January 1, 2019, each facility must have adequate staff on duty to provide 3.6 hours per resident per day, as adjusted by an acuity factor determined by the department. At least 1.1 hours per resident per day must be provided by licensed staff.

(3) The department shall require facilities to submit monthly reports to the department that include the number of staff according to eight hour work shifts, for three shifts per day. The department shall develop an automated system for collecting information, including payroll records for relevant pay periods. The department shall also adopt procedures to assure consistency in reporting standards.

(a) If the department determines that a facility has failed to comply with the standards established under subsection (2) of this section, the department may cite the facility for deficiencies and assess a penalty of up to ten thousand dollars for each month that the facility failed to comply, including five percent interest;

(b) If the department determines that a facility has failed to comply with the standards established under subsection (2) of this section for more than twenty percent of the shifts in a month, the department may cite the facility for deficiencies, assess a penalty of up to fifteen thousand dollars for each month that the facility failed to comply, including five percent interest, and place restrictions on the admission of new residents.

(5) When conducting an investigation under subsection (4) of this section, if the department determines that any residents or employees experienced negative outcomes that were caused by the failure to comply with the standards established under subsection (2) of this section, the department may cite the facility for deficiencies and assess a penalty of up to twenty thousand dollars, including five percent interest, per event. These penalties are in addition to any penalties assessed under subsection (4) of this section.

(6) The department shall assess cost report data for quality indicators in facilities with low staffing levels. The quality indicators shall include: Prevalence of falls, prevalence of stage one through four pressure ulcers, high rates of antipsychotic use in the absence of psychotic and related conditions, medication error rates of five percent or higher, incidence of decline in late loss of activities of daily living, direct care staff injuries while handling patients, and staff turnover rates above forty percent annually.

(1) The department shall develop a payment methodology to incorporate outcome-based measures into nursing home rates. The payment methodology must designate up to ten percent of the rate paid to nursing homes to be based upon achieving quality indicators, such as reducing bed sores, reducing resident falls, reducing medication errors, reducing worker injuries, reducing worker turnover, increasing resident and family satisfaction, and other measures identified by the stakeholder group established in subsection (2) of this section.

(2) When determining the quality indicators, the department shall consult advice regarding appropriate standards from stakeholders including advocates for residents, workers, and care providers.