SENATE BILL REPORT

SB 6271

BYSenators Deccio, Wojahn, Smith, Kreidler and Nelson

Regulating care provided in the home to ill, disabled, or infirm persons.

Senate Committee on Health Care & Corrections

Senate Hearing Date(s):January 19, 1988

Majority Report:  Do pass.

      Signed by Senators Deccio, Chairman; Johnson, Vice Chairman; Kreidler, Niemi, Smith, West, Wojahn.

Senate Staff:Scott Plack (786-7409)

                  March 5, 1988

AS PASSED SENATE, JANUARY 29, 1988

BACKGROUND:

In-home services for the ill, disabled and aged population are classified into three categories:  home health care, home care and hospice care.  Home health care refers to health and medical services such as nursing rehabilitation therapies, nutritional therapy, and a variety of other vital health services.  Home care refers to supportive services such as personal care assistance which help maintain the independence of the home bound person.  Hospice care refers to physical, social and emotional care for the terminally ill, and emotional support to the family during the bereavement period.

There are no minimum mandatory state standards for providers of in-home services.  Home health and hospice services are subject to a voluntary certification program administered by the Department of Social and Health Services.  Present certification standards are based upon federal Medicare requirements.  Certification is often required for third-party reimbursement.

The growing elderly population plus potential cost- containment benefits of providing in-home services are expected to increase future demand for home health, home care and hospice services.

SUMMARY:

The in-home health care industry is regulated by separately licensing home health, hospice and home care agencies. The Department of Social and Health Services (DSHS) is the designated licensure authority.  Licensure standards are established for each type of agency.  A certificate of need is not required for licensure.  DSHS is given enforcement authority and may revoke a license or assess a penalty in order to assure compliance.  The Secretary of DSHS is authorized to establish licensure fees.

Home health agencies provide home health aide services or two or more medical or health related services.  Home care agencies provide personal care, homemaker services, respite care or other non-medical in-home services.  Hospice agencies provide medical and home care services to the terminally ill.

Exemptions from licensure are provided for family members, certain entities furnishing durable medical equipment; providers who contract with a licensed agency; employees, volunteers or contract providers of a licensed agency; certain facilities and institutions already licensed by the state; medically approved kidney dialysis programs and volunteer home care agencies.

Volunteer hospice programs established before January 1, 1988 that do not meet licensure requirements may use the term "volunteer hospice."  All volunteer hospice agencies that apply for licensure are exempted from professional liability, public liability and property damage insurance requirements.

Nursing homes and hospitals are required to be licensed for home health, home care and hospice services provided outside the nursing home or hospital facility.

Insurance requirements are established.

In-home service agencies must submit applications for licensure with licensure fee to DSHS by July 1, 1989.  DSHS must license these applicants by July 1, 1990.

DSHS collects data on services provided by licensed agencies.  DSHS may combine applications, on-site inspections and audits and may reduce fees for agencies applying for more than one in-home service license.

Each in-home agency is required to issue clients a consumer bill of rights.

Third party payment may be made only to licensed home health and hospice agencies, though third party payments may also require adherence to Medicare standards as a condition for payment.

The act will sunset on July 1, 1993.  The LBC is directed to conduct a fiscal and program review on this act by December 31, 1992.

Appropriation:    An appropriation is made of $38,875 from the general fund-state.

Revenue:    none

Fiscal Note:      requested January 14, 1988

Senate Committee - Testified: Margaret Shepard, Home Care Association of Washington; Gail Toraason, Home Care Association of Washington; Betty Jorgensen, Washington State Hospice Organization; Pat Hayes, Chore Providers Association; Glen Hudson, Washington Health Care Association; Pat Greenstreet, Washington State Nurses Association

HOUSE AMENDMENTS:

Additional entities exempt from licensure are case management services and individuals providing home care through a direct agreement with third party payers where home care services are not readily available through an agency.  A surcharge to license fees may be added to cover initial implementation costs.