FINAL BILL REPORT

SHB 1968

PARTIAL VETO

                                  C 427 L 89

BYHouse Committee on Health Care (originally sponsored by Representatives Braddock, Brooks, Day, Cantwell, Leonard, Prentice, Bristow, Brekke, Vekich, Kremen, Valle, Raiter, D. Sommers, Morris, Sprenkle, Ebersole, Wineberry, H. Sommers, Cole, Hine, Basich, Anderson, Van Luven, Dellwo, Todd, Winsley, Sayan, Cooper, R. King, Crane, Rector, Brough, Zellinsky, Phillips, Pruitt, O'Brien, Nelson, Spanel, G. Fisher, Rasmussen,  H. Myers and Fraser)

Establishing a plan for long-term care services.

House Committe on Health Care

House Committe on Appropriations

Senate Committee on Health Care & Corrections and Committee on Ways & Means

SYNOPSIS AS ENACTED

BACKGROUND:

In the next ten years, the demand for long term care services is expected to grow substantially.  This demand is being driven largely by a virtual age wave of adults, many of whom are over the age of 85.  Persons with AIDS, the mentally retarded, traumatically brain injured, and others with functional dependency due to incapacity will also require an array of community based long term care services.

Long term care services in this state are delivered through several independent programs that are not uniformly bound in terms of common goals, methods of approach, eligibility criteria, and overall coordination of services.  Both federal and state funding categories have influenced this fractured approach.  Long term care programs are scattered among several divisions within the Department of Social and Health Services (DSHS), including the Division of Developmental Disabilities, Division of Aging and Adult Services, Division of Mental Health, Division of Children and Family Services, Division of Vocational Rehabilitation, Office on AIDS, Division of Health, and Bureau of Alcohol and Substance Abuse.

A range of community based health, social and supportive services, including chore services, limited respite assistance, adult family homes, group homes and other types of long term care services are provided to the elderly, developmentally disabled, and mentally ill.  Respite services are not provided state-wide, uniform case management services are lacking, and there is no personal care service program for persons with AIDS.  Community based services make up only a small fraction of the state's total long term care budget.  Nursing home care accounts for 76 percent of the total long term care budget.  Funding for community based long term care is hampered by the lack of federal funds.  Title XIX federal Medicaid funding for personal care, hospice or case management is not used for our state's community based long term care service system.  This funding option is available if the state is willing to accept the eligibility requirements established by the federal government.  The need to have a balanced and funded array of community based long term care services has been noted in several recent legislative and executive branch reports and by advocates of long term care services.

Adult family homes are regular family abodes whose regular residents provide full-time family care and supervision for adults in need of personal or special care.  They include persons age 18 or over who, because of developmental disability, age, or physical or mental infirmity, require some degree of supervision or health care beyond the level of room and board.  Homes are required to be licensed if the residents served are developmentally disabled, have their care paid for by the state or if there are more than two residents in the home.  No home may have more than four residents and are inspected by DSHS about every three years.

There is no uniform approach to siting residential care facilities in cities and counties across the state.  Siting such facilities frequently is very difficult because of local opposition.

SUMMARY:

A long term care policy is established for the state.  This policy calls for the coordination of long term care services, a state-wide balanced array of community based care, and long term care service eligibility based on a person's measurable functional incapacity due to disability.

State funded chore services are revised to make service categories comply with similar categories mandated by federal law and to maintain consistency with existing administrative policies.  Persons who were receiving chore services for household tasks only or attendant care prior to the chore service program changes in 1988 will be allowed to remain in the chore service program.

The Department of Social and Health Services is authorized to establish a Title XIX personal care program and set program eligibility standards for medicaid categorically needy persons.  The department is required to operate the respite care program within available state funds.  The department is also required to establish a medicaid Hospice program for the categorically needy, and report to the Legislature on the cost of the program by December 20, 1989.

The department is required to request permission from the federal government to provide Medicaid funded respite services under the state's Community Options Program Entry System (COPES).  The department is also directed to request another separate Medicaid waiver to allow personal care services for persons with AIDS.

A long term care commission is created.  The commission is to develop a plan to establish coordination between all Department of Social and Health Services long-term care providers; design a non-categorical long term care system; develop a statewide case management; improve non-institutional residential options; design a uniform sliding fee scale for non-Title XIX federal social security act programs; establish programs to increase the involvement of volunteers in long term care; design a coordinated information system; and ensure a coordinated long term care education system.

All adult family homes must be licensed by July 1, 1990.  An initial and yearly license fee of $50 is established for adult family homes.  For good cause, DSHS may permit an adult family home to operate with up to six residents.  The inspection of adult family homes is required every 18 months.

Provisions are established for client rights and enforcement.  Sanctions are specified for failure to meet health and safety requirements.

A siting policy is established for all residential care facilities.

VOTES ON FINAL PASSAGE:

      House 96   0

      Senate    45     0 (Senate amended)

                  (House refused to concur)

Free Conference Committee

      Senate    45     0

      House 97   0

EFFECTIVE:July 23, 1989

Partial Veto Summary:  Four sections were vetoed:  the vetoed sections would have required the Department of Social and Health Services to develop rules for adult family homes that are equal to the rules currently existing; required training materials for adult family home operators; required the department to report to the Legislature; repealed the rule-making authority over congregate care facilities; and established a preemptive zoning status for residential care facilities servicing up to 15 individuals.  (See VETO MESSAGE)