SENATE BILL REPORT
ESHB 1864
BYHouse Committee on Health Care (originally sponsored by Representatives Day, Brooks, Braddock, D. Sommers, R. Meyers, Sprenkle, Cantwell, Morris, Scott, Wolfe, Vekich, Patrick, Chandler, Crane, Winsley, Dellwo, Brough, Wineberry, P. King, S. Wilson, Bowman, Kremen, Dorn, Schoon, Van Luven, Wood, R. King, Cooper, Doty, Todd, McLean and O'Brien)
Concerning quality of care in nursing homes.
House Committe on Health Care
Rereferred House Committee on Appropriations
Senate Committee on Health Care & Corrections
Senate Hearing Date(s):March 22, 1989; March 29, 1989
Majority Report: Do pass as amended and be referred to Committee on Ways & Means.
Signed by Senators West, Chairman; Smith, Vice Chairman; Amondson, Johnson, Kreidler, Niemi, Wojahn.
Senate Staff:Scott Plack (786-7409)
March 30, 1989
Senate Committee on Ways & Means
Senate Hearing Date(s):April 10, 1989
Majority Report: Do pass as amended.
Signed by Senators McDonald, Chairman; Craswell, Vice Chairman; Amondson, Bailey, Bluechel, Cantu, Hayner, Johnson, Lee, Matson, Newhouse, Saling.
Senate Staff:Jan Sharar (786-7715)
April 10, 1989
AS REPORTED BY COMMITTEE ON WAYS & MEANS, APRIL 10, 1989
BACKGROUND:
The current nursing shortage has created concerns about the ability of nursing homes to attract and retain high quality nursing staff. Estimated wages paid to nursing home staff are 8 to 22 percent below wages paid to nurses in acute care hospitals. To meet personnel needs, nursing homes are using temporary health personnel agencies. The cost of using the personnel agencies is higher than having nursing personnel on permanent staff. Concerns are also raised about quality and continuity of care when temporary staff is used.
Changes in the federal requirements through OBRA (Omnibus Budget Reconciliation Act of 1987) require the state modify current statutes with regard to regulations affecting sanctions, stop payments, license suspensions, revocations and receiverships.
The state currently does not assess a fee for post survey visits to nursing homes. These visits are necessitated to verify whether the home has corrected deficiencies found on the initial survey.
Residents of nursing homes must sometimes leave the facility for a short period of time to receive inpatient care at a hospital. The Medicaid program does not pay for the bed when temporarily vacated by the resident and homes may fill it with another resident.
The shortage of licensed nursing staff in nursing homes has created a need for student and graduate nurses to be utilized to the fullest extent possible. Supervised nursing students working and training in hospitals are currently allowed to provide medication to patients. This same professional privilege, however, is not available in nursing homes.
The increased numbers of highly debilitated nursing home residents may place additional strains on the nursing home. Very little information, however, is available about the size, scope, and impact of heavy care patients in nursing homes.
SUMMARY:
A 12 1/2 percent increase for wages and benefits for nursing home nursing staff (RN, LPN) is requested with the qualification that funds are appropriated.
Graduate nurses and student nurses are permitted to administer medication to nursing home residents.
New rules are established for the Division of Aging and Adult Services to allow for denying a nursing home license to an applicant. Sanctions imposed for violation of federal regulations are also revised to allow the Division of Aging and Adult services to order immediate closure of the home and/or immediate transfer of residents if an emergency exists affecting the health or safety of residents. The department may deny payment for all Medicaid eligible individuals admitted after the nursing home has been cited for deficiencies and did not correct those deficiencies within three months, or if the home has been found in violation of standards of care on three consecutive surveys. Monetary penalties are also established.
The department is given the authority to impose due process rights for stop placement and emergency transfer in nursing homes.
The process of dealing with nursing homes in receivership status is changed to reflect a need to maintain the smooth functioning of the nursing home and protection of its residents during the transfer of the home.
Post survey charges of $12 per bed are assessed to the nursing home for those surveys requested by the facility after the second and subsequent post survey or visit.
If nursing homes are at or above a 92 percent rate of occupancy, they must reserve a Medicaid patient's bed and reimburse the established Medicaid reimbursement rate for the unoccupied bed.
Aging and Adult Services Administration is directed to conduct an evaluation of the dynamic needs of heavy care Medicaid nursing home patients.
Appropriation: none
Revenue: none
Fiscal Note: requested February 10, 1989
SUMMARY OF PROPOSED HEALTH CARE & CORRECTIONS AMENDMENTS:
The provision is removed to require nursing homes to reserve beds for Medicaid patients when they temporarily leave the nursing home and enter the hospital. Language is removed that authorizes a 12.5 percent increase in nursing wages and benefits and substitute language allows for an increase subject to appropriation. A moratorium is established on the cost lid for Medicaid reimbursement for nursing homes that submit plans to improve recruitment and retention of nursing staff. This provision is subject to an appropriation and expires on July 1, 1991. Technical changes are made in language authorizing nursing home post survey changes. A provision is added to allow for a reassessment of the assets of certain nursing homes by the Department of General Administration.
SUMMARY OF PROPOSED WAYS & MEANS AMENDMENTS:
Language is removed allowing for increases in nursing wages and benefits subject to appropriation. Language establishing a moratorium on the cost lid for Medicaid reimbursement for nursing homes that submit plans to improve recruitment and retention of nursing staff is removed. Reimbursable costs and fees for legal, accounting and bookkeeping services are established at an average of 85 percent over any of the preceding three annual cost report periods. The division is allowed to purchase care in institutions for the mentally diseased by contract. Nursing home applicants shall receive information on alternatives to nursing home care.
Senate Committee - Testified: HEALTH CARE & CORRECTIONS: Fred Mills; Charles Reed, DSHS; Glen Hudson, Washington Health Care Association; Jane Boyajian, State Long Term Care Ombudsman
Senate Committee - Testified: WAYS & MEANS: No one