SENATE BILL REPORT
ESHB 1968
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
Rereferred House Committee on Appropriations
Senate Committee on Health Care & Corrections
Senate Hearing Date(s):March 22, 1989; March 30, 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:Don Sloma (786-7414)
March 31, 1989
Senate Committee on Ways & Means
Senate Hearing Date(s):April 13, 1989
Majority Report: Do pass as amended.
Signed by Senators McDonald, Chairman; Craswell, Vice Chairman; Amondson, Bailey, Bauer, Bluechel, Cantu, Hayner, Johnson, Lee, Moore, Newhouse, Niemi, Saling, Smith, Talmadge, Warnke, Wojahn.
Senate Staff:Jan Sharar (786-7715)
April 13, 1989
AS REPORTED BY COMMITTEE ON WAYS & MEANS, APRIL 13, 1989
BACKGROUND:
The need to have a balanced and funded array of community based long-term care services has been uniformly expressed in several recent legislative and departmental reports and by advocates of long-term care services.
The most likely reason persons seek long-term care services is the inability to care for themselves because of functional disability. However, eligibility for most long-term care services is based on categorical eligibility guidelines, such as age and/or income. DSHS uses no uniform measurement and application of functional disability to determine the need for long-term care.
Long-term care services 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 currently provided to the elderly, developmentally disabled, and mentally ill. Respite services are not provided statewide, uniform case management services are lacking, and currently there is no personal care service tailored to the needs of persons with AIDS.
Community based services only make up a small fraction of the state's total long-term care budget, while nursing home care consumes the remainder. Unequal funding for community based long-term care is in part due to the lack of federal funds. Title XIX federal Medicaid funding for personal care, hospice or case management is currently not part of the state's federal funding sources for community based long-term care services. This funding option is available if the state is willing to accept the eligibility requirements established by the federal government.
SUMMARY:
A long-term care policy is established for the state. The policy calls for the coordination between all DSHS divisions involved in long-term care, a statewide 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 Title XIX personal care categories and to keep consistent with aging and adult services administrative policy. Persons receiving assistance with household tasks only or attendant care prior to the Department of Social and Health Services' program changes in 1988 will be grandparented into the chore program.
The Department of Social and Health Services is authorized to expand the respite program statewide for children, as well as adults who are at risk, to placement in a long-term care facility. A DSHS progress report is required for the respite services provided before 1991. Case management services are limited to individuals with at least one personal care need diagnosed by a physician. Eligibility for Title XIX personal care services will be based on the categorically needy while case management and hospice services will use the definition of medically needy.
The Department of Social and Health Services is directed to request an amendment from the federal government to their Medicaid waiver Community Options Program Entry System (COPES). The amendment will include respite services. The department is also directed to request another separate Medicaid waiver to allow personal care services for persons with AIDS. All persons receiving services under the Medicaid community based waiver such as COPES, personal care, hospice, or in a nursing home, will be required to comply with the federal Omnibus Reconciliation Act of 1987 (OBRA). These federal requirements direct the Department of Social and Health Services to allow the spouse of the person receiving these services to retain the maximum amount of allowable resources ($60,000), and starting September 30 the maximum monthly income ($1500).
The Department of Social and Health Services may retain the funds saved by taking advantage of Title XIX personal care for funding state funded chore services and respite services.
A long-term care implementation team consisting of 11 long-term care experts is created. The team is to develop a plan for coordination between all long-term care providers; design a noncategorical long-term care system; review county designated long-term care services; statewide case management; improved noninstitutional residential options; a uniform sliding fee scale for non-Title XIX federal social security act programs; creative and active involvement of volunteers in long-term care; information systems development; coordinated long-term care education; and long-term care cost information.
Residential care facilities serving from five to 15 functionally disabled persons will be able to locate in zoning areas for single family housing.
One hundred and fifty thousand dollars is appropriated for the Department of Social and Health Services to coordinate the activities of the long-term care implementation team.
Appropriation: $150,000
Revenue: none
Fiscal Note: available
SUMMARY OF PROPOSED HEALTH CARE & CORRECTIONS AMENDMENTS:
The legislative intent is added that long-term care services be coordinated to minimize administrative costs and maximize the use of available funding for service delivery. Local governments are intended to play a significant role in planning, administering and coordinating services.
Encouragement for a common entry point to services is removed from the act.
Chore services are defined as personal care and related tasks as provided for in the state medical assistance plan. Nonpersonal care services cannot be provided through the chore services program.
State policy is established to encourage the development of volunteer chore services and to fund these services on a priority basis.
Existing law requiring referral of certain persons to volunteer chore services is reinstated. The current statutory requirement is retained that the capability of relatives and community resources to provide services be assessed in determining eligibility for chore services.
Respite care services for children are removed and the requirement that respite care services be available statewide is deleted. Respite care may be provided to the extent funds are available.
All provisions related to income and asset limits of the spouses of Medicaid nursing home patients are eliminated.
The requirement is deleted that savings which may result from adding Title XIX funds to the chore services program be used for other community-based long-term care services.
The implementation team is replaced with a 16-member long-term care commission which must propose legislation and administrative changes to implement long-term care reforms consistent with intent of the act.
Special provisions governing the siting of residential facilities in areas not zoned for them are replaced by a study of the issue. Adult family homes are redefined and allowed in residential neighborhoods.
SUMMARY OF PROPOSED WAYS & MEANS AMENDMENT:
DSHS is directed to amend the state plan for medical assistance to include personal care services for persons based on financial eligibility.
An additional member of the long term care commission executive committee representing the Governor is added.
New provisions pertaining to regulation and licensure of adult family homes is added.
Senate Committee - Testified: HEALTH CARE & CORRECTIONS: Kamala Bremer, Dewey Dessler, Washington State Association of Area Agencies on Aging (pro); Kevin Foley, City of Tacoma, (con); Evan Iverson, Senior Lobby (pro); Margaret Shephard, Home Care Association of Washington (pro); Fred Mills, AARP (pro); Lida Brodoff, Puget Sound Legal Services (pro); Betty Jorgensen, Washington State Hospice Organization (pro); Charles Reed, DSHS; Jeff Larsen, Adult Family Homes of Washington (pro); Frank Winslow, Alzheimer Society of Washington; Scott Sigmon, WFSE; Andrea Dahl, Association of Washington Cities
Senate Committee - Testified: WAYS & MEANS: No one