SENATE BILL REPORT
SB 5805
BYSenators Amondson, Wojahn, West, Kreidler, Thorsness, Niemi, Anderson, Gaspard, Benitz, Stratton, Moore and Fleming
Regulating nursing homes.
Senate Committee on Health Care & Corrections
Senate Hearing Date(s):February 21, 1989; March 1, 1989
Majority Report: That Substitute Senate Bill No. 5805 be substituted therefor, and the substitute bill do pass 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 3, 1989
Senate Committee on Ways & Means
Senate Hearing Date(s):March 20, 1989
Senate Staff:Jan Sharar (786-7715)
March 20, 1989
AS REPORTED BY COMMITTEE ON HEALTH CARE & CORRECTIONS, MARCH 1, 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.
Nursing homes employ a director of nursing services to oversee the care provided by the nursing staff. A qualified director is important in assuring the special care needs of residents are being met by the nursing staff.
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.
Resident councils exist in many nursing homes to allow for residents to have input into the care they receive. There is currently no special funding for resident councils.
SUMMARY:
Wages and benefits for registered nurses, licensed practical nurses and registered nursing assistants are increased by 25 percent. The Department of Social and Health Services (DSHS) is required to assure that the wage and benefit increases are not shifted to other cost centers. The current statutory lid in the Medicaid reimbursement system for nurse wage increases is eliminated.
The director of nursing services in-house training program is created and made a reimbursable cost through the Medicaid program.
Graduate nurses and student nurses are permitted to administer medications. Numerous OBRA required changes are made for Medicaid nursing home contractors with regard to sanctions, suspension and revocation of nursing homes licenses and stop payments when homes are out of compliance with regulations.
Revisions are made in the nursing home receivership provisions to allow for a six-month temporary license to receivers pending a survey. Receivers are permitted to acquire a financial interest in the home after they have been appointed. Provisions are revised to clarify the liability of receivers for certain debts. DSHS is permitted to grant transition funds to a non-Medicaid facility and to take action against the facility to recover any transitional funds granted to the facility.
Post survey charges will be assessed to a nursing home after the first post survey at a rate of $6 per bed.
A nursing home bed surcharge of $2.50 will be collected to fund consumer organizations concerned with resident care.
A bed hold policy is established for Medicaid patients. Nursing homes will be required to hold beds for up to five days for residents who temporarily leave the facility for hospitalization. The facility Medicaid per diem will be paid to the home for holding the bed if the home's occupancy is at or above the minimum occupancy lid.
Three studies are authorized. DSHS will identify the care needs of special needs populations in nursing homes. They will also analyze nursing personnel needs in meeting the various care level needs of residents. The Legislative Budget Committee will analyze existing and needed nursing home data bases necessary for policy and planning needs.
EFFECT OF PROPOSED SUBSTITUTE:
Graduate nurses and student nurses are permitted to administer medications. Numerous OBRA required changes are made with regard to sanctions, suspension and revocation of nursing homes licenses and stop payments, appointment of temporary management, civil penalties and stop placements when homes are out of compliance with regulations.
Revisions are made in the nursing home receivership provisions to allow for a six-month temporary license to receivers pending a survey. Receivers are permitted to acquire a financial interest in the home after they have been appointed. Provisions are revised to clarify the liability of receivers for certain debts. DSHS is permitted to grant transition funds to a non-Medicaid facility and to take action against the facility to recover any transitional funds granted to the facility.
Post survey charges will be assessed to a nursing home after the first post survey at a rate of $12 per bed.
A nursing home bed surcharge of $2.50 will be collected to fund consumer organizations concerned with resident care and an additional $2.50 per bed to fund the training of volunteer ombudsmen.
A bed hold policy is established for Medicaid patients. Nursing homes will be required to hold beds for up to five days for residents who temporarily leave the facility for hospitalization. The facility Medicaid per diem will be paid to the home for holding the bed if the home's occupancy is at or above the minimum occupancy lid.
The Department of Social and Health Services is directed to publish information on long-term care services in the state and to distribute to nursing homes and physicians. Nursing homes are required to provide information to applicants.
Appropriation: none
Revenue: none
Fiscal Note: requested on February 8, 1989
Senate Committee - Testified: HEALTH CARE & CORRECTIONS: Hilka Faber, Nursing Home Coalition (pro); Charles Reed, DSHS, (con); Jan Boyajian, State Long Term Care Ombudsman (con); Jeanne Marie Thomas, Seattle/KIng Co. LTC Ombudsman (con); Peggy Jo Mihata, DCD