H-1215 _______________________________________________
HOUSE BILL NO. 1968
_______________________________________________
State of Washington 51st Legislature 1989 Regular Session
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
!ae160Read first time 2/13/89 and referred to Committee on Health Care.
AN ACT Relating to long-term care; amending RCW 74.09.520, 74.09.700, 74.09.510, 11.94.050, 74.08.541, 74.08.545, 74.08.550, 74.08.570, 74.41.030, 74.41.040, 74.41.050, and 74.41.070; adding a new chapter to Title 74 RCW; adding new sections to chapter 74.09 RCW; adding a new section to chapter 84.52 RCW; creating new sections; repealing RCW 74.09.532, 74.09.534, 74.09.536, 74.09.538, and 74.09.545; making an appropriation; providing a contingent effective date; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1. The legislature finds that:
Washington's chronically functionally disabled population is growing at a rapid pace. This growth, along with economic and social changes and the coming age wave, presents opportunities for the development of long-term care community services networks and enhanced volunteer participation in those networks, and creates a need for different approaches to currently fragmented long-term care programs. The legislature further recognizes that persons with functional disabilities should receive long-term care services that encourage individual dignity, autonomy, and development of their fullest human potential.
NEW SECTION. Sec. 2. The purpose of this chapter is to:
(1) Establish a balanced range of community-based health, social, and supportive services that deliver long-term care services to chronically, functionally disabled persons of all ages;
(2) Ensure that functional disability shall be the determining factor in defining long-term care service needs and that these needs will be determined by a uniform system for comprehensively assessing functional disability;
(3) Ensure that services are provided in the most independent living situation consistent with individual needs;
(4) Ensure that long-term care service options shall be developed and made available that enable functionally disabled persons to continue to live in their homes or other community residential facilities while in the care of their families or other volunteer support persons;
(5) Develop a systematic plan for the coordination, planning, budgeting, and administration of long-term care services between the division of developmental disabilities, division of mental health, division of aging and adult services, division of children and family services, division of vocational rehabilitation, office on AIDS, division of health, and bureau of alcohol and substance abuse;
(6) Encourage the development of a state-wide long-term care case management system that effectively coordinates the plan of care and services provided to eligible clients;
(7) Ensure that individuals and organizations affected by or interested in long-term care programs have an opportunity to participate in identification of needs and priorities, policy development, planning, and development, implementation, and monitoring of state supported long-term care programs;
(8) Ensure the development of a state-wide long-term care system state-wide that provides a common entry point for clients, centralized information and referral system, an integrated data base with the capability to provide client tracking, centralized complaint reporting, investigation and resolution, and the capacity to link the acute care and long-term care systems;
(9) Support educational institutions in Washington state to assist in the procurement of federal support for expanded research and training in long-term care; and
(10) Facilitate the development of a coordinated system of long-term care education that is clearly articulated between all levels of higher education and reflective of both in-home care needs and institutional care needs of functionally disabled persons.
NEW SECTION. Sec. 3. A valuable option available to Washington state to achieve the goals of sections 1 and 2 of this act is the flexibility in personal care and other long-term care services encouraged by the federal government under Title XIX of the federal social security act. These services include options to expand community-based long-term care services, such as adult family homes, congregate care facilities, respite, chore services, hospice, and case management.
I. CHORE SERVICES
Sec. 4. Section 17, chapter 6, Laws of 1981 1st ex. sess. as last amended by section 1, chapter 222, Laws of 1986 and RCW 74.08.541 are each amended to read as follows:
(1) "Department" as used in this chapter, means the department of social and health services.
(2) "Long-term care facility" as used in this chapter, means a nursing home licensed under chapter 18.51 RCW or a residential habilitation center licensed under chapter 71A.20 RCW.
(3)
"Chore services," as used in this chapter, means personal care
services ((in performing light work and household and other personal)) and
related tasks ((which eligible persons are unable to do for themselves
because of frailty or handicapping conditions)) provided under the
department's medical assistance personal care benefit. To the extent
additional funds may be specifically authorized by the legislature for this
purpose, "chore services" may mean household tasks eligible persons
are unable to do for themselves because of a functional disability.
(((2)))
(4) Persons eligible for chore services are ((adult individuals))
persons having resources less than a level determined by the department,
((and)) whose need for chore services and risk of being placed in a ((residential))
long-term care facility have been determined by the department, and
who are not eligible to receive medical assistance personal care benefits under
sections 13 and 14 of this 1989 act.
(a) Persons
are eligible for the level ((or amount)) of services determined by the
department under RCW 74.08.545 if the persons ((are: (i) Adult recipients of
supplemental security income or state supplementation; (ii) eligible at the
time their eligibility for chore services is determined or redetermined, for
limited casualty program medical care as defined by RCW 74.09.010; or (iii)))
have an income at or below thirty percent of the state median income.
(b) For
other persons, the department shall develop a scale which progressively reduces
the level ((or amount)) of chore services provided by the department
based on the ability of applicants and ((recipients)) clients to
purchase the chore services. ((To determine the ability of
applicants and recipients to purchase chore services,)) The
department shall not consider income below thirty percent of the state median
income.
(c) Effort
shall be made to obtain chore services from volunteer chore service providers
under the senior citizens services act, chapter 74.38 RCW, for ((those
individuals at risk of being placed in a residential care facility and who are
age sixty or over but eligible for five hours of chore services per month or
less, rather than have those services provided by paid providers.)) any
((individual)) person who is age sixty or older, is at risk of
being placed in a ((residential)) long-term care facility,
and ((who is age sixty or over but not eligible for chore services or
eligible for a reduced amount of service shall be referred to a volunteer chore
service program under the senior citizens services act, chapter 74.38 RCW,
where available for needed services not authorized by the department)) is:
(i) Eligible for five hours or less of chore services per month; or (ii) not
financially eligible for chore services.
(d) ((Individuals))
Persons determined by the department to be eligible for adult protective
services are eligible to receive emergency chore services without regard to
income if the services are essential to, and a subordinate part of, the adult
protective services plan. Emergency chore services under adult protective
services shall be provided only until the situation necessitating the services
has stabilized, not to exceed ninety days.
(((3)))
(4) The department shall establish a monthly dollar lid on chore
services expenditures as necessary to maintain such expenditures within the
legislative appropriation. To maintain expenditures for chore services within
the limits of funds appropriated for this purpose, the department may reduce
the level ((or amount)) of services authorized below the level of need
assessed pursuant to RCW 74.08.545 for some or all ((recipients, but)) clients.
The reductions shall be done in a manner which maintains state-wide
uniformity of eligibility and service authorization standards and which considers
the level of need for services and the degree of risk of being placed in a ((residential))
long-term care facility of all applicants for, and recipients of, chore
services: PROVIDED, That the department may implement a ratable reduction
of hours or payment for some or all clients receiving chore services.
(5) The department may continue providing chore services for those clients who were receiving assistance only with household tasks prior to December 14, 1987, provided that those clients are receiving this same service as of June 1989.
(6) The department may continue providing chore services to clients who were receiving attendant care services prior to April 1, 1988, provided that those clients are receiving the same services as of June 1989.
Sec. 5. Section 16, chapter 6, Laws of 1981 1st ex. sess. and RCW 74.08.545 are each amended to read as follows:
It is the
intent of the legislature that chore services be provided to eligible persons
within the limits of funds appropriated for that purpose. Therefore, the
department shall provide services only to those persons identified as at risk
of being placed in a ((residential)) long-term care facility in
the absence of such services. Chore services shall be provided ((only))
to the extent necessary to maintain a safe and healthful living environment.
In determining ((an individual's)) eligibility for chore services, the
department shall consider the following:
(1) ((The
kind of services needed;
(2))) The degree of service need, and the extent to which an
individual is dependent upon such services to remain in his or her home or
return to his or her home; and
(((3)
The availability of personal or community resources which may be utilized to
meet the individual's need; and
(4))) (2) Such other factors as the department
considers necessary to insure service is provided only to those persons whose
chore service needs ((cannot be)) are not being met by relatives,
friends, nonprofit organizations, or other ((persons)) community
resources.
In
determining the level of services to be provided under this chapter, ((the
department shall utilize a client review questionnaire designed)) client
shall be assessed using an instrument designed by the department to
determine ((both)) the ((degree and level of service)) level
of functional disability, the need for service and the ((individual's))
person's risk of ((institutionalization if such needs are not met by
this chapter)) long-term care facility placement.
Sec. 6. Section 3, chapter 51, Laws of 1973 1st ex. sess. as last amended by section 189, chapter 3, Laws of 1983 and RCW 74.08.550 are each amended to read as follows:
(1) The
department ((of social and health services)) is authorized to develop a
program to provide for those services enumerated in RCW 74.08.541.
(2) ((The
department shall endeavor to assure that, for each individual receiving in-home
services, a single caseworker is responsible for coordinating the delivery of
all necessary in-home services for which the recipient is eligible.
(3))) The department may provide assistance in the
recruiting of providers of the services enumerated in RCW 74.08.541 and seek to
assure the timely provision of services in emergency situations.
(((4)))
(3) The department shall assure that all providers of the services
enumerated in RCW 74.08.541 are compensated for the delivery of the services on
a prompt and regular basis.
Sec. 7. Section 3, chapter 137, Laws of 1980 and RCW 74.08.570 are each amended to read as follows:
(1) An otherwise eligible disabled person shall not be deemed ineligible for chore services under this chapter if the person's gross income from employment, adjusted downward by the cost of the chore services to be provided and the disabled person's work expenses, does not exceed the maximum eligibility standard established by the department for such chore services. The department shall establish a sliding scale fee schedule for such disabled persons, taking into consideration the person's ability to pay and work expenses.
(2) If a
disabled person arranges for chore services through an individual provider
arrangement, the ((recipient's)) client's contribution shall be
counted as first dollar toward the total amount owed to the provider for chore
services rendered.
(3) As used in this section:
(a) "Gross income" means total earned wages, commissions, salary, and any bonus;
(b) "Work expenses" includes:
(i) Payroll deductions required by law or as a condition of employment, in amounts actually withheld;
(ii) The necessary cost of transportation to and from the place of employment by the most economical means, except rental cars; and
(iii) Expenses of employment necessary for continued employment, such as tools, materials, union dues, transportation to service customers if not furnished by the employer, and uniforms and clothing needed on the job and not suitable for wear away from the job;
(c) "Employment" means any work activity for which a recipient receives monetary compensation;
(d) "Disabled" means:
(i)
Permanently and totally disabled as defined by the department and as such
definition is approved by the federal social security ((agency)) administration
for federal matching funds;
(ii) Eighteen years of age or older;
(iii) A resident of the state of Washington; and
(iv) Willing to submit to such examinations as are deemed necessary by the department to establish the extent and nature of the disability.
II. RESPITE SERVICES
Sec. 8. Section 3, chapter 158, Laws of 1984 as amended by section 2, chapter 409, Laws of 1987 and RCW 74.41.030 are each amended to read as follows:
Unless the context clearly indicates otherwise, the definitions in this section apply throughout this chapter.
(1)
"Respite ((care)) services" means relief care for families or
other caregivers of disabled ((adults)) persons, eligibility for
which shall be determined by the department by rule. The services provide
temporary care or supervision of disabled ((adults)) persons in
substitution for the caregiver. The term includes social day care.
(2)
"Eligible participant" means ((an adult)) a person (a)
who needs substantially continuous care or supervision by reason of his or her
functional disability, and (b) who is assessed as requiring ((institutionalization))
placement in a long-term care facility in the absence of a caregiver
assisted by home and community support services, including respite ((care))
services. In evaluating the need for respite services, consideration shall
be given to the mental and physical ability of the caregiver to perform
necessary caregiver functions.
(3)
"Caregiver" means a spouse, relative, or friend who has primary
responsibility for the care of a functionally disabled ((adult)) person,
who does not receive financial compensation for the care, and who is assessed
as being at risk of placing the eligible participant in a long-term care
facility if respite ((care is)) services are not available.
(4) (("Institutionalization"
means placement in a long-term care facility)) "Long-term care
facility" means a nursing home licensed under chapter 18.51 RCW or a
residential habilitation center licensed under chapter 71A.20 RCW.
(5)
"Social day care" means nonmedical services to persons who live with
their families, cannot be left unsupervised, and are at risk of being placed in
a ((twenty-four-hour)) long-term care facility if their families
do not receive some relief from constant care.
(6) "Department" means the department of social and health services.
Sec. 9. Section 4, chapter 158, Laws of 1984 as amended by section 3, chapter 409, Laws of 1987 and RCW 74.41.040 are each amended to read as follows:
The
department shall administer this chapter and shall establish such rules and
standards as the department deems necessary in carrying out this chapter. The
department shall not require the development of plans of care or discharge
plans by nursing homes providing respite ((care)) services under
this chapter.
The
department shall develop standards for the respite program in conjunction with
((the selected)) area agencies on aging. The program standards shall
serve as the basis for soliciting bids, entering into subcontracts, and
developing sliding fee scales to be used in determining the ability of eligible
participants to participate in paying for respite ((care)) services.
Sec. 10. Section 5, chapter 158, Laws of 1984 as amended by section 4, chapter 409, Laws of 1987 and RCW 74.41.050 are each amended to read as follows:
((The
department shall select)) Area agencies on aging ((to)) shall
conduct respite ((care)) projects. The responsibilities of the selected
area agencies on aging shall include but not be limited to: Negotiating rates
of payment, administering sliding-fee scales to enable eligible participants to
participate in paying for respite ((care)) services, and
arranging for respite ((care)) services. Rates of payment to respite ((care))
service providers shall not exceed, and may be less than, rates paid by the
department to providers for the same level of service.
Sec. 11. Section 7, chapter 158, Laws of 1984 as amended by section 5, chapter 409, Laws of 1987 and RCW 74.41.070 are each amended to read as follows:
(1) The
area agencies administering respite ((care)) programs shall maintain data
which indicates demand for respite ((care)) services, and which
includes information on in-home and out-of-home day care and in-home and
out-of-home overnight care demand.
(2) The
department shall provide a progress report to the legislature on the respite ((care))
programs authorized in this chapter. The report shall at least include a
comparison of the relative cost-effectiveness of the services provided under
this chapter with all other programs and services which are intended to
forestall ((institutionalization)) long-term care facility placement.
In addition, the report shall include a similar comparison between in-home and
out-of-home respite ((care)) services. ((The department shall make
recommendations on the inclusion of respite care services under the senior
citizens act for delivery and funding of respite care services described in
this chapter.)) The report shall be provided to the legislature not later
than thirty days prior to the ((1989)) 1991 legislative session.
III. TITLE XIX COMMUNITY-BASED LONG-TERM CARE SERVICES
NEW SECTION. Sec. 12. Title XIX of the federal social security act offers valuable opportunities to increase federal funds available to provide community-based long-term care services to functionally disabled persons in their homes, and in noninstitutional residential facilities, such as adult family homes and congregate care facilities. To achieve this goal, the department of social and health services may, with funds appropriated for this purpose, increase the rates paid to adult family homes and congregate care facilities to a level commensurate with the skills and services necessary to maintain and care for functionally disabled residents of these facilities.
A. PERSONAL CARE, HOSPICE, CASE MANAGEMENT
Sec. 13. Section 5, chapter 30, Laws of 1967 ex. sess. as last amended by section 3, chapter 5, Laws of 1985 and RCW 74.09.520 are each amended to read as follows:
(1)
The term "medical assistance" may include the following care and
services: (((1))) (a) Inpatient hospital services; (((2)))
(b) outpatient hospital services; (((3))) (c) other
laboratory and x-ray services; (((4))) (d) skilled nursing home
services; (((5))) (e) physicians' services, which shall include
prescribed medication and instruction on birth control devices; (((6))) (f)
medical care, or any other type of remedial care as may be established by the
secretary; (((7))) (g) home health care services; (((8))) (h)
private duty nursing services; (((9))) (i) dental services; (((10)))
(j) physical therapy and related services; (((11))) (k)
prescribed drugs, dentures, and prosthetic devices; and eyeglasses prescribed
by a physician skilled in diseases of the eye or by an optometrist, whichever
the individual may select; (((12))) (l) personal care services, as
provided in subsection (2) of this section; (m) hospice services; (n) case
management services, provided that eligibility for such services shall be
limited to persons who have one or more personal care needs, as defined under
the medical assistance program; (o) other diagnostic, screening,
preventive, and rehabilitative services: PROVIDED, That the department may not
cut off any prescription medications, oxygen supplies, respiratory services, or
other life-sustaining medical services or supplies.
"Medical assistance," notwithstanding any other provision of law, shall not include routine foot care, or dental services delivered by any health care provider, that are not mandated by Title XIX of the social security act unless there is a specific appropriation for these services.
(2) Effective July 1, 1989, the department may offer, in accordance with available funds, personal care services, which for the purposes of this section are defined as health-related tasks and household services that are directly related to and necessitated by an individual's health care needs and are provided pursuant to a plan of treatment authorized by a physician. An individual's continued need for such services shall be reviewed by the department not less than every ninety days. The monthly cost of personal care services provided to a recipient of services under this section shall not exceed sixty-five percent of the average state-wide rate for monthly nursing home costs. Payment shall be made for personal care services provided to eligible persons residing in their own homes, the home of another adult, or residential care facilities, which include but are not limited to adult family homes and congregate care facilities.
Sec. 14. Section 22, chapter 6, Laws of 1981 1st ex. sess. as last amended by section 4, chapter 5, Laws of 1985 and RCW 74.09.700 are each amended to read as follows:
(1) To the extent of available funds, medical care may be provided under the limited casualty program to persons not otherwise eligible for medical assistance or medical care services who are medically needy as defined in the social security Title XIX state plan and medical indigents in accordance with medical eligibility requirements established by the department. This includes residents of skilled nursing homes, intermediate care facilities, and intermediate care facilities for the mentally retarded who are aged, blind, or disabled as defined in Title XVI of the federal social security act and whose income exceeds three hundred percent of the federal supplement security income benefit level.
(2) Determination of the amount, scope, and duration of medical coverage under the limited casualty program shall be the responsibility of the department, subject to the following:
(a) Except as provided in (b) of this subsection, only inpatient hospital services; outpatient hospital and rural health clinic services; physicians' and clinic services; prescribed drugs, dentures, prosthetic devices, and eyeglasses; skilled nursing home services, intermediate care facility services, and intermediate care facility services for the mentally retarded; home health services; other laboratory and x-ray services; rehabilitative services; medically necessary transportation; and other services for which funds are specifically provided in the omnibus appropriations act shall be covered;
(b) Effective July 1, 1989, the department may offer, in accordance with available funds, the following services under the limited casualty program for the medically needy:
(i) Personal care services, which for the purposes of this section are defined as health-related tasks and household services that are directly related to and necessitated by an individual's health care needs and are provided pursuant to a plan of treatment authorized by a physician. An individual's continued need for such services shall be reviewed by the department not less than every ninety days. The monthly cost of personal care services provided to a recipient of services under this section shall not exceed sixty-five percent of the average state-wide rate for monthly nursing home costs. Payment shall be made for personal care services provided to eligible persons residing in their own homes, the home of another adult, or residential care facilities, which include but are not limited to adult family homes and congregate care facilities;
(ii) Hospice services; and
(iii) Case management services for persons who have one or more personal care needs, as defined under the medical assistance program.
(c) Persons who are medically indigent and are not eligible for a federal aid program shall satisfy a deductible of not less than one hundred dollars nor more than five hundred dollars in any twelve-month period;
(((c)))
(d) Medical care services provided to the medically indigent and
received no more than seven days prior to the date of application shall be
retroactively certified and approved for payment on behalf of a person who was
otherwise eligible at the time the medical services were furnished: PROVIDED,
That eligible persons who fail to apply within the seven-day time period for
medical reasons or other good cause may be retroactively certified and approved
for payment.
(3) The
department shall establish standards of assistance and resource and income
exemptions. All nonexempt income and resources of limited casualty program
recipients shall be applied against the cost of their medical care services.
((In addition, the department shall include a prohibition against the
knowing and wilful assignment of property or cash for the purpose of qualifying
for assistance under RCW 74.09.532 through 74.09.536.))
B. COPES RESPITE SERVICES
NEW SECTION. Sec. 15. The department shall request an amendment to its community options program entry system waiver under section 1905(c) of the federal social security act to include respite services as a service available under the waiver.
C. COMMUNITY-BASED SERVICES FOR PERSONS WITH AIDS
NEW SECTION. Sec. 16. A new section is added to chapter 74.09 RCW to read as follows:
The department shall prepare and request a waiver under section 1915(c) of the federal social security act to provide community based long-term care services to persons with AIDS or AIDS-related conditions who qualify for the medical assistance program under RCW 74.09.510 or the limited casualty program for the medically needy under RCW 74.09.700. Respite services shall be included as a service available under the waiver.
D. SPOUSAL IMPOVERISHMENT
NEW SECTION. Sec. 17. A new section is added to chapter 74.09 RCW to read as follows:
For purposes of determining eligibility for medical assistance or the limited casualty program for the medically needy for a married person in need of institutional care, or care under waivers as defined in section 1915(c) of the federal social security act, the department shall:
(1) Promulgate rules consistent with the provisions of section 1924 of the federal social security act to allocate income between the spouses. The department shall establish the monthly maintenance needs allowance for the spouse not applying for or receiving the benefits referred to in this section at the minimum amount authorized in section 1924 of the federal social security act which is seven hundred eighty-six dollars per month, effective September 30, 1989, plus any applicable excess shelter allowance;
(2) Promulgate rules consistent with the provisions of section 1924 of the federal social security act to determine the value of resources available to the spouse applying for or receiving the benefits referred to in this section. In the interest of supporting the spouse not applying for these benefits, the department shall allow that spouse to retain up to sixty thousand dollars in nonexempt resources;
The department shall establish standards consistent with section 1917 of the federal social security act in determining whether there shall be a period of ineligibility due to the transfer of resources by an applicant for or recipient of benefits under this section. For purposes of these standards, "undue hardship" means that determination of a period of ineligibility will result in the applicant or recipient being unable to meet his or her shelter, food, clothing, and health care needs or being unable to meet existing financial obligations;
(3) The department shall, in compliance with section 1924 of the federal social security act, implement procedures which provide fair hearing and due process rights to applicants and recipients of benefits under this section respecting ownership or availability of income or resources and the determination of the monthly income or resource allowance for the spouse not applying for or receiving benefits under this section.
Sec. 18. Section 4, chapter 30, Laws of 1967 ex. sess. as last amended by section 2, chapter 5, Laws of 1985 and RCW 74.09.510 are each amended to read as follows:
Medical
assistance may be provided in accordance with eligibility requirements
established by the department of social and health services((, including the
prohibition under RCW 74.09.532 through 74.09.536 against the knowing and
wilful assignment of property or cash for the purpose of qualifying for such
assistance,)) as defined in the social security Title XIX state plan for
mandatory categorically needy persons and: (1) Individuals who would be
eligible for cash assistance except for their institutional status; (2)
individuals who are under twenty-one years of age, who would be eligible for
aid to families with dependent children, but do not qualify as dependent
children and who are in (a) foster care, (b) subsidized adoption, (c) an
intermediate care facility or an intermediate care facility for the mentally
retarded, or (d) inpatient psychiatric facilities; (3) the aged, blind, and
disabled who: (a) Receive only a state supplement, or (b) would not be
eligible for cash assistance if they were not institutionalized; (4)
individuals who would be eligible for but choose not to receive cash
assistance; (5) pregnant women who would be eligible for aid to families with
dependent children if the child had been born and was living with the mother
during the month of the payment, and the pregnancy has been medically verified;
(6) individuals who are enrolled in managed health care systems, who have otherwise
lost eligibility for medical assistance, but who have not completed a current
six-month enrollment in a managed health care system, and who are eligible for
federal financial participation under Title XIX of the social security act; and
(7) other individuals eligible for medical services under RCW 74.09.035 and
74.09.700 for whom federal financial participation is available under Title XIX
of the social security act.
Sec. 19. Section 29, chapter 30, Laws of 1985 and RCW 11.94.050 are each amended to read as follows:
(1) Although a designated attorney in fact or agent has all powers of absolute ownership of the principal, or the document has language to indicate that the attorney in fact or agent shall have all the powers the principal would have if alive and competent, the attorney in fact or agent shall not have the power, unless specifically provided otherwise in the document: To make, amend, alter, or revoke any of the principal's wills, codicils, life insurance beneficiary designations, employee benefit plan beneficiary designations, trust agreements, community property agreements; to make any gifts of property owned by the principal; to make transfers of property to any trust (whether or not created by the principal) unless the trust benefits the principal alone and does not have dispositive provisions which are different from those which would have governed the property had it not been transferred into the trust, or to disclaim property.
(2) Nothing
in subsection (1) of this section prohibits an attorney in fact or agent from
making any transfer of resources not prohibited under ((RCW 74.09.532)) section
17 of this 1989 act when the transfer is for the purpose of qualifying the
principal for medical assistance or the limited casualty program for the
medically needy.
NEW SECTION. Sec. 20. All moneys from the general fund conserved as a result of instituting the Title XIX long-term care services expansions provided in sections 13 and 14 of this act shall be retained by the department of social and health services for long-term care services. The moneys conserved shall be used to serve chore services clients who are not eligible for Title XIX personal care services. The first priority for expending these moneys shall be to expand the volunteer chore program as provided in RCW 74.08.541. The second priority shall be to expand the chore services program, as provided in RCW 74.08.541 through 74.08.570.
IV. LONG-TERM CARE REFORM IMPLEMENTATION TEAM
NEW SECTION. Sec. 21. (1) Recognizing the complexity of changing our current categorically based long-term care system and the necessity for timely development of long-term care system changes with cooperation of consumers and providers of long-term care services and the state, federal, and local governments, an implementation team is created which will advise the department of social and health services, the legislature, and local governments on statutory, regulatory, and funding changes needed to achieve the goals of this long-term care act.
(2) The Washington long-term care reform implementation team shall be composed of eleven members. Nine members shall have expertise and experience in one or more of the following areas: Gerontology, developmental disabilities, neurological impairments, physical disabilities, nursing, long-term care service delivery, long-term care financing, case management, and systems analysis. One member shall represent consumers of long-term care services and one member shall represent all divisions, bureaus, and offices of the department of social and health services that administer long-term care services. The members shall be selected by the chairpersons of the house of representatives health care committee and the senate health care and corrections committee, except that the secretary of the department of social and health services shall select the member that will represent the department on the implementation team.
The members of the implementation team shall choose one member of the team to serve as chair.
(3) The implementation team may hire staff or contract for professional assistance with funds made available for their activities. To the extent possible, the department of social and health services, the house of representatives, and the senate shall provide staff support. The implementation team may apply for, receive, and accept grants, gifts, or other payments, including property and services, from any governmental or other public or private entity or person, and may make arrangements as to the use of these receipts, including the undertaking of special studies and other projects relating to long-term care.
(4) The public members of the implementation team shall receive no compensation for their services as members, but shall be reimbursed for their travel expenses while attending any meetings of the team under RCW 43.03.050 and 43.03.060.
(5) The implementation team may establish ad hoc technical advisory committees to assist with the matters deemed necessary and any person serving in such capacity may be reimbursed for their expenses while attending any meetings of such committee or the implementation team in the same manner as the members of the implementation team.
NEW SECTION. Sec. 22. The implementation team shall recommend actions necessary to develop the following long-term care reforms in Washington state:
(1) A systematic plan for the coordination, planning, budgeting, and administration of long-term care services currently administered by the department of social and health services 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;
(2) Provision of long-term care services to persons with functional disabilities in a noncategorical manner and in the most independent living situation consistent with the person's needs;
(3) A systematic plan which gives a county or group of counties the option to administer long-term care services to functionally disabled persons within their jurisdiction;
(4) A case management system that coordinates the plan of care and services provided to eligible functionally disabled persons, which includes:
(a) Assessment of each eligible client's care needs and development of a service plan with participation of the client and other appropriate persons;
(b) Assessment of the client's financial resources;
(c) Authorization of services and arrangement for the provision of such services through purchase by the state or third-party payors, or referral to volunteer or informal caregivers; and
(d) Monitoring of the appropriateness, quality, and timeliness of the services being provided to each eligible client through periodic contact with each client.
(5) A sufficient supply of quality noninstitutional residential alternatives for functionally disabled persons needing such services, and a system to support the providers of such services;
(6) A uniform fee scale for identified long-term care programs that are not funded by Title XIX of the federal social security act that establishes a maximum available resource level and a sliding fee scale which requires progressively higher client participation in the cost of long-term care services needed by the client based upon the ability of the client to purchase such services;
(7) Active involvement of volunteers and volunteer groups, such as the retired senior volunteer program, in a variety of roles in the long-term care services delivery system, including ombudsman activities and informal caregiving;
(8) An integrated data base that provides for client tracking;
(9) A coordinated system of long-term care education that is clearly articulated and reflects the long-term care needs of functionally disabled persons in Washington state; and
(10) A long-term care services payment and reimbursement system, including nursing home reimbursement, that will provide access to needed services while controlling the rate of cost increases for such services.
NEW SECTION. Sec. 23. The implementation team shall report its preliminary recommendations as provided in section 22 of this act to the house of representatives health care committee and the senate health care and corrections committee on or before January 31, 1990. The implementation team shall submit a final report and implementation schedule to the aforementioned committees on or before December 31, 1990.
V. RESIDENTIAL CARE FACILITY SITING
NEW SECTION. Sec. 24. (1) Unless the context clearly requires otherwise, these definitions shall apply throughout this section:
(a) "Adult family home" means a residential care facility that cares for four or fewer persons in the family abode of the person or persons providing the care.
(b) "Residential care facility" means a facility that cares for at least five, but not more than fifteen functionally disabled persons.
(c) "Sponsor" means any agency or unit of government, or any person or organization that intends to establish an adult family home or a residential care facility.
(d) "Municipality" means a town or city where a residential care facility is to be located, or a county, if the residential care facility is to be located therein and not simultaneously within a town or city.
(e) "Department" means the department of social and health services.
(2) An adult family home shall be considered a residential use of property for zoning purposes. Adult family homes shall be a permitted use in all areas zoned for residential or commercial purposes, including areas zoned for single family dwellings.
(3)(a) When a sponsor seeks to establish a residential care facility in a municipality, the sponsor shall notify the chief executive officer of the municipality in writing and include in such notice the specific address of the site, the functional disabilities of the persons to be served, the number of residents, and the community support requirements of the program. The municipality shall have forty days after the receipt of such notice to:
(i) Approve the site recommended by the sponsor;
(ii) Suggest one or more suitable sites within its jurisdiction which could accommodate such a residential care facility; or
(iii) Object to the establishment of the residential care facility because it would result in such concentration of residential care facilities in the municipality or in the area in proximity to the site selected that the nature and character of the areas within the municipality would be substantially altered.
Such response shall be forwarded to the sponsor and the department. If the municipality does not respond within forty days, the sponsor may establish a residential care facility at the site recommended in its notice.
(b) Prior to forwarding a response to the sponsor and the department, the municipality may hold a public hearing pursuant to local law.
(c) If the municipality approves the site recommended by the department, the department shall seek to establish the residential care facility at the approved site.
(d) If the municipality suggests an alternative site or sites which are not satisfactory to the sponsor, or the municipality objects to establishment of a residential care facility in the municipality because it would result in such a concentration of residential care facilities that the nature and character of areas within the municipality would be substantially altered, or in the event that the sponsor and the municipality cannot agree upon a site, the sponsor or the municipality may request an immediate hearing before the department to resolve the issue. The department shall conduct the hearing within fifteen days of such request.
In reviewing any such objections, the need for residential care facilities in the municipality shall be considered, as shall the existing concentration of such facilities in the municipality or in the area in proximity to the site selected. The department may sustain the objection if it determines that the nature and character of the area in which the facility is to be located would be substantially altered as a result of establishment of the facility. The department shall make a determination within thirty days of the hearing. Review of a decision rendered by the department may be heard in a court of competent jurisdiction within thirty days of the determination by the department.
(e) The department shall not issue a license to a residential care facility if the sponsor does not notify the municipality of its intent to establish a residential care facility.
VI. LONG-TERM CARE SERVICES FINANCING
NEW SECTION. Sec. 25. A new section is added to chapter 84.52 RCW to read as follows:
In each year the state shall levy for collection in the following year, for the sole purpose of funding noninstitutional community-based long-term care as provided under chapters 71.24, 71.34, 71A.12, 74.08, 74.09, 74.26, 74.38, and 74.41 RCW, a tax of twenty-five cents per thousand dollars of assessed value of all taxable property within the state adjusted to the state equalized value in accordance with the indicated ratio fixed by the state department of revenue.
NEW SECTION. Sec. 26. The following acts or parts of acts are each repealed:
(1) Section 1, chapter 3, Laws of 1981 2nd ex. sess. and RCW 74.09.532;
(2) Section 2, chapter 3, Laws of 1981 2nd ex. sess. and RCW 74.09.534;
(3) Section 3, chapter 3, Laws of 1981 2nd ex. sess. and RCW 74.09.536;
(4) Section 4, chapter 3, Laws of 1981 2nd ex. sess., section 41, chapter 75, Laws of 1987 and RCW 74.09.538; and
(5) Section 1, chapter 220, Laws of 1986 and RCW 74.09.545.
NEW SECTION. Sec. 27. The sum of one hundred fifty thousand dollars, or as much thereof as may be necessary, is appropriated for the biennium ending June 30, 1991, from the general fund to the department of social and health services solely for the purpose of implementing sections 21 through 23 of this act.
NEW SECTION. Sec. 28. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.
NEW SECTION. Sec. 29. Section 25 of this act shall take effect January 1, 1990, if house joint resolution ...., the proposed amendment to Article VII, section 2 of the state Constitution authorizing a state levy for long-term care is validly submitted to and is approved and ratified by the voters at a general election held in November 1989. If the proposed amendment is not so approved and ratified, section 25 of this act is void in its entirety.
NEW SECTION. Sec. 30. Sections 2 through 24 and 26 through 28 of this act are necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately.
NEW SECTION. Sec. 31. Sections 2, 3, 12, 15, 16, 20, 21, 22, 23, and 24 of this act shall constitute a new chapter in Title 74 RCW.
NEW SECTION. Sec. 32. Subchapter headings as used in this act do not constitute any part of the law.