AN ACT Relating to long-term care; amending RCW 74.08.530, 74.08.541, 74.08.545, 74.08.550, 11.94.050, 74.09.510, 74.09.700, 74.41.040, and 74.41.050; adding new sections to chapter 74.09 RCW; and creating a new section.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1. Section 1, chapter 51, Laws of 1973 1st ex. sess. as amended by section 1, chapter 137, Laws of 1980 and RCW 74.08.530 are each amended to read as follows:

The legislature finds that it is desirable to provide a coordinated and comprehensive program of in-home services for certain citizens in order that such persons may remain in their own homes, obtain employment if possible, and maintain a closer contact with the community. Such a program will seek to prevent mental and psychological deterioration which our citizens might otherwise experience. The legislature intends that the services will be provided in a fashion which promotes independent living.

The legislature recognizes that persons with functional limitations should receive long-term care that encourages individual dignity and autonomy and helps individuals meet their maximum potential. The legislature finds that necessary and effective long-term care should be provided to persons who have functional limitations associated with their disabilities through a comprehensive and integrated array of community-based services. These services should be provided in a manner that respects individual choice and supports informal caregivers. The legislature further finds that, to the extent possible, long-term care services should be administered in a manner consistent with the intent expressed in this section.

Sec. 2. 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) "Chore services," as used in this chapter, means services in performing ((~~light work and household and other~~)) personal care and related tasks ((~~which eligible persons are unable to do for themselves because of frailty or handicapping conditions~~)) as provided in the department's medical assistance state plan provision addressing personal care. To the extent additional funds may be specifically authorized by the legislature for this purpose, "chore services" may mean any additional task eligible persons are unable to do for themselves.

(2) 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 care facility have been determined by the department, and who are not eligible to receive medicaid personal care services as authorized under RCW 18.51.500 and section 5 of this 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)~~)) Are 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)~~)) (ii) 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)) any person who is age sixty or over, is at risk of being placed in a residential care facility, and ((~~who is age sixty or over but not eligible for chore services or~~)) is:

(i) Eligible for five hours or less of chore services a month; or

(ii) Eligible for a reduced ((~~amount~~)) level of service; or

(iii) Not eligible for chore services.

!ix((~~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.~~))

(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) 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 care facility of all applicants for, and recipients of, chore services.

(4) The department may continue providing chore services for those clients who were eligible for and receiving assistance only with household tasks prior to December 14, 1987, provided that those clients were receiving this same service as of June 1989.

(5) The department may continue providing chore services to clients who were eligible for and receiving attendant care services prior to April 1, 1988, provided that those clients were receiving this same service as of June 1989.

Sec. 3. 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 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~~));

(2) The extent to which ((~~an individual~~)) a person 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)~~)) 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 met by relatives, friends, ((~~nonprofit organizations,~~)) or other ((~~persons~~)) community resources.

In determining the level of services to be provided under this chapter, the client shall be assessed using an instrument designed by the department ((~~shall utilize a client review questionnaire designed~~)) to determine ((~~both~~)) the ((~~degree and level of service~~)) need for service and the ((~~individual's~~)) person's risk of ((~~institutionalization if such needs are not met by this chapter~~)) residential care placement.

Sec. 4. 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~~)) that a case manager provide for the coordination of all necessary services for which the ((~~recipient~~)) client 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) 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.

NEW SECTION. Sec. 5. A new section is added to chapter 74.09 RCW to read as follows:

The department shall amend the state plan for medical assistance under Title XIX of the federal social security act to include personal care services and case management services. The amendments shall maximize federal medical assistance matching payments for personal care and case management and shall define eligibility for such services in terms of functional limitation, regardless of categorical classifications such as age, developmental disability, and mental illness. This amendment shall be submitted to the federal approving authority for the quarter beginning July 1, 1989.

Sec. 6. 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~~)) when the transfer is for the purpose of qualifying the principal for medical assistance or the limited casualty program for the medically needy.

Sec. 7. 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. 8. 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) 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) 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) 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.))

NEW SECTION. Sec. 9. A new section is added to chapter 74.09 RCW to read as follows:

(1) The department shall promulgate rules consistent with the provisions of section 1921 of the social security act entitled "Treatment of Income and Resources for Certain Institutionalized Spouses," in determining the allocation of income between an institutionalized and community spouse.

(2) The department shall establish the monthly maintenance needs allowance for the community spouse at one thousand five hundred dollars.

(3) An agreement between spouses transferring or assigning rights to future income from one spouse to the other shall be invalid for purposes of determining eligibility for medical assistance or the limited casualty program for the medically needy, but this subsection does not affect agreements between spouses transferring or assigning resources, and income produced by transferred or assigned resources shall continue to be recognized as the separate income of the transferee.

NEW SECTION. Sec. 10. A new section is added to chapter 74.09 RCW to read as follows:

(1) The department shall promulgate rules consistent with the treatment of resources provisions of section 1921 of the social security act entitled "Treatment of Income and Resources for Certain Institutionalized Spouses," in determining the allocation of resources between the institutionalized and community spouse.

(2) In the interest of supporting the community spouse the department shall allow the maximum resource allowance amount permissible under the social security act for the community spouse.

NEW SECTION. Sec. 11. A new section is added to chapter 74.09 RCW to read as follows:

The department shall establish standards consistent with section 1921 of the social security act entitled "Treatment of Income and Resources for Certain Institutionalized Spouses," in determining the period of ineligibility for medical assistance due to the transfer of resources.

NEW SECTION. Sec. 12. A new section is added to chapter 74.09 RCW to read as follows:

The department shall in compliance with section 1921 of the social security act adopt procedures which provide due process for institutionalized or community spouses who request a fair hearing as to the valuation of resources, the amount of the community spouse resource allowance, or the monthly maintenance needs allowance.

Sec. 13. 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 service 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.

Sec. 14. 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~~)) contract with all area agencies on aging to 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, 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.

NEW SECTION. Sec. 15. Counties, client advocate organizations, service providers, and the department of social and health services shall collaborate in a comprehensive review of the current statutory structure, organization, administration, and financing of long-term care in Washington. The study shall include long-term care for all adults with functional limitations regardless of disability, including at least the elderly, developmentally disabled, mentally ill, and physically disabled. The study shall determine the extent to which state and federally funded long-term care is delivered in a manner consistent with the presumption of the client's competence and dignity, individual choice, and support for informal caregivers. The governor shall report to the legislature on the outcome of the study including the governor's recommendation for statutory, administrative, and financing changes. The governor's report shall recommend the continuation of categorical program distinctions and state level control of service delivery and financing mechanisms only to the degree such distinctions are shown to be directly related to the legislative intent expressed in chapter 74.08 RCW regarding long-term care services. The report shall include a status report on the department's efforts to implement changes required by the federal omnibus budget reconciliation act of 1987 regarding mentally ill and developmentally disabled and the consistency of those changes with the legislative intent expressed in chapter 74.08 RCW regarding long-term care services. The report shall be submitted to the appropriate legislative committees by December 1, 1990.