AN ACT Relating to long-term care; amending RCW 74.08.541, 74.08.545, and 74.41.050; adding a new section to chapter 74.09 RCW; creating new sections; and providing an expiration date.

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

Sec. 1. 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 section 3 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) 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 to purchase the 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 at risk of being placed in a residential 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.

(d) Individuals 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 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. The department may implement a ratable reduction of hours or payment for some or all clients receiving 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. 2. 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. It is the policy of the state to encourage the development of volunteer chore services in local communities as a means of meeting chore care service needs and directing financial resources. The department shall fund volunteer chore services on a priority basis. 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;

(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 met by relatives, friends, nonprofit organizations, or other persons.

In determining the level of services to be provided under this chapter, the department shall utilize a client review questionnaire designed to determine both the degree and level of service need and the individual's risk of institutionalization if such needs are not met by this chapter.

NEW SECTION. Sec. 3. A new section is added to chapter 74.09 RCW to read as follows:

(1) The department shall amend the state plan for medical assistance under Title XIX of the federal social security act to include personal care services, as defined in 42 C.F.R. 440.170(f), in the categorically needy program.

(2) The department shall adopt, amend, and rescind such administrative rules as are necessary to ensure that Title XIX personal care services are provided to eligible persons in conformance with federal regulations. (a) These administrative rules shall include financial eligibility indexed according to the requirements of the social security act providing for medicaid eligibility.

(b) The rules shall require clients be assessed as having a medical condition requiring assistance with personal care tasks. Plans of care must be approved by a physician and reviewed by a nurse every ninety days.

(3) The department shall design a means to assess the level of functional disability of persons eligible for personal care services under this section. Personal care services shall be provided to the extent funding is available. Any reductions in services made necessary for funding reasons should be accomplished in a manner that assures that priority for maintaining services is given to persons with the greatest need as determined by the assessment of functional disability.

Sec. 4. 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 to the extent of available funding. 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. 5. The legislature finds an increasing rate of growth in the elderly population age sixty-five and over. The growth in the elderly population will be matched with an increasing demand for all types of long-term care services. The state has become a major payer for long-term care services, and limited state financial resources require that future expenditures be carefully planned to assure the effective use of limited resources.

The legislature recognizes that the long-term care population includes the elderly, developmentally disabled, mentally ill, and others with functional limitations. The legislature further recognizes that the long-term care population are people whose dignity should not be denied but, who because of some functional limitation, require some degree of assistance.

The policy of the state of Washington is that long-term care services should allow people to achieve their maximum potential and maintain dignity, self-respect, normality, and the greatest amount of independence and autonomy possible. The long-term care needs of the state can most effectively be met through an accessible continuum of integrated community-based services. The state should promote and encourage innovation and quality in the provision of these services.

Whenever possible, the state shall encourage local control in the planning and delivery of long-term care services. Community participation in defining needs and identifying services is essential to assure the provision of high-quality care delivered in a cost-effective manner. The organization of long-term care services administered by state government should be coordinated in a manner that minimizes administrative cost, unnecessarily complex organization and program and service duplication, and maximizes the use of financial resources in directly meeting the needs of persons with functional limitations. The use of volunteer services should be developed and encouraged. State funding decisions should be made in a manner consistent with this policy.

NEW SECTION. Sec. 6. (1) The joint select commission on long-term care is created. The commission shall be composed of eight legislators, who shall be the executive committee, two from each caucus in the house of representatives and senate to be chosen by the speaker of the house of representatives and the president of the senate. Eight public members shall be selected by the executive committee and who represent at least consumers, providers, payers, and regulators. The executive committee shall select a chairman from the public membership.

(2) The commission shall be staffed, to the extent possible, by staff from the house of representatives health care committee and the senate committee on health care and corrections. The commission may form technical advisory committees to assist it with any particular matters deemed necessary by the commission. The commission and technical advisory committee members shall receive no compensation, but shall, to the extent funds are available, be reimbursed for their expenses while attending any meetings in the same manner as legislators engaged in interim committee business as specified in RCW 44.04.120.

(3) The commission may apply for and receive and accept grants, gifts, and other payments 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, or to defray the cost to the state of travel expenses of the membership.

(4) The commission may contract with third parties for professional assistance with funds made available for this purpose upon the approval of the senate committee on facilities and operations and the house of representatives executive rules committee.

NEW SECTION. Sec. 7. (1) The commission shall make recommendations on actions necessary to develop and implement the long-term care policy of the state. The commission shall:

(a) Conduct an examination and propose recommendations on changes needed in the current organization, planning, administration, and delivery of long-term care services which is consistent with the long-term care policy of the state;

(b) Analyze the present and future need for long-term care services and recommend what services will best meet the needs of the long-term care population;

(c) Evaluate the current system of payment and reimbursement for nursing homes and other long-term care services and recommend changes necessary to most effectively meet the increasing demand for a greater variety of services;

(d) Assess the need for specific public and private alternative funding for long-term care services such as federal Title XIX funding and private long-term care insurance;

(e) Assess the need for categorical program distinctions and state level control of service delivery and financing mechanisms;

(f) Define appropriate roles and responsibilities for state and local government, regional organizations, and private organizations in the planning, administration, and delivery of long-term care services;

(g) Evaluate and recommend possible need for technical assistance necessary to enable local communities to have greater participation and control in the design, administration, and provision of long-term care services;

(h) Identify cost-efficient ways to manage the coordinated provision of multiple services to individuals which assures appropriate services are provided and promotes maximum participation by the individual in identifying services;

(i) Evaluate the current effectiveness of long-term care service quality assurance mechanisms; and

(j) Examine other issues deemed appropriate by the commission.

(2) A report of the commission shall be made with its findings and recommendations to the legislature by December 1, 1990.

NEW SECTION. Sec. 8. Sections 5 through 7 of this act shall expire on December 31, 1990.