H-2622.1

5966-S AMH MEYR H2622.1

SSB 5966 - H AMD

By Representative R. Meyers

Strike everything after the enacting clause and insert the following:

"NEW SECTION. Sec. 1. The legislature finds that continued operation of state veterans' homes is necessary to meet the needs of eligible veterans for shelter, personal and nursing care, and related services; that certain residents of veterans' homes or services provided to them may be eligible for participation in the state's medicaid reimbursement system; and that authorizing medicaid participation is appropriate to address the homes' long-term funding needs. The legislature also finds that it is important to maintain the dignity and self-respect of residents of veterans' homes, by providing for continued resident involvement in the homes' operation, and through retention of current law guaranteeing a minimum amount of allowable personal income necessary to meet the greater costs for these residents of transportation, communication, and participation in family and community activities that are vitally important to their maintenance and rehabilitation.

NEW SECTION. Sec. 2. A new section is added to chapter 72.36 RCW to read as follows:

Qualifying operations at state veterans' homes operated by the department of veterans affairs, may be provided under the state's medicaid reimbursement system as administered by the department of social and health services.

The department of veterans affairs may contract with the department of social and health services under the authority of RCW 74.09.120 but the provisions of RCW 74.46.420 through 74.46.590 shall not apply to the medicaid rate-setting and reimbursement systems. The nursing care operations at the state veterans' homes shall be subject to inspection by the department of social and health services. This includes every part of the state veterans' home's premises, an examination of all records, including financial records, methods of administration, general and special dietary programs, the disbursement of drugs, methods of supply, and any other records the department deems relevant.

NEW SECTION. Sec. 3. A new section is added to chapter 72.36 RCW to read as follows:

The department of veterans affairs shall provide by rule for the annual election of a resident council for each state veterans' home. The council shall annually elect a chair from among its members, who shall call and preside at council meetings. The resident council shall serve in an advisory capacity to the director of the department of veterans affairs and to the superintendent in all matters related to policy and operational decisions affecting resident care and life in the home.

By October 31, 1993, the department shall adopt rules that provide for specific duties and procedures of the resident council which create an appropriate and effective relationship between residents and the administration. These rules shall be adopted after consultation with the resident councils and the state long-term care ombuds, and shall include, but not be limited to the following:

(1) Provision of staff technical assistance to the councils;

(2) Provision of an active role for residents in developing choices regarding activities, foods, living arrangements, personal care, and other aspects of resident life;

(3) A procedure for resolving resident grievances; and

(4) The role of the councils in assuring that resident rights are observed.

The development of these rules should include consultation with all residents through the use of both questionnaires and group discussions.

The resident council for each state veterans' home shall annually review the proposed expenditures from the benefit fund that shall contain all private donations to the home, all bequeaths, and gifts. Disbursements from each benefit fund shall be for the benefit and welfare of the residents of the state veteran's homes. Disbursements form the benefits funds shall be on the authorization of the superintendent or his or her authorized representative after approval has been received from the home's resident council.

The superintendent or his or her designated representative shall meet with the resident council at least monthly. The director of the department of veterans affairs shall meet with each resident council at least three times each year.

Sec. 4. RCW 72.36.020 and 1977 c 31 s 2 are each amended to read as follows:

The director of the department of veterans affairs shall appoint a superintendent for ((~~the state soldiers' home and colony, and a superintendent for the Washington veterans' home, who, with the consent of the director, may be styled, respectively, "commandant of the home"~~)) each state veterans' home. The superintendent shall exercise management and control of the institution in accordance with either policies ((~~and/or~~)) or procedures promulgated by the director of the department of veterans affairs, or both, and rules and regulations of the department. In accordance with chapter 18.52 RCW, the individual appointed as superintendent for either state veterans' home shall be a licensed nursing home administrator. The department may request a waiver to, or seek an alternate method of compliance with, the federal requirement for a licensed on-site administrator during a transition phase from July 1, 1993, to June 30, 1994.

Sec. 5. RCW 72.36.030 and 1977 ex.s. c 186 s 1 are each amended to read as follows:

((All honorably discharged veterans who have served the United States government in any of its wars, and members of the state militia disabled while in the line of duty, may be admitted to the state soldiers' home at Orting under such rules and regulations as may be adopted by the department: PROVIDED, That such applicants have been actual bona fide residents of this state at the time of their application, and are indigent and unable to support themselves: PROVIDED FURTHER, That the surviving spouses of all veterans and members of the state militia disabled while in the line of duty, who were members of a soldiers' home or colony or veterans' home in this state or entitled to admission thereto at the time of death, and surviving spouses of all such veterans and members of the state militia, who would have been entitled to admission to a soldiers' home or colony or veterans' home in this state at the time of death, but for the fact that they were not indigent and unable to earn a support for themselves and families, which spouses have since the death of their husbands or wives, become indigent and unable to earn a support for themselves shall be admitted to such home: PROVIDED, FURTHER, That such spouses are not less than fifty years of age and were married and living with their husbands or wives on or before three years prior to the date of their application, and have not been married since the decease of their husbands or wives to any person not a member of a soldiers' home or colony or veterans' home in this state or entitled to admission thereto: AND PROVIDED, FURTHER, That sufficient facilities and resources are available to accommodate such applicant.)) All of the following persons who have been actual bona fide residents of this state at the time of their application, and who are indigent and unable to support themselves and their families may be admitted to a state veterans' home under rules as may be adopted by the director of the department, unless sufficient facilities and resources are not available to accommodate these people:

(1)(a) All honorably discharged veterans of a branch of the armed forces of the United States or merchant marines; (b) members of the state militia disabled while in the line of duty; and (c) the spouses of these veterans, merchant marines, and members of the state militia. However, it is required that the spouse was married to and living with the veteran three years prior to the date of application for admittance, or, if married to him or her since that date, was also a resident of a state veterans' home in this state or entitled to admission thereto;

(2)(a) The spouses of: (i) All honorably discharged veterans of the United States armed forces; (ii) merchant marines; and (iii) members of the state militia who were disabled while in the line of duty and who were residents of a state veterans' home in this state or were entitled to admission to one of this state's state veteran homes at the time of death; (b) the spouses of: (i) All honorably discharged veterans of a branch of the United States armed forces; (ii) merchant marines; and (iii) members of the state militia who would have been entitled to admission to one of this state's state veterans' homes at the time of death, but for the fact that the spouse was not indigent, but has since become indigent and unable to support himself or herself and his or her family. However, the included spouse shall be at least fifty years old and have been married to and living with their husband or wife for three years prior to the date of their application. The included spouse shall not have been married since the death of his or her husband or wife to a person who is not a resident of one of this state's state veterans' homes or entitled to admission to one of this state's state veterans' homes; and

(3) All applicants for admission to a state veterans' home shall apply for all federal and state benefits for which they may be eligible, including medical assistance under chapter 74.09 RCW.

Sec. 6. RCW 72.36.035 and 1991 c 240 s 2 are each amended to read as follows:

For purposes of this chapter, unless the context clearly indicates otherwise((,)):

(1) "Actual bona fide residents of this state" ((~~shall mean~~)) means persons who have a domicile in the state of Washington immediately prior to application for ((~~membership in the soldiers' home or colony or veterans'~~)) admission to a state veterans' home.

((~~The term~~)) (2) "Department" means the Washington state department of veterans affairs.

(3) "Domicile" ((~~shall mean~~)) means a person's true, fixed, and permanent home and place of habitation, and shall be the place where the person intends to remain, and to which the person expects to return when the person leaves without intending to establish a new domicile elsewhere.

(4) "State veterans' home" means either the Washington soldiers' home and colony in Orting, or the Washington veterans' home in Retsil, or both.

(5) "Veteran" has the same meaning established in RCW 41.04.005.

Sec. 7. RCW 72.36.120 and 1977 ex.s. c 186 s 7 are each amended to read as follows:

((All income of members of the soldiers' home in excess of allowable income shall be deposited in the soldiers' home revolving fund as established in section 55, chapter 269, Laws of 1975 1st ex. sess. (uncodified, and herein continued and reenacted).

(1) Allowable income shall be defined by the rules and regulations adopted by the department: PROVIDED, That the allowable income of members accepted for membership shall not be decreased below one hundred sixty dollars per month during periods that such members are resident thereat.

(2) Disbursements from the soldiers' home revolving fund shall be for the benefit and welfare of all members of the soldiers' home and such disbursements shall be on the authorization of the superintendent or his authorized representative after approval has been received from a duly constituted body representative of the members.

(3) In order to maintain an effective expenditure and revenue control, the soldiers' home revolving fund shall be subject in all respects to chapter 43.88 RCW, but no appropriation shall be required to permit expenditures from such funds.)) All income of residents of a state veterans' home, other than the personal needs allowance, shall be deposited in the state general fund‑-local and be available to apply against the cost of care provided by the state veterans' homes. All expenditures and revenue control shall be subject to chapter 43.88 RCW.

Sec. 8. RCW 74.09.120 and 1992 c 8 s 1 are each amended to read as follows:

The department shall purchase necessary physician and dentist services by contract or "fee for service." The department shall purchase nursing home care by contract. The department shall establish regulations for reasonable nursing home accounting and reimbursement systems which shall provide that no payment shall be made to a nursing home which does not permit inspection by the department of social and health services of every part of its premises and an examination of all records, including financial records, methods of administration, general and special dietary programs, the disbursement of drugs and methods of supply, and any other records the department deems relevant to the establishment of such a system.

The department may purchase nursing home care by contract in veterans' homes operated by the state department of veterans affairs. The department shall establish rules for reasonable accounting and reimbursement systems for such care.

The department may purchase care in institutions for the mentally retarded, also known as intermediate care facilities for the mentally retarded. The department shall establish rules for reasonable accounting and reimbursement systems for such care. Institutions for the mentally retarded include licensed nursing homes, public institutions, licensed boarding homes with fifteen beds or less, and hospital facilities certified as intermediate care facilities for the mentally retarded under the federal medicaid program to provide health, habilitative, or rehabilitative services and twenty-four hour supervision for mentally retarded individuals or persons with related conditions and includes in the program "active treatment" as federally defined.

The department may purchase care in institutions for mental diseases by contract. The department shall establish rules for reasonable accounting and reimbursement systems for such care. Institutions for mental diseases are certified under the federal medicaid program and primarily engaged in providing diagnosis, treatment, or care to persons with mental diseases, including medical attention, nursing care, and related services.

The department may purchase all other services provided under this chapter by contract or at rates established by the department.

NEW SECTION. Sec. 9. A new section is added to chapter 72.36 RCW to read as follows:

The legislature finds that to meet the objectives of section 1, chapter ...., Laws of 1993 (section 1 of this act), an adequate personal needs allowance for all residents of the state veterans' homes, including both domiciliary and nursing care residents, shall not be less than one hundred sixty dollars per month during periods of residency.

NEW SECTION. Sec. 10. A new section is added to chapter 72.36 RCW to read as follows:

No reduction in the allowable income provided for in current department rules may take effect until the effective date of certification of qualifying operations at state veterans' homes for participation in the state's medicaid reimbursement system.

NEW SECTION. Sec. 11. (1) The legislative budget committee shall conduct an examination of the department of veterans affairs, the Washington soldiers' home at Orting, and the Washington veterans' home at Retsil. The examination shall specifically address:

(a) The quality of patient care at the Washington soldiers' home and the Washington veterans' home to determine the quality of patient care and whether staffing ratios and funding are sufficient; and

(b) A determination as to whether funds in the revolving funds governed under RCW 72.36.120 and 72.36.130 are being expended for the benefit and welfare of the members of these homes, and whether any of these funds are being inappropriately transferred to administrative offices in Olympia.

(2) To ensure that there is no duplication of effort, prior to conducting the examination, the legislative budget committee shall confirm that these specific issues have not been fully addressed by recent federal or other audits. If these issues have been fully addressed by other audits, the legislative budget committee shall report on the findings of these audits. If these issues have not been fully addressed by other audits, the legislative budget committee shall conduct the examination described in subsection (1) of this section.

(3) The legislative budget committee shall report the results of their findings and any recommendations to the legislature by January 1, 1994."

NEW SECTION. Sec. 12. The following acts or parts of acts are each repealed:

(1) RCW 72.36.080 and 1977 ex.s. c 186 s 5, 1975 c 13 s 2, 1973 1st ex.s. c 154 s 104, & 1959 c 28 s 72.36.080; and

(2) RCW 72.36.130 and 1977 ex.s. c 186 s 8.

NEW SECTION. Sec. 13. This act is 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 July 1, 1993."