BP BHEAD INT S [atlas:bill]

AN ACT Relating to long-term care; amending RCW 74.39A.008, 74.39A.050, 74.39A.060, 70.129.030, 70.129.105, 70.129.110, 70.129.150, 70.128.175, 18.20.020, and 18.20.190; adding new sections to chapter 74.39A RCW; adding a new section to chapter 18.20 RCW; providing an effective date; and declaring an emergency.

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

NEW SECTION. Sec. 1. The legislature recognizes that most long-term care facilities in this state provide appropriate and high quality care for their residents, who are frail, elderly, and disabled. The legislature finds, however, that too many instances have been brought to its attention of poor care, insufficiently trained facility staff, and inadequate state monitoring of facilities.

The legislature finds that many residents of long-term care facilities are exceptionally vulnerable and their health and well-being are often dependent on their caregivers. The legislature reaffirms its intention in the residents' rights law, chapter 70.129 RCW, and in the elder abuse law, chapter 74.34 RCW, that residents in all long-term care facilities should receive appropriate and needed services, be treated with courtesy and respect, and not be subject to abuse, neglect, or exploitation.

The legislature also reaffirms its intention that the monitoring of long-term care facilities by state regulatory agencies must be based upon a combination of clear, reasonable rules; consultation and technical assistance for providers when needed; the inclusion of residents, their families, complainants, and others in licensing inspections and complaint investigations; and prompt, definite penalties for violations that are serious or recurring or negatively impact residents.

The legislature further finds that the division of state oversight of long-term care facilities between two different state agencies has led to inconsistent monitoring and is not an effective, efficient use of state resources. These state responsibilities should be combined and coordinated within one state agency.

The legislature further finds that the quality of staff in long-term care facilities is often the key to good care. The need for well-trained staff, and well-managed facilities, is growing as the state's population ages and the acuity of the health care problems of residents increases. To better protect and care for residents, the legislature directs that the training standards for facility caregiver staff must be enhanced, and that staff serving residents with special needs, such as mental illness or dementia, must receive additional training.

Sec. 2. RCW 74.39A.008 and 1995 1st sp.s. c 18 s 1 are each amended to read as follows:

Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Adult family home" means a facility licensed under chapter 70.128 RCW.

(2) "Adult residential care" means personal care services provided by a boarding home that is licensed under chapter 18.20 RCW and that has a contract with the department under RCW 74.39A.020.

(3) "Aging and adult services administration" means the aging and adult services administration of the department.

(4) "Assisted living services" means services provided by a boarding home that has a contract with the department under RCW 74.39A.010 and the resident is housed in a private apartment-like unit.

(5) "Boarding home" means a facility licensed under chapter 18.20 RCW.

(6) "Cost-effective care" means care provided in a setting of an individual's choice that is necessary to promote the most appropriate level of physical, mental, and psychosocial well-being consistent with client choice, in an environment that is appropriate to the care and safety needs of the individual, and such care cannot be provided at a lower cost in any other setting. But this in no way precludes an individual from choosing a different residential setting to achieve his or her desired quality of life.

(7) "Department" means the department of social and health services.

(8) "Home and community services" means assisted living services, enhanced adult residential care, adult residential care, adult family homes, boarding homes, in-home services, and other services administered by the aging and adult services administration of the department directly or through contract with area agencies on aging or similar services provided by facilities and agencies licensed by the department.

(9) "Long-term care services" means the services administered directly or through contract, or under license, by the aging and adult services administration of the department or by long-term care facilities, including but not limited to nursing facility care and home and community services.

(10) "Enhanced adult residential care" means personal care services and limited nursing services, as defined by the department ((~~of health~~)) in rule, which services are provided by a boarding home that is licensed under chapter 18.20 RCW and that has a contract with the department under RCW 74.39A.020.

(11) "Nursing facility" means a nursing facility as defined in section 1919(a) of the federal social security act and regulations adopted thereunder.

(12) "Nursing home" means a facility licensed under chapter 18.51 RCW.

(13) "Tribally licensed boarding home" means a boarding home licensed by a federally recognized Indian tribe which home provides services similar to boarding homes licensed under chapter 18.20 RCW.

Sec. 3. RCW 74.39A.050 and 1995 1st sp.s. c 18 s 12 are each amended to read as follows:

The department's system of quality improvement for long-term care services shall ((~~be guided by~~)) use the following principles, consistent with applicable federal laws and regulations:

(1) The system shall be resident centered or, in the home setting, consumer centered and promote privacy, independence, dignity, choice, and a home or home-like environment for residents and consumers.

(2) The goal of the system is continuous quality improvement with the focus on consumer satisfaction and outcomes for residents and consumers. When conducting or preparing for licensing inspections or contract monitoring, the department shall interview an appropriate percentage of residents or consumers, family members, and case managers and advocates who have resident, consumer, or facility-specific information, in addition to interviewing providers and staff.

(3) Providers should be supported in their efforts to improve quality through training, technical assistance, and case management.

(4) The emphasis should be on problem prevention both in monitoring and in screening potential providers of service.

(5) Monitoring should be outcome based and responsive to resident and consumer complaints and a clear set of health, quality of care, and safety standards that are easily understandable and have been made available to providers.

(6) Facility-based providers ((~~generally~~)) at all levels of care should be assisted in addressing identified problems, including those with potential for harm, initially through consultation and technical assistance, unless the safety, health, or well-being of a resident is endangered. Prompt, strict, and specific enforcement remedies shall be ((~~available~~)) implemented for providers found to have delivered care, or failed to deliver care, resulting in problems that are serious, recurring, or ((~~that have been~~)) uncorrected or negatively impact a resident. The enforcement remedies include, but are not limited to, those set forth in RCW 74.39A.080, 18.20.190, 70.128.160, and chapter 18.51 RCW. The enforcement remedies for substantiated violations of the rules applicable to the provider must be set forth by rule by the department. In the implementation of remedies, the safety and physical, emotional, and mental well-being of residents must be of paramount importance.

(7) To the extent of available funding, providers at all levels and their staff must be screened in a uniform and timely manner to ensure that they do not have a criminal history that would disqualify them from working with vulnerable adults. No provider or staff, or prospective provider or staff, with a final decision entered into the state registry or with the department finding them guilty of abuse, neglect, exploitation, or abandonment of a minor, or a vulnerable adult as defined in chapter 74.34 RCW, may be employed in the care of and have unsupervised access to vulnerable adults.

(8) The training and qualification standards for facility-based providers of long-term care services and their caregiving staff must be enhanced to further ensure that providers and staff possess adequate skills, education, and training to provide the highest quality of care consistent with the needs of the residents. The initial training requirement for all facility-based providers and caregiving staff must be not less than seventy-five hours, with annual continuing education. Providers and caregiving staff who serve residents with specialized care needs, including but not limited to those associated with dementia, traumatic brain injury, mental illness, and developmental disabilities, shall complete additional training regarding the care of such individuals. The training requirements must be effective upon the adoption of standards by the department by rule. The standards must be developed with the input of resident and provider representatives and other vested interest groups. The standards must include coursework and practical clinical training and must include competency testing with an examination and a demonstration of skills. Prospective and current providers and caregiving staff with professional health care licenses may be exempted from the minimum training requirement, if their prior health care license training was seventy-five hours or more, and upon successful completion of competency testing; however, no providers or staff may be exempted from the portion of the training concerning residents' rights. Prior training required by the department of current providers or staff, if successfully completed, shall be credited toward the seventy-five hour minimum requirement of this subsection.

(9) After the effective date of the department's rule adopted pursuant to subsection (8) of this section, prospective providers and prospective resident managers shall complete the training requirements prior to receiving a license and providing care to residents. Prospective caregiving staff shall complete a minimum of sixteen hours of training on key areas of resident care prior to any direct contact with a resident. The remainder of the training requirements for caregiving staff must be completed within four months of the date of employment. Until the training is successfully completed, caregiving staff hired after the effective date of the department's rule shall provide care only under the direct supervision of an individual who has successfully completed the training requirements. Current providers and caregiving staff shall complete the training requirements within four months of the adoption of rules by the department.

(10) In implementing the requirements of subsection (8) of this section, the department shall promote the development of a training system that is practical and relevant to the needs of residents, providers, and staff. To improve access to training, especially for rural communities, the training system may include, but is not limited to, the use of satellite technology distance learning that is coordinated through community colleges or other entities, long-term care facility-based training and mentoring, training through area agencies on aging, and training by other entities with expertise on long-term care or specialized care needs. The training provider or entity must first be approved by the department and may not include facilities or individuals with a history of significant noncompliance with federal or state laws or rules concerning the care of vulnerable adults or children.

(11) The cost for compliance with the training requirements of subsection (8) of this section may not be at public expense, except that the department's reimbursement rate for facilities with a contract with the department shall compensate facilities on a pro rata basis based upon the number of state-funded residents that the facility serves.

Sec. 4. RCW 74.39A.060 and 1995 1st sp.s. c 18 s 13 are each amended to read as follows:

(1) The aging and adult services administration of the department shall establish and maintain a toll-free telephone number for receiving complaints regarding a facility that the administration licenses or with which it contracts for long-term care services.

(2) All facilities that are licensed by, or that contract with the aging and adult services administration to provide long-term care services shall post in a place and manner clearly visible to residents and visitors the department's toll-free complaint telephone number and the toll-free number and program description of the long-term care ombudsman, as provided by RCW 43.190.050.

(3) The aging and adult services administration shall investigate complaints if the subject of the complaint is within its authority unless the department determines that: (a) The complaint is intended to willfully harass a licensee or employee of the licensee; or (b) there is no reasonable basis for investigation((~~; or (c) corrective action has been taken~~)).

(4) The aging and adult services administration shall refer complaints to appropriate state agencies, law enforcement agencies, the attorney general, the long-term care ombudsman, or other entities if the department lacks authority to investigate or if its investigation reveals that a follow-up referral to one or more of these entities is appropriate.

(5) The department shall adopt rules that include the following complaint investigation protocols for all long-term care services:

(a) Upon receipt of a complaint, the department shall make a preliminary review of the complaint, assess the severity of the complaint, and, unless the complaint is intended to willfully harass a licensee or employee of the licensee or there is no reasonable basis for investigation, assign an appropriate response time. Complaints involving imminent danger to the health, safety, or well-being of a resident must be responded to within at least two days. In all assigned cases, the department shall make an on-site investigation within a reasonable time after receipt of the complaint or otherwise ensure that complaints are responded to.

(b) The complainant must be: Promptly contacted by the department and informed of the right to meet the investigator at the site of the alleged violations, unless the investigator determines that the privacy of residents would be violated or compromised or the investigator determines that imminent danger to the resident necessitates an initial response before the complainant is available; informed of the department's proposed course of action; and informed of the right to receive a written copy of the investigation report.

(c) In conducting the investigation, the department shall interview the complainant, unless anonymous, and shall use its best efforts to interview the resident or residents allegedly harmed by the violations, and, in addition to facility staff, any available independent sources of relevant information, including if appropriate the family members of these residents.

(d) After a department finding of a violation that is serious, recurring, or uncorrected following a previous citation, the department shall make an on-site revisit of the facility to ensure correction of the violation.

(e) Substantiated complaints involving neglect, abuse, exploitation, or abandonment of residents, or suspected criminal violations, must also be referred to appropriate law enforcement agencies, the attorney general, and appropriate professional disciplinary boards.

(6) The department may not provide the substance of the complaint to the licensee or contractor before the completion of the investigation by the department. Neither the substance of the complaint provided to the licensee or contractor nor any copy of the complaint or related report published, released, or made otherwise available shall disclose, or reasonably lead to the disclosure of, the name, title, or identity of any complainant, or other person mentioned in the complaint, except that the name of the provider and the name or names of any officer, employee, or agent of the department conducting the investigation shall be disclosed. The department may disclose the identity of the complainant if such disclosure is requested in writing by the complainant. Nothing in this subsection shall be construed to interfere with the obligation of the long-term care ombudsman program to monitor the department's licensing, contract, and complaint investigation files for long-term care facilities.

((~~(6)~~)) (7) The resident has the right to be free from interference, coercion, discrimination, and reprisal from a facility in exercising his or her rights, including the right to voice grievances about treatment furnished or not furnished. A facility that provides long-term care services shall not discriminate or retaliate in any manner against a resident, employee, or other person on the basis or for the reason that such resident or any other person made a complaint to the department, the attorney general, law enforcement agencies, or the long-term care ombudsman, provided information, or otherwise cooperated with the investigation of such a complaint. Any attempt to discharge a resident against the resident's wishes, or any type of retaliatory treatment of a resident by whom or upon whose behalf a complaint has been made to the department, the attorney general, law enforcement agencies, or the long-term care ombudsman, within one year of the filing of the complaint, raises a rebuttable presumption that such action was in retaliation for the filing of the complaint. "Retaliatory treatment" means, but is not limited to: Monitoring a resident's phone, mail, or visits; involuntary seclusion or isolation; transferring a resident to a different room unless requested or based upon legitimate management reasons; withholding or threatening to withhold food or treatment, unless authorized by a terminally ill patient or representative pursuant to law; or persistently delaying responses to a resident's request for service or assistance. A facility that provides long-term care services also shall not willfully interfere with the performance of official duties by a long-term care ombudsman. The department ((~~may~~)) shall impose a civil penalty of not more than three thousand dollars for a violation of this subsection and require the facility to mitigate any damages incurred by the resident, employee, or other person.

(8) Any employee of a facility providing long-term care services who in good faith reports to the department, attorney general, law enforcement agencies, or the long-term care ombudsman suspected neglect, abuse, exploitation, or abandonment of a resident, shall be considered a whistleblower. An employee who as a result of being a whistleblower has been subjected to workplace reprisal or retaliatory action has the remedies provided under chapter 49.60 RCW and the protections found in RCW 4.24.500 through 4.24.520. "Reprisal or retaliatory action" means, but is not limited to: Denial of adequate staff support to perform duties; frequent staff changes; refusal to assign meaningful work; unwarranted and unsubstantiated report of misconduct; letters of reprimand or unsatisfactory performance evaluations; demotion; denial of employment; or a supervisor encouraging coworkers to behave in a hostile manner toward the whistleblower. Nothing in this subsection prohibits a facility from exercising its authority to terminate, suspend, or discipline any employee who engages in workplace reprisal or retaliatory action against a whistleblower, nor does it prevent a facility from terminating, suspending, or disciplining a whistleblower for other lawful purposes.

Sec. 5. RCW 70.129.030 and 1994 c 214 s 4 are each amended to read as follows:

(1) The facility must inform the resident both orally and in writing in a language that the resident understands of his or her rights and all rules and regulations governing resident conduct and responsibilities during the stay in the facility. The notification must be made prior to or upon admission. Receipt of the information must be acknowledged in writing.

(2) The facility shall admit only individuals whose needs it can safely and appropriately serve in the facility with current staff or through the provision of reasonable accommodations required by state or federal law. Except in cases of emergency, the facility shall not admit an individual before obtaining an assessment of the resident's needs and preferences. The assessment must contain, unless unavailable despite the best efforts of the facility and other interested parties, the following information: Recent medical history; necessary and prohibited medications; a medical professional's diagnosis; significant known behaviors or symptoms that may cause concern or require special care; mental illness unless protected by confidentiality laws; level of personal care needs; activities and service preferences; and preferences regarding issues important to the potential resident, such as food and daily routine.

(3) The resident or his or her legal representative has the right:

(a) Upon an oral or written request, to access all records pertaining to himself or herself including clinical records within twenty-four hours; and

(b) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or portions of them upon request and two working days' advance notice to the facility.

((~~(3)~~)) (4) The facility must inform each resident in writing in a language the resident or his or her representative understands before((~~, or at the time of~~)) admission, and at least once every twenty-four months thereafter of: (a) Services, items, and activities customarily available in the facility or arranged for by the facility; (b) charges for those services, items, and activities including charges for services, items, and activities not covered by the facility's per diem rate or applicable public benefit programs; and (c) the rules of facility operations required under RCW 70.129.140(2). Each resident and his or her representative must be informed in writing in advance of changes in the availability or the charges for services, items, or activities, or of changes in the facility's rules. Except in unusual circumstances, thirty days' advance notice must be given prior to the change.

((~~(4)~~)) (5) The facility must furnish a written description of residents rights that includes:

(a) A description of the manner of protecting personal funds, under RCW 70.129.040;

(b) A posting of names, addresses, and telephone numbers of the state survey and certification agency, the state licensure office, the state ombudsmen program, and the protection and advocacy systems; and

(c) A statement that the resident may file a complaint with the appropriate state licensing agency concerning resident abuse, neglect, and misappropriation of resident property in the facility.

((~~(5)~~)) (6) Notification of changes.

(a) A facility must immediately consult with the resident's physician, and if known, make reasonable efforts to notify the resident's legal representative or an interested family member when there is:

(i) An accident involving the resident which requires or has the potential for requiring physician intervention;

(ii) A significant change in the resident's physical, mental, or psychosocial status (i.e., a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications).

(b) The facility must promptly notify the resident or the resident's representative shall make reasonable efforts to notify an interested family member, if known, when there is:

(i) A change in room or roommate assignment; or

(ii) A decision to transfer or discharge the resident from the facility.

(c) The facility must record and update the address and phone number of the resident's representative or interested family member, upon receipt of notice from them.

(7) This section applies to long-term care facilities covered under this chapter and nursing facilities licensed under chapter 18.51 RCW.

Sec. 6. RCW 70.129.105 and 1994 c 214 s 17 are each amended to read as follows:

No long-term care facility or nursing facility licensed under chapter 18.51 RCW shall require or request residents to sign waivers of potential liability for losses of personal property or injury, or to sign waivers of residents' rights set forth in this chapter or in the applicable licensing or certification laws.

Sec. 7. RCW 70.129.110 and 1994 c 214 s 12 are each amended to read as follows:

(1) The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless:

(a) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;

(b) The safety of individuals in the facility is endangered;

(d) The resident has failed to make the required payment for his or her stay; or

(e) The facility ceases to operate.

(2) Before a long-term care facility or nursing facility licensed under chapter 18.51 RCW transfers or discharges a resident, the facility must:

(a) First attempt through reasonable accommodations, as defined by the department, to avoid the transfer or discharge, unless agreed to by the resident;

(b) Notify the resident and representative and make a reasonable effort to notify, if known, an interested family member of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand;

((~~(b)~~)) (c) Record the reasons in the resident's record; and

((~~(c)~~)) (d) Include in the notice the items described in subsection (4) of this section.

(3)(a) Except when specified in this subsection, the notice of transfer ((~~of [or]~~)) or discharge required under subsection (2) of this section must be made by the facility at least thirty days before the resident is transferred or discharged.

(b) Notice may be made as soon as practicable before transfer or discharge when:

(i) The safety of individuals in the facility would be endangered;

(ii) The health of individuals in the facility would be endangered;

(iii) An immediate transfer or discharge is required by the resident's urgent medical needs; or

(iv) A resident has not resided in the facility for thirty days.

(4) The written notice specified in subsection (2) of this section must include the following:

(a) The reason for transfer or discharge;

(b) The effective date of transfer or discharge;

(d) The name, address, and telephone number of the state long-term care ombudsman;

(e) For residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled individuals established under part C of the developmental disabilities assistance and bill of rights act; and

(f) For residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals established under the protection and advocacy for mentally ill individuals act.

(5) A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.

(6) A resident discharged in violation of this section has the right to be readmitted immediately upon the first availability of a gender-appropriate bed in the facility.

Sec. 8. RCW 70.129.150 and 1994 c 214 s 16 are each amended to read as follows:

(1) Prior to admission, all long-term care facilities or nursing facilities licensed under chapter 18.51 RCW that require payment of an admissions fee, deposit, advance notice before transferring from the facility, or a minimum stay fee, by or on behalf of a person seeking admission((~~s [admission]~~)) to the long-term care facility or nursing facility, shall provide the resident, or his or her representative, full disclosure in writing ((~~of the long-term care facility or nursing facility's schedule of charges for items and services provided by the facility and~~)) in a language the resident or his or her representative understands, a statement of the amount of any admissions fees, deposits, prepaid charges, or minimum stay fees. In addition, the long-term care facility or nursing facility shall also fully disclose in writing prior to admission what portion of the deposits, admissions fees, prepaid charges, or minimum stay fees will be refunded to the resident or his or her representative if the resident leaves the long-term care facility or nursing facility. Receipt of the disclosures must be acknowledged in writing. If the facility does not provide these disclosures, the deposits, admissions fees, prepaid charges, or minimum stay fees may not be kept by the facility. If a resident((~~, during the first thirty days of residence,~~)) dies ((or)), is hospitalized, or is transferred to another facility for more appropriate care and does not return to the original facility, the facility shall refund any deposit or charges already paid less the facility's per diem rate for the days the resident actually resided or reserved or retained a bed in the facility notwithstanding any minimum stay policy or discharge notice requirements, except that the facility may retain an additional amount to cover its reasonable, actual expenses incurred as a result of a resident's move, not to exceed five days per diem charges. All long-term care facilities or nursing facilities covered under this section are required to refund any and all refunds due the resident or ((~~their~~)) his or her representative within thirty days from the resident's date of discharge from the facility. Nothing in this section applies to provisions in contracts negotiated between a nursing facility or long-term care facility and a certified health plan, health or disability insurer, health maintenance organization, managed care organization, or similar entities.

(2) Where a long-term care facility or nursing facility requires the execution of an admission contract by or on behalf of an individual seeking admission to the facility, the terms of the contract shall be consistent with the requirements of this ((~~section~~)) chapter.

Sec. 9. RCW 70.128.175 and 1995 1st sp.s. c 18 s 29 are each amended to read as follows:

(1) Unless the context clearly requires otherwise, these definitions shall apply throughout this section and RCW 35.63.140, 35A.63.149, 36.70.755, 35.22.680, and 36.32.560:

(a) "Adult family home" means a regular family abode ((of)) in which a person or persons ((~~providing~~)) provide personal care, special care, room, and board to more than one but not more than six adults who are not related by blood or marriage to the person or persons providing the services.

(b) "Residential care facility" means a facility that cares for at least five, but not more than fifteen functionally disabled persons, that is not licensed pursuant to chapter 70.128 RCW.

(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.

NEW SECTION. Sec. 10. (1) The powers and duties of the department of health and the secretary of health under chapter 18.20 RCW, boarding homes, and the related programs, services, and management and support services, presently administered by the department of health are hereby transferred to the department of social and health services. All references to the secretary of health or the department of health in the Revised Code of Washington shall be construed to mean the secretary of social and health services or the department of social and health services when referring to the functions transferred in this section.

(2)(a) All reports, documents, surveys, books, records, data, files, papers, or written material in the possession of the department of health pertaining to the powers, functions, and duties transferred shall be delivered to the custody of the department of social and health services. All cabinets, furniture, office equipment, motor vehicles, and other tangible property employed by the department of health in carrying out the powers, functions, and duties transferred shall be made available to the department of social and health services. All funds, credits, or other assets held in connection with the powers, functions, and duties transferred shall be assigned to the department of social and health services.

(b) Any appropriations or license fees made to the department of health for carrying out the powers, functions, and duties transferred shall, on the effective date of this section, be transferred and credited to the department of social and health services.

(c) Whenever any question arises as to the transfer of any personnel, funds, books, documents, records, papers, files, equipment, or other tangible property used or held in the exercise of the powers and the performance of the duties and functions transferred, the director of financial management shall make a determination as to the proper allocation and certify the same to the state agencies concerned.

(3) All rules and all pending business before the department of health pertaining to the powers, functions, and duties transferred shall be continued and acted upon by the department of social and health services. All existing contracts and obligations shall remain in full force and shall be performed by the department of social and health services.

(4) The transfer of the powers, duties, functions, and personnel of the department of health shall not affect the validity of any act performed before the effective date of this section.

(5) If apportionments of budgeted funds are required because of the transfers directed in this section, the director of financial management shall certify the apportionments to the agencies affected, the state auditor, and the state treasurer. Each of these shall make the appropriate transfer and adjustments in funds and appropriation accounts and equipment records in accordance with the certification.

(6) Nothing contained in this section may be construed to alter any existing collective bargaining unit or the provisions of any existing collective bargaining agreement until the agreement has expired or until the bargaining unit has been modified by action of the personnel board as provided by law.

Sec. 11. RCW 18.20.020 and 1991 c 3 s 34 are each amended to read as follows:

As used in this chapter:

(1) "Aged person" means a person of the age sixty-five years or more, or a person of less than sixty-five years who by reason of infirmity requires domiciliary care.

(2) "Boarding home" means any home or other institution, however named, which is advertised, announced or maintained for the express or implied purpose of providing board and domiciliary care to three or more aged persons not related by blood or marriage to the operator. It shall not include facilities certified as group training homes pursuant to RCW 71A.22.040, nor any home, institution or section thereof which is otherwise licensed and regulated under the provisions of state law providing specifically for the licensing and regulation of such home, institution or section thereof. Nor shall it include any independent senior housing, independent living units in continuing care retirement communities, or other similar living situations including those subsidized by the department of housing and urban development.

(3) "Person" means any individual, firm, partnership, corporation, company, association, or joint stock association, and the legal successor thereof.

(4) "Secretary" means the secretary of ((~~health~~)) social and health services.

(5) "Department" means the state department of ((~~health~~)) social and health services.

(6) "Authorized department" means any city, county, city‑county health department or health district authorized by the secretary ((~~of health~~)) to carry out the provisions of this chapter.

Sec. 12. RCW 18.20.190 and 1995 1st sp.s. c 18 s 18 are each amended to read as follows:

(1) The department ((~~of health~~)) is authorized to take one or more of the actions listed in subsection (2) of this section in any case in which the department finds that a boarding home provider has:

(a) Failed or refused to comply with the requirements of this chapter or the rules adopted under this chapter;

(b) Operated a boarding home without a license or under a revoked license;

(c) Knowingly, or with reason to know, made a false statement of material fact on his or her application for license or any data attached thereto, or in any matter under investigation by the department; or

(d) Willfully prevented or interfered with any inspection or investigation by the department.

(2) When authorized by subsection (1) of this section, the department may take one or more of the following actions:

(a) Refuse to issue a license;

(b) Impose reasonable conditions on a license, such as correction within a specified time, training, and limits on the type of clients the provider may admit or serve;

(d) Suspend, revoke, or refuse to renew a license; or

(e) Suspend admissions to the boarding home by imposing stop placement.

(3) When the department orders stop placement, the facility shall not admit any new resident until the stop placement order is terminated. The department may approve readmission of a resident to the facility from a hospital or nursing home during the stop placement. The department shall terminate the stop placement when: (a) The violations necessitating the stop placement have been corrected; and (b) the provider exhibits the capacity to maintain adequate care and service.

(4) Chapter 34.05 RCW applies to department actions under this section, except that orders of the department imposing license suspension, stop placement, or conditions for continuation of a license are effective immediately upon notice and shall continue pending any hearing.

NEW SECTION. Sec. 13. In furtherance of the policy of the state to cooperate with the federal government in all of the programs under the jurisdiction of the department, such rules as may become necessary to entitle the state to participate in federal funds may be adopted, unless expressly prohibited by law. Any internal reorganization carried out under the terms of this chapter shall meet federal requirements that are a necessary condition to state receipt of federal funds. Any section or provision of law dealing with the department that may be susceptible to more than one construction shall be interpreted in favor of the construction most likely to comply with federal laws entitling this state to receive federal funds for the various programs of the department. If any law dealing with the department is ruled to be in conflict with federal requirements that are a prescribed condition of the allocation of federal funds to the state, or to any departments or agencies thereof, the conflicting part is declared to be inoperative solely to the extent of the conflict.

NEW SECTION. Sec. 14. 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. 15. 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 takes effect immediately, except that sections 10 through 12 of this act take effect January 1, 1998.

NEW SECTION. Sec. 16. Sections 1 and 13 of this act are each added to chapter 74.39A RCW.

NEW SECTION. Sec. 17. Section 10 of this act is added to chapter 18.20 RCW.