H-1378.3  _______________________________________________

                          HOUSE BILL 1937

          _______________________________________________

State of Washington      56th Legislature     1999 Regular Session

By Representatives Anderson, Haigh, Constantine, Kenney, Edmonds, Wood, Lantz, Schual‑Berke, Murray, Santos, Conway, Miloscia, Tokuda, Veloria, Stensen, Edwards, Keiser and Ogden

Read first time 02/11/1999.  Referred to Committee on Health Care.

Allowing a health maintenance organization to return an individual to his or her nursing care facility.

    AN ACT Relating to allowing residents of long-term care facilities to return to their home; adding a new section to chapter 48.46 RCW; and creating a new section.

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

NEW SECTION. Sec. 1.  The legislature finds that a long-term care facility is home for the individual residing therein, and the individual has the right to receive services in his or her own home and to be cared for by the organization with which he or she has a contractual agreement to provide housing and related services.  The legislature further finds that health maintenance organizations, or any other similar health plan, that restricts individuals from returning to the long-term care facility in which they were residing prior to hospitalization may be impacting the health and well-being of frail individuals and their families.

NEW SECTION. Sec. 2.  A new section is added to chapter 48.46 RCW to read as follows:

    Upon the request of the patient, or his or her legal representative, a health maintenance organization licensed under this chapter shall discharge individuals from a hospital stay, back to the nursing facility licensed under chapter 18.51 RCW, continuing care retirement community defined under RCW 70.38.025, boarding home licensed under chapter 18.20 RCW, or assisted living facility in which they resided prior to the hospital stay, provided that the following conditions are met:

    (1) The primary care physician determines that the individual needs a specific level of care and refers the enrollee to that nursing home facility, continuing care retirement community, boarding home, or assisted living facility's appropriate care setting.  If the attending physician is unable to provide care for the patient at that nursing home facility, continuing care retirement community, boarding home, or assisted living facility, the attending physician shall transfer the care to another physician who is willing and able to follow the patient's care at that facility;

    (2) The nursing facility, continuing care retirement community, boarding home, or assisted living facility agrees to be reimbursed at the rate that the health maintenance organization plan company's contract rate negotiated with similar providers for the same services and supplies; and

    (3) The nursing facility, continuing care retirement community, boarding home, or assisted living facility meets all guidelines established by the health maintenance organization plan company related to health, safety, and quality of care standards, and other appropriate criteria applicable to providers under contract for the same services and supplies.

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