S-1983.1  _______________________________________________

                    SUBSTITUTE SENATE BILL 5864

          _______________________________________________

State of Washington      56th Legislature     1999 Regular Session

By Senate Committee on Health & Long‑Term Care (originally sponsored by Senators Fairley, Thibaudeau and Kohl‑Welles)

Read first time 03/03/99.

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 48.43 RCW; and creating new sections.

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 any individual who resides there, 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 restricting individuals from returning to the long-term care facility in which they were residing prior to hospitalization may detrimentally impact the health and well-being of frail individuals and their families.

NEW SECTION. Sec. 2.  A new section is added to chapter 48.43 RCW to read as follows:

    (1) A carrier that provides coverage for a person at a long-term care facility following the person's hospitalization shall, upon the request of the person or his or her legal guardian, provide such coverage at the facility in which the person resided immediately prior to the hospitalization if:

    (a) The person's primary care physician determines that the medical care needs of the person can be met at the requested facility;

    (b) The requested facility has all applicable licenses and certifications, and is not under a stop placement order that prevents  the person's readmission;

    (c) The requested facility agrees to accept payment from the carrier for covered services at the rate paid to similar facilities that otherwise contract with the carrier to provide such services; and

    (d) The requested facility, with regard to the following, agrees to abide by the standards, terms, and conditions required by the carrier of similar facilities with which the carrier otherwise contracts:  (i) Utilization review, quality assurance, and peer review; and (ii) management and administrative procedures, including data and financial reporting that may be required by the carrier.

    (2) For purposes of this section, "long-term care facility" or "facility" means a 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.

NEW SECTION. Sec. 3.  This act may be known and cited as the Kitson act.

                            --- END ---