BILL REQ. #:  H-3633.1 

Read first time 01/15/2004.   Referred to Committee on Health Care.

     AN ACT Relating to payments for boarding home services; amending RCW 74.39A.030; adding a new section to chapter 74.39A RCW; creating a new section; and declaring an emergency.

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

Sec. 1   RCW 74.39A.030 and 2002 c 3 s 10 are each amended to read as follows:
     (1) To the extent of available funding, the department shall expand cost-effective options for home and community services for consumers for whom the state participates in the cost of their care.
     (2) In expanding home and community services, the department shall: (a) Take full advantage of federal funding available under Title XVIII and Title XIX of the federal social security act, including home health, adult day care, waiver options, and state plan services; and (b) be authorized to use funds available under its community options program entry system waiver granted under section 1915(c) of the federal social security act to expand the availability of in-home, adult residential care, adult family homes, enhanced adult residential care, and assisted living services. By June 30, 1997, the department shall undertake to reduce the nursing home medicaid census by at least one thousand six hundred by assisting individuals who would otherwise require nursing facility services to obtain services of their choice, including assisted living services, enhanced adult residential care, and other home and community services. If a resident, or his or her legal representative, objects to a discharge decision initiated by the department, the resident shall not be discharged if the resident has been assessed and determined to require nursing facility services. In contracting with nursing homes and boarding homes for enhanced adult residential care placements, the department shall not require, by contract or through other means, structural modifications to existing building construction.
     (3)(a) The department shall by rule establish payment rates for home and community services that support the provision of cost-effective care. In the event of any conflict between any such rule and a collective bargaining agreement entered into under RCW 74.39A.270 and 74.39A.300, the collective bargaining agreement prevails.
     (b) The department may authorize an enhanced adult residential care rate for nursing homes that temporarily or permanently convert their bed use for the purpose of providing enhanced adult residential care under chapter 70.38 RCW, when the department determines that payment of an enhanced rate is cost-effective and necessary to foster expansion of contracted enhanced adult residential care services. As an incentive for nursing homes to permanently convert a portion of its nursing home bed capacity for the purpose of providing enhanced adult residential care, the department may authorize a supplemental add-on to the enhanced adult residential care rate.
     (c) The department may authorize a supplemental assisted living services rate for up to four years for facilities that convert from nursing home use and do not retain rights to the converted nursing home beds under chapter 70.38 RCW, if the department determines that payment of a supplemental rate is cost-effective and necessary to foster expansion of contracted assisted living services.
     (4) The department shall provide base payment for adult residential care and enhanced adult residential care that shall be no less than a weighted average rate of fifty-three dollars and seventy-four cents per resident, per day. The department shall provide base payment for assisted living services that shall be no less than a weighted average rate of fifty-nine dollars and fifty-eight cents per resident, per day. To the extent of available funding, payments shall include the following additional components:
     (a) A payment add-on that addresses the cost of workers' compensation insurance premiums assessed by the department of labor and industries under chapter 51.16 RCW, based upon the proportionate share of such cost allocable to medicaid care as determined by dividing the contracting facility's number of medicaid client days into the facility's aggregate workers' compensation insurance premium cost; and
     (b) A payment add-on that addresses the cost of liability insurance, based upon the proportionate share of such cost allocable to medicaid care as determined by dividing the contracting facility's number of medicaid client days into the facility's liability insurance premium cost. In assessing such cost, the department may use a survey method.
     (5) The department shall establish an appeals process whereby boarding homes contracting with the department to provide adult residential care, enhanced adult residential care, and assisted living services may appeal a client assessment by the department that serves as a basis for payment.
     (6) The department shall, based upon assessments and within existing funds, pay dementia pilot project rates of not less than ninety dollars and thirty-four cents per day in metropolitan statistical areas, and eighty-five dollars and twenty-three cents per resident day in nonmetropolitan statistical areas, on behalf of up to two hundred persons with Alzheimer's disease or related dementias who would otherwise qualify for placement in nursing facilities.

NEW SECTION.  Sec. 2   A new section is added to chapter 74.39A RCW to read as follows:
     This section recognizes the significant financial commitment made by providers to construct new or remodeled housing for the state's elderly who receive medicaid contracted assisted living services in boarding homes. Boarding home providers who had submitted new construction plans, or plans to remodel an existing boarding home to the department of health, construction review, before June 30, 2002, shall, on the effective date of this act, receive a capital rate add-on if:
     (1) The boarding home provider was receiving a capital rate add-on payment before June 30, 2002; and
     (2) The boarding home was built or remodeled to provide the following:
     (a) Private apartment-like units;
     (b) A kitchen area equipped with a refrigerator, a microwave oven or stovetop, and a counter or table for food preparation. In a new facility, a kitchen area must also be equipped with a sink and counter area, and storage space for utensils and supplies;
     (c) A lockable entry door;
     (d) A separate private bathroom, including a sink, toilet, and shower or bathtub. In a new facility, a minimum of fifty percent of the bathrooms shall be wheelchair accessible and have a roll-in shower;
     (e) In a remodeled facility, an individual unit shall have a minimum of one hundred eighty square feet including counters, closets, and built-ins, excluding the bathroom. In a new facility, an individual unit shall have a minimum of two hundred twenty square feet including counters, closets, and built-ins, excluding the bathroom;
     (f) A living area shall be wired for telephone service and, where geographically possible, wired for television service;
     (g) In a new facility, the contractor shall provide a private accessible mailbox; and
     (h) A home-like smoke-free common area or areas with sufficient space for socialization designed to meet resident needs.
     The capital rate add-on payment made under this section shall be at least equal to the rate amount received before implementation of the capital rate add-on reduction in funding resulting from chapter 371, Laws of 2002.

NEW SECTION.  Sec. 3   This act may be known and cited as the medicaid payment fairness act for licensed boarding home care.

NEW SECTION.  Sec. 4   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.