READ FIRST TIME 02/09/04.   

     AN ACT Relating to boarding homes; amending RCW 18.20.020, 18.20.160, 18.20.290, 74.39A.009, 74.39A.020, and 18.20.030; adding new sections to chapter 18.20 RCW; adding a new section to chapter 42.17 RCW; creating a new section; providing an effective date; and declaring an emergency.

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

Sec. 1   RCW 18.20.020 and 2003 c 231 s 2 are each amended to read as follows:
     As used in this chapter:
     (1) "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)) housing, basic services, and assuming general responsibility for the safety and well-being of the residents, and may also provide domiciliary care, consistent with this act, to seven or more residents after July 1, 2000. However, a boarding home that is licensed ((to provide board and domiciliary care to)) for three to six residents prior to or on July 1, 2000, may maintain its boarding home license as long as it is continually licensed as a boarding home. "Boarding home" 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.
     (2) "Basic services" means housekeeping services, meals, nutritious snacks, laundry, and activities.
     (3) "Person" means any individual, firm, partnership, corporation, company, association, or joint stock association, and the legal successor thereof.
     (((3))) (4) "Secretary" means the secretary of social and health services.
     (((4))) (5) "Department" means the state department of social and health services.
     (((5))) (6) "Resident's representative" means a person designated voluntarily by a competent resident, in writing, to act in the resident's behalf concerning the care and services provided by the boarding home and to receive information from the boarding home, if there is no legal representative. The resident's competence shall be determined using the criteria in RCW 11.88.010(1)(e). The resident's representative may not be affiliated with the licensee, boarding home, or management company, unless the affiliated person is a family member of the resident. The resident's representative shall not have authority to act on behalf of the resident once the resident is no longer competent.
     (7) "Domiciliary care" means: Assistance with activities of daily living provided by the boarding home either directly or indirectly; or ((assuming general responsibility for the safety and well-being of the resident)) health support services, if provided directly or indirectly by the boarding home; or intermittent nursing services, if provided directly or indirectly by the boarding home. (("Domiciliary care" does not include general observation or preadmission assessment for the purposes of transitioning to a licensed care setting.
     (6))) (8) "General responsibility for the safety and well-being of the resident" means the provision of the following: Prescribed general low sodium diets; prescribed general diabetic diets; prescribed mechanical soft foods; emergency assistance; monitoring of the resident; arranging health care appointments with outside health care providers and reminding residents of such appointments as necessary; coordinating health care services with outside health care providers consistent with section 10 of this act; assisting the resident to obtain and maintain glasses, hearing aids, dentures, canes, crutches, walkers, wheelchairs, and assistive communication devices; observation of the resident for changes in overall functioning; blood pressure checks as scheduled; responding appropriately when there are observable or reported changes in the resident's physical, mental, or emotional functioning; or medication assistance as permitted under RCW 69.41.085 and as defined in RCW 69.41.010.
     (("General responsibility for the safety and well-being of the resident" does not include: (a) Emergency assistance provided on an intermittent or nonroutine basis to any nonresident individual; or (b) services customarily provided under landlord tenant agreements governed by the residential landlord-tenant act, chapter 59.18 RCW. Such services do not include care or supervision.
     (7))) (9) "Legal representative" means a person or persons identified in RCW 7.70.065 who may act on behalf of the resident pursuant to the scope of their legal authority. The legal representative shall not be affiliated with the licensee, boarding home, or management company, unless the affiliated person is a family member of the resident.
     (10) "Nonresident individual" means a person who resides in independent senior housing, independent living units in continuing care retirement communities, or in other similar living environments or in a boarding home and may receive one or more of the services listed in RCW 18.20.030(5), but may not receive domiciliary care, as defined in this chapter, directly or indirectly by the facility and may not receive the items and services listed in subsection (8) of this section.
     (11) "Resident" means an individual who((: Lives in a boarding home, including those receiving respite care;)) is not related by blood or marriage to the operator of the boarding home((;)), and by reason of age or disability, ((receives)) chooses to reside in the boarding home and receives basic services and one or more of the services listed under general responsibility for the safety and well-being of the resident and may receive domiciliary care or respite care provided ((either)) directly or indirectly by the boarding home and shall be permitted to receive hospice care through an outside service provider when arranged by the resident or the resident's legal representative under section 10 of this act.
     (12) "Resident applicant" means an individual who is seeking admission to a licensed boarding home and who has completed and signed an application for admission, or such application for admission has been completed and signed in their behalf by their legal representative if any, and if not, then the designated representative if any.

NEW SECTION.  Sec. 2   A new section is added to chapter 18.20 RCW to read as follows:
     (1) A boarding home, licensed under this chapter, may provide domiciliary care services, as defined in this chapter, and shall disclose the scope of care and services that it chooses to provide.
     (2) The boarding home licensee shall disclose to the residents, the residents' legal representative if any, and if not, the residents' representative if any, and to interested consumers upon request, the scope of care and services offered, using the form developed and provided by the department, in addition to any supplemental information that may be provided by the licensee. The form that the department develops shall be standardized, reasonable in length, and easy to read. The boarding home's disclosure statement shall indicate the scope of domiciliary care assistance provided and shall indicate that it permits the resident or the resident's legal representative to independently arrange for outside services under section 10 of this act.
     (3)(a) If the boarding home licensee decreases the scope of services that it provides due to circumstances beyond the licensee's control, the licensee shall provide a minimum of thirty days' written notice to the residents, the residents' legal representative if any, and if not, the residents' representative if any, before the effective date of the decrease in the scope of care or services provided.
     (b) If the licensee voluntarily decreases the scope of services, and any such decrease in the scope of services provided will result in the discharge of one or more residents, then ninety days' written notice shall be provided prior to the effective date of the decrease. Notice shall be provided to the affected residents, the residents' legal representative if any, and if not, the residents' representative if any.
     (c) If the boarding home licensee increases the scope of services that it chooses to provide, the licensee shall promptly provide written notice to the residents, the residents' legal representative if any, and if not, the residents' representative if any, and shall indicate the date on which the increase in the scope of care or services is effective.
     (4) When the care needs of a resident exceed the disclosed scope of care or services that a boarding home licensee provides, the licensee may exceed the care or services disclosed consistent with RCW 70.129.030(3) and RCW 70.129.110(3)(a). Providing care or services to a resident that exceed the care and services disclosed may or may not mean that the provider is capable of or required to provide the same care or services to other residents.
     (5) Even though the boarding home licensee may disclose that it can provide certain care or services to resident applicants or to their legal representative if any, and if not, to the resident applicants' representative if any, the licensee may deny admission to a resident applicant when the licensee determines that the needs of the resident applicant cannot be met, as long as the provider operates in compliance with state and federal law, including RCW 70.129.030(3).
     (6) The disclosure form is intended to assist consumers in selecting boarding home services and, therefore, shall not be construed as an implied or express contract between the boarding home licensee and the resident.

NEW SECTION.  Sec. 3   A new section is added to chapter 18.20 RCW to read as follows:
     (1) Boarding homes are not required to provide assistance with one or more activities of daily living.
     (2) If a boarding home licensee chooses to provide assistance with activities of daily living, the licensee shall provide at least the minimal level of assistance for all activities of daily living consistent with subsection (3) of this section and consistent with the reasonable accommodation requirements in state or federal laws. Activities of daily living are limited to and include the following:
     (a) Bathing;
     (b) Dressing;
     (c) Eating;
     (d) Personal hygiene;
     (e) Transferring;
     (f) Toileting; and
     (g) Ambulation and mobility.
     (3) The department shall, in rule, define the minimum level of assistance that will be provided for all activities of daily living, however, such rules shall not require more than occasional stand-by assistance or more than occasional physical assistance.
     (4) The licensee shall clarify, through the disclosure form, the assistance with activities of daily living that may be provided, and any limitations or conditions that may apply. The licensee shall also clarify through the disclosure form any additional services that may be provided.
     (5) In providing assistance with activities of daily living, the boarding home shall observe the resident for changes in overall functioning and respond appropriately when there are observable or reported changes in the resident's physical, mental, or emotional functioning.

NEW SECTION.  Sec. 4   A new section is added to chapter 18.20 RCW to read as follows:
     (1) The boarding home licensee may choose to provide any of the following health support services, however, the facility may or may not need to provide additional health support services to comply with the reasonable accommodation requirements in federal or state law:
     (a) Blood glucose testing;
     (b) Puree diets;
     (c) Calorie controlled diabetic diets;
     (d) Dementia care;
     (e) Mental health care; and
     (f) Developmental disabilities care.
     (2) The licensee shall clarify on the disclosure form any limitations, additional services, or conditions that may apply.
     (3) In providing health support services, the boarding home shall observe the resident for changes in overall functioning and respond appropriately when there are observable or reported changes in the resident's physical, mental, or emotional functioning.

NEW SECTION.  Sec. 5   A new section is added to chapter 18.20 RCW to read as follows:
     (1) Boarding homes are not required to provide intermittent nursing services. The boarding home licensee may choose to provide any of the following intermittent nursing services through appropriately licensed and credentialed staff, however, the facility may or may not need to provide additional intermittent nursing services to comply with the reasonable accommodation requirements in federal or state law:
     (a) Medication administration;
     (b) Administration of health care treatments;
     (c) Diabetic management;
     (d) Nonroutine ostomy care;
     (e) Tube feeding; and
     (f) Nurse delegation consistent with chapter 18.79 RCW.
     (2) The licensee shall clarify on the disclosure form any limitations, additional services, or conditions that may apply under this section.
     (3) In providing intermittent nursing services, the boarding home shall observe the resident for changes in overall functioning and respond appropriately when there are observable or reported changes in the resident's physical, mental, or emotional functioning.
     (4) The boarding home may provide intermittent nursing services to the extent permitted by RCW 18.20.160.

NEW SECTION.  Sec. 6   A new section is added to chapter 18.20 RCW to read as follows:
     (1) A boarding home licensee may permit a resident's family member to administer medications or treatments or to provide medication or treatment assistance to the resident. The licensee shall disclose to the department, residents, the residents' legal representative if any, and if not, the residents' representative if any, and to interested consumers upon request, information describing whether the licensee permits such family administration or assistance and, if so, the extent of limitations or conditions thereof.
     (2) If a boarding home licensee permits a resident's family member to administer medications or treatments or to provide medication or treatment assistance, the licensee shall request that the family member submit to the licensee a written medication or treatment plan. At a minimum, the written medication or treatment plan shall identify:
     (a) By name, the family member who will administer the medication or treatment or provide assistance therewith;
     (b) The medication or treatment administration or assistance that the family member will provide consistent with subsection (1) of this section. This will be referred to as the primary plan;
     (c) An alternate plan that will meet the resident's medication or treatment needs if the family member is unable to fulfill his or her duties as specified in the primary plan; and
     (d) An emergency contact person and telephone number if the boarding home licensee observes changes in the resident's overall functioning or condition that may relate to the medication or treatment plan.
     (3) The boarding home licensee may require that the primary or alternate medication or treatment plan include other information in addition to that specified in subsection (2) of this section.
     (4) The medication or treatment plan shall be signed and dated by:
     (a) The resident, if able;
     (b) The resident's legal representative, if any, and, if not, the resident's representative, if any;
     (c) The resident's family member; and
     (d) The boarding home licensee.
     (5) The boarding home may through policy or procedure require the resident's family member to immediately notify the boarding home licensee of any change in the primary or alternate medication or treatment plan.
     (6) When a boarding home licensee permits residents' family members to assist with or administer medications or treatments, the licensee's duty of care, and any negligence that may be attributed thereto, shall be limited to: Observation of the resident for changes in overall functioning consistent with RCW 18.20.280; notification to the person or persons identified in RCW 70.129.030 when there are observed changes in the resident's overall functioning or condition, or when the boarding home is aware that both the primary and alternate plan are not implemented; and appropriately responding to obtain needed assistance when there are observable or reported changes in the resident's physical or mental functioning.

NEW SECTION.  Sec. 7   A new section is added to chapter 18.20 RCW to read as follows:
     (1) The boarding home licensee shall conduct a preadmission assessment for each resident applicant. The preadmission assessment shall include the following information, unless unavailable despite the best efforts of the licensee:
     (a) Medical history;
     (b) Necessary and contraindicated medications;
     (c) A licensed medical or health professional's diagnosis, unless the individual objects for religious reasons;
     (d) Significant known behaviors or symptoms that may cause concern or require special care;
     (e) Mental illness diagnosis, except where protected by confidentiality laws;
     (f) Level of personal care needs;
     (g) Activities and service preferences; and
     (h) Preferences regarding other issues important to the resident applicant, such as food and daily routine.
     (2) The boarding home licensee shall complete the preadmission assessment before admission unless there is an emergency. If there is an emergency admission, the preadmission assessment shall be completed within five days of the date of admission. For purposes of this section, "emergency" includes, but is not limited to: Evening, weekend, or Friday afternoon admissions if the resident applicant would otherwise need to remain in an unsafe setting or be without adequate and safe housing.
     (3) The boarding home licensee shall complete an initial resident service plan upon move-in to identify the resident's immediate needs and to provide direction to staff and caregivers relating to the resident's immediate needs. The initial resident service plan shall include as much information as can be obtained, under subsection (1) of this section.

NEW SECTION.  Sec. 8   A new section is added to chapter 18.20 RCW to read as follows:
     (1) The boarding home licensee shall within fourteen days of the resident's date of move-in, unless extended by the department for good cause, and thereafter at least annually, complete a full reassessment addressing the following:
     (a) The individual's recent medical history, including, but not limited to: A health professional's diagnosis, unless the resident objects for religious reasons; chronic, current, and potential skin conditions; known allergies to foods or medications; or other considerations for providing care or services;
     (b) Current necessary and contraindicated medications and treatments for the individual, including:
     (i) Any prescribed medications and over-the-counter medications that are commonly taken by the individual, and that the individual is able to independently self-administer or safely and accurately direct others to administer to him or her;
     (ii) Any prescribed medications and over-the-counter medications that are commonly taken by the individual and that the individual is able to self-administer when he or she has the assistance of a resident-care staff person; and
     (iii) Any prescribed medications and over-the-counter medications that are commonly taken by the individual and that the individual is not able to self-administer;
     (c) The individual's nursing needs when the individual requires the services of a nurse on the boarding home premises;
     (d) The individual's sensory abilities, including vision and hearing;
     (e) The individual's communication abilities, including modes of expression, ability to make himself or herself understood, and ability to understand others;
     (f) Significant known behaviors or symptoms of the individual causing concern or requiring special care, including: History of substance abuse; history of harming self, others, or property, or other conditions that may require behavioral intervention strategies; the individual's ability to leave the boarding home unsupervised; and other safety considerations that may pose a danger to the individual or others, such as use of medical devices or the individual's ability to smoke unsupervised, if smoking is permitted in the boarding home;
     (g) The individual's special needs, by evaluating available information, or selecting and using an appropriate tool to determine the presence of symptoms consistent with, and implications for care and services of: Mental illness, or needs for psychological or mental health services, except where protected by confidentiality laws; developmental disability; dementia; or other conditions affecting cognition, such as traumatic brain injury;
     (h) The individual's level of personal care needs, including: Ability to perform activities of daily living; medication management ability, including the individual's ability to obtain and appropriately use over-the-counter medications; and how the individual will obtain prescribed medications for use in the boarding home;
     (i) The individual's activities, typical daily routines, habits, and service preferences;
     (j) The individual's personal identity and lifestyle, to the extent the individual is willing to share the information, and the manner in which they are expressed, including preferences regarding food, community contacts, hobbies, spiritual preferences, or other sources of pleasure and comfort; and
     (k) Who has decision-making authority for the individual, including: The presence of any advance directive, or other legal document that will establish a substitute decision maker in the future; the presence of any legal document that establishes a current substitute decision maker; and the scope of decision-making authority of any substitute decision maker.
     (2) Complete a limited assessment of a resident's change of condition when the resident's negotiated service agreement no longer addresses the resident's current needs.

NEW SECTION.  Sec. 9   A new section is added to chapter 18.20 RCW to read as follows:
     (1) The boarding home licensee shall complete a negotiated service agreement using the preadmission assessment, initial resident service plan, and full reassessment information obtained under sections 7 and 8 of this act. The licensee shall include the resident and the resident's legal representative if any, or the resident's representative if any, in the development of the negotiated service agreement. If the resident is a medicaid client, the department's case manager shall also be involved.
     (2) The negotiated service agreement shall be completed or updated:
     (a) Within thirty days of the date of move-in;
     (b) As necessary following the annual full assessment of the resident; and
     (c) Whenever the resident's negotiated service agreement no longer adequately addresses the resident's current needs and preferences.

NEW SECTION.  Sec. 10   A new section is added to chapter 18.20 RCW to read as follows:
     (1) The boarding home licensee shall permit the resident, or the resident's legal representative if any, to independently arrange for or contract with a practitioner licensed under Title 18 RCW regulating health care professions, or a home health, hospice, or home care agency licensed under chapter 70.127 RCW, to provide on-site care and services to the resident, consistent with RCW 18.20.160 and chapter 70.129 RCW. The boarding home licensee may permit the resident, or the resident's legal representative if any, to independently arrange for other persons to provide on-site care and services to the resident.
     (2) The boarding home licensee may establish policies and procedures that describe limitations, conditions, or requirements that must be met prior to an outside service provider being allowed on-site.
     (3) When the resident or the resident's legal representative independently arranges for outside services under subsection (1) of this section, the licensee's duty of care, and any negligence that may be attributed thereto, shall be limited to: The responsibilities described under subsection (4) of this section, excluding supervising the activities of the outside service provider; observation of the resident for changes in overall functioning, consistent with RCW 18.20.280; notification to the person or persons identified in RCW 70.129.030 when there are observed changes in the resident's overall functioning or condition; and appropriately responding to obtain needed assistance when there are observable or reported changes in the resident's physical or mental functioning.
     (4) Consistent with RCW 18.20.280, the boarding home licensee shall not be responsible for supervising the activities of the outside service provider. When information sharing is authorized by the resident or the resident's legal representative, the licensee shall request such information and integrate relevant information from the outside service provider into the resident's negotiated service agreement, only to the extent that such information is actually shared with the licensee.

NEW SECTION.  Sec. 11   A new section is added to chapter 18.20 RCW to read as follows:
     By December 12, 2005, the department shall report on the payment system for licensed boarding homes to the chairs of the senate and house of representatives health care committees. The department shall include in the report findings regarding the average costs of providing care and services for the nonmetropolitan statistical areas, metropolitan statistical areas, and King county to determine whether the rates of payment within the designated areas are, on average, reasonably related to the identified average costs. The cost data is exempt from disclosure as provided in section 16 of this act. The purpose of this cost-to-rate comparison study is to assess any cost impacts that may be attributed to the implementation of new boarding home rules occurring between September 1, 2004, and June 30, 2005. If the department adopts new boarding home rules after June 30, 2005, the report to the chairs of the senate and house of representatives health care committees will instead be due by December 12, 2006.

Sec. 12   RCW 18.20.160 and 1985 c 297 s 2 are each amended to read as follows:
     No person operating a boarding home licensed under this chapter shall admit to or retain in the boarding home any aged person requiring nursing or medical care of a type provided by institutions licensed under chapters 18.51, 70.41 or 71.12 RCW, except that when registered nurses are available, and upon a doctor's order that a supervised medication service is needed, it may be provided. Supervised medication services, as defined by the department and consistent with chapters 69.41 and 18.79 RCW, may include an approved program of self-medication or self-directed medication. Such medication service shall be provided only to ((boarders)) residents who otherwise meet all requirements for residency in a boarding home. No boarding home shall admit or retain a person who requires the frequent presence and frequent evaluation of a registered nurse, excluding persons who are receiving hospice care or persons who have a short-term illness that is expected to be resolved within fourteen days.

Sec. 13   RCW 18.20.290 and 2003 c 231 s 11 are each amended to read as follows:
     (1) When a boarding home contracts with the department to provide adult residential care services, enhanced adult residential care services, or assisted living services under chapter 74.39A RCW, the boarding home must hold a medicaid eligible resident's room or unit when short-term care is needed in a nursing home or hospital, the resident is likely to return to the boarding home, and payment is made under subsection (2) of this section.
     (2) The medicaid resident's bed or unit shall be held for up to twenty days. The per day bed or unit hold compensation amount shall be seventy percent of the daily rate paid for the first seven days the bed or unit is held for the resident who needs short-term nursing home care or hospitalization. The rate for the eighth through the twentieth day a bed is held shall be established in rule, but shall be no lower than ten dollars per day the bed or unit is held.
     (3) The boarding home may seek third-party payment to hold a bed or unit for twenty-one days or longer. The third-party payment shall not exceed ((eighty-five percent of)) the ((average)) medicaid daily rate paid to the facility for the resident. If third-party payment is not available, the medicaid resident may return to the first available and appropriate bed or unit, if the resident continues to meet the admission criteria under this chapter.
     (4) The department shall monitor the use and impact of the policy established under this section and shall report its findings to the appropriate committees of the senate and house of representatives by December 31, 2005.
     (5) This section expires June 30, 2006.

Sec. 14   RCW 74.39A.009 and 1997 c 392 s 103 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 home licensed under chapter 70.128 RCW.
     (2) "Adult residential care" means 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 to provide personal care services.
     (3) "Assisted living services" means services provided by a boarding home that has a contract with the department under RCW 74.39A.010 to provide personal care services, intermittent nursing services, and medication administration services, and the resident is housed in a private apartment-like unit.
     (4) "Boarding home" means a facility licensed under chapter 18.20 RCW.
     (5) "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.
     (6) "Department" means the department of social and health services.
     (7) "Enhanced adult residential care" means 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.010 to provide personal care services, intermittent nursing services, and medication administration services.
     (8) "Functionally disabled person" is synonymous with chronic functionally disabled and means a person who because of a recognized chronic physical or mental condition or disease, including chemical dependency, is impaired to the extent of being dependent upon others for direct care, support, supervision, or monitoring to perform activities of daily living. "Activities of daily living", in this context, means self-care abilities related to personal care such as bathing, eating, using the toilet, dressing, and transfer. Instrumental activities of daily living may also be used to assess a person's functional abilities as they are related to the mental capacity to perform activities in the home and the community such as cooking, shopping, house cleaning, doing laundry, working, and managing personal finances.
     (9) "Home and community services" means adult family homes, in-home services, and other services administered or provided by contract by the department directly or through contract with area agencies on aging or similar services provided by facilities and agencies licensed by the department.
     (10) "Long-term care" is synonymous with chronic care and means care and supports delivered indefinitely, intermittently, or over a sustained time to persons of any age disabled by chronic mental or physical illness, disease, chemical dependency, or a medical condition that is permanent, not reversible or curable, or is long-lasting and severely limits their mental or physical capacity for self-care. The use of this definition is not intended to expand the scope of services, care, or assistance by any individuals, groups, residential care settings, or professions unless otherwise expressed by law.
     (11) "Nursing home" means a facility licensed under chapter 18.51 RCW.
     (12) "Secretary" means the secretary of social and health services.
     (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. 15   RCW 74.39A.020 and 1995 1st sp.s. c 18 s 15 are each amended to read as follows:
     (1) To the extent of available funding, the department of social and health services may contract for adult residential care ((and enhanced adult residential care)).
     (2) The department shall, by rule, develop terms and conditions for facilities that contract with the department for adult residential care ((and enhanced adult residential care)) to establish:
     (a) Facility service standards consistent with the principles in RCW 74.39A.050 and consistent with chapter 70.129 RCW; and
     (b) Training requirements for providers and their staff.
     (3) The department shall, by rule, provide that services in adult residential care ((and enhanced adult residential care)) facilities:
     (a) Recognize individual needs, privacy, and autonomy;
     (b) Include personal care ((and limited nursing services)) and other services that promote independence and self-sufficiency and aging in place;
     (c) Are directed first to those persons most likely, in the absence of adult residential care ((and enhanced adult residential care)) services, to need hospital, nursing facility, or other out-of-home placement; and
     (d) Are provided in compliance with applicable facility and professional licensing laws and rules.
     (4) When a facility contracts with the department for adult residential care ((and enhanced adult residential care)), only services and facility standards that are provided to or in behalf of the adult residential care ((or the enhanced adult residential care)) client shall be subject to the adult residential care ((or enhanced adult residential care)) rules.
     (5) To the extent of available funding, the department may also contract under this section with a tribally licensed boarding home for the provision of services of the same nature as the services provided by adult residential care facilities. The provisions of subsections (2)(a) and (b) and (3)(a) through (d) of this section apply to such a contract.

NEW SECTION.  Sec. 16   A new section is added to chapter 42.17 RCW to read as follows:
     Data collected by the department of social and health services for the reports required by section 11 of this act and section 8, chapter 231, Laws of 2003, except as compiled in the aggregate and reported to the senate and house of representatives, is exempt from disclosure under this chapter.

Sec. 17   RCW 18.20.030 and 2003 c 231 s 3 are each amended to read as follows:
     (1) After January 1, 1958, no person shall operate or maintain a boarding home as defined in this chapter within this state without a license under this chapter.
     (2) A boarding home license is not required for the housing, or services, that are customarily provided under landlord tenant agreements governed by the residential landlord-tenant act, chapter 59.18 RCW, or when housing nonresident individuals who, without ongoing assistance from the boarding home, initiate and arrange for services provided by persons other than the boarding home licensee or the licensee's contractor. This subsection does not prohibit the licensee from furnishing written information concerning available community resources to the nonresident individual or the individual's family members or legal representatives. The licensee may not require the use of any particular service provider.
     (3) Residents receiving domiciliary care, directly or indirectly by the boarding home, are not considered nonresident individuals for the purposes of this section.
     (4) A boarding home license is required when any person other than an outside service provider, under section 10 of this act, or family member:
     (a) Assumes general responsibility for the safety and well-being of a resident;
     (b) Provides assistance with activities of daily living, either directly or indirectly;
     (c) Provides health support services, either directly or indirectly; or
     (d) Provides intermittent nursing services, either directly or indirectly.
     (5) A boarding home license is not required for ((emergency assistance when that emergency assistance is not provided on a frequent or routine basis to any one nonresident individual and the nonresident individual resides in independent senior housing, independent living units in continuing care retirement communities, independent living units having common ownership with a licensed boarding home, or other similar living situations including those subsidized by the department of housing and urban development)) one or more of the following services that may be provided to a nonresident individual: (a) Emergency assistance provided on an intermittent or nonroutine basis to any nonresident individual; (b) systems employed by independent senior housing, or independent living units in continuing care retirement communities, to respond to the potential need for emergency services for nonresident individuals; (c) infrequent, voluntary, and nonscheduled blood pressure checks for nonresident individuals; (d) nurse referral services provided at the request of a nonresident individual to determine whether referral to an outside health care provider is recommended; (e) making health care appointments at the request of nonresident individuals; (f) preadmission assessment, at the request of the nonresident individual, for the purposes of transitioning to a licensed care setting; or (g) services customarily provided under landlord tenant agreements governed by the residential landlord-tenant act, chapter 59.18 RCW. The preceding services may not include continual care or supervision of a nonresident individual without a boarding home license.

NEW SECTION.  Sec. 18   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 1 through 10 and 12 of this act take effect September 1, 2004.

NEW SECTION.  Sec. 19   The department of social and health services shall adopt rules by September 1, 2004, for the implementation of sections 1 through 10 and 12 of this act.