BILL REQ. #:  H-4239.2 

Read first time 01/15/08.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to required basic training and certification of long-term care workers; amending RCW 74.39A.009, 74.39A.360, 74.39A.050, 70.128.230, and 18.20.270; adding new sections to chapter 74.39A RCW; adding a new section to chapter 18.88A RCW; creating a new section; and repealing RCW 18.20.230, and 70.128.210.

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

NEW SECTION.  Sec. 1   (1) The legislature finds that:
     (a) An underlying premise of Washington's long-term care system is the value of consumer choice across a full continuum of care with the right to accessible, quality care;
     (b) The level and content of basic training should be focused upon the client with respect to client care needs, health status, choice, and flexibility;
     (c) An appropriately trained and motivated long-term care workforce contributes to the quality of long-term care services;
     (d) There is a need for increased workforce diversity throughout the long-term care system;
     (e) Long-term care worker training should acknowledge cultural diversity and strive to achieve a greater understanding of the relationships between culture and health;
     (f) The long-term care workforce has diverse work-life expectations such as career advancement and quality job performance;
     (g) The long-term care workforce has variable learning styles, and can benefit from flexibility in training settings, modalities, accessibility, and methods;
     (h) Long-term care training should prepare workers and caregivers to perform in as many long-term care settings as possible with economic security and safety, but also should accommodate the interests of those workers who intend to care exclusively for their family members;
     (i) The care and support provided by unpaid long-term caregivers should not be disrupted, but enhanced and stabilized by any changes to long-term care training and certification; and
     (j) The long-term care workforce should be increased and enhanced to meet current and future needs. New policies and requirements should not result in decreasing the available workforce or the services available to consumers.
     (2) The legislature intends to establish long-term care worker training standards that are consistent with the findings of subsection (1) of this section.

Sec. 2   RCW 74.39A.009 and 2007 c 361 s 2 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" or "person who is functionally disabled" 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)(a) "Long-term care workers" includes all persons who are paid long-term care workers for ((the elderly or)) persons with functional disabilities, including but not limited to individual providers of home care services, direct care employees of home care agencies, providers of home care services to persons with developmental disabilities under Title 71 RCW, all direct care workers in state-licensed boarding homes, assisted living facilities, and adult family homes, respite care providers, community residential service providers, and any other direct care worker providing home or community-based services to the elderly or persons with functional disabilities or developmental disabilities.
     (b) "Long-term care workers" do not include persons employed in nursing homes subject to chapter 18.51 RCW, hospitals or other acute care settings, hospice agencies subject to chapter 70.127 RCW, adult day care centers, and adult day health care centers.
     (12) "Nursing home" means a facility licensed under chapter 18.51 RCW.
     (13) "Secretary" means the secretary of social and health services.
     (14) "Training partnership" means a joint partnership or trust established and maintained jointly by the office of the governor and the exclusive bargaining representative of individual providers under RCW 74.39A.270 to provide training, peer mentoring, and examinations required under this chapter, and educational, career development, or other services to individual providers.
     (15) "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.

NEW SECTION.  Sec. 3   A new section is added to chapter 74.39A RCW to read as follows:
     (1) Except to the extent provided otherwise in subsection (9) of this section, long-term care workers must meet the basic training requirements established in this section. Training standards and the delivery system shall be relevant to the varied needs of individuals served by long-term care workers, and shall be sufficient to ensure that long-term care workers have the skills and knowledge necessary to provide high quality, appropriate care in a manner that respects each individual's preferences.
     (2)(a) Basic training shall include two components:
     (i) Thirty-five hours of classroom training. In an effort to improve the quality of training, increase access to training, and reduce costs, especially for rural communities, the coordinated system of long-term care training and education should include:
     (A) The use of innovative learning strategies such as internet resources, videotapes, and distance learning using satellite technology coordinated through community colleges or other entities, as defined by the department; and
     (B) The use of varied adult learner strategies, such as opportunities to practice or demonstrate skills, role playing, and group discussions.
     (ii) Fifty hours of experiential training. In an effort to improve the quality of training, increase access to training, and reduce costs, the department shall allow, and the training partnership shall accommodate, significant flexibility in defining experiential training. Experiential training should include but not be limited to hours individual providers spend with mentors under RCW 74.39A.330, hours spent being trained by the individual to whom a worker is providing care regarding the individual's caregiving preferences and needs, on- the-job training provided by the worker's employer, and attendance at relevant conferences. The department shall adopt experiential training standards in rule to address the integrity and quality of the training, and to verify participation in experiential training.
     (b) Training required under RCW 18.20.270(5) and 70.128.230(5) shall count toward the eighty-five hours of training required under this subsection.
     (3) Required basic training consists of modules on the knowledge and competencies that caregivers need to learn and understand to effectively and safely provide care to functionally disabled persons. Training must consist of:
     (a) A set of core competencies that all long-term care workers must complete. Core competencies consist of competencies and knowledge necessary to meet the needs of, and safely care for, any individual who requires personal care services. Core training modules must include worker orientation, which must consist of introductory information on residents' rights, communication skills, fire and life safety, and universal precautions; and
     (b) Additional population or setting specific competencies that allow long-term care workers to acquire competencies unique to the individuals they will be serving or the care setting in which they will be working.
     (4) Required basic training must be completed by long-term care workers within one hundred twenty days of the date on which they begin to provide hands-on care. Long-term care worker orientation under subsection (3)(a) of this section must be completed by all long-term care workers before the worker has routine interaction with the individual or individuals they will be caring for.
     (5) Required basic training must be outcome-based, and the effectiveness of the training must be measured through the use of a competency test.
     (6) As specified by the department in rule, the following persons are fully or partially exempt from the training requirements of this section:
     (a) Registered nurses, licensed practical nurses, certified nursing assistants, medicare certified home health aides, or persons who hold a similar health certification or license. However, these individuals must complete worker orientation training as described in subsection (3)(a) of this section;
     (b) Persons who successfully challenge the competency test for required basic training. However, these individuals must complete worker orientation training as described in subsection (3)(a) of this section; and
     (c) Long-term care workers employed by supportive living providers regulated under chapter 388-101 WAC who are subject to the training required in WAC 388-101-1680. If the supportive living staff training requirements included in chapter 388-101 WAC as of the effective date of this act are reduced to eighty-five hours or less, the requirements of this section shall apply to long-term care workers employed by supportive living programs.
     (7) The department shall develop criteria for the approval of training programs. Only training curricula approved by the department may be used to fulfill the requirements of this section. Boarding homes, adult family homes, home care agencies, or other entities employing long-term care workers that desire to deliver facility or agency-based training with facility or agency designated trainers, or facilities and agencies that desire to pool their resources to create shared training systems, must be encouraged by the department in their efforts. The department shall develop criteria for reviewing and approving trainers and training materials that are substantially similar to or better than the materials developed by the department. The department may approve a curriculum based upon attestation by a boarding home administrator, an adult family home provider or resident manager, or a home care agency administrator that the facility's or agency's training curriculum addresses required training competencies identified by the department, and shall review a curriculum to verify that it meets these requirements. The department, or the department of health as applicable, may conduct the review as part of the next regularly scheduled yearly inspection and investigation required under RCW 18.20.110, 70.128.090, or 70.127.100. The department shall rescind approval of any curriculum if it determines that the curriculum does not meet these requirements.
     (8)(a) The basic training requirements of this section commence January 1, 2010, or one hundred twenty days from the date of contracting or employment, whichever is later, and shall be applied to long-term care workers newly contracted or hired subsequent to January 1, 2010. Long-term care workers contracted or employed prior to January 1, 2010, must complete all training requirements in effect prior to that date.
     (b) If the department determines that administrative capacities essential to implementation of long-term care worker training requirements of this section will not be fully functional by January 1, 2010, the department may defer the implementation date of the training requirements to no later than July 1, 2010.
     (9)(a) Biological, step, or adoptive parents who are the individual provider for only their developmentally disabled son or daughter who is receiving services through the department's division of developmental disabilities; and persons who provide respite care on an intermittent basis to the developmentally disabled son or daughter of a biological, step, or adoptive parent who is an individual provider or who is an unpaid caregiver, must meet the basic training requirements established in this subsection. As used in this subsection, "intermittent basis" means care provided exclusively to one individual for not more than an average of sixteen hours per month.
     (b) Basic training must include twelve hours of training relevant to the needs of adults with developmental disabilities.

NEW SECTION.  Sec. 4   A new section is added to chapter 74.39A RCW to read as follows:
     (1) Except to the extent provided otherwise in subsection (5) of this section, after January 1, 2010, all long-term care workers must obtain certification by the department within one hundred eighty days of employment. This section does not apply to persons already contracted or employed as long-term care workers prior to January 1, 2010.
     (2) A long-term care worker may provide direct, hands-on personal care and other assistance services to persons with functional disabilities requiring long-term care services. Personal care services include assistance with eating, bathing, dressing, and other activities of daily living.
     (3) The department has the authority to:
     (a) Set certification and renewal fees;
     (b) Establish forms, procedures, and examinations necessary to certify long-term care workers pursuant to this chapter;
     (c) Hire clerical, administrative, and investigative staff as needed to implement this section;
     (d) Issue a certificate to any applicant who has met the training, background check, and certification examination requirements of this chapter; and
     (e) Maintain the official record of all applicants and persons with certificates.
     (4)(a) The certification requirement of this section commences January 1, 2010, or one hundred eighty days from the date of initial contracting or employment, whichever is later, and shall be applied to long-term care workers contracted or hired subsequent to January 1, 2010.
     (b) If the department determines that administrative capacities essential to implementation of long-term care worker certification will not be fully functional by January 1, 2010, the department may defer the implementation date of certification to no later than July 1, 2010.
     (5) Long-term care workers who are caring exclusively for a family member and intermittent respite providers described in section 3(9) of this act, are exempt from the requirement to obtain certification as a long-term care worker. For purposes of this section, "family member" means a biological parent, grandparent, sibling, aunt, or uncle, or a parent, grandparent, sibling, aunt, or uncle related by marriage or adoption.

NEW SECTION.  Sec. 5   A new section is added to chapter 74.39A RCW to read as follows:
     (1) The department shall develop a long-term care worker certification examination to evaluate whether applicants possess the minimum skills and knowledge necessary to practice competently. Only those who have completed the training requirements or have had those requirements waived pursuant to section 3(6) of this act shall be eligible to sit for this examination.
     (2) The examination shall include both a skills demonstration and a written or oral knowledge test. Examinations shall be limited to the purpose of determining whether the applicant possesses the minimum skill and knowledge necessary to practice competently.
     (3) The examination papers, all grading of the papers, and the grading of skills demonstration shall be preserved for a period of at least one year. All examinations shall be conducted under fair and wholly impartial methods.
     (4) The certification exam shall be administered and evaluated by the department or by contractor to the department that is neither an employer of long-term care workers or a private contractor providing training services under this act.

NEW SECTION.  Sec. 6   A new section is added to chapter 74.39A RCW to read as follows:
     (1) The department shall deny payment to any individual provider of home care services who does not complete the training requirements or obtain certification as a long-term care worker within the time limit specified in this chapter.
     (2) The department may deny certification to an applicant who does not meet training, background check, or competency examination requirements for certification.
     (3) The department may revoke the certification of any long-term care worker, terminate the contract of any individual provider of home care services, or take any other enforcement measure deemed appropriate by the department upon a finding of unprofessional conduct, as defined in RCW 18.130.180. For purposes of this act, the department shall be considered the disciplining authority.
     (4) The department may take action to immediately suspend the certification of a long-term care worker, or immediately terminate the contract of an individual provider of home care services, upon finding that conduct of the long-term care worker or individual provider has caused or presents an imminent threat of harm to a functionally disabled person in their care.
     (5) The department shall take appropriate enforcement action related to the contract or licensure of a provider of home and community-based services, other than an individual provider, who knowingly employs a long-term care worker who has failed to complete the training requirements or obtain certification as a long-term care worker within the time limits specified in this act.
     (6) Chapter 34.05 RCW shall govern department actions under this section, except that orders of the department imposing certificate suspension or conditions for continuation of a certificate are effective immediately upon notice and shall continue in effect pending any hearing.

NEW SECTION.  Sec. 7   A new section is added to chapter 74.39A RCW to read as follows:
     The department shall adopt rules by September 1, 2009, necessary to implement the training, certification, and enforcement provisions of this act. In developing rules, the department shall consult with the department of health, the nursing care quality assurance commission, adult family home providers, boarding home providers, in-home personal care providers, affected labor organizations, community and technical colleges, and long-term care consumers and other interested organizations.

NEW SECTION.  Sec. 8   A new section is added to chapter 18.88A RCW to read as follows:
     By January 1, 2010, the department shall develop, in consultation with the nursing care quality assurance commission and consumer and worker representatives, rules permitting reciprocity to the maximum extent possible under federal law between long-term care worker certification and nursing assistant certification.

Sec. 9   RCW 74.39A.360 and 2007 c 361 s 6 are each amended to read as follows:
     (1) Beginning January 1, 2010, for individual providers represented by an exclusive bargaining representative under RCW 74.39A.270, all training and peer mentoring required under this chapter shall be provided by a training partnership. Contributions to the partnership pursuant to a collective bargaining agreement negotiated under this chapter shall be made beginning July 1, 2009. The training partnership shall provide reports as required by the department verifying that all individual providers have complied with all training requirements. The exclusive bargaining representative shall designate the training partnership.
     (2) The training partnership shall offer persons who are acting as unpaid informal caregivers for family members or friends the opportunity to attend up to ten hours per year of training offered through the partnership at no cost to the individual caregiver or the state. Attendance opportunities may be limited to the extent that:
     (a) There is fixed maximum seating or participation capacity for a training module that satisfies long-term care worker basic training or continuing education requirements under this chapter; and
     (b) The maximum capacity for a particular training module is reserved twenty-four hours in advance of the scheduled date and time of the module.

Sec. 10   RCW 74.39A.050 and 2004 c 140 s 6 are each amended to read as follows:
     The department's system of quality improvement for long-term care services shall use the following principles, consistent with applicable federal laws and regulations:
     (1) The system shall be client-centered and promote privacy, independence, dignity, choice, and a home or home-like environment for consumers consistent with chapter 392, Laws of 1997.
     (2) The goal of the system is continuous quality improvement with the focus on consumer satisfaction and outcomes for consumers. This includes that when conducting licensing or contract inspections, the department shall interview an appropriate percentage of residents, family members, resident case managers, and advocates in addition to interviewing providers and staff.
     (3) Providers should be supported in their efforts to improve quality and address identified problems initially through training, consultation, 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 consumer complaints and based on a clear set of health, quality of care, and safety standards that are easily understandable and have been made available to providers, residents, and other interested parties.
     (6) Prompt and specific enforcement remedies shall also be implemented without delay, pursuant to RCW 74.39A.080, RCW 70.128.160, chapter 18.51 RCW, or chapter 74.42 RCW, for providers found to have delivered care or failed to deliver care resulting in problems that are serious, recurring, or uncorrected, or that create a hazard that is causing or likely to cause death or serious harm to one or more residents. These enforcement remedies may also include, when appropriate, reasonable conditions on a contract or license. In the selection of remedies, the safety, health, and well-being of residents shall be of paramount importance.
     (7) To the extent funding is available, all long-term care staff directly responsible for the care, supervision, or treatment of vulnerable persons should be screened through background checks in a uniform and timely manner to ensure that they do not have a criminal history that would disqualify them from working with vulnerable persons. Whenever a state conviction record check is required by state law, persons may be employed or engaged as volunteers or independent contractors on a conditional basis according to law and rules adopted by the department.
     (8) No provider or staff, or prospective provider or staff, with a stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into a state registry finding him or her guilty of abuse, neglect, exploitation, or abandonment of a minor or a vulnerable adult as defined in chapter 74.34 RCW shall be employed in the care of and have unsupervised access to vulnerable adults.
     (9) The department shall establish, by rule, a state registry which contains identifying information about personal care aides identified under this chapter who have substantiated findings of abuse, neglect, financial exploitation, or abandonment of a vulnerable adult as defined in RCW 74.34.020. The rule must include disclosure, disposition of findings, notification, findings of fact, appeal rights, and fair hearing requirements. The department shall disclose, upon request, substantiated findings of abuse, neglect, financial exploitation, or abandonment to any person so requesting this information.
     (10) ((The department shall by rule develop training requirements for individual providers and home care agency providers. Effective March 1, 2002, individual providers and home care agency providers must satisfactorily complete department-approved orientation, basic training, and continuing education within the time period specified by the department in rule. The department shall adopt rules by March 1, 2002, for the implementation of this section based on the recommendations of the community long-term care training and education steering committee established in RCW 74.39A.190. The department shall deny payment to an individual provider or a home care provider who does not complete the training requirements within the time limit specified by the department by rule.
     (11) In an effort to improve access to training and education and reduce costs, especially for rural communities, the coordinated system of long-term care training and education must include the use of innovative types of learning strategies such as internet resources, videotapes, and distance learning using satellite technology coordinated through community colleges or other entities, as defined by the department.
     (12) The department shall create an approval system by March 1, 2002, for those seeking to conduct department-approved training. In the rule-making process, the department shall adopt rules based on the recommendations of the community long-term care training and education steering committee established in RCW 74.39A.190.
     (13))) The department shall establish, by rule, ((training,)) background checks((,)) and other quality assurance requirements for personal aides who provide in-home services funded by medicaid personal care as described in RCW 74.09.520, community options program entry system waiver services as described in RCW 74.39A.030, or chore services as described in RCW 74.39A.110 that are equivalent to requirements for individual providers.
     (((14))) (11) Under existing funds the department shall establish internally a quality improvement standards committee to monitor the development of standards and to suggest modifications.
     (((15) Within existing funds, the department shall design, develop, and implement a long-term care training program that is flexible, relevant, and qualifies towards the requirements for a nursing assistant certificate as established under chapter 18.88A RCW. This subsection does not require completion of the nursing assistant certificate training program by providers or their staff. The long-term care teaching curriculum must consist of a fundamental module, or modules, and a range of other available relevant training modules that provide the caregiver with appropriate options that assist in meeting the resident's care needs. Some of the training modules may include, but are not limited to, specific training on the special care needs of persons with developmental disabilities, dementia, mental illness, and the care needs of the elderly. No less than one training module must be dedicated to workplace violence prevention. The nursing care quality assurance commission shall work together with the department to develop the curriculum modules. The nursing care quality assurance commission shall direct the nursing assistant training programs to accept some or all of the skills and competencies from the curriculum modules towards meeting the requirements for a nursing assistant certificate as defined in chapter 18.88A RCW. A process may be developed to test persons completing modules from a caregiver's class to verify that they have the transferable skills and competencies for entry into a nursing assistant training program. The department may review whether facilities can develop their own related long-term care training programs. The department may develop a review process for determining what previous experience and training may be used to waive some or all of the mandatory training. The department of social and health services and the nursing care quality assurance commission shall work together to develop an implementation plan by December 12, 1998.))

Sec. 11   RCW 70.128.230 and 2002 c 233 s 3 are each amended to read as follows:
     (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
     (a) "Caregiver" includes all adult family home resident managers and any ((person)) long-term care worker who provides residents with hands-on personal care on behalf of an adult family home, except volunteers who are directly supervised.
     (b) "Indirect supervision" means oversight by a person who has demonstrated competency in the core areas or has been fully exempted from the training requirements pursuant to this section and is quickly and easily available to the caregiver, but not necessarily on-site.
     (c) "Long-term care worker" has the same meaning as defined in RCW 74.39A.009(11).
     (2) Training must have three components: Orientation, basic training, and continuing education. All adult family home providers, resident managers, and employees, or volunteers who routinely interact with residents shall complete orientation. Caregivers shall complete orientation, basic training, and continuing education. Training of caregivers employed by adult family homes is governed by chapter 74.39A RCW. Any caregiver who has satisfied the training and competency testing requirements of section 3 of this act or the continuing education requirements of RCW 74.39A.340 shall be deemed to have satisfied the orientation, basic training, and continuing education requirements of this section.
     (3) Orientation consists of introductory information on residents' rights, communication skills, fire and life safety, and universal precautions. Orientation must be provided at the facility by appropriate adult family home staff to all adult family home employees before the employees have routine interaction with residents.
     (4) Basic training consists of modules on the core knowledge and skills that caregivers need to learn and understand to effectively and safely provide care to residents. Basic training must be outcome-based, and the effectiveness of the basic training must be measured by demonstrated competency in the core areas through the use of a competency test. ((Basic training must be completed by caregivers within one hundred twenty days of the date on which they begin to provide hands-on care or within one hundred twenty days of September 1, 2002, whichever is later.)) Until ((competency in the core areas has been demonstrated, caregivers)) a caregiver provides verification that he or she has satisfied the basic training requirements under section 3 of this act, a caregiver shall not provide hands-on personal care to residents without indirect supervision.
     (5) For adult family homes that serve residents with special needs such as dementia, developmental disabilities, or mental illness, specialty training is required of providers and resident managers. Specialty training consists of modules on the core knowledge and skills that providers and resident managers need to effectively and safely provide care to residents with special needs. Specialty training should be integrated into basic training wherever appropriate. Specialty training must be outcome-based, and the effectiveness of the specialty training measured by demonstrated competency in the core specialty areas through the use of a competency test. Specialty training must be completed by providers and resident managers before admitting and serving residents who have been determined to have special needs related to mental illness, dementia, or a developmental disability. Should a resident develop special needs while living in a home without specialty designation, the provider and resident manager have one hundred twenty days to complete specialty training. If training received by a caregiver under section 2 of this act involves core knowledge and skills to effectively and safely provide care to residents of the adult family home with special needs, the hours of training received by the caregiver shall apply toward meeting the specialty training requirements under this section.
     (6) ((Continuing education consists of ongoing delivery of information to caregivers on various topics relevant to the care setting and care needs of residents. Competency testing is not required for continuing education. Continuing education is not required in the same calendar year in which basic or modified basic training is successfully completed. Continuing education is required in each calendar year thereafter.)) If specialty training is completed, the specialty training applies toward any continuing education requirement for up to two years following the completion of the specialty training.
     (7) Persons who successfully challenge the competency test for basic training are fully exempt from the basic training requirements of this section. Persons who successfully challenge the specialty training competency test are fully exempt from the specialty training requirements of this section.
     (8) Licensed persons who perform the tasks for which they are licensed are fully or partially exempt from the training requirements of this section, as specified by the department in rule.
     (9) In an effort to improve access to training and education and reduce costs, especially for rural communities, the coordinated system of long-term care training and education must include the use of innovative types of learning strategies such as internet resources, videotapes, and distance learning using satellite technology coordinated through community colleges, private associations, or other entities, as defined by the department.
     (10) ((Adult family homes that desire to deliver facility-based training with facility designated trainers, or adult family homes that desire to pool their resources to create shared training systems, must be encouraged by the department in their efforts. The department shall develop criteria for reviewing and approving trainers and training materials. The department may approve a curriculum based upon attestation by an adult family home administrator that the adult family home's training curriculum addresses basic and specialty training competencies identified by the department, and shall review a curriculum to verify that it meets these requirements. The department may conduct the review as part of the next regularly scheduled inspection authorized under RCW 70.128.070. The department shall rescind approval of any curriculum if it determines that the curriculum does not meet these requirements.
     (11))) The department shall adopt rules by September 1, 2002, for the implementation of this section.
     (((12))) (11) The orientation, basic training, specialty training, and continuing education requirements of this section commence September 1, 2002, and shall be applied to (a) employees hired subsequent to September 1, 2002; or (b) existing employees that on September 1, 2002, have not successfully completed the training requirements under RCW 70.128.120 or 70.128.130 and this section. Existing employees who have not successfully completed the training requirements under RCW 70.128.120 or 70.128.130 shall be subject to all applicable requirements of this section. ((However, until September 1, 2002, nothing in this section affects the current training requirements under RCW 70.128.120 and 70.128.130.))

Sec. 12   RCW 18.20.270 and 2002 c 233 s 1 are each amended to read as follows:
     (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
     (a) "Caregiver" includes any ((person)) long-term care worker who provides residents with hands-on personal care on behalf of a boarding home, except volunteers who are directly supervised.
     (b) "Direct supervision" means oversight by a person who has demonstrated competency in the core areas or has been fully exempted from the training requirements pursuant to this section, is on the premises, and is quickly and easily available to the caregiver.
     (c) "Long-term care worker" has the same meaning as defined in RCW 74.39A.009(11).
     (2) Training must have the following components: Orientation, basic training, specialty training as appropriate, and continuing education. All boarding home employees or volunteers who routinely interact with residents shall complete orientation. Boarding home administrators, or their designees, and caregivers shall complete orientation, basic training, specialty training as appropriate, and continuing education. Training of caregivers employed by boarding homes is governed by chapter 74.39A RCW. Any caregiver who has satisfied the training and competency testing requirements of section 3 of this act or the continuing education requirements of RCW 74.39A.340 shall be deemed to have satisfied the orientation, basic training, and continuing education requirements of this section.
     (3) Orientation consists of introductory information on residents' rights, communication skills, fire and life safety, and universal precautions. Orientation must be provided at the facility by appropriate boarding home staff to all boarding home employees before the employees have routine interaction with residents.
     (4) Basic training consists of modules on the core knowledge and skills that caregivers need to learn and understand to effectively and safely provide care to residents. Basic training must be outcome-based, and the effectiveness of the basic training must be measured by demonstrated competency in the core areas through the use of a competency test. ((Basic training must be completed by caregivers within one hundred twenty days of the date on which they begin to provide hands-on care or within one hundred twenty days of September 1, 2002, whichever is later.)) Until ((competency in the core areas has been demonstrated, caregivers)) a caregiver provides verification that he or she has met the basic training requirements under section 3 of this act, a caregiver shall not provide hands-on personal care to residents without direct supervision. Boarding home administrators, or their designees, must complete basic training and demonstrate competency within one hundred twenty days of employment or within one hundred twenty days of September 1, 2002, whichever is later.
     (5) For boarding homes that serve residents with special needs such as dementia, developmental disabilities, or mental illness, specialty training is required of administrators, or designees, and caregivers. Specialty training consists of modules on the core knowledge and skills that caregivers need to effectively and safely provide care to residents with special needs. Specialty training should be integrated into basic training wherever appropriate. Specialty training must be outcome-based, and the effectiveness of the specialty training measured by demonstrated competency in the core specialty areas through the use of a competency test. Specialty training must be completed by caregivers within one hundred twenty days of the date on which they begin to provide hands-on care to a resident having special needs or within one hundred twenty days of September 1, 2002, whichever is later. However, if specialty training is not integrated with basic training, the specialty training must be completed within ninety days of completion of basic training. Until competency in the core specialty areas has been demonstrated, caregivers shall not provide hands-on personal care to residents with special needs without direct supervision. If training received by a caregiver under section 3 of this act involves core knowledge and skills to effectively and safely provide care to residents of the boarding home with special needs, the hours of training received by the caregiver shall apply toward meeting the specialty training requirements under this section. Boarding home administrators, or their designees, must complete specialty training and demonstrate competency within one hundred twenty days of September 1, 2002, or one hundred twenty days from the date on which the administrator or his or her designee is hired, whichever is later, if the boarding home serves one or more residents with special needs.
     (6) ((Continuing education consists of ongoing delivery of information to caregivers on various topics relevant to the care setting and care needs of residents. Competency testing is not required for continuing education. Continuing education is not required in the same calendar year in which basic or modified basic training is successfully completed. Continuing education is required in each calendar year thereafter.)) If specialty training is completed, the specialty training applies toward any continuing education requirement for up to two years following the completion of the specialty training.
     (7) Persons who successfully challenge the competency test for basic training are fully exempt from the basic training requirements of this section. Persons who successfully challenge the specialty training competency test are fully exempt from the specialty training requirements of this section.
     (8) Licensed persons who perform the tasks for which they are licensed are fully or partially exempt from the training requirements of this section, as specified by the department in rule.
     (9) In an effort to improve access to training and education and reduce costs, especially for rural communities, the coordinated system of long-term care training and education must include the use of innovative types of learning strategies such as internet resources, videotapes, and distance learning using satellite technology coordinated through community colleges or other entities, as defined by the department.
     (10) The department shall develop criteria for the approval of orientation, basic training, and specialty training programs.
     (11) ((Boarding homes that desire to deliver facility-based training with facility designated trainers, or boarding homes that desire to pool their resources to create shared training systems, must be encouraged by the department in their efforts. The department shall develop criteria for reviewing and approving trainers and training materials that are substantially similar to or better than the materials developed by the department. The department may approve a curriculum based upon attestation by a boarding home administrator that the boarding home's training curriculum addresses basic and specialty training competencies identified by the department, and shall review a curriculum to verify that it meets these requirements. The department may conduct the review as part of the next regularly scheduled yearly inspection and investigation required under RCW 18.20.110. The department shall rescind approval of any curriculum if it determines that the curriculum does not meet these requirements.
     (12) The department shall adopt rules by September 1, 2002, for the implementation of this section.
     (13))) The orientation, basic training, specialty training, and continuing education requirements of this section commence September 1, 2002, or one hundred twenty days from the date of employment, whichever is later, and shall be applied to (a) employees hired subsequent to September 1, 2002; and (b) existing employees that on September 1, 2002, have not successfully completed the training requirements under RCW 74.39A.010 or 74.39A.020 and this section. Existing employees who have not successfully completed the training requirements under RCW 74.39A.010 or 74.39A.020 shall be subject to all applicable requirements of this section. ((However, prior to September 1, 2002, nothing in this section affects the current training requirements under RCW 74.39A.010.))

NEW SECTION.  Sec. 13   The following acts or parts of acts are each repealed:
     (1) RCW 18.20.230 (Training standards review -- Proposed enhancements) and 1999 c 372 s 3 & 1998 c 272 s 2; and
     (2) RCW 70.128.210 (Training standards review -- Delivery system--Issues reviewed -- Report to the legislature) and 1998 c 272 s 3.