BILL REQ. #:  Z-0199.4 

Read first time 01/25/11.   Referred to Committee on Ways & Means.

     AN ACT Relating to implementation of long-term care worker requirements regarding background checks and training; amending RCW 18.88B.020, 18.88B.030, 18.88B.040, 18.88B.050, 74.39A.050, 74.39A.055, 74.39A.073, 74.39A.075, 74.39A.085, 74.39A.260, 74.39A.330, 74.39A.340, and 74.39A.350; and declaring an emergency.

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

Sec. 1   RCW 18.88B.020 and 2009 c 580 s 18 are each amended to read as follows:
     (1) Effective January 1, ((2011)) 2014, except as provided in RCW 18.88B.040, the department of health shall require that any person hired as a long-term care worker for the elderly or persons with disabilities must be certified as a home care aide within one hundred fifty days from the date of being hired.
     (2) Except as provided in RCW 18.88B.040, certification as a home care aide requires both completion of seventy-five hours of training and successful completion of a certification examination pursuant to RCW 74.39A.073 and 18.88B.030.
     (3) No person may practice or, by use of any title or description, represent himself or herself as a certified home care aide without being certified pursuant to this chapter.
     (4) The department of health shall adopt rules by August 1, ((2010)) 2013, to implement this section.

Sec. 2   RCW 18.88B.030 and 2009 c 580 s 4 are each amended to read as follows:
     (1) Effective January 1, ((2011)) 2014, except as provided in RCW 18.88B.040, the department of health shall require that all long-term care workers successfully complete a certification examination. Any long-term care worker failing to make the required grade for the examination will not be certified as a home care aide.
     (2) The department of health, in consultation with consumer and worker representatives, shall develop a home care aide certification examination to evaluate whether an applicant possesses the skills and knowledge necessary to practice competently. Unless excluded by RCW 18.88B.040 (1) and (2), only those who have completed the training requirements in RCW 74.39A.073 shall be eligible to sit for this examination.
     (3) The examination shall include both a skills demonstration and a written or oral knowledge test. The examination papers, all grading of the papers, and records related to the grading of skills demonstration shall be preserved for a period of not less than one year. The department of health shall establish rules governing the number of times and under what circumstances individuals who have failed the examination may sit for the examination, including whether any intermediate remedial steps should be required.
     (4) All examinations shall be conducted by fair and wholly impartial methods. The certification examination shall be administered and evaluated by the department of health or by a contractor to the department of health that is neither an employer of long-term care workers or private contractors providing training services under this chapter.
     (5) The department of health has the authority to:
     (a) Establish forms, procedures, and examinations necessary to certify home care aides pursuant to this chapter;
     (b) Hire clerical, administrative, and investigative staff as needed to implement this section;
     (c) Issue certification as a home care aide to any applicant who has successfully completed the home care aide examination;
     (d) Maintain the official record of all applicants and persons with certificates;
     (e) Exercise disciplinary authority as authorized in chapter 18.130 RCW; and
     (f) Deny certification to applicants who do not meet training, competency examination, and conduct requirements for certification.
     (6) The department of health shall adopt rules by August 1, ((2010)) 2013, that establish the procedures, including criteria for reviewing an applicant's state and federal background checks, and examinations necessary to carry this section into effect.

Sec. 3   RCW 18.88B.040 and 2010 c 169 s 11 are each amended to read as follows:
     The following long-term care workers are not required to become a certified home care aide pursuant to this chapter.
     (1) Registered nurses, licensed practical nurses, certified nursing assistants or persons who are in an approved training program for certified nursing assistants under chapter 18.88A RCW, medicare-certified home health aides, or other persons who hold a similar health credential, as determined by the secretary of health, or persons with special education training and an endorsement granted by the superintendent of public instruction, as described in RCW 28A.300.010, if the secretary of health determines that the circumstances do not require certification. After December 31, 2013, individuals exempted by this subsection may obtain certification as a home care aide from the department of health without fulfilling the training requirements in RCW 74.39A.073 but must successfully complete a certification examination pursuant to RCW 18.88B.030.
     (2) A person already employed as a long-term care worker prior to January 1, ((2011)) 2014, who completes all of his or her training requirements in effect as of the date he or she was hired, is not required to obtain certification. After December 31, 2013, individuals exempted by this subsection may obtain certification as a home care aide from the department of health without fulfilling the training requirements in RCW 74.39A.073 but must successfully complete a certification examination pursuant to RCW 18.88B.030.
     (3) All long-term care workers employed by supported living providers are not required to obtain certification under this chapter.
     (4) An individual provider caring only for his or her biological, step, or adoptive child or parent is not required to obtain certification under this chapter.
     (5) ((Prior to June 30, 2014, a person hired as an individual provider who provides twenty hours or less of care for one person in any calendar month is not required to obtain certification under this chapter.
     (6))) A long-term care worker exempted by this section from the training requirements contained in RCW 74.39A.073 may not be prohibited from enrolling in training pursuant to that section.
     (((7))) (6) The department of health shall adopt rules by August 1, ((2010)) 2013, to implement this section.

Sec. 4   RCW 18.88B.050 and 2009 c 580 s 17 are each amended to read as follows:
     (1) The uniform disciplinary act, chapter 18.130 RCW, governs uncertified practice, issuance of certificates, and the discipline of persons with certificates under this chapter. The secretary of health shall be the disciplinary authority under this chapter.
     (2) The secretary of health may take action to immediately suspend the certification of a long-term care worker upon finding that conduct of the long-term care worker has caused or presents an imminent threat of harm to a functionally disabled person in his or her care.
     (3) If the secretary of health imposes suspension or conditions for continuation of certification, the suspension or conditions for continuation are effective immediately upon notice and shall continue in effect pending the outcome of any hearing.
     (4) The department of health shall take appropriate enforcement action related to the licensure of a private agency or facility licensed by the state, to provide personal care services, other than an individual provider, who knowingly employs a long-term care worker who is not a certified home care aide as required under this chapter or, if exempted from certification by RCW 18.88B.040, has not completed his or her required training pursuant to this chapter.
     (5) Chapter 34.05 RCW shall govern actions by the department of health under this section.
     (6) The department of health shall adopt rules by August 1, ((2010)) 2013, to implement this section.

Sec. 5   RCW 74.39A.050 and 2009 c 580 s 7 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) All long-term care workers shall 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. Long-term care workers who are hired after January 1, ((2012)) 2014, are subject to background checks under RCW 74.39A.055. This information will be shared with the department of health in accordance with RCW 74.39A.055 to advance the purposes of chapter 2, Laws of 2009.
     (8) No provider, or its staff, or long-term care worker, or prospective provider or long-term care worker, 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 long-term care workers 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. This information will also be shared with the department of health to advance the purposes of chapter 2, Laws of 2009.
     (10) Until December 31, ((2010)) 2013, 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. 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) Until December 31, ((2010)) 2013, 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.
     (13) The department shall establish, by rule, background checks and other quality assurance requirements for long-term care workers 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. Long-term care workers who are hired after January 1, ((2012)) 2014, are subject to background checks under RCW 74.39A.055.
     (14) 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. 6   RCW 74.39A.055 and 2009 c 580 s 2 are each amended to read as follows:
     (1) All long-term care workers for the elderly or persons with disabilities hired after January 1, ((2012)) 2014, shall be screened through state and federal 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. These background checks shall include checking against the federal bureau of investigation fingerprint identification records system and against the national sex offenders registry or their successor programs. The department shall require these long-term care workers to submit fingerprints for the purpose of investigating conviction records through both the Washington state patrol and the federal bureau of investigation.
     (2) To allow the department of health to satisfy its certification responsibilities under chapter 18.88B RCW, the department shall share state and federal background check results with the department of health. Neither department may share the federal background check results with any other state agency or person.
     (3) The department shall not pass on the cost of these criminal background checks to the workers or their employers.
     (4) The department shall adopt rules to implement the provisions of this section by August 1, ((2010)) 2013.

Sec. 7   RCW 74.39A.073 and 2009 c 580 s 10 are each amended to read as follows:
     (1) Effective January 1, ((2011)) 2014, except as provided in RCW 18.88B.040, all persons employed as long-term care workers for the elderly or persons with disabilities must meet the minimum training requirements in this section within one hundred twenty calendar days of employment.
     (2) All persons employed as long-term care workers must obtain seventy-five hours of entry-level training approved by the department. A long-term care worker must accomplish five of these seventy-five hours before becoming eligible to provide care.
     (3) Training required by subsection (4)(c) of this section will be applied towards training required under RCW 18.20.270 or 70.128.230 as well as any statutory or regulatory training requirements for long-term care workers employed by supportive living providers.
     (4) Only training curriculum approved by the department may be used to fulfill the training requirements specified in this section. The seventy-five hours of entry-level training required shall be as follows:
     (a) Before a long-term care worker is eligible to provide care, he or she must complete two hours of orientation training regarding his or her role as caregiver and the applicable terms of employment;
     (b) Before a long-term care worker is eligible to provide care, he or she must complete three hours of safety training, including basic safety precautions, emergency procedures, and infection control; and
     (c) All long-term care workers must complete seventy hours of long-term care basic training, including training related to core competencies and population specific competencies.
     (5) The department shall only approve training curriculum that:
     (a) Has been developed with input from consumer and worker representatives; and
     (b) Requires comprehensive instruction by qualified instructors on the competencies and training topics in this section.
     (6) Individual providers under RCW 74.39A.270 shall be compensated for training time required by this section.
     (7) The department of health shall adopt rules by August 1, ((2010)) 2013, to implement subsections (1), (2), and (3) of this section.
     (8) The department shall adopt rules by August 1, ((2010)) 2013, to implement subsections (4) and (5) of this section.

Sec. 8   RCW 74.39A.075 and 2009 c 580 s 11 are each amended to read as follows:
     (1) Effective January 1, ((2011)) 2014, a biological, step, or adoptive parent who is the individual provider only for his or her developmentally disabled son or daughter must receive twelve hours of training relevant to the needs of adults with developmental disabilities within the first one hundred twenty days of becoming an individual provider.
     (2) Effective January 1, ((2011)) 2014, individual providers identified in (((a) and (b) of)) this subsection must complete thirty-five hours of training within the first one hundred twenty days of becoming an individual provider. Five of the thirty-five hours must be completed before becoming eligible to provide care. Two of these five hours shall be devoted to an orientation training regarding an individual provider's role as caregiver and the applicable terms of employment, and three hours shall be devoted to safety training, including basic safety precautions, emergency procedures, and infection control. Individual providers subject to this requirement include((:
     (a))) an individual provider caring only for his or her biological, step, or adoptive child or parent unless covered by subsection (1) of this section((; and
     (b) Before January 1, 2014, a person hired as an individual provider who provides twenty hours or less of care for one person in any calendar month)).
     (3) Only training curriculum approved by the department may be used to fulfill the training requirements specified in this section. The department shall only approve training curriculum that:
     (a) Has been developed with input from consumer and worker representatives; and
     (b) Requires comprehensive instruction by qualified instructors.
     (4) The department shall adopt rules by August 1, ((2010)) 2013, to implement this section.

Sec. 9   RCW 74.39A.085 and 2009 c 580 s 14 are each amended to read as follows:
     (1) The department shall deny payment to any individual provider of home care services who has not been certified by the department of health as a home care aide as required under chapter 2, Laws of 2009 or, if exempted from certification by RCW 18.88B.040, has not completed his or her required training pursuant to chapter 2, Laws of 2009.
     (2) The department may terminate the contract of any individual provider of home care services, or take any other enforcement measure deemed appropriate by the department if the individual provider's certification is revoked under chapter 2, Laws of 2009 or, if exempted from certification by RCW 18.88B.040, has not completed his or her required training pursuant to chapter 2, Laws of 2009.
     (3) The department shall take appropriate enforcement action related to the contract of a private agency or facility licensed by the state, to provide personal care services, other than an individual provider, who knowingly employs a long-term care worker who is not a certified home care aide as required under chapter 2, Laws of 2009 or, if exempted from certification by RCW 18.88B.040, has not completed his or her required training pursuant to chapter 2, Laws of 2009.
     (4) Chapter 34.05 RCW shall govern actions by the department under this section.
     (5) The department shall adopt rules by August 1, ((2010)) 2013, to implement this section.

Sec. 10   RCW 74.39A.260 and 2009 c 580 s 9 are each amended to read as follows:
     The department must perform criminal background checks for individual providers and prospective individual providers and ensure that the authority has ready access to any long-term care abuse and neglect registry used by the department. Individual providers who are hired after January 1, ((2012)) 2014, are subject to background checks under RCW 74.39A.055.

Sec. 11   RCW 74.39A.330 and 2009 c 478 s 1 are each amended to read as follows:
     Long-term care workers shall be offered on-the-job training or peer mentorship for at least one hour per week in the first ninety days of work from a long-term care worker who has completed at least twelve hours of mentor training and is mentoring no more than ten other workers at any given time. This requirement applies to long-term care workers who begin work on or after ((July 1, 2011)) January 1, 2014.

Sec. 12   RCW 74.39A.340 and 2009 c 580 s 12 are each amended to read as follows:
     (1) The department of health shall ensure that all long-term care workers shall complete twelve hours of continuing education training in advanced training topics each year. This requirement applies beginning on July 1, ((2011)) 2014.
     (2) Completion of continuing education as required in this section is a prerequisite to maintaining home care aide certification under chapter 2, Laws of 2009.
     (3) Unless voluntarily certified as a home care aide under chapter 2, Laws of 2009, subsection (1) of this section does not apply to((:
     (a))) an individual provider caring only for his or her biological, step, or adoptive child((; and
     (b) Before June 30, 2014, a person hired as an individual provider who provides twenty hours or less of care for one person in any calendar month)).
     (4) Only training curriculum approved by the department may be used to fulfill the training requirements specified in this section. The department shall only approve training curriculum that:
     (a) Has been developed with input from consumer and worker representatives; and
     (b) Requires comprehensive instruction by qualified instructors.
     (5) Individual providers under RCW 74.39A.270 shall be compensated for training time required by this section.
     (6) The department of health shall adopt rules by August 1, ((2010)) 2013, to implement subsections (1), (2), and (3) of this section.
     (7) The department shall adopt rules by August 1, ((2010)) 2013, to implement subsection (4) of this section.

Sec. 13   RCW 74.39A.350 and 2009 c 580 s 13 are each amended to read as follows:
     The department shall offer, directly or through contract, training opportunities sufficient for a long-term care worker to accumulate seventy hours of training within a reasonable time period. For individual providers represented by an exclusive bargaining representative under RCW 74.39A.270, the training opportunities shall be offered through the training partnership established under RCW 74.39A.360. Training topics shall include, but are not limited to: Client rights; personal care; mental illness; dementia; developmental disabilities; depression; medication assistance; advanced communication skills; positive client behavior support; developing or improving client-centered activities; dealing with wandering or aggressive client behaviors; medical conditions; nurse delegation core training; peer mentor training; and advocacy for quality care training. The department may not require long-term care workers to obtain the training described in this section. This requirement to offer advanced training applies beginning January 1, ((2012)) 2014.

NEW SECTION.  Sec. 14   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.