BILL REQ. #: H-3292.3
| State of Washington | 62nd Legislature | 2012 Regular Session |
Read first time 01/11/12. Referred to Committee on Health Care & Wellness.
AN ACT Relating to implementing revisions to long-term care services without delaying the start of the long-term care worker minimum training or certification requirements in Initiative Measure No. 1163 beyond January 7, 2012, reducing those requirements, or, except for long-term care workers employed by community residential service businesses, exempting additional workers from those requirements; amending RCW 18.88B.010, 74.39A.009, 18.88B.021, 18.88B.041, 18.88B.031, 74.39A.074, 74.39A.076, 74.39A.331, 74.39A.351, 74.39A.341, 18.79.260, 74.39A.261, 74.39A.056, 18.20.125, 43.20A.710, 43.43.837, 18.88B.050, 74.39A.086, 74.39A.051, 18.20.270, 70.128.230, and 41.56.030; amending 2012 c 1 ss 201 and 303 (uncodified); reenacting and amending RCW 74.39A.095; adding new sections to chapter 18.88B RCW; creating a new section; repealing RCW 74.39A.240; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 101 The legislature finds that numerous
enactments and amendments to long-term care services statutes over many
years have resulted in duplicated provisions, ambiguities, and other
technical errors. The legislature intends to make corrections and
clarify provisions governing services by long-term care workers.
Sec. 201 RCW 18.88B.010 and 2009 c 2 s 17 are each amended to
read as follows:
The definitions in ((RCW 74.39A.009)) this section apply throughout
this chapter unless the context clearly requires otherwise.
(1) "Community residential service business" has the same meaning
as defined in RCW 74.39A.009.
(2) "Department" means the department of health.
(3) "Home care aide" means a person certified under this chapter.
(4) "Personal care services" has the same meaning as defined in RCW
74.39A.009.
(5) "Secretary" means the secretary of the department of health.
(6) "Long-term care worker" has the same meaning as defined in RCW
74.39A.009.
Sec. 202 RCW 74.39A.009 and 2009 c 580 s 1 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) "Community residential service business" means a business that:
(a) Is licensed or certified by the department of social and health
services to provide to individuals who have a developmental disability
as defined in RCW 71A.10.020(4):
(i) Group home services;
(ii) Group training home services;
(iii) Supported living services; or
(iv) Voluntary placement services provided in a licensed staff
residential facility for children; and
(b) Has a contract with the division of developmental disabilities
to provide the services identified in (a) of this subsection.
(6) "Core competencies" means basic training topics, including but
not limited to, communication skills, worker self-care, problem
solving, maintaining dignity, consumer directed care, cultural
sensitivity, body mechanics, fall prevention, skin and body care, long-term care worker roles and boundaries, supporting activities of daily
living, and food preparation and handling.
(((6))) (7) "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.
(((7))) (8) "Department" means the department of social and health
services.
(((8))) (9) "Developmental disability" has the same meaning as
defined in RCW 71A.10.020.
(((9))) (10) "Direct care worker" means a paid caregiver who
provides direct, hands-on personal care services to persons with
disabilities or the elderly requiring long-term care.
(((10))) (11) "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.
(((11))) (12) "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, or developmental disability, 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.
(((12))) (13) "Home and community-based 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.
(((13))) (14) "Home care aide" means a long-term care worker who
has obtained certification as a home care aide by the department of
health.
(((14))) (15) "Individual provider" ((is defined according to RCW
74.39A.240)) means a person, including a personal aide, who has
contracted with the department to provide personal care or respite care
services to functionally disabled persons under the medicaid personal
care, community options program entry system, chore services program,
or respite care program, or to provide respite care or residential
services and support to persons with developmental disabilities under
chapter 71A.12 RCW, or to provide respite care as defined in RCW
74.13.270.
(((15))) (16) "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.
(((16))) (17)(a) "Long-term care workers ((for the elderly or
persons with disabilities" or "long-term care workers))" include((s))
all persons who ((are long-term care workers)) provide paid, hands-on
personal care services for the elderly or persons with disabilities,
including but not limited to individual providers of home care
services, direct care ((employees of)) workers employed by home care
agencies, providers of home care services to persons with developmental
disabilities under Title 71A RCW, all direct care workers in
state-licensed boarding homes, assisted living facilities, and adult
family homes, respite care providers, direct care workers employed by
community residential service ((providers)) businesses, 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: (i) Persons employed
by the following facilities or agencies: Nursing homes subject to
chapter 18.51 RCW, hospitals or other acute care settings, residential
habilitation centers under chapter 71A.20 RCW, facilities certified
under 42 C.F.R., Part 483, hospice agencies subject to chapter 70.127
RCW, adult day care centers, and adult day health care centers; or (ii)
persons who are not paid by the state or by a private agency or
facility licensed by the state to provide personal care services.
(((17))) (18) "Nursing home" means a facility licensed under
chapter 18.51 RCW.
(((18))) (19) "Personal care services" means physical or verbal
assistance with activities of daily living and instrumental activities
of daily living provided because of a person's functional disability.
(((19))) (20) "Population specific competencies" means basic
training topics unique to the care needs of the population the long-term care worker is serving, including but not limited to, mental
health, dementia, developmental disabilities, young adults with
physical disabilities, and older adults.
(((20))) (21) "Qualified instructor" means a registered nurse or
other person with specific knowledge, training, and work experience in
the provision of direct, hands-on personal care and other assistance
services to the elderly or persons with disabilities requiring
long-term care.
(((21))) (22) "Secretary" means the secretary of social and health
services.
(((22))) (23) "Secretary of health" means the secretary of health
or the secretary's designee.
(((23))) (24) "Training partnership" means a joint partnership or
trust that includes the office of the governor and the exclusive
bargaining representative of individual providers under RCW 74.39A.270
with the capacity to provide training, peer mentoring, and workforce
development, or other services to individual providers.
(((24))) (25) "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. 301 RCW 18.88B.021 and 2012 c 1 s 103 (Initiative Measure
No. 1163) are each amended to read as follows:
(1) ((Effective January 1, 2011,)) Beginning January 7, 2012,
except as provided in RCW ((18.88B.040, the department of health shall
require that)) 18.88B.041, any person hired as a long-term care worker
((for the elderly or persons with disabilities)) must be certified as
a home care aide as provided in this chapter within one hundred fifty
calendar days ((from)) after the date of being hired or within one
hundred fifty calendar days after the effective date of this section,
whichever is later.
(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.)) (a) "Practice as a certified home care aide" means the
provision by a person of home care services as defined in RCW
70.127.010. 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 ((
(3)pursuant to)) as provided in this chapter.
(((4))) (b) This section does not prohibit a person: (i) From
practicing a profession for which the person has been issued a license
or which is specifically authorized under this state's laws; or (ii)
who is exempt from certification under RCW 18.88B.041 from providing
home care services.
(3) The department ((of health)) shall adopt rules ((by August 1,
2010,)) to implement this section.
Sec. 302 RCW 18.88B.041 and 2012 c 1 s 105 (Initiative Measure
No. 1163) are each amended to read as follows:
(1) The following long-term care workers are not required to become
a certified home care aide pursuant to this chapter((.)):
(1)
(a)(i)(A) 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. ((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.)) (B) A person ((
(2)already employed)) who was initially hired as
a long-term care worker prior to January ((1, 2011)) 7, 2012, and 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)).
(ii) Individuals exempted by (a)(i) of 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))
74.39A.074(1)(d)(ii) but must successfully complete a certification
examination pursuant to RCW ((18.88B.030)) 18.88B.031.
(((3))) All long-term care workers employed by ((supported living
providers are not required to obtain certification under this chapter))
community residential service businesses.
(((4))) (c) 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))) (d) Prior to ((June 30)) July 1, 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))) (2) A long-term care worker exempted from certification 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)) RCW 74.39A.074.
(((7))) (3) The department ((of health)) shall adopt rules ((by
August 1, 2010,)) to implement this section.
NEW SECTION. Sec. 303 A new section is added to chapter 18.88B
RCW to read as follows:
(1) The department 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, and renew
such certificates;
(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, including background
checks, for certification.
(2) The department shall adopt rules that establish the procedures,
including criteria for reviewing an applicant's state and federal
background checks, and examinations necessary to implement this
section.
Sec. 304 RCW 18.88B.031 and 2012 c 1 s 104 (Initiative Measure
No. 1163) are each amended to read as follows:
(1) ((Effective January 1, 2011,)) Except as provided in RCW
((18.88B.040)) 18.88B.041 and subject to the other requirements of this
chapter, ((the department of health shall require that all)) to be
certified as a home care aide, a long-term care worker((s)) must
successfully complete the training required under RCW
74.39A.074(1)(d)(ii) and a certification examination. Any long-term
care worker failing to make the required grade for the examination
((will)) may 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))
Except as provided by RCW ((18.88B.040 (1) and (2)))
18.88B.041(1)(a)(ii), only those who have completed the training
requirements in RCW ((74.39A.073)) 74.39A.074(1) 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 a private contractor((s)) providing training services under
this chapter.
(5) ((The department of health has the authority to:)) The department ((
(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)of health)) shall adopt rules ((by August 1,
2010, 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)) to implement this
section.
Sec. 401 RCW 74.39A.074 and 2012 c 1 s 107 (Initiative Measure
No. 1163) are each amended to read as follows:
(1) ((Effective January 1, 2011,)) (a) Beginning January 7, 2012,
except ((as provided in RCW 18.88B.040)) for long-term care workers
exempt from certification under RCW 18.88B.041(1), all persons
((employed)) hired 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)) after the date of being hired or within one hundred twenty
calendar days after the effective date of this section, whichever is
later.
(((2) All persons employed as long-term care workers must obtain))
(b) Except as provided in RCW 74.39A.076, the minimum training
requirement is seventy-five hours of entry-level training approved by
the department. A long-term care worker must ((accomplish))
successfully complete five of these seventy-five hours before
((becoming)) being eligible to provide care.
(((3))) (c) Training required by (d)(ii) of this subsection
(((4)(c) of this section will be applied)) applies toward((s)) the
training required under RCW 18.20.270 or 70.128.230 ((as well as)), but
any statutory or regulatory training requirements for long-term care
workers employed by ((supportive living providers)) community
residential service businesses apply toward the training required in
(d)(ii) of this subsection.
(((4) Only training curriculum approved by the department may be
used to fulfill the training requirements specified in this section.))
(d) The seventy-five hours of entry-level training required shall be
as follows:
(((a))) (i) Before a long-term care worker is eligible to provide
care, he or she must complete:
(A) Two hours of orientation training regarding his or her role as
caregiver and the applicable terms of employment; and
(((b) Before a long-term care worker is eligible to provide care,
he or she must complete)) (B) Three hours of safety training, including
basic safety precautions, emergency procedures, and infection control;
and
(((c) All long-term care workers must complete)) (ii) Seventy hours
of long-term care basic training, including training related to core
competencies and population specific competencies.
(((5))) (2) 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 on
the competencies and training topics in this section.
(((6))) (3) 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,
to implement subsections (1), (2), and (3) of this section.)) (4) The department shall adopt rules ((
(8)by August 1, 2010,))
to implement ((subsections (4) and (5) of)) this section.
Sec. 402 RCW 74.39A.076 and 2012 c 1 s 108 (Initiative Measure
No. 1163) are each amended to read as follows:
(1) ((Effective January 1, 2011,)) Beginning January 7, 2012:
(a) 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)) after becoming an individual provider or within one hundred
twenty calendar days after the effective date of this section,
whichever is later.
(((2) Effective January 1, 2011,)) (b) Individual providers
identified in (((a) and)) (b)(i) and (ii) of this subsection must
complete thirty-five hours of training within the first one hundred
twenty days ((of)) after becoming an individual provider or within one
hundred twenty calendar days after the effective date of this section,
whichever is later. 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))) (i) An individual provider caring only for his or her
biological, step, or adoptive child or parent unless covered by (a) of
this subsection (((1) of this section)); and
(((b) Before)) (ii) Until 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))) (2) 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))) (3) The department shall adopt rules ((by August 1, 2010,))
to implement this section.
Sec. 403 RCW 74.39A.331 and 2012 c 1 s 111 (Initiative Measure
No. 1163) 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)) 2012.
Sec. 404 RCW 74.39A.351 and 2012 c 1 s 113 (Initiative Measure
No. 1163) are each amended to read as follows:
(1) 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.
(2) Training topics offered under this section 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.
(3) The department may not require long-term care workers to obtain
the training described in this section. ((This))
(4) The requirement to offer advanced training applies beginning
January 1, ((2012)) 2013.
Sec. 405 RCW 74.39A.341 and 2012 c 1 s 112 (Initiative Measure
No. 1163) 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)) 2012.
(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)) 18.88B RCW.
(3) Unless voluntarily certified as a home care aide under chapter
((2, Laws of 2009)) 18.88B RCW, 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) A long-term care worker employed by a community residential
service business;
(c) A person exempt under RCW 18.88B.041(1)(a)(i)(A) who maintains
his or her credential in good standing; or
(d) Before ((June 30)) July 1, 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,)) to implement subsection((s)) (1)((, (2), and (3))) of this
section.
(7) The department shall adopt rules ((by August 1, 2010,)) to
implement subsection (((4))) (2) of this section.
NEW SECTION. Sec. 406 A new section is added to chapter 18.88B
RCW to read as follows:
(1) The legislature recognizes that nurses have been successfully
delegating nursing care tasks to family members and others for many
years. The opportunity for a nurse to delegate nursing care tasks to
home care aides certified under this chapter may enhance the viability
and quality of health care services in community-based care settings
and in-home care settings to allow individuals to live as independently
as possible with maximum safeguards.
(2)(a) A certified home care aide who wishes to perform a nurse
delegated task pursuant to RCW 18.79.260 must complete nurse delegation
core training under chapter 18.88A RCW before the home care aide may be
delegated a nursing care task by a registered nurse delegator. Before
administering insulin, a home care aide must also complete the
specialized diabetes nurse delegation training under chapter 18.88A
RCW. Before commencing any specific nursing care tasks authorized
under RCW 18.79.260, the home care aide must:
(i) Provide to the delegating nurse a transcript or certificate of
successful completion of training issued by an approved instructor or
approved training entity indicating the completion of basic core nurse
delegation training; and
(ii) Meet any additional training requirements mandated by the
nursing care quality assurance commission. Any exception to these
training requirements is subject to RCW 18.79.260(3)(e)(vi).
(b) In addition to meeting the requirements of (a) of this
subsection, before providing delegated nursing care tasks that involve
administration of insulin by injection to individuals with diabetes,
the home care aide must provide to the delegating nurse a transcript or
certificate of successful completion of training issued by an approved
instructor or approved training entity indicating completion of
specialized diabetes nurse delegation training. The training must
include, but is not limited to, instruction regarding diabetes,
insulin, sliding scale insulin orders, and proper injection procedures.
(3) The home care aide is accountable for his or her own individual
actions in the delegation process. Home care aides accurately
following written delegation instructions from a registered nurse are
immune from liability regarding the performance of the delegated
duties.
(4) Home care aides are not subject to any employer reprisal or
disciplinary action by the secretary for refusing to accept delegation
of a nursing care task based on his or her concerns about patient
safety issues. No provider of a community-based care setting as
defined in RCW 18.79.260, or in-home services agency as defined in RCW
70.127.010, may discriminate or retaliate in any manner against a
person because the person made a complaint about the nurse delegation
process or cooperated in the investigation of the complaint.
Sec. 407 RCW 18.79.260 and 2009 c 203 s 1 are each amended to
read as follows:
(1) A registered nurse under his or her license may perform for
compensation nursing care, as that term is usually understood, to
individuals with illnesses, injuries, or disabilities.
(2) A registered nurse may, at or under the general direction of a
licensed physician and surgeon, dentist, osteopathic physician and
surgeon, naturopathic physician, optometrist, podiatric physician and
surgeon, physician assistant, osteopathic physician assistant, or
advanced registered nurse practitioner acting within the scope of his
or her license, administer medications, treatments, tests, and
inoculations, whether or not the severing or penetrating of tissues is
involved and whether or not a degree of independent judgment and skill
is required. Such direction must be for acts which are within the
scope of registered nursing practice.
(3) A registered nurse may delegate tasks of nursing care to other
individuals where the registered nurse determines that it is in the
best interest of the patient.
(a) The delegating nurse shall:
(i) Determine the competency of the individual to perform the
tasks;
(ii) Evaluate the appropriateness of the delegation;
(iii) Supervise the actions of the person performing the delegated
task; and
(iv) Delegate only those tasks that are within the registered
nurse's scope of practice.
(b) A registered nurse, working for a home health or hospice agency
regulated under chapter 70.127 RCW, may delegate the application,
instillation, or insertion of medications to a registered or certified
nursing assistant under a plan of care.
(c) Except as authorized in (b) or (e) of this subsection, a
registered nurse may not delegate the administration of medications.
Except as authorized in (e) of this subsection, a registered nurse may
not delegate acts requiring substantial skill, and may not delegate
piercing or severing of tissues. Acts that require nursing judgment
shall not be delegated.
(d) No person may coerce a nurse into compromising patient safety
by requiring the nurse to delegate if the nurse determines that it is
inappropriate to do so. Nurses shall not be subject to any employer
reprisal or disciplinary action by the nursing care quality assurance
commission for refusing to delegate tasks or refusing to provide the
required training for delegation if the nurse determines delegation may
compromise patient safety.
(e) For delegation in community-based care settings or in-home care
settings, a registered nurse may delegate nursing care tasks only to
registered or certified nursing assistants or home care aides certified
under chapter 18.88B RCW. Simple care tasks such as blood pressure
monitoring, personal care service, diabetic insulin device set up,
verbal verification of insulin dosage for sight-impaired individuals,
or other tasks as defined by the nursing care quality assurance
commission are exempted from this requirement.
(i) "Community-based care settings" includes: Community
residential programs for people with developmental disabilities,
certified by the department of social and health services under chapter
71A.12 RCW; adult family homes licensed under chapter 70.128 RCW; and
boarding homes licensed under chapter 18.20 RCW. Community-based care
settings do not include acute care or skilled nursing facilities.
(ii) "In-home care settings" include an individual's place of
temporary or permanent residence, but does not include acute care or
skilled nursing facilities, and does not include community-based care
settings as defined in (e)(i) of this subsection.
(iii) Delegation of nursing care tasks in community-based care
settings and in-home care settings is only allowed for individuals who
have a stable and predictable condition. "Stable and predictable
condition" means a situation in which the individual's clinical and
behavioral status is known and does not require the frequent presence
and evaluation of a registered nurse.
(iv) The determination of the appropriateness of delegation of a
nursing task is at the discretion of the registered nurse. Other than
delegation of the administration of insulin by injection for the
purpose of caring for individuals with diabetes, the administration of
medications by injection, sterile procedures, and central line
maintenance may never be delegated.
(v) When delegating insulin injections under this section, the
registered nurse delegator must instruct the individual regarding
proper injection procedures and the use of insulin, demonstrate proper
injection procedures, and must supervise and evaluate the individual
performing the delegated task weekly during the first four weeks of
delegation of insulin injections. If the registered nurse delegator
determines that the individual is competent to perform the injection
properly and safely, supervision and evaluation shall occur at least
every ninety days thereafter.
(vi)(A) The registered nurse shall verify that the nursing
assistant or home care aide, as the case may be, has completed the
required core nurse delegation training required in chapter 18.88A RCW
prior to authorizing delegation.
(B) Before commencing any specific nursing tasks authorized to be
delegated in this section, a home care aide must be certified pursuant
to chapter 18.88B RCW and must comply with section 406 of this act.
(vii) The nurse is accountable for his or her own individual
actions in the delegation process. Nurses acting within the protocols
of their delegation authority are immune from liability for any action
performed in the course of their delegation duties.
(viii) Nursing task delegation protocols are not intended to
regulate the settings in which delegation may occur, but are intended
to ensure that nursing care services have a consistent standard of
practice upon which the public and the profession may rely, and to
safeguard the authority of the nurse to make independent professional
decisions regarding the delegation of a task.
(f) The nursing care quality assurance commission may adopt rules
to implement this section.
(4) Only a person licensed as a registered nurse may instruct
nurses in technical subjects pertaining to nursing.
(5) Only a person licensed as a registered nurse may hold herself
or himself out to the public or designate herself or himself as a
registered nurse.
NEW SECTION. Sec. 501 A new section is added to chapter 18.88B
RCW to read as follows:
A long-term care worker disqualified from working with vulnerable
persons under chapter 74.39A RCW may not be certified as a home care
aide under this chapter. To allow the department to satisfy its
certification responsibilities under this chapter, the department of
social and health services shall share the results of state and federal
background checks conducted pursuant to RCW 74.39A.056 with the
department. Neither department may share the federal background check
results with any other state agency or person.
Sec. 502 RCW 74.39A.261 and 2012 c 1 s 102 (Initiative Measure
No. 1163) 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, are subject to background checks)) under
RCW ((74.39A.055)) 74.39A.056.
Sec. 503 RCW 74.39A.056 and 2012 c 1 s 101 (Initiative Measure
No. 1163) are each amended to read as follows:
(1)(a) All long-term care workers ((for the elderly or persons with
disabilities hired after January 1, 2012,)) shall be screened through
state and federal background checks in a uniform and timely manner to
((ensure)) verify that they do not have a criminal history that would
disqualify them from working with vulnerable persons. ((These)) The
department must perform criminal background checks for individual
providers and prospective individual providers and make the information
available to any long-term care abuse and neglect registry used by the
department.
(b) For long-term care workers hired after January 7, 2012, the
background checks required under this section 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. The department shall not pass on the
cost of these criminal background checks to the workers or their
employers.
(((2) To allow the department of health to satisfy its
certification responsibilities under chapter 18.88B RCW,)) (c) 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)) in
accordance with section 501 of this act.
(((3) The department shall not pass on the cost of these criminal
background checks to the workers or their employers.)) (2) 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 or 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.
(3) 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 must also be shared with the department
of health to advance the purposes of chapter 18.88B RCW.
(4) The department shall adopt rules to implement ((the provisions
of)) this section ((by August 1, 2010)).
Sec. 504 RCW 18.20.125 and 2011 1st sp.s. c 31 s 15 are each
amended to read as follows:
(1) Inspections must be outcome based and responsive to resident
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 facilities, residents, and other interested parties. This
includes that when conducting licensing inspections, the department
shall interview an appropriate percentage of residents, family members,
and advocates in addition to interviewing appropriate staff.
(2) Prompt and specific enforcement remedies shall also be
implemented without delay, consistent with RCW 18.20.190, for
facilities 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 license. In
the selection of remedies, the safety, health, and well-being of
residents shall be of paramount importance.
(3)(a) To the extent funding is available, the licensee,
administrator, and their staff 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 adults. Employees may be provisionally hired pending the
results of the background check if they have been given three positive
references.
(b) Long-term care workers, as defined in RCW 74.39A.009, who are
hired after January ((1, 2014)) 7, 2012, are subject to background
checks under RCW ((74.39A.055)) 74.39A.056.
(4) No licensee, administrator, or staff, or prospective licensee,
administrator, or staff, with a stipulated finding of fact, conclusion
of law, and agreed order, or finding of fact, conclusion of law, or
final order issued by a disciplining authority, a court of law, or
entered into the 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.
Sec. 505 RCW 43.20A.710 and 2011 1st sp.s. c 31 s 16 are each
amended to read as follows:
(1) The secretary shall investigate the conviction records, pending
charges and disciplinary board final decisions of:
(a) Any current employee or applicant seeking or being considered
for any position with the department who will or may have unsupervised
access to children, vulnerable adults, or individuals with mental
illness or developmental disabilities. This includes, but is not
limited to, positions conducting comprehensive assessments, financial
eligibility determinations, licensing and certification activities,
investigations, surveys, or case management; or for state positions
otherwise required by federal law to meet employment standards;
(b) Individual providers who are paid by the state and providers
who are paid by home care agencies to provide in-home services
involving unsupervised access to persons with physical, mental, or
developmental disabilities or mental illness, or to vulnerable adults
as defined in chapter 74.34 RCW, including but not limited to services
provided under chapter 74.39 or 74.39A RCW; and
(c) Individuals or businesses or organizations for the care,
supervision, case management, or treatment of children, persons with
developmental disabilities, or vulnerable adults, including but not
limited to services contracted for under chapter 18.20, 70.127, 70.128,
72.36, or 74.39A RCW or Title 71A RCW.
(2) The secretary shall require a fingerprint-based background
check through both the Washington state patrol and the federal bureau
of investigation as provided in RCW 43.43.837. Unless otherwise
authorized by law, the secretary shall use the information solely for
the purpose of determining the character, suitability, and competence
of the applicant.
(3) Except as provided in subsection (4) of this section, an
individual provider or home care agency provider who has resided in the
state less than three years before applying for employment involving
unsupervised access to a vulnerable adult as defined in chapter 74.34
RCW must be fingerprinted for the purpose of investigating conviction
records through both the Washington state patrol and the federal bureau
of investigation. This subsection applies only with respect to the
provision of in-home services funded by medicaid personal care under
RCW 74.09.520, community options program entry system waiver services
under RCW 74.39A.030, or chore services under RCW 74.39A.110. However,
this subsection does not supersede RCW 74.15.030(2)(b).
(4) Long-term care workers, as defined in RCW 74.39A.009, who are
hired after January ((1, 2014)) 7, 2012, are subject to background
checks under RCW ((74.39A.055)) 74.39A.056, except that the department
may require a background check at any time under RCW 43.43.837. For
the purposes of this subsection, "background check" includes, but is
not limited to, a fingerprint check submitted for the purpose of
investigating conviction records through both the Washington state
patrol and the federal bureau of investigation.
(5) An individual provider or home care agency provider hired to
provide in-home care for and having unsupervised access to a vulnerable
adult as defined in chapter 74.34 RCW must have no conviction for a
disqualifying crime under RCW 43.43.830 and 43.43.842. An individual
or home care agency provider must also have no conviction for a crime
relating to drugs as defined in RCW 43.43.830. This subsection applies
only with respect to the provision of in-home services funded by
medicaid personal care under RCW 74.09.520, community options program
entry system waiver services under RCW 74.39A.030, or chore services
under RCW 74.39A.110.
(6) The secretary shall provide the results of the state background
check on long-term care workers, including individual providers, to the
persons hiring them or to their legal guardians, if any, for their
determination of the character, suitability, and competence of the
applicants. If the person elects to hire or retain an individual
provider after receiving notice from the department that the applicant
has a conviction for an offense that would disqualify the applicant
from having unsupervised access to persons with physical, mental, or
developmental disabilities or mental illness, or to vulnerable adults
as defined in chapter 74.34 RCW, then the secretary shall deny payment
for any subsequent services rendered by the disqualified individual
provider.
(7) Criminal justice agencies shall provide the secretary such
information as they may have and that the secretary may require for
such purpose.
Sec. 506 RCW 43.43.837 and 2011 1st sp.s. c 31 s 17 are each
amended to read as follows:
(1) Except as provided in subsection (2) of this section, in order
to determine the character, competence, and suitability of any
applicant or service provider to have unsupervised access, the
secretary may require a fingerprint-based background check through both
the Washington state patrol and the federal bureau of investigation at
any time, but shall require a fingerprint-based background check when
the applicant or service provider has resided in the state less than
three consecutive years before application, and:
(a) Is an applicant or service provider providing services to
children or people with developmental disabilities under RCW 74.15.030;
(b) Is an individual residing in an applicant or service provider's
home, facility, entity, agency, or business or who is authorized by the
department to provide services to children or people with developmental
disabilities under RCW 74.15.030; or
(c) Is an applicant or service provider providing in-home services
funded by:
(i) Medicaid personal care under RCW 74.09.520;
(ii) Community options program entry system waiver services under
RCW 74.39A.030;
(iii) Chore services under RCW 74.39A.110; or
(iv) Other home and community long-term care programs, established
pursuant to chapters 74.39 and 74.39A RCW, administered by the
department.
(2) Long-term care workers, as defined in RCW 74.39A.009, who are
hired after January ((1, 2014)) 7, 2012, are subject to background
checks under RCW ((74.39A.055)) 74.39A.056.
(3) To satisfy the shared background check requirements provided
for in RCW 43.215.215 and 43.20A.710, the department of early learning
and the department of social and health services shall share federal
fingerprint-based background check results as permitted under the law.
The purpose of this provision is to allow both departments to fulfill
their joint background check responsibility of checking any individual
who may have unsupervised access to vulnerable adults, children, or
juveniles. Neither department may share the federal background check
results with any other state agency or person.
(4) The secretary shall require a fingerprint-based background
check through the Washington state patrol identification and criminal
history section and the federal bureau of investigation when the
department seeks to approve an applicant or service provider for a
foster or adoptive placement of children in accordance with federal and
state law.
(5) Any secure facility operated by the department under chapter
71.09 RCW shall require applicants and service providers to undergo a
fingerprint-based background check through the Washington state patrol
identification and criminal history section and the federal bureau of
investigation.
(6) Service providers and service provider applicants who are
required to complete a fingerprint-based background check may be hired
for a one hundred twenty-day provisional period as allowed under law or
program rules when:
(a) A fingerprint-based background check is pending; and
(b) The applicant or service provider is not disqualified based on
the immediate result of the background check.
(7) Fees charged by the Washington state patrol and the federal
bureau of investigation for fingerprint-based background checks shall
be paid by the department for applicants or service providers
providing:
(a) Services to people with a developmental disability under RCW
74.15.030;
(b) In-home services funded by medicaid personal care under RCW
74.09.520;
(c) Community options program entry system waiver services under
RCW 74.39A.030;
(d) Chore services under RCW 74.39A.110;
(e) Services under other home and community long-term care
programs, established pursuant to chapters 74.39 and 74.39A RCW,
administered by the department;
(f) Services in, or to residents of, a secure facility under RCW
71.09.115; and
(g) Foster care as required under RCW 74.15.030.
(8) Service providers licensed under RCW 74.15.030 must pay fees
charged by the Washington state patrol and the federal bureau of
investigation for conducting fingerprint-based background checks.
(9) Children's administration service providers licensed under RCW
74.15.030 may not pass on the cost of the background check fees to
their applicants unless the individual is determined to be disqualified
due to the background information.
(10) The department shall develop rules identifying the financial
responsibility of service providers, applicants, and the department for
paying the fees charged by law enforcement to roll, print, or scan
fingerprints-based for the purpose of a Washington state patrol or
federal bureau of investigation fingerprint-based background check.
(11) For purposes of this section, unless the context plainly
indicates otherwise:
(a) "Applicant" means a current or prospective department or
service provider employee, volunteer, student, intern, researcher,
contractor, or any other individual who will or may have unsupervised
access because of the nature of the work or services he or she
provides. "Applicant" includes but is not limited to any individual
who will or may have unsupervised access and is:
(i) Applying for a license or certification from the department;
(ii) Seeking a contract with the department or a service provider;
(iii) Applying for employment, promotion, reallocation, or
transfer;
(iv) An individual that a department client or guardian of a
department client chooses to hire or engage to provide services to
himself or herself or another vulnerable adult, juvenile, or child and
who might be eligible to receive payment from the department for
services rendered; or
(v) A department applicant who will or may work in a department-covered position.
(b) "Authorized" means the department grants an applicant, home, or
facility permission to:
(i) Conduct licensing, certification, or contracting activities;
(ii) Have unsupervised access to vulnerable adults, juveniles, and
children;
(iii) Receive payments from a department program; or
(iv) Work or serve in a department-covered position.
(c) "Department" means the department of social and health
services.
(d) "Secretary" means the secretary of the department of social and
health services.
(e) "Secure facility" has the meaning provided in RCW 71.09.020.
(f) "Service provider" means entities, facilities, agencies,
businesses, or individuals who are licensed, certified, authorized, or
regulated by, receive payment from, or have contracts or agreements
with the department to provide services to vulnerable adults,
juveniles, or children. "Service provider" includes individuals whom
a department client or guardian of a department client may choose to
hire or engage to provide services to himself or herself or another
vulnerable adult, juvenile, or child and who might be eligible to
receive payment from the department for services rendered. "Service
provider" does not include those certified under chapter 70.96A RCW.
Sec. 507 RCW 74.39A.095 and 2011 1st sp.s. c 31 s 14 and 2011 1st
sp.s. c 21 s 5 are each reenacted and amended to read as follows:
(1) In carrying out case management responsibilities established
under RCW 74.39A.090 for consumers who are receiving services under the
medicaid personal care, community options programs entry system or
chore services program through an individual provider, each area agency
on aging shall provide oversight of the care being provided to
consumers receiving services under this section to the extent of
available funding. Case management responsibilities incorporate this
oversight, and include, but are not limited to:
(a) Verification that any individual provider has met any training
requirements established by the department;
(b) Verification of a sample of worker time sheets;
(c) Monitoring the consumer's plan of care to verify that it
adequately meets the needs of the consumer, through activities such as
home visits, telephone contacts, and responses to information received
by the area agency on aging indicating that a consumer may be
experiencing problems relating to his or her home care;
(d) Reassessing and reauthorizing services;
(e) Monitoring of individual provider performance; and
(f) Conducting criminal background checks or verifying that
criminal background checks have been conducted for any individual
provider. Individual providers who are hired after January ((1, 2014))
7, 2012, are subject to background checks under RCW ((74.39A.055))
74.39A.056.
(2) The area agency on aging case manager shall work with each
consumer to develop a plan of care under this section that identifies
and ensures coordination of health and long-term care services that
meet the consumer's needs. In developing the plan, they shall utilize,
and modify as needed, any comprehensive community service plan
developed by the department as provided in RCW 74.39A.040. The plan of
care shall include, at a minimum:
(a) The name and telephone number of the consumer's area agency on
aging case manager, and a statement as to how the case manager can be
contacted about any concerns related to the consumer's well-being or
the adequacy of care provided;
(b) The name and telephone numbers of the consumer's primary health
care provider, and other health or long-term care providers with whom
the consumer has frequent contacts;
(c) A clear description of the roles and responsibilities of the
area agency on aging case manager and the consumer receiving services
under this section;
(d) The duties and tasks to be performed by the area agency on
aging case manager and the consumer receiving services under this
section;
(e) The type of in-home services authorized, and the number of
hours of services to be provided;
(f) The terms of compensation of the individual provider;
(g) A statement by the individual provider that he or she has the
ability and willingness to carry out his or her responsibilities
relative to the plan of care; and
(h)(i) Except as provided in (h)(ii) of this subsection, a clear
statement indicating that a consumer receiving services under this
section has the right to waive any of the case management services
offered by the area agency on aging under this section, and a clear
indication of whether the consumer has, in fact, waived any of these
services.
(ii) The consumer's right to waive case management services does
not include the right to waive reassessment or reauthorization of
services, or verification that services are being provided in
accordance with the plan of care.
(3) Each area agency on aging shall retain a record of each waiver
of services included in a plan of care under this section.
(4) Each consumer has the right to direct and participate in the
development of their plan of care to the maximum practicable extent of
their abilities and desires, and to be provided with the time and
support necessary to facilitate that participation.
(5) A copy of the plan of care must be distributed to the
consumer's primary care provider, individual provider, and other
relevant providers with whom the consumer has frequent contact, as
authorized by the consumer.
(6) The consumer's plan of care shall be an attachment to the
contract between the department, or their designee, and the individual
provider.
(7) If the department or area agency on aging case manager finds
that an individual provider's inadequate performance or inability to
deliver quality care is jeopardizing the health, safety, or well-being
of a consumer receiving service under this section, the department or
the area agency on aging may take action to terminate the contract
between the department and the individual provider. If the department
or the area agency on aging has a reasonable, good faith belief that
the health, safety, or well-being of a consumer is in imminent
jeopardy, the department or area agency on aging may summarily suspend
the contract pending a fair hearing. The consumer may request a fair
hearing to contest the planned action of the case manager, as provided
in chapter 34.05 RCW. The department may by rule adopt guidelines for
implementing this subsection.
(8) The department or area agency on aging may reject a request by
a consumer receiving services under this section to have a family
member or other person serve as his or her individual provider if the
case manager has a reasonable, good faith belief that the family member
or other person will be unable to appropriately meet the care needs of
the consumer. The consumer may request a fair hearing to contest the
decision of the case manager, as provided in chapter 34.05 RCW. The
department may by rule adopt guidelines for implementing this
subsection.
Sec. 601 RCW 18.88B.050 and 2011 1st sp.s. c 31 s 4 are each
amended to read as follows:
(1) The uniform disciplinary act, chapter 18.130 RCW, governs
uncertified practice, issuance and renewal 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)) home care aide
upon finding that conduct of the ((long-term care worker)) home care
aide 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 or renewal of certification, the suspension or
conditions for continuation or renewal 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
whose certification is revoked or, if exempted from certification by
RCW ((18.88B.040)) 18.88B.041, who has not completed his or her
required training pursuant to ((this chapter)) RCW 74.39A.074 or rules
of the department of social and health services, as applicable.
(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,
2013,)) to implement this section.
Sec. 602 RCW 74.39A.086 and 2012 c 1 s 109 (Initiative Measure
No. 1163) are each amended to read as follows:
(1) The department:
(a) 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,)) 18.88B RCW or whose
certification is revoked or, if exempted from certification under RCW
18.88B.041, who has not completed his or her required training pursuant
to ((chapter 2, Laws of 2009)) RCW 74.39A.074 or rules of the
department of social and health services, as applicable.
(((2) The department)) (b) 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 has not been certified or the individual provider's
certification is revoked under chapter ((2, Laws of 2009)) 18.88B RCW
or, if exempted from certification by RCW ((18.88B.040)) 18.88B.041,
the individual provider has not completed his or her required training
pursuant to ((chapter 2, Laws of 2009)) RCW 74.39A.074 or rules of the
department of social and health services, as applicable.
(((3))) (2) 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,)) 18.88B
RCW or whose certification is revoked or, if exempted from
certification under RCW 18.88B.041, who has not completed his or her
required training pursuant to ((chapter 2, Laws of 2009)) RCW
74.39A.074 or rules of the department of social and health services, as
applicable.
(((4))) (3) Chapter 34.05 RCW shall govern actions by the
department under this section.
(((5))) (4) The department shall adopt rules ((by August 1, 2010,))
to implement this section.
Sec. 701 RCW 74.39A.051 and 2012 c 1 s 106 (Initiative Measure
No. 1163) 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)) or
70.128.160, or 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, 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.)) Background checks of long-term care
workers must be conducted as provided in RCW 74.39A.056.
(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,
(8) Except as provided in RCW 74.39A.074 and 74.39A.076:
(a) 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,)) (b) 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))) (9) 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,
are subject to background checks under RCW 74.39A.055.)) (10) Under existing funds the department shall establish
internally a quality improvement standards committee to monitor the
development of standards and to suggest modifications.
(14)
(((15))) (11) 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. 702 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 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.
(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.
(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 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.
(a) 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.
(b) 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.
(c) 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)(a) Except as provided in (b) of this subsection, 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))) (i) employees hired subsequent
to September 1, 2002; and (((b))) (ii) 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.))
(b) Beginning January 7, 2012, boarding home long-term care
workers, as defined in RCW 74.39A.009, are also subject to the training
requirements under RCW 74.39A.074.
Sec. 703 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 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.
(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.
(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 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.
(a) 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.
(b) 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.
(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)(a) Except as provided in (b) of this subsection, the
orientation, basic training, specialty training, and continuing
education requirements of this section commence September 1, 2002, and
shall be applied to (((a))) (i) employees hired subsequent to September
1, 2002; or (((b))) (ii) 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.))
(b) Beginning January 7, 2012, adult family home long-term care
workers, as defined in RCW 74.39A.009, are also subject to the training
requirements under RCW 74.39A.074.
Sec. 704 RCW 41.56.030 and 2011 1st sp.s. c 21 s 11 are each
amended to read as follows:
As used in this chapter:
(1) "Adult family home provider" means a provider as defined in RCW
70.128.010 who receives payments from the medicaid and state-funded
long-term care programs.
(2) "Bargaining representative" means any lawful organization which
has as one of its primary purposes the representation of employees in
their employment relations with employers.
(3) "Child care subsidy" means a payment from the state through a
child care subsidy program established pursuant to RCW 74.12.340 or
74.08A.340, 45 C.F.R. Sec. 98.1 through 98.17, or any successor
program.
(4) "Collective bargaining" means the performance of the mutual
obligations of the public employer and the exclusive bargaining
representative to meet at reasonable times, to confer and negotiate in
good faith, and to execute a written agreement with respect to
grievance procedures and collective negotiations on personnel matters,
including wages, hours and working conditions, which may be peculiar to
an appropriate bargaining unit of such public employer, except that by
such obligation neither party shall be compelled to agree to a proposal
or be required to make a concession unless otherwise provided in this
chapter.
(5) "Commission" means the public employment relations commission.
(6) "Executive director" means the executive director of the
commission.
(7) "Family child care provider" means a person who: (a) Provides
regularly scheduled care for a child or children in the home of the
provider or in the home of the child or children for periods of less
than twenty-four hours or, if necessary due to the nature of the
parent's work, for periods equal to or greater than twenty-four hours;
(b) receives child care subsidies; and (c) is either licensed by the
state under RCW 74.15.030 or is exempt from licensing under chapter
74.15 RCW.
(8) "Individual provider" means an individual provider as defined
in RCW ((74.39A.240(4))) 74.39A.009 who, solely for the purposes of
collective bargaining, is a public employee as provided in RCW
74.39A.270.
(9) "Institution of higher education" means the University of
Washington, Washington State University, Central Washington University,
Eastern Washington University, Western Washington University, The
Evergreen State College, and the various state community colleges.
(10)(a) "Language access provider" means any independent contractor
who provides spoken language interpreter services for department of
social and health services appointments or medicaid enrollee
appointments, or provided these services on or after January 1, 2009,
and before June 10, 2010, whether paid by a broker, language access
agency, or the department.
(b) "Language access provider" does not mean an owner, manager, or
employee of a broker or a language access agency.
(11) "Public employee" means any employee of a public employer
except any person (a) elected by popular vote, or (b) appointed to
office pursuant to statute, ordinance or resolution for a specified
term of office as a member of a multimember board, commission, or
committee, whether appointed by the executive head or body of the
public employer, or (c) whose duties as deputy, administrative
assistant or secretary necessarily imply a confidential relationship to
(i) the executive head or body of the applicable bargaining unit, or
(ii) any person elected by popular vote, or (iii) any person appointed
to office pursuant to statute, ordinance or resolution for a specified
term of office as a member of a multimember board, commission, or
committee, whether appointed by the executive head or body of the
public employer, or (d) who is a court commissioner or a court
magistrate of superior court, district court, or a department of a
district court organized under chapter 3.46 RCW, or (e) who is a
personal assistant to a district court judge, superior court judge, or
court commissioner. For the purpose of (e) of this subsection, no more
than one assistant for each judge or commissioner may be excluded from
a bargaining unit.
(12) "Public employer" means any officer, board, commission,
council, or other person or body acting on behalf of any public body
governed by this chapter, or any subdivision of such public body. For
the purposes of this section, the public employer of district court or
superior court employees for wage-related matters is the respective
county legislative authority, or person or body acting on behalf of the
legislative authority, and the public employer for nonwage-related
matters is the judge or judge's designee of the respective district
court or superior court.
(13) "Uniformed personnel" means: (a) Law enforcement officers as
defined in RCW 41.26.030 employed by the governing body of any city or
town with a population of two thousand five hundred or more and law
enforcement officers employed by the governing body of any county with
a population of ten thousand or more; (b) correctional employees who
are uniformed and nonuniformed, commissioned and noncommissioned
security personnel employed in a jail as defined in RCW 70.48.020(9),
by a county with a population of seventy thousand or more, and who are
trained for and charged with the responsibility of controlling and
maintaining custody of inmates in the jail and safeguarding inmates
from other inmates; (c) general authority Washington peace officers as
defined in RCW 10.93.020 employed by a port district in a county with
a population of one million or more; (d) security forces established
under RCW 43.52.520; (e) firefighters as that term is defined in RCW
41.26.030; (f) employees of a port district in a county with a
population of one million or more whose duties include crash fire
rescue or other firefighting duties; (g) employees of fire departments
of public employers who dispatch exclusively either fire or emergency
medical services, or both; or (h) employees in the several classes of
advanced life support technicians, as defined in RCW 18.71.200, who are
employed by a public employer.
Sec. 705 2012 c 1 s 201 (uncodified) (Initiative Measure No.
1163) is amended to read as follows:
The state auditor shall conduct performance audits of the long-term
in-home care program. The first audit must be completed within twelve
months after January 7, 2012, and must be completed on a ((biannual))
biennial basis thereafter. As part of this auditing process, the state
shall hire five additional fraud investigators to ensure that clients
receiving services at taxpayers' expense are medically and financially
qualified to receive the services and are actually receiving the
services.
Sec. 706 2012 c 1 s 303 (uncodified) (Initiative Measure No.
1163) is amended to read as follows:
Notwithstanding any action of the legislature during 2011, all
long-term care workers as defined under RCW 74.39A.009(16), as it
existed on April 1, 2011, are covered by sections 101 through 113 of
this act or by the corresponding original versions of the statutes, as
referenced in section 302 (1) through (13) on the schedules set forth
in those sections, as amended by chapter . . ., Laws of 2012 (this
act), except that long-term care workers employed as community
residential service ((providers are covered by sections 101 through 113
of this act beginning January 1, 2016)) businesses are exempt as
provided in RCW 18.88B.041 and 74.39A.074.
NEW SECTION. Sec. 707 RCW 74.39A.240 (Definitions) and 2011 1st
sp.s. c 21 s 7 & 2002 c 3 s 3 are each repealed.
NEW SECTION. Sec. 708 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.