BILL REQ. #:  H-3168.1 

Read first time 01/15/14.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to adult family homes; amending RCW 70.128.010, 70.128.060, and 74.39A.320; and adding a new section to chapter 70.128 RCW.

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

Sec. 1   RCW 70.128.010 and 2007 c 184 s 7 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 residential home in which a person or persons provide personal care, special care, room, and board to more than one but not more than six adults who are not related by blood or marriage to the person or persons providing the services.
     (2) "Provider" means any person who is licensed under this chapter to operate an adult family home. For the purposes of this section, "person" means any individual, partnership, corporation, association, or limited liability company.
     (3) "Department" means the department of social and health services.
     (4) "Resident" means an adult in need of personal or special care in an adult family home who is not related to the provider.
     (5) "Adults" means persons who have attained the age of eighteen years.
     (6) "Home" means an adult family home.
     (7) "Imminent danger" means serious physical harm to or death of a resident has occurred, or there is a serious threat to resident life, health, or safety.
     (8) "Special care" means care beyond personal care as defined by the department, in rule.
     (9) "Capacity" means the maximum number of persons in need of personal or special care permitted in an adult family home at a given time. This number shall include related children or adults in the home and who received special care.
     (10) "Resident manager" means a person employed or designated by the provider to manage the adult family home.
     (11) "Adult family home licensee" means a provider as defined in this section who does not receive payments from the medicaid and state-funded long-term care programs.
     (12) "Nonresident individual" means a person who resides in an unlicensed bed located within an adult family home.

NEW SECTION.  Sec. 2   A new section is added to chapter 70.128 RCW to read as follows:
     (1) An adult family home may provide any of the following services to a nonresident individual, upon the request of the nonresident individual:
     (a) Emergency assistance provided on an intermittent or nonroutine basis;
     (b) Systems, including technology-based monitoring devices, employed by independent senior housing, or independent living units in continuing care retirement communities, to respond to the potential need for emergency services;
     (c) Scheduled and nonscheduled blood pressure checks;
     (d) Nursing assessment services to determine whether referral to an outside health care provider is recommended;
     (e) Making and reminding the nonresident of health care appointments;
     (f) Preadmission assessment for the purposes of transitioning to a licensed care setting;
     (g) Medication assistance which may include reminding or coaching the nonresident, opening the nonresident's medication container, using an enabler, and handing prefilled insulin syringes to the nonresident;
     (h) Falls risk assessment;
     (i) Nutrition management and education services;
     (j) Dental services;
     (k) Wellness programs;
     (l) Prefilling insulin syringes when performed by a nurse licensed under chapter 18.79 RCW; or
     (m) Services customarily provided under landlord tenant agreements governed by the residential landlord-tenant act, chapter 59.18 RCW.
     (2) Except as authorized under subsection (1) of this section, an adult family home may not directly or indirectly provide the following services to a nonresident individual:
     (a) Assistance with activities of daily living;
     (b) Health support services; or
     (c) Intermittent nursing services.
     (3)(a) An adult family home must provide each nonresident individual with a disclosure statement upon admission and at the time that additional services are requested by a nonresident.
     (b) The disclosure statement must notify the nonresident individual that:
     (i) The resident rights of chapter 70.129 RCW do not apply to nonresident individuals;
     (ii) Licensing requirements for adult family homes under this chapter do not apply to nonresident beds; and
     (iii) The jurisdiction of the long-term care ombuds does not apply to nonresident individuals and nonresident beds.

Sec. 3   RCW 70.128.060 and 2013 c 300 s 2 are each amended to read as follows:
     (1) An application for license shall be made to the department upon forms provided by it and shall contain such information as the department reasonably requires.
     (2) Subject to the provisions of this section, the department shall issue a license to an adult family home if the department finds that the applicant and the home are in compliance with this chapter and the rules adopted under this chapter. The department may not issue a license if (a) the applicant or a person affiliated with the applicant has prior violations of this chapter relating to the adult family home subject to the application or any other adult family home, or of any other law regulating residential care facilities within the past ten years that resulted in revocation, suspension, or nonrenewal of a license or contract with the department; or (b) the applicant or a person affiliated with the applicant has a history of significant noncompliance with federal, state, or local laws, rules, or regulations relating to the provision of care or services to vulnerable adults or to children. A person is considered affiliated with an applicant if the person is listed on the license application as a partner, officer, director, resident manager, or majority owner of the applying entity, or is the spouse of the applicant.
     (3) The license fee shall be submitted with the application.
     (4) Proof of financial solvency must be submitted when requested by the department.
     (5) The department shall serve upon the applicant a copy of the decision granting or denying an application for a license. An applicant shall have the right to contest denial of his or her application for a license as provided in chapter 34.05 RCW by requesting a hearing in writing within twenty-eight days after receipt of the notice of denial.
     (6) The department shall not issue a license to a provider if the department finds that the provider or spouse of the provider or any partner, officer, director, managerial employee, or majority owner has a history of significant noncompliance with federal or state regulations, rules, or laws in providing care or services to vulnerable adults or to children.
     (7) The department shall license an adult family home for the maximum level of care that the adult family home may provide. The department shall define, in rule, license levels based upon the education, training, and caregiving experience of the licensed provider or staff.
     (8) 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 consistent with RCW 70.128.230, and also is required for caregivers, with standardized competency testing for caregivers hired after July 28, 2013, as set forth by the department in rule. The department shall examine, with input from experts, providers, consumers, and advocates, whether the existing specialty training courses are adequate for providers, resident managers, and caregivers to meet these residents' special needs, are sufficiently standardized in curricula and instructional techniques, and are accompanied by effective tools to fairly evaluate successful student completion. The department may enhance the existing specialty training requirements by rule, and may update curricula, instructional techniques, and competency testing based upon its review and stakeholder input. In addition, the department shall examine, with input from experts, providers, consumers, and advocates, whether additional specialty training categories should be created for adult family homes serving residents with other special needs, such as traumatic brain injury, skilled nursing, or bariatric care. The department may establish, by rule, additional specialty training categories and requirements for providers, resident managers, and caregivers, if needed to better serve residents with such special needs.
     (9) The department shall establish, by rule, standards used to license nonresident providers and multiple facility operators.
     (10) The department shall establish, by rule, for multiple facility operators educational standards substantially equivalent to recognized national certification standards for residential care administrators.
     (11)(a) At the time of an application for an adult family home license and upon the annual fee renewal date set by the department, the licensee shall pay a license fee. Beginning July 1, 2011, the per bed license fee and any processing fees, including the initial license fee, must be established in the omnibus appropriations act and any amendment or additions made to that act. The license fees established in the omnibus appropriations act and any amendment or additions made to that act may not exceed the department's annual licensing and oversight activity costs and must include the department's cost of paying providers for the amount of the license fee attributed to medicaid clients.
     (b) The department may authorize a one-time waiver of all or any portion of the licensing and processing fees required under this subsection (11) in any case in which the department determines that an adult family home is being relicensed because of exceptional circumstances, such as death or incapacity of a provider, and that to require the full payment of the licensing and processing fees would present a hardship to the applicant.
     (12) A provider who receives notification of the department's initiation of a denial, suspension, nonrenewal, or revocation of an adult family home license may, in lieu of appealing the department's action, surrender or relinquish the license. The department shall not issue a new license to or contract with the provider, for the purposes of providing care to vulnerable adults or children, for a period of twenty years following the surrendering or relinquishment of the former license. The licensing record shall indicate that the provider relinquished or surrendered the license, without admitting the violations, after receiving notice of the department's initiation of a denial, suspension, nonrenewal, or revocation of a license.
     (13) The department shall establish, by rule, the circumstances requiring a change in the licensed provider, which include, but are not limited to, a change in ownership or control of the adult family home or provider, a change in the provider's form of legal organization, such as from sole proprietorship to partnership or corporation, and a dissolution or merger of the licensed entity with another legal organization. The new provider is subject to the provisions of this chapter, the rules adopted under this chapter, and other applicable law. In order to ensure that the safety of residents is not compromised by a change in provider, the new provider is responsible for correction of all violations that may exist at the time of the new license.

Sec. 4   RCW 74.39A.320 and 2012 c 10 s 67 are each amended to read as follows:
     (1)(a) To the extent funds are appropriated for this purpose, the department shall establish a capital add-on rate, not less than the July 1, 2005, capital add-on rate established by the department, for those assisted living facilities contracting with the department that have a medicaid occupancy percentage of sixty percent or greater.
     (((2))) (b) Effective for July 1, 2006, and for each July 1st rate-setting period thereafter, the department shall determine the facility's medicaid occupancy percentage using the last six months' medicaid resident days from the preceding calendar year divided by the product of all its licensed assisted living facility beds irrespective of use, times calendar days for the six-month period. For the purposes of this section, medicaid resident days include those clients who are enrolled in a medicaid managed long-term care program, including but not limited to the program for all inclusive care and the medicaid integration project.
     (((3))) (c) The medicaid occupancy percentage established beginning on July 1, 2006, and for each July 1st thereafter, shall be used to determine whether an assisted living facility qualifies for the capital add-on rate under this section. Those facilities that qualify for the capital add-on rate shall receive the capital add-on rate throughout the applicable fiscal year.
     (2) The department may negotiate with adult family homes to establish a capital add-on rate for those adult family homes contracting with the department that have a medicaid occupancy percentage of sixty percent or greater.