SB 6094 — Concerning facilities licensed to provide pediatric transitional care services.

(9) "Technical assistance" means the provision of information on the state laws and rules applicable to the regulation of private establishments, the process to apply for a license, and methods and resources to avoid or address compliance problems.

Technical assistance does not include assistance provided under chapter 43.05 RCW.

(10) "Trained caregiver" means a noncredentialed, unlicensed person trained by the establishment providing pediatric transitional care services to provide hands-on care to ((drug exposed)) substance- exposed infants.

Caregivers may not provide medical care to infants and may only work under the supervision of an appropriate health care professional.

Sec.

5.

RCW 71.12.680 and 2017 c 263 s 3 are each amended to read as follows:

(1) An establishment providing pediatric transitional care services to ((drug exposed infants)) substance-exposed infants and their parents must demonstrate that it is capable of providing services for ((children who:

(a) Are no more than one year of age;

(b) Have been exposed to drugs before birth;

(c) Require twenty-four hour continuous residential care and skilled nursing services as a result of prenatal substance exposure;

and (d) Are referred to the establishment by the department of social and health services, regional hospitals, and private parties.

(2))) infants who:

(a) Have been exposed to substances before birth;

(b) Have been determined by the clinical director or medical director of the establishment to respond favorably developmentally to specialized care to assist bonding and attachment from 24-hour continuous residential care treatment services including nursing and infant care services as a result of prenatal substance exposure;

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5 SB 6094 (c) Are referred to the establishment by the department of children, youth, and families, regional hospitals, and private parties.

(2) An establishment providing pediatric transitional care services to substance-exposed infants and their parents shall:

(a) Provide services including, but not limited to:

Medication management for withdrawal of neonatal abstinence syndrome and neonatal opioid withdrawal syndrome;

specialized feeding in collaboration with the early support for infants and toddlers program at the department of children, youth, and families;

oxygen therapy;

feeding tubes when necessary;

wound care;

and comorbid conditions that are managed in a nonacute setting;

(b) Have capacity to provide room and board to one or both parents of an infant receiving treatment at the establishment;

and (c) Provide wraparound services as described in section 3(3) of this act to one or both parents of an infant receiving treatment at the establishment regardless of whether the parent is residing at the establishment when the infant is receiving treatment.

(3) After January 1, 2019, no person may operate or maintain an establishment that provides pediatric transitional care services without a license under this chapter.

Sec.

6.

RCW 71.12.684 and 2017 c 263 s 5 are each amended to read as follows:

The secretary must, in consultation with the department of ((social and health services)) children, youth, and families, adopt rules on pediatric transitional care services.

The rules must:

(1) Establish requirements for medical examinations and consultations which must be delivered by an appropriate health care professional;

(2) Require twenty-four hour medical supervision for children receiving pediatric transitional services in accordance with the staffing ratios established under subsection (3) of this section;

(3) Include staffing ratios that consider the number of registered nurses or licensed practical nurses employed by the establishment and the number of trained caregivers on duty at the establishment.

These staffing ratios may not require more than:

(a) One registered nurse to be on duty at all times;

(b) One registered nurse or licensed practical nurse to eight infants;

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6 SB 6094 (c) One trained caregiver to four infants;

(4) Require establishments that provide pediatric transitional care services to prepare weekly plans specific to each infant in their care and in ((accordance)) collaboration with the health care professional's standing orders.

The health care professional may modify an infant's weekly plan without reexamining the infant if he or she determines the modification is in the best interest of the child.

This modification may be communicated to the registered nurse on duty at the establishment who must then implement the modification.

Weekly plans are to include short-term goals for each infant and outcomes must be included in reports required by the department;

(5) Ensure that neonatal abstinence syndrome scoring is conducted by an appropriate health care professional;

(6) Establish drug exposed infant developmental screening tests for establishments that provide pediatric transitional care services to administer according to a schedule established by the secretary;

(7) Require the establishment to collaborate with the department of ((social and health services)) children, youth, and families to develop an individualized safety plan for each child and to meet other contractual requirements of the department of ((social and health services)) children, youth, and families to identify strategies to meet supervision needs, medical concerns, and family support needs;

(8) ((Establish the maximum amount of days an infant may be placed at an establishment)) Require, at a minimum, weekly assessments on each infant to determine whether the infant continues to benefit from receiving care or services;

(9) Develop timelines for initial and ongoing parent-infant visits to nurture and help develop attachment and bonding between the child and parent, if the parents are not sharing a room with the infant at the facility and if such visits are possible.

Timelines must be developed upon placement of the infant in the establishment providing pediatric transitional care services;

(10) Determine how transportation for the infant will be provided, if needed;

(11) Establish on-site training requirements for caregivers, volunteers, parents, foster parents, and relatives;

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7 SB 6094 (12) Establish background check requirements for caregivers, volunteers, employees, and any other person with unsupervised access to the infants under the care of the establishment;

((and)) (13) Establish supportive family rules for the parent of an infant to stay at the facility while the infant is receiving care.

Supportive family rules shall provide for:

(a) Room and board for any parent who the establishment deems eligible for such services;

(b) Access to and secure storage for medication-assisted treatment medications;

(c) Training on infant cues to promote dyadic bonding and attachment;

(d) Transportation to inpatient or outpatient substance use disorder services for the parents;

(e) Training on safe sleep techniques;

(f) Coordination between providers from the early support for infants and toddlers program of the department of children, youth, and families and parents to promote continuity of care;

(g) Training on basic parental skills;

(h) Care management services;

(i) Support in securing housing;

(j) Peer support;

(k) Supervised visitation services;

and (l) Education on secondary exposure to opioids;

and (14) Establish other requirements necessary to support the infant and the infant's family.

Sec.

7.

RCW 71.12.686 and 2017 c 263 s 6 are each amended to read as follows:

After referral by the department of ((social and health services)) children, youth, and families of an infant to an establishment approved to provide pediatric transitional care services, the department of ((social and health services)) children, youth, and families:

(1) Retains primary responsibility for case management and must provide consultation to the establishment regarding all placements and permanency planning issues, including developing a parent-child visitation plan;

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8 SB 6094 (2) Must work with the department and the establishment to identify and implement evidence-based practices that address current and best medical practices and ((parent)) dyadic participation;

and (3) ((Work)) Must work with the establishment to ensure medicaid- eligible services are so billed.

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