HB 2750 — Concerning quality in assisted living facilities.

H-3696.1HOUSEENGROSSED HOUSE BILL 2750State of Washington65th Legislature2018 Regular SessionBy Representatives Tharinger, Johnson, Cody, Stonier, Slatter, Robinson, Jinkins, Appleton, Muri, and GregersonRead first time 01/15/18.

and prescribing penalties;penalties.BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:NEW SECTION.  Sec. 1.  The legislature finds that:(1) Washington state is ranked number one in the nation in offering quality choices in its long-term services and supports system.

and providing an expiration date.BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:NEW SECTION.  Sec. 1.  The legislature finds that:(1) Washington state is ranked number one in the nation in offering quality choices in its long-term services and supports system.

Providing transparency will allow for more informed consumer choices;(5) State medicaid pays for approximately twenty-five percent of all residents in assisted living facilities, and the state should have more data on the quality of care offered to those residents;(6) A work group has been developing recommendations regarding medicaid rates to inform the legislature as it considers a methodology for adequately funding assisted living facilities so they may deliver safe and quality care to residents;(7) Consumers already have access to information on nursing homes and adult family homes.

and(8)and(6) Assisted living facilities need to be held accountable for the residents in their care and the fine structure should be reflective of that responsibility.NEW SECTION.  Sec. 2.  A new section is added to chapter 18.20 RCW to read as follows:(1)follows:The Thedepartment assistedshall livingprovide facilityinformation qualityto councilconsumers isabout established.assisted living facilities.

TheThis councilinformation shallmust makebe recommendationsmade onavailable measuringonline quality, providing consumer information, and reportingmust value.(2)include Theinformation panelrelated shallto consistsite ofvisits, seventeensubstantiated members,inspection asand follows:(a)complaint Oneinvestigation memberreports, fromincluding eachany ofcitation theand tworemedy largestimposed, caucusesand ofa thelisting house of representatives,licensed asassisted appointedliving facilities by thegeographic speakerlocation.NEW ofSECTION.  Sec. 3.  A thenew housesection ofis representatives;(b)added Oneto memberchapter from18.20 eachRCW ofto theread two largest caucuses of the senate, as appointedfollows:(1) by the president of the senate;(c) The assistant secretary of the department ofshall socialfacilitate anda healthwork servicesgroup withprocess jurisdiction over aging and long-term supports issues;(d) One representative of the office of the state long-term care ombuds;(e) One representative of the office of the developmental disabilities ombuds;(f) One representative of the state protection and advocacy program established pursuant to RCWrecommend 71A.10.080;(g)quality Onemetrics representativefor ofassisted theliving Washingtonfacilities. state developmental disabilities council;

and(h) The followingdepartment members,shall askeep appointeda bypublic therecord governor:(i) One representative of thecomments governor;(ii)submitted Twoby representativesstakeholders ofthroughout organizationsthe thatwork representgroup assistedprocess.(2) livingThe facilitieswork ingroup Washington;(iii)shall Oneconsist personof withrepresentatives expertisefrom inthe servingdepartment, personsassisted withliving mentalprovider healthassociations, needsthe inlong-term an institutional setting;(iv) One person with expertise in serving persons with various forms of dementia;(v) One licensed health care professionalombuds; with experience caring for geriatric patients;(vi) One representative of an organization that represents persons in Washington with Alzheimer's disease;

and(vii)organizations Onewith representativeexpertise ofin anserving organizationpersons thatwith providesmental consumer advocacy services related to senior and aging issues.(3) The council shall be cochaired by the assistant secretary from the department of social and health servicesneeds andin onean ofinstitutional thesetting, legislatorsas fromselected a majority caucus of the legislature.(4) Staffing support for the council shall be provided by the assisteddepartment; living facilities quality measurement program established in section 3 of this act.(5) The council must create a uniform quality metric system for assisted living facilities by September 1, 2019.

Theorganizations qualitywith metricexpertise systemin mustserving addresspersons thewith safety,developmental health,disability andneeds well-beingin of residents of assisted living facilities.(6)(a) The council must submit an interiminstitutional reportsetting, toas theselected governor and the legislature by December 1, 2018, and a final report on the qualitydepartment; metric system by September 1, 2019.(b) The final report to the governor and the legislature must include recommendations that:(i) Identify quality measures for all assisted living facilities;(ii) Propose a process for monitoring and tracking performance;(iii) Propose a process for providing information to consumers;(iv) Propose a process for using quality measures when establishing medicaid rates;(v) Select data metrics to be reported by assisted living facilities to the department.

Thelicensed selectedhealth data should promote quality care andprofessionals avoidwith reportingexperience datacaring thatfor isgeriatric unnecessarilypatients, burdensomeas toselected assistedby livingthe facilities;(vi)department; Propose a process and frequency for reporting data;

and(vii) Evaluate the merits of including a quality incentive payment program.(7) This section expires June 30, 2020.NEW SECTION.  Sec. 3.  A new section is added to chapter 18.20 RCW to read as follows:(1) The assisted living facilities quality measurement program is established within the department to provide consumers with information and dataan aboutAlzheimer's assistedadvocacy livingorganization. facilities to allow them to make informed decisions about residential options.(2) The program shall:(a) Provide staffing support to the assisted living facility quality council;

and(b)The Providework informationgroup may solicit input from individuals with additional expertise, if necessary.(3) The work group shall make an interim report by September 1, 2019, and final recommendations to consumersthe aboutappropriate legislative committees by September 1, 2020, and shall include a dissent report if agreement is not achieved among stakeholders and the department.(4) The work group must submit recommendations for a quality metric system, propose a process for monitoring and tracking performance, and recommend a process to inform consumers.(5) The department shall include at least one meeting dedicated to review and analysis of other states with quality metric methodologies for assisted living facilities.and must include information on how well each state is achieving quality care outcomes.

TheIn informationaddressing mustdata bemetrics made available online and include information related to site visits, inspection and complaint investigation reports, licenses issued by the department,work andgroup citationsshall issuedconsider bywhether the department.(3)data Thethat program must submitbe anreported implementationreflect reportand topromote thequality governorof care and thewhether legislaturereporting bythe Novemberdata 1,is 2020,unnecessarily andburdensome anupon updateassisted reportliving byfacilities.Sec. 4.  RCW November 1, 2022.Sec. 4.  RCW 18.20.190 and 2012 c 10 s 13 are each amended to read as follows:(1) The department of social and health services is authorized to take one or more of the actions listed in subsection (2) of this section in any case in which the department finds that an assisted living facility provider has:(a) Failed or refused to comply with the requirements of this chapter or the rules adopted under this chapter;(b) Operated an assisted living facility without a license or under a revoked license;(c) Knowingly, or with reason to know, made a false statement of material fact on his or her application for license or any data attached thereto, or in any matter under investigation by the department;

or(d) Willfully prevented or interfered with any inspection or investigation by the department.(2) When authorized by subsection (1) of this section, the department may take one or more of the following actions:(a)actions, using a tiered sanction grid that considers the extent of harm from the deficiency and the regularity of the occurrence of the deficiency when imposing civil fines:(a) Refuse to issue a license;(b) Impose reasonable conditions on a license, such as correction within a specified time, training, and limits on the type of clients the provider may admit or serve;(c) Impose civil penalties of ((not more than)) at least one hundred dollars per day per violation;(d)violation. Impose civil penalties of up to three thousand dollars for each incident that violates assisted living facility licensing statutes or rules, including this chapter and chapters 70.129, 74.34, and 74.39A RCW, and related rules.

EachUntil dayJuly upon1, which2019, the same or substantially similar action occurs is a separate violation subject to the assessment of a separate penalty;(e) Impose civil penalties ofmay upnot toexceed tenone thousand dollars forper aday currentper orviolation. former licensed provider who is operating an unlicensed facility;(f) Suspend, revoke, or refuse to renew a license;(((e))) (g) Suspend admissions to the assisted living facility by imposing stop placement;

or(((f)))Beginning (h)July Suspend1, admission2019, ofthrough aJune specific30, category2020, or categories of residents as related to the violationcivil bypenalties imposingmay anot limitedexceed stoptwo placement.(3)thousand Thedollars departmentper shallday adoptper aviolation. method for determining appropriate actions to respond to deficiencies identified in subsection (1) of this section according to the severity and scope of the deficiencies.

TheBeginning methodJuly shall1, include2020, the usecivil ofpenalties amay tierednot sanctionexceed gridthree thatthousand considersdollars theper extentday ofper harmviolation;(d) fromImpose thecivil deficiencypenalties and the regularity of theup occurrenceto often thethousand deficiencydollars whenfor imposinga civilcurrent fines.(4)or Whenformer thelicensed departmentprovider orderswho stopis placementoperating oran aunlicensed limitedfacility;(e) stopSuspend, placement,revoke, theor facilityrefuse shallto notrenew admita anylicense;(((e))) new(f) residentSuspend untiladmissions to the stopassisted placementliving orfacility limitedby imposing stop placementplacement; order is terminated.

or(((f))) (g) Suspend admission of a specific category or categories of residents as related to the violation by imposing a limited stop placement.(3) When the department orders stop placement or a limited stop placement, the facility shall not admit any new resident until the stop placement or limited stop placement order is terminated.

However, if upon the revisit the department finds new violations that the department reasonably believes will result in a new stop placement or new limited stop placement, the previous stop placement or limited stop placement shall remain in effect until the new stop placement or new limited stop placement is imposed.(((4)))imposed.(4) (5) After a department finding of a violation for which a stop placement or limited stop placement has been imposed, the department shall make an on-site revisit of the provider within fifteen working days from the request for revisit, to ensure correction of the violation.

Nothing in this subsection shall interfere with or diminish the department's authority and duty to ensure that the provider adequately cares for residents, including to make departmental on-site revisits as needed to ensure that the provider protects residents, and to enforce compliance with this chapter.(((5)))chapter.(5) (6) RCW 43.20A.205 governs notice of a license denial, revocation, suspension, or modification.

Chapter 34.05 RCW applies to department actions under this section, except that orders of the department imposing license suspension, stop placement, limited stop placement, or conditions for continuation of a license are effective immediately upon notice and shall continue pending any hearing.(((6)))hearing.(6) (7) All receipts from civil penalties imposed under this chapter must be deposited in the assisted living facility temporary management account created in RCW 18.20.430.(8)18.20.430.(7) For the purposes of this section, "limited stop placement" means the ability to suspend admission of a specific category or categories of residents.Sec. 5.  RCW 18.20.430 and 2016 sp.s.