SB 5867 — Creating a flexible voluntary program to allow family members to provide personal care services to persons with developmental disabilities or long-term care needs under a consumer-directed medicaid service program.

SECOND ENGROSSED SENATE BILL 5867State of Washington65th Legislature2017 Regular SessionBy Senator BraunAN ACT Relating to creating a flexible voluntary program to allow family members to provide personal care services to persons with developmental disabilities or long-term care needs under a consumer-directed medicaid service program;

amending RCW 74.39A.074, 74.39A.076, 74.39A.240, 74.39A.341, 18.88B.041, and 74.39A.326;

addingcreating new sectionssections; to chapter 74.39A RCW;

and creatingproviding aan newexpiration section.BEdate.BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:NEW SECTION.  Sec. 1.  The legislature finds that the most common form of long-term care provided to persons who are elderly, disabled, or have a developmental disability is provided by a family member in a personal residence.

The current system of medicaid services has complexities that may create obstacles for consumers who wish to be cared for by a family member and for family members who enter the system solely to provide care for their loved ones.Therefore, the legislature intends to createdirect ana optionalstudy consumer-directedof programthe current options allowing for providingthe delivery of medicaid personal care services forby individualscaregivers withwho long-termare carefamily needsmembers orof developmentalthe disabilitiesstate's receivingcitizens carewho fromare aging, disabled, or who have a familydevelopmental member.disability.

ThisThe programlegislature isintends intended to providepromote individuals with more flexibility infor accessingclients to access their benefits and to reduce obstacles for consumersclients who wish to hire family members to provide their care.NEW SECTION.  Sec. 2.  ASECTION.  Sec. 2.  (1) newThe sectionjoint legislative executive committee on aging and disability is addeddirected to chapterexplore 74.39Alegislation RCWthat towould readallow asfamily follows:Themembers departmentto isprovide directedpersonal care services to developpersons andwith implementdevelopmental adisabilities, consumer-directedor medicaidlong-term programcare asneeds providedunder ina chaptervoluntary .consumer-directed medicaid service program.

.,As Lawspart of 2017this (thiswork, act).the committee must also include a discussion of consumer-directed approaches, including those approaches that allow family members of the consumer to provide care, and develop recommendations on:(a) Promoting consumer health, safety, and autonomy;(b) Ensuring adequate caregiver training and support;(c) Verifying the quality and appropriateness of care;(d) Reducing barriers for consumers who prefer to receive care from caregivers of their choosing, including family members;

and(e) Mitigating or minimizing potential liability issues that may arise in the context of consumer-directed programs.(2) The joint legislative executive committee on aging and disability must submit a report with recommendations to the appropriate policy and fiscal committee of the legislature by July 1, 2018.(3) This programsection isexpires intendedJuly 1, 2018.Sec. 3.  RCW 74.39A.326 and 2009 c 571 s 1 are each amended to beread aas voluntaryfollows:(1)(a) alternativeExcept optionas forprovided individualsunder with(b) long-termof this subsection, the department shall not pay a home care needsagency orlicensed developmentalunder disabilitieschapter who70.127 chooseRCW tofor receivein-home personal care or respite services fromprovided under this chapter, Title 71A RCW, or chapter 74.39 RCW if the care is provided to a client by a family member.member of the client.

The department shall review existing medicaid programs and determine the appropriate waiver to seek from the centers for medicare and medicaid services.

The department shall seek stakeholder input on the new consumer-directed program's design to inform its submission of a waiver proposal to the centers for medicare and medicaid services.

The department's waiver proposal must be submitted to the centers for medicare and medicaid services by March 1, 2018.

By January 1, 2019, and September 1, 2019, the department must submit status reports to the legislature that provide information about the department's activities, program design, necessary statutory changes, barriers to implementation, and estimated implementation date, caseload, and costs.

The consumer-directed medicaid program as provided in chapter .

., Laws of 2017 (this act) must be available to consumers by January 1, 2019.NEW SECTION.  Sec. 3.  A new section is added to chapter 74.39A RCW to read as follows:(1) The consumer-directed medicaid program is a voluntary alternative option for consumers who seek to receive personal care services from a family member.

The consumer-directed medicaid program must also reduce barriers that prevent consumers from being able to select a family member as their paid personal care or respite provider.

The consumer, or his or her representatives, if applicable, must have decision-making authority to recruit, hire and fire, determine wages, train, supervise, and determine other conditions of employment for his or her family member providing personal care and respite services.

The consumer, or his or her representatives, or both, must also have decision-making authority over how the medicaid funds in his or her individual budgets are spent.(2) The consumer-directed medicaid program must include the following characteristics:(a) A consumer-centered planning process that is directed by the consumer with assistance as needed or desired by a representative of the consumer's choosing.

The process must include an assessment and service plan that establishes eligibility, the available budget amount, and the preferences, abilities, needs, and desired measurable outcomes of the consumer.

The process may include other persons, freely chosen by the consumer, who are able to serve as important contributors to the process.

The planning process must include planning for contingencies such as when a needed service is not provided due to the family member being unavailable.

As part of the contingency planning process, an assessment of the risks to the consumer must be completed, and a discussion about how risks will be addressed must be held;(b) A service plan that specifies the services and supports that are to be furnished to meet the preferences, choices, abilities, and needs of the consumer, and that assists the consumer to direct those services and supports so he or she is able to remain in his or her community;

and(c) An individualized budget that is under the control and direction of either the consumer, or his or her representative, or both.

The budget plan is developed using a consumer-centered planning process and is individually tailored in accordance with the consumer's needs and preferences as established in the service plan.

The department must describe the method for calculating the dollar values of consumer budgets and define a process for making adjustments to the budget amount when there are significant changes in the consumer's support and service needs.(3) The program must also include a system of supports to provide information and assistance to consumers to address assessed needs including, but not limited to:(a) Information regarding how consumer-directed programs work;(b) Information about a consumer's rights and responsibilities when enrolled in a consumer-directed program;(c) A consumer may provide training directly to his or her family members or determine training topics that must be completed.

The content of the training must be related to the consumer's preferences, care needs, conditions, health, safety, or topics relevant to his or her consumer-centered plan and spending plan under the program.

The department may assist consumers by offering voluntary training, including training offered under RCW 74.39A.351, on how to select, manage, train, and dismiss employees.

This may include referrals to other agencies, educational institutions, and consumer and community advocacy organizations to obtain information and assistance;

and(d) A consumer must determine the compensation, hours, and working conditions of his or her family members.

The hourly wage paid must be at least the state minimum wage.(4) The department must contract with an independent third party to provide financial management services to assist consumers in exercising their budget authority unless they are able to perform some or all of these functions themselves.

Financial management services may include assistance in understanding billing and documentation responsibilities, performance of payroll and employer-related duties, assistance purchasing approved goods and services, tracking and monitoring goods and services purchased and provided, and identifying expenditures that are over or under the budget.(5) The program must include necessary safeguards to protect the health and welfare of consumers.

The program must include a requirement that any family member providing services pass appropriate state and federal criminal background checks to verify that he or she does not have a criminal history that would disqualify him or her from working with vulnerable persons.

The family member providing services also must not be listed on any long-term care abuse and neglect registry, child abuse registry, or any other registry or list used by the department to disqualify the person from caring for vulnerable persons.(6) A consumer must be allowed to disenroll from the program at any time and return to a traditional service delivery system.(7) For the purposes of this section and section 2 of this act:(a) "Consumer" means a person who:(i) Is functionally disabled and eligible for personal care or respite care services under medicaid personal care, community first choice option, community options program entry system, chore services program, new freedom system, or respite care program;(ii) Is eligible for respite care or residential service and support as a person with developmental disabilities under Title 71A RCW;

or(iii) Is eligible for respite care as defined in RCW 74.13.270.(b) "Family member" means a person who is related by blood, adoption, or marriage as a child, parent, or sibling, including those relations denoted with the prefix "grand" or "great."(8) The department shall adopt rules necessary to implement this section.Sec. 4.  RCW 74.39A.074 and 2012 c 164 s 401 are each amended to read as follows:(1)(a) Beginning January 7, 2012, except for long-term care workers exempt from certification under RCW 18.88B.041(1) (a) and (f) and, until January 1, 2016, those exempt under RCW 18.88B.041(1)(b), all persons hired as long-term care workers must meet the minimum training requirements in this section within one hundred twenty calendar days after the date of being hired or within one hundred twenty calendar days after March 29, 2012, whichever is later.

In computing the time periods in this subsection, the first day is the date of hire or March 29, 2012, whichever is applicable.(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 successfully complete five of these seventy-five hours before being eligible to provide care.(c) Training required by (d) of this subsection applies toward the training required under RCW 18.20.270 or 70.128.230 or any statutory or regulatory training requirements for long-term care workers employed by community residential service businesses.(d) The seventy-five hours of entry-level training required shall be as follows:(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) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control;

and(ii) Seventy hours of long-term care basic training, including training related to core competencies and population specific competencies.(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.(3) Individual providers under RCW 74.39A.270 shall be compensated for training time required by this section.(4) The department shall adopt rules to implement this section.Sec. 5.  RCW 74.39A.076 and 2015 c 152 s 2 are each amended to read as follows:(1) Beginning January 7, 2012, except for long-term care workers exempt from certification under RCW 18.88B.041(1) (a) and (f):(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 after becoming an individual provider or within one hundred twenty calendar days after March 29, 2012, whichever is later.(b) Individual providers identified in (b)(i), (ii), and (iii) of this subsection must complete thirty-five hours of training within the first one hundred twenty days after becoming an individual provider or within one hundred twenty calendar days after March 29, 2012, whichever is later.

Five of the thirty-five hours must be completed before becoming eligible to provide care.