Legislative

Prepared by Leslie

Legislative Overview

My how has the world changed in the last month…. As you are all painfully aware, Washington state has been the lead on addressing the COVID-19 virus as we were the first state to see a US death in the Seattle area where it spread rapidly from an elder care facility in Kirkland. Our state health department has been planning for a pandemic for a long time and has been ahead of the curve by setting up an Incident Response Team at the Department of Health and initiating emergency measures early through Governor Inslee.

Although the state legislature budgeted around $200 million out of our “rainy day” funds to address the pandemic before the end of the session on March 12^th, and the state is seeing millions in federal dollars coming in, it will not be enough to address the financial impacts on the state budget which is experiencing a deep loss of tax revenues that keep services afloat.

According to the Seattle Times, April 3, 2020: “With the coronavirus effectively shuttering Washington’s economy and crushing state tax collections, Gov. Jay Inslee used his veto pen Friday to slash $445 million in spending from the state operating budget. In a perhaps unprecedented move, Inslee made line-item vetoes to 147 programs as he signed the state supplemental operating budget, which tweaked Washington’s two-year spending blueprint. But with the outbreak choking the economy, budget experts suggested the damage to tax collections could be worse than during the Great Recession. The darkening economic portrait might even require a special legislative session for further spending cuts before lawmakers are scheduled to return in January 2021.”

We are hearing rumblings that the state legislature may do an emergency session tapping additional state funding from the “rainy day fund”…but I think that may be after they see how far the federal dollars go that are now starting to come into the state. The next state revenue council forecast comes out in June this year.

New Governor Proclamation requires accommodations for high-risk employees On Monday, Gov. Inslee issued Proclamation 20-46 “High-Risk Employees—Workers’ Rights – which requires employers to take extra measures to accommodate employees who are considered at high risk for severe illness or death if they contract COVID-19. According to the Centers for Disease Control and Prevention (CDC), these are people over 65 and those with certain chronic underlying health conditions, regardless of age. The proclamation requires all Washington employers, private and public, to provide all available options for alternative work assignments to protect the employee from exposure to COVID-19, if requested. If a reasonable accommodation is not possible, the employee must be permitted to take leave or file for unemployment benefits. (Jaclyn Greenberg) Read more >

Final Supplemental Operating Budget (ESSB 6168) Related Issues

ESSB 6168 Making 2019-2021 fiscal biennium supplemental operating appropriations.

(aa) $75,000 of the general fund—state appropriation for fiscal year 2021 and $96,000 of the general fund—federal appropriation are provided solely to implement House Bill No. 2380 (home care agencies). If the bill is not enacted by June 30, 2020, the amounts provided in this subsection shall lapse. (See bill info below)

Administrative Rate for Home Care Agencies Section Vetoed by Governor: (28) $306,000 of the general fund—state appropriation for fiscal year 2020, (($317,000)) $634,000 of the general fund—state appropriation for fiscal year 2021, and (($794,000)) $1,198,000 of the general fund—federal appropriation are provided solely to increase the administrative rate for home care agencies by five cents per hour effective July 1, 2019, and by an additional five cents per hour effective July 1, 2020.

Palliative Care Insurance Workgroup: This proviso is included in the final state operating budget! This proviso based on the WA State Bree Collaborative Palliative Care Workgroup Report which included a recommendation to increase the availability of palliative care through revision of benefit structure such as a per member per month (PMPM) benefit. The report will also recommend to “Convene a workgroup to determine next steps for insurance coverage of specialty palliative care as defined in this report.” The work group shall report its recommendations to the full joint legislative executive committee on aging and disability issues by November 1, 2020.

Medicaid Home Health: Those of you who participated in the In-Home Services Day this year you may remember the Medicaid Home Health Reimbursement bill that was on our “song sheet”. I have bad news and good news about this issue. HB 2451 Medicaid Home Health, matching Medicaid to Medicare rates did not pass the legislature this session. The good news is that their was a budget proviso in ESSB 6168 that increases funding for Medicaid Home Health by 33%!Here is the language in ESSB 6168 (Page 196):

(80) $770,000 of the general fund—state appropriation for fiscal year 2021 and $800,000 of the general fund—federal appropriation are provided solely to increase home health rates beginning January 1, 2021.

We are not in the clear yet as we do not know how deep the virus related recession will be for our state…but let’s hope they continue to see the value of home health serving the Medicaid population of our state and preserve this much deserved rate increase.

From the Governor’s Veto Message:  The supplemental budget includes task forces, work groups, reports, pilot programs, new programs, and program expansions that would be smart investments for the state under normal circumstances. However, under the extraordinary situation we now face, we cannot afford all of them at this time. For this reason, I have vetoed the following sections:

Section 221(59), pages 265-266, Department of Health, Telemedicine Work Group: This section directs the Department of Health, within existing resources, to convene a work group to collect information and establish guidelines and recommendations for how the Office of the Insurance Commissioner can include telemedicine services in network adequacy requirements. The staff and stakeholders necessary to convene this work group are the same individuals working to address the COVID-19 outbreak. This work group requirement would divert critical resources from the pandemic response. For these reasons I have vetoed Section 221(59) and am directing the Department of Health to perform as much of the activity as feasible within available resources, given that this is important work in the current environment.

Administrative Rate for Home Care Agencies Section 204(34), page 154: Section 204(28), page 152, DSHS Aging and Long-Term Care Services Administration,

Dementia Education Section 204(38), pages 154-155: DSHS Aging and Long-Term Care Services Administration

Specialized Dementia: DSHS, Aging and Long-Term Care Services Administration

WAHCA Bills from 2020 Session

HB 2380 Changing the home care agency vendor rate and repealing electronic timekeeping. Effective date 6/11/2020. Allows the home care agency vendor rate calculation to reflect the average home care agency employer tax rate. Adds employer premiums for the state Paid Family and Medical Leave Act to the premiums addressed in the home care agency vendor rate calculation. Clarifies language in how rate parity between home care agencies and individual providers of home care services relates to changes in benefits. Repeals electronic timekeeping requirements that are inconsistent with federal law.

E2SSB 6205/(HB 2681) Preventing harassment, abuse, and discrimination experienced by long-term care workers. Summary: Home care agencies and the Consumer Directed Employer must adopt and maintain a comprehensive written policy about how they will address instances of discrimination, abusive conduct, and challenging behavior by July 1, 2021. (Effective June 10, 2020)

ESSB 6492 Workforce Surcharge: Summary: Except for certain advanced computing businesses, the workforce education investment surcharge is eliminated and replaced with an increase in the B&O service rate from 1.5 percent to 1.75 percent for businesses earning more than $1 million annually in the preceding calendar year.  Businesses conducting service activities, but not meeting the $1 million threshold, continue to pay B&O tax at the 1.5 percent rate.  Hospitals are excluded from the increase. For the purpose of determining whether a business has met the $1 million threshold, the income of any affiliates of the business is also included in the calculation.  An affiliate is any business that directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with another business.

SSB 6061 – Telemedicine training: March 25, 2020 – Governor signed. Effective date 6/11/2020.

Beginning January 1, 2021, health care professionals who provide clinical services through telemedicine, other than physicians and osteopathic physicians, must complete either:

• a telemedicine training made available by the telemedicine collaborative; or
• an alternative telemedicine training, which may include training offered by hospitals and other health care facilities, continuing education courses, or trainings developed by a health professional board or commission.

Health care professionals must sign and retain an attestation that they completed either the telemedicine collaborative or alternative telemedicine training.

ESSB 5385 – Telemedicine reimbursement: March 19, 2020 – Governor signed. Effective date 3/19/2020. Beginning January 1, 2021, regulated health insurance carriers, the state employee health plans, and Medicaid managed care plans must reimburse a provider for health care service provided through telemedicine at the same rate as health care service provided in-person.

SSB 6267 – Long-term services trust: March 19, 2020 – Governor signed. Effective date 6/11/2020. An employee who attests they have long-term care insurance is permitted to apply for an exemption from the premium assessment.  An exempt employee is permanently ineligible from receiving LTSS Trust Program benefits. 

Department of Health Issues

DOH COVID-19 Response/Governor’s Office: DOH has been on the forefront of fighting the COVID-19 virus in our state and is in charge of the Incident Command Center for the state. For information and updates on the statues of COVID-19 in WA State:https://www.doh.wa.gov/Emergencies/Coronavirus

On March 26, Governor Jay Inslee issued proclamation 20-25 on healthcare worker licensing. The proclamation waived certain statutes and rules with the intent to increase the health care system’s capacity to respond to COVID-19. The proclamation is in effect until midnight on April 25, 2020, unless extended by legislative approval.

The information below summarizes the rules that were waived for health professions. The Governor’s powers to issue proclamations that waive law during emergencies (RCW 43.7.06.220(4)) states that no orders concerning waiver or suspension may continue longer than thirty days unless extended by the legislature. 

Waiver of continuing education requirements for returning from expired to active status:

The Governor has waived continuing education and training requirements to return from expired to active licensing status through April 25, 2020 by waiving WAC 246-980-115(1)(c), and (2)(a) language “submit proof of twelve continuing education hours as required by RCW 74.39A.341 and WAC 246-980-110 for each year it has been expired.” 

Extension of health profession license expiration dates

Barriers to the practice of health care provider volunteers: The requirement to verify that an NA has completed basic caregiver training and core delegation training before delegation, and the Washington State Nursing Care Quality Assurance Commission community-based and in-home care setting delegation decision tree are waived.

Long-term care worker rules proclamation: The governor has issued a proclamation suspending certification requirements in community-based settings (adult family homes, assisted living facilities and home care agencies). You can find it here. This means that NARs can work in a community-based facility past 200 days before obtaining their NAC or HCA credential.

DOH Temporarily Suspends Routine State Compliance Inspections

DOH has temporarily suspended routine state compliance inspections in all health care facilities it regulates. This change will allow health care facilities to focus their energy, resources, and staff on the COVID-19 response and caring for patients. It will also allow the department to focus our work on technical assistance, resolution of on-going enforcement actions, and investigations of complaints that pose the greatest risk to patients. This approach is consistent with guidance published by the Centers for Medicare & Medicaid Services (CMS). Additional CMS guidance is located here. We will continue the following state compliance activities and investigating complaints that allege immediate risk to patient safety or patient abuse/neglect. The DOH will continue to:

DOH has published new guidance for in-home care providers working in the absence of PPE – see attachment below. Also attached for your reference is a DSHS published guidance “Caring for Clients with COVID-19.”

• PPE Guidance.pdf
• Caring for COVID clients.pdf

Nursing Care Quality Assurance Commission (NCQAC) Nurse Licensing

Please see the attachment for information on applications and fees for licensing, or visit the Nursing Commission’s licensing webpage.

Extension of renewal fees: For nurses and nursing assistants whose birthdates are between April 1, 2020, and September 30, 2020, the renewal fee due date is extended to September 30, 2020. Your renewal date on Provider Credential Search and NURSYs will continue to show your birthdate, but the renewal date will be September 30, 2020.

120-Day or 4-Month Rule for Nursing Assistant Training – Proclamation 20-37 from Governor Inslee waives the requirement for nursing assistants-registered (NARs) to complete training and testing to become certified nursing assistants within four months of employment with a nursing home, effective through April 29, 2020.

NAR Work Hours in Sanctioned Facilities – While the NCQAC can now temporarily allow programs to count students’ NAR work hours as their clinical hours when documentation of hours and competency evaluation by the supervising LPN or RN is provided –this not true in sanctioned facilities. Federal regulations for sanctioned facilities mandate that clinical training will not be conducted or assessed by any employee of the sanctioned nursing facility.

Skills Checklist for NAR Work Hours – A process and checklist to document these hours is in development and expected to be available next week.

Nursing Assistant Students Still Deemed Essential – March 27 communication to programs continues to be in effect regarding skills lab and clinical rotations. This means:

In-Home Services Roundtable: The next Department of Health (DOH) In-Home Services Roundtable will be April 23, 2020. Home care, home health, and hospice agency representatives and other interested parties are encouraged to attend. The purpose of these meetings is to provide agencies an opportunity to meet with DOH staff, to receive licensing, survey, and industry related information and updates, to have the opportunity to ask questions / raise concerns, and to collaborate with colleagues. The Roundtable will be held at the following address: Contact In-Home Services program manager if you have any questions at [email protected].

Long-Term Care Workforce Development Steering Committee: I have been regularly attending the workgroup meetings of the Curriculum and Testing Committees for reviewing and assessing what would be in a core curriculum for all types of certified nursing assistants and have been participating in monthly workgroup meetings. The committee I am on is reviewing potential curriculum for CNA’s that would be transferable to many environments.   Palliative Care Roadmap: We have had a number of meetings editing the “PC roadmap”, with DOH staff to review and sort the compiled information that was gathered at the first big meeting. Shawn D’Amelio attended the first meeting where they took broad feedback for the larger workgroup and will be part of the broader review as we narrow down the content to more manageable levels. The booklet will be very similar to the Dementia Roadmap published by DSHS a few years ago. Hard copies must be available for distribution no later than September 30, 2020. Palliative Care-Rural Health Integration Advisory Team (PC-RHIAT): This is an ongoing workgroup thatI am involved in. I am on the advisory team for the Community Engagement Workgroup. To learn more about the Washington Rural Palliative Care Initiative please visit :  https://waportal.org/partners/home/washington-rural-palliative-care-initiative

Labor and Industries Issues

L&I offering struggling employers grace period to pay workers’ comp premiums in response to pandemic:

April 6, 2020   L&I is now offering a grace period for premium payments, along with payment plans for employers facing financial difficulties during the pandemic. Under this new offer, employers can request for their payment to be deferred for up to 90 days or can ask for a 90-day payment plan. The delayed payments will be penalty- and interest-free. As part of the agreement, businesses must file their quarterly report on time, which is no later than April 30, 2020. Quarterly reports can be filed online through QuickFile. For additional services, call the L&I Office of Information and Assistance at 360-902-5800.

DSHS Issues

See Professional and Provider resources for ALTSA Provider/Administrator letters, PPE guidance, CMS waivers, and other information of note.

• COVID-19 Resources for Professionals and Providers

COVID-19 Problems with Medicaid home care, home health and hospice accessing residential facilities: I have been in contact with Candace (Candy) Goehring / Director / DSHS Residential Care Services Aging and Long-Term Support Administration/ (360-725-2401   [email protected] regarding this issue. Here response was “We have sent out communication to all our facility and agency types to describe for them that hospice and home health staff are not considered visitors and are to be allowed to provide the essential health and social services to their patients.  If you can provide us with the names of facilities that are not allowing visitors in we will contact them and provide education about allowing entry to the facility. The hospice and home health staff will need to allow health screening before entry. 

I suggest reaching out to the facilities management first, but if all else fails, please consider reporting them to DSHS if they refusal to allow Medicaid home care, health or hospice visits for any discipline to DSHS at: 1-800-562-6078 or on line reporting at https://www.dshs.wa.gov/altsa/residential-care-services/residential-care-services-online-incident-reporting

Consumer Directed Employer (CDE): You are invited to participate in a webinar on the Consumer Directed Employer project. This webinar is intended for members of the public who are interested in learning more about the Consumer Directed Employer project.  After registering, you will receive a confirmation email containing information about joining the webinar. April 21, 2020 at 10:30am   Register online

Public Policy Updates

WA State Telemedicine Collaborative: Discussed that they amend RWC 48.43.735 Reimbursement of health care services provided through telemedicine or store and forward technologies (7) (f) & (g) to remove “does not include the use of audio-only telephone”. Not all patients have access to broadband services, wi-fi or a smart phone. It is discriminatory and unnecessary to require a two-way audio-visual connection when relaying vital statistic information for patient home monitoring such as weight, blood pressure and oximetry. The health care data could easily be relayed via a follow-up phone call with a patient.

WA State Dementia Collaborative: This is an ongoing meeting that I attend on a quarterly basis as part of the Health and Medical group. There are ongoing discussions about how to integrate dementia care into more medical settings. https://www.dshs.wa.gov/altsa/dementia-action-collaborative. If anyone wants to order some more Dementia Roadmaps for your agency, please go to: www.dshs.wa.go/altsa/dementa-action-collaborative.

Additional Covid-19 Resources:

Office of the Insurance Commissioner: https://www.insurance.wa.gov/coronavirus

WA State Telehealth Collaborative: https://www.wsha.org/policy-advocacy/issues/telemedicine/washington-state-telemedicine-collaborative/

• Telemedicine Frequently Asked Questions for Patients: https://www.wsha.org/wp-content/uploads/Telemedicine-Frequently-Asked-Questions-for-Patients-Dec-2018.pdf
• Telemedicine Frequently Asked Questions for Providers: https://www.wsha.org/wp-content/uploads/Frequently-Asked-Questions-about-Telehealth-for-Providers-Dec-2018.pdf

WA State Employment Security Department: https://esd.wa.gov/newsroom/covid-19

WA State Department of Commerce: https://startup.choosewashingtonstate.com/links/crisis/covid-19-resources/

Governor Inslee’s COVID-19 webpage: https://www.governor.wa.gov/issues/issues/covid-19-resources

Washington state COVID-19 webpage: https://www.coronavirus.wa.gov Federal COVID-19 webpage: https://www.coronavirus.gov

Prepared by Leslie Emerick, Lobbyist

Legislative Overview

The 60-day short session of the Washington State Legislature ended on March 12^th, 2020. It seems so long ago now, but on March 2^nd I attended the Senate Ways & Means committee hearing with Secretary of Health John Wiesman requesting $100,000 million in additional funding to address the coronavirus outbreak in Washington state. The good news was that the legislature was still in session and able to address the public health crisis while they were still in Olympia. Both the Senate and the House agreed to tap the “rainy day” fund to address the funding issue and by the end of session legislators had decided to pull $200,000 out of the fund to protect public health because in the span of one week it had become even more clear that we were in a public health crisis.

My how the world has changed is the span of a few weeks…with the spread of the coronavirus, we now live in a new reality. With virus cases climbing by the day, experts say we are in for a severe pandemic that has already impacted home care providers throughout the state. Sadly, Washington state is ground zero in the United States with much of the initial outbreak stemming from a Kirkland nursing home. Since we do not have statewide testing easily available, it was hard to know early on how widespread the virus was and now it has shown up in most counties in the state. Governor Inslee has been on the forefront of asking for federal assistance and proclaiming an emergency in our state on February 27^th, 2020. For more information please go to:

Department of Health: https://www.doh.wa.gov/Emergencies/Coronavirus

WA State Employment Security: https://esd.wa.gov/newsroom/covid-19

DSHS Coronavirus Alert: https://www.dshs.wa.gov/alert/covid-19-information

Bills of High Interest and Concern

E2SSB 6205/(HB 2681) Preventing harassment, abuse, and discrimination experienced by long-term care workers.

Summary: Home care agencies and the Consumer Directed Employer must adopt and maintain a comprehensive written policy about how they will address instances of discrimination, abusive conduct, and challenging behavior by July 1, 2021.  Abusive conduct includes workplace aggression, workplace violence, aggravated workplace violence, physical sexual aggression, rape, attempted rape, sexual contact, sexual harassment, workplace verbal aggression, or inappropriate sexual behavior.  Discrimination includes existing prohibited practices and discriminatory harassment but does not include a client refusing to hire or terminate an employee based on gender preferences.  Challenging behavior is behavior by a service recipient that is caused by or related to a disability that might be experienced by the employee as offensive or presenting a safety risk.  The policy must:

Define discrimination, harassment, abusive conduct, and challenging behavior; describe the types of discrimination and abusive conduct covered by the policy; identify multiple people to whom an employee may report discrimination, abusive conduct, and challenging behavior; include permission and a process allowing workers to leave situations where they feel their safety is at immediate risk; include prohibition against retaliation and describe how the employer will protect employees against retaliatory behavior; provide resources for a worker to utilize; and include any additional recommendations from the training work group convened by DSHS. 

The employer must review and update the policy annually and ensure that all employees are aware of the policy.  The policy must be disseminated to each employee at the beginning of employment, annually, and when substantive updates occur, posted in prominent locations at the place of business, and available in English and the top three languages spoken most by long-term care workers in the state. 

Prevention Plan. Beginning July 1, 2021, home care agencies and the CDE must implement a plan to prevent and protect employees from abusive conduct, assist employees working in environments with challenging behavior, and work to resolve issues impacting the provision of personal care.

A workplace safety committee consisting of employee-elected individuals, employer-selected individuals, and at least one service recipient representative, must develop and monitor the plan and review the number of miscategorizations in aggregate.  If the workplace committee does not have the required number of members, the employer must document evidence showing that they were unable to get employees or service representatives to participate.  A labor management committee established by a collective bargaining agreement that receives formal input from representatives of service recipients who wish to participate in the committee’s deliberations is sufficient to fulfill the requirement for a workplace safety committee.  The plan should be reviewed and updated as necessary, at least every three years, and must be adjusted based on the workplace safety and employer’s annual review of incidents of discrimination and abusive conduct in the home care setting.

The plan must include processes for intervening and assisting employees affected by challenging behaviors and abusive conduct, engaging appropriate members of the care team when allegations of discrimination, abusive conduct, or challenging behaviors occur and engaging the service recipient in problem resolution. In developing the plan, the employer must consider any guidelines on violence in the workplace or in health care settings issued by the Department of Health (DOH), DSHS, L&I, the federal Occupational Safety and Health Administration, and the training work group convened by DSHS.

Informing Workers. Prior to assigning an employee to a service recipient and throughout the duration of service, home care agencies and the CDE must inform employees of instances of discrimination and abusive conduct occurring in, or around the service recipient’s home care setting, if those incidents are documented by the employer or DSHS.  Prior to assigning an employee to a service recipient, home care agencies and the CDE must inform employees of a service recipient’s challenging behavior that is documented in the service recipient’s care plan, by the employer, or by DSHS and communicated to the employer.  Upon request of the service recipient, an employer must provide the service recipient with a copy of the information that was communicated to the employee.  Home care agencies and the CDE may not terminate, reduce pay, or not offer future assignments to an employee for requesting reassignment due to alleged discrimination, abusive conduct, or challenging behavior.

Recordkeeping. Home care agencies and the CDE must keep a record of any reported incidents of discrimination or abusive conduct experienced by an employee while providing home care services.  The records must be kept for at least five years and made available for inspection by L&I.  Anonymized aggregate data of the reported incidents must be made available to the training work group. If the employer makes its records available to the exclusive bargaining representative representing the employer’s employees, the exclusive bargaining representative my assess whether the employer is meeting the data collection requirements.  L&I must take into consideration this assessment when determining compliance with recordkeeping.  The records must include certain information about the incident including: the employer’s name and address; the date, time, and location of where the incident occurred; the reporting method; the person who experienced the act; a description of the person committing the act and the type of act; and a description of the actions taken by the employee and employer in response to the act and how the incident was resolved. The employer must correct any miscategorizations of instances as discrimination, abusive conduct or challenging behavior.

Training Work Group. DSHS must convene a stakeholder work group recommending policy changes and best practices for training employers, long-term care workers, and service recipients to keep home care settings free from discrimination and abusive conduct while maintaining the ability for individuals who need services to access these services and maintaining the ability to provide services.  The work group must include:

Representatives from DSHS, L&I, HRC, home care agencies and the CDE, labor organizations representing employees, disability advocacy organizations, and area agencies on aging; organizations with at least five years of experience training at least 10,000 long-term care workers; service recipients; a family member or guardian of a service recipient; the self-advocacy community; and subject matter experts deemed necessary by the work group. 

The work group must consider specific items in developing their recommendations and report its training recommendations to the Legislature by December 1, 2021.  The report must also address issues regarding the continuation of collecting and reviewing data, the future role of the work group, and how the work group measures the efficacy of its recommendations.

Enforcement. L&I is authorized to investigate home care agencies and the CDE to ensure compliance with the policy, prevention plan, informing workers, retaliation, and recordkeeping requirements.  Employers that are found to be non-compliant by L&I, must be subjected to citations under the Washington Industrial Safety and Health Act. Votes on Final Passage:  Senate 37 11 House 74 23 (House amended) Senate 40 9 (Senate concurred) 

Effective:  Ninety days after adjournment of session in which bill is passed. (Session ended March 12, 2020/Effective June 10, 2020)

ESSB 6492 Workforce Surcharge replaced the Workforce Surcharge bill from 2019. There were accounting problems with the original bill that passed last session, so they had to go back in and fix it in a hurry this session before any taxes were actually collected. Many people got letters for DOH stating that the implementation of the bill was on hold.  The new bill was signed by the Governor on February 7, effective February 10, 2020. Just goes to show you that the legislature can move fast when they want to!

Summary: Except for certain advanced computing businesses, the workforce education investment surcharge is eliminated and replaced with an increase in the B&O service rate from 1.5 percent to 1.75 percent for businesses earning more than $1 million annually in the preceding calendar year.  Businesses conducting service activities, but not meeting the $1 million threshold, continue to pay B&O tax at the 1.5 percent rate.  Hospitals are excluded from the increase. For the purpose of determining whether a business has met the $1 million threshold, the income of any affiliates of the business is also included in the calculation.  An affiliate is any business that directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with another business.

HB 2380 – Changing the home care agency vendor rate and repealing electronic timekeeping.

Summary: Allows the home care agency vendor rate calculation to reflect the average home care agency employer tax rate. Adds employer premiums for the state Paid Family and Medical Leave Act to the premiums addressed in the home care agency vendor rate calculation. Clarifies language in how rate parity between home care agencies and individual providers of home care services relates to changes in benefits. Repeals electronic timekeeping requirements that are inconsistent with federal law. 

Please see the attached bill tracking report for the remaining bills that passed this session!

Department of Health Issues

The next Department of Health (DOH) In-Home Services Roundtable will be April 23, 2020. Home care, home health, and hospice agency representatives and other interested parties are encouraged to attend. The purpose of these meetings is to provide agencies an opportunity to meet with DOH staff, to receive licensing, survey, and industry related information and updates, to have the opportunity to ask questions / raise concerns, and to collaborate with colleagues. The Roundtable will be held at the following address:

• Department of Health, Town Center Two, 111 Israel Rd SE (room 166) Tumwater, WA
• Roundtable – 9:00 to 11:00am

Visitor parking is available in front of the main DOH buildings as well as the parking structure. You can park in any space that is not marked for special purposes. An agenda will be sent out prior to the April 23rd Roundtable. A call-in option will also be available for those who cannot attend in person.

Contact In-Home Services program manager if you have any questions at [email protected].

Long-Term Care Workforce Development Steering Committee: Julie Ferguson, WAHCA member and I have been regularly attending the workgroup meetings of the Curriculum and Testing Committees for reviewing and assessing what would be in a core curriculum for all types of certified nursing assistants and have been participating in monthly workgroup meetings. The committee I am on is reviewing potential curriculum for CNA’s that would be transferable to many environments. A good example of a unit that we are currently reviewing is: Infection Control Introduction:  Because of the significant direct care they provide, nursing assistants play a critical role in preventing and responding to infection to support the health and wellness of the people they care for as well as themselves, their loved ones, co-workers, and the community generally. Background: In 2019, the legislature re-convened the Nursing Care Quality Assurance Commission (NCQAC) LTC Workforce committee to address key recommendations by providing detailed plans to improve availability and use of workforce-related data and make updates and revisions to training, and testing. The legislature also directed the committee to develop recommendations for skilled nursing facility staffing models and address deficiencies in resident care. Palliative Care Roadmap: We have had a number of meetings editing the “PC roadmap”, with DOH staff to review and sort the compiled information that was gathered at the first big meeting. Shawn D’Amelio attended the first meeting where they took broad feedback for the larger workgroup and will be part of the broader review as we narrow down the content to more manageable levels. As you may remember, we had excellent representation from across the state with many different types of palliative care providers and experts at the table for the initial source of content for the booklet. The booklet will be very similar to the Dementia Roadmap published by DSHS a few years ago. It is to be used as a resource for patients, their families and practitioners when a patient has been diagnosed with a serious or life-threatening illness. Hard copies must be available for distribution no later than September 30, 2020. More to come! Palliative Care-Rural Health Integration Advisory Team (PC-RHIAT): This is an ongoing workgroup thatI am involved in. I am on the advisory team for the Community Engagement Workgroup. To learn more about the Washington Rural Palliative Care Initiative please visit :  https://waportal.org/partners/home/washington-rural-palliative-care-initiative

Labor and Industries Issues

Just areminder that  House Bill 1931: Concerning workplace violence in health care settings, which passed last session impacting in-home services agencies licensed under RCW 70.127. It requires workforce violence prevention planning and training for hospitals, including in-home services providers under RCW 70.127. See the WA State Hospital Association article below:

New Requirements For Workplace Violence Prevention Planning And Training

DSHS Issues

Long-Term Care Trust Act Implementation: This will be an ongoing issue over the next few years as it is implemented.Provides benefits for long-term services and supports to qualified individuals who need assistance with at least three activities of daily living. Establishes eligibility requirements for the Trust Program for persons who pay a premium of 0.58 percent of $100 (a little over a nickel) of a person’s wages for a specific amount of time. Here is a good fact sheet on the impacts of the bill: https://www.agingwashington.org/files/2019/02/2019-Long-Term-Care-Trust-Act-Factsheet.pdf

Consumer Directed Employer (CDE): will establish a contract between the Department of Social and Health Services and Consumer Direct of Washington (CDWA) to become the Consumer Directed Employer.  This entity will serve as the employer for Individual Providers of in-home personal care and respite in Washington state.  When the Consumer Directed Employer contract goes into effect, CDWA will handle the credentialing, payroll and other employer responsibilities currently managed by the Aging and Long-Term Support Administration, Developmental Disabilities Administration and the Area Agencies on Aging. Consumers will continue to select, schedule, supervise, and dismiss their Individual Providers. To learn more visit the CDE webpage. Please see the Questions and Answers page for additional details and background information.

Prepared by Leslie Emerick, Lobbyist

Legislative Overview

Today is the 41^st day of the 60-day “short-session of the 2020 WA State Legislative Session!  The  “supplemental budget” comes out on Monday, February 24th for both the House and the Senate so we will know what the legislature is willing to fund beyond the original Operating budget this year.  Time flies from here on out as bills begin to die and we know which ones “still have legs”! We started out with a high of 67 bills we were tracking, and we are down to 24 bills on our list. Right now, House bills go to the Senate for consideration in committee and vice versa. The next bill cut-off is February 28^th to get out of the opposite House policy committees and March 2, 2020 is the last day for bills in the opposite house to pass out of the House fiscal committees and Senate Ways & Means. March 6, 2020 at 5 PM is the last day to pass opposite house bills and March 12 is the last day of the session!

We had a great In-Home Services Day on January 28th in Olympia! We had 36 attendees from all three associations and met with over 50 legislators. We received positive feedback from the attendees and were able to spread the good work of home health, home care and hospice to legislators from across Washington state. I enjoyed attending the board meeting the night before and giving the group an overview of our legislative agenda. Some members receive excellent one-on-one time with their state legislator and were really able to share stories about their experiences with family members in home care…such a valuable interaction when that happens!

Bills of High Interest and Concern

HB 2681 Preventing harassment, abuse, and discrimination experienced by long-term care workers The night before the In-Home Services Day, Jeff Wiberg and I worked on testimony for a public hearing the next day on. Jeff got a rude cut-off about halfway from the Committee Chair, Representative Sells as he went through his testimony. Even so, I think his voice was heard about having concerns with the impact of the bill on home care agencies. The bill has since been amended to form a workgroup and to reduce some of the duplication of training and documentation.

SB 6492 Workforce Surcharge replace the Workforce Surcharge bill from 2019. There were accounting problems with the original bill that passed last session, so they had to go back in and fix it in a hurry this session before any taxes were actually collected. Many people got letters for DOH stating that the implementation of the bill was on hold.  The bill has already been signed by the Governor.

The bill has been very controversial this session and there were many long hearings with lots of amendments with requests to be excluded from the bill by many different health care providers. None of those amendments were accepted in the revised bill. They struck out all the language related to health care and to make it more generic and inclusive. The 1.5 % rate went from 1.8% then to 1.75% for all health care providers.  The bill now includes hospice, home health and home care. Hospitals and health care practitioners who make less than $1 mill a year are exempt from the increase. Here is a link to the final bill language:https://lawfilesext.leg.wa.gov/biennium/2019-20/Pdf/Bill%20Reports/House/6492-S.E%20HBR%20APH%2020.pdf?q=20200208115720

Department of Health Issues

The next Department of Health (DOH) In-Home Services Roundtable will be April 23, 2020. Home care, home health, and hospice agency representatives and other interested parties are encouraged to attend. The purpose of these meetings is to provide agencies an opportunity to meet with DOH staff, to receive licensing, survey, and industry related information and updates, to have the opportunity to ask questions / raise concerns, and to collaborate with colleagues. The Roundtable will be held at the following address:

• Department of Health, Town Center Two, 111 Israel Rd SE (room 166) Tumwater, WA 98501
• Roundtable – 9:00 to 11:00am

Visitor parking is available in front of the main DOH buildings as well as the parking structure. You can park in any space that is not marked for special purposes. An agenda will be sent out prior to the April 23rd Roundtable. A call-in option will also be available for those who cannot attend in person.

Contact In-Home Services program manager if you have any questions at [email protected].

Long-Term Care Workforce Development Steering Committee: Julie Ferguson, WAHCA member and I have been regularly attending the workgroup meetings of the Curriculum and Testing Committees for reviewing and assessing what would be in a core curriculum for all types of certified nursing assistants and have been participating in monthly workgroup meetings. Our last meeting was on February 10th. Background: In 2019, the legislature re-convened the Nursing Care Quality Assurance Commission (NCQAC) LTC Workforce committee to address key recommendations by providing detailed plans to improve availability and use of workforce-related data and make updates and revisions to training, and testing. The legislature also directed the committee to develop recommendations for skilled nursing facility staffing models and address deficiencies in resident care. Meeting Agenda and Materials Palliative Care Roadmap: We have had a second meeting for the “PC roadmap”, working with DOH staff to review the compiled information that was gathered at the first big meeting. Shawn D’Amelio attended the first meeting where they took broad feedback for the larger workgroup. The next few meetings will be editing with a smaller group of palliative care experts as to the direction and content for the report. As you may remember, we had excellent representation from across the state with many different types of palliative care providers and experts at the table for the initial source of content for the booklet. Now it’s time to start narrowing it down and organizing the content. The booklet will be very similar to the Dementia Roadmap published by DSHS a few years ago. It is to be used as a resource for patients, their families and practitioners when a patient has been diagnosed with a serious or life-threatening illness. Hard copies must be available for distribution no later than September 30, 2020. More to come! Palliative Care-Rural Health Integration Advisory Team (PC-RHIAT): This is an ongoing workgroup thatI am involved in. I am on the advisory team for the Community Engagement Workgroup. To learn more about the Washington Rural Palliative Care Initiative please visit :  https://waportal.org/partners/home/washington-rural-palliative-care-initiative

Labor and Industries Issues

Just areminder that  House Bill 1931: Concerning workplace violence in health care settings, which passed last session impacting in-home services agencies licensed under RCW 70.127. It requires workforce violence prevention planning and training for hospitals, including in-home services providers under RCW 70.127. See the WA State Hospital Association article below:

DSHS Issues

Long-Term Care Trust Act Implementation: This will be an ongoing issue over the next few years as it is implemented.Provides benefits for long-term services and supports to qualified individuals who need assistance with at least three activities of daily living. Establishes eligibility requirements for the Trust Program for persons who pay a premium of 0.58 percent of $100 (a little over a nickel) of a person’s wages for a specific amount of time. Here is a good fact sheet on the impacts of the bill: https://www.agingwashington.org/files/2019/02/2019-Long-Term-Care-Trust-Act-Factsheet.pdf

Consumer Directed Employer (CDE)

Starting in 2018, this multi-year process will establish a contract between the Department of Social and Health Services and Consumer Direct of Washington (CDWA) to become the Consumer Directed Employer.  This entity will serve as the employer for Individual Providers of in-home personal care and respite in Washington state.  When the Consumer Directed Employer contract goes into effect, CDWA will handle the credentialing, payroll and other employer responsibilities currently managed by the Aging and Long-Term Support Administration, Developmental Disabilities Administration and the Area Agencies on Aging. Consumers will continue to select, schedule, supervise, and dismiss their Individual Providers.

In November 2019, DSHS signed a contract with Consumer Direct of Washington (CDWA). The Department remains committed to initiating the transition to the CDE by the legislatively required date of June 30, 2021.

The move to a CDE model will shift the IP employment-related activities to the CDEs and will help DSHS realize the goal of increasing the capacity of DSHS/AAA case management, customer service, and other social services staff to focus on core case management activities.

New federal requirements were enacted in 2016 as part of the “21st Century Cures Act”.  The Act requires states to implement an electronic visit verification (EVV) system for personal care services delivered in the home.  The CDE will implement the EVV system for IPs. Home Care Agencies will implement separate EVV systems for Home Care Agency workers.

Please see the Questions and Answers page for additional details and background information.

Public Policy Updates

WA State Dementia Collaborative: They are creating a “First Responder Toolkit” to help reduce ER admissions and public awareness campaigns at DOH. They are also working on a legal Alzheimer package for advance directives. https://www.dshs.wa.gov/altsa/dementia-action-collaborative. If anyone wants to order some more Dementia Roadmaps for your agency, please go to: www.dshs.wa.go/altsa/dementa-action-collaborative.

Prepared by Leslie Emerick, Lobbyist

Legislative Overview

Amazing that another year has flown by and the 2020 WA State Legislative Session, which is the 60-day “short-session” of the biennial state legislature, starts on Monday January 13^th!  Legislators prepare a “supplemental budget” to fix problems with the 2019 budget or to address emergencies such as floods and fires. Keep in mind that 2020 is an election year and our Governor is running for his 3^rd term in office. Half the Senate and the entire House of Representatives will be running for re-election this fall. Sometimes politics can get a little crazy in an election year and we just had an initiative to the people pass reducing transportation funding I our state by $4 billion dollars… so that will make life interesting this session!

Our In-Home Services Day is January 28^th in Olympia! Time to call and make appointments!

For the past seven years the WA Home Care Association, Home Care Association of WA and the WA State Hospice and Palliative Care Organization have joined forces to meet with state legislators to discuss important issues for In-Home Services. We are all licensed under the Department of Health (DOH) In-Home Services program and in the real world, home health, hospice and home care agencies work cooperatively together all the time. Our associations typically have a very similar legislative agenda and legislators really appreciate the fact that we coordinate this day together instead of three different meetings! It’s also a fun way to get to know other in-homes services providers from around the state and in your region.

Please contact your local legislators ASAP and set up a meeting on January 28^th!!  We are contacting legislators early this year because our legislative day is less than 3 weeks away! Here is a link to find out who your state legislators are with their contact information: https://app.leg.wa.gov/DistrictFinder/.  Please use your home address and not your business location as they want to meet with their constituents who live in their districts. You have 2 Representatives and 1 Senator from your legislative district. You can either call their office or send them an email request for an appointment. I often call and send a follow-up email.

Please schedule appointments to begin after 8:00 AM so that attendees can participate in the morning advocacy training activities. Some legislative assistants may ask for what you are going to talk about. Just explain to them what In-Home Services are (home health, hospice and home care) and we will be talking about issues related to these services.

Important!! Once you’ve made your legislative appointments, please send Leslie Emerick your appointment times at [email protected] and I will put your meeting on the master calendar. We have some legislative districts that overlap between constituents and I try to consolidate those meetings. You will also be attending meetings with members of the other organizations from your district so I may need to move your meeting to a new time, but that will be on the final master meeting list. If you need additional assistance, please call 360-280-6142.

We will be in the Washington Library Room in the lower level of the Prichard Building. It’s a great room and we have it reserved until 2:00 pm. Food is available in two cafeterias on the Capital Campus. Dome Deli in the Capital Building and the Prichard Library Cafeteria. The Prichard Building Physical Address is: 415 Sid Snyder Avenue SW, Olympia, WA 98504. Parking is not easy on campus but will be accessible early in the morning at the Visitor’s Center. Please pay for 8 hours of parking at the pay station so you don’t have to worry. It only takes credit cards. For additional parking see: Visitor Parking

Department of Health Issues

Palliative Care Roadmap: The first meeting for the “PC roadmap” was a great success and we are waiting for DOH to compile the information that was gathered for the next draft of the document. Shawn D’Amelio, WAHCA President, did a good job bringing the home care perspective for the consideration of the workgroup. Pat Justis did a great job of facilitating and we were able to collect a large amount of information to begin the process. We had excellent representation from across the state with many different types of palliative care providers and experts at the table. The booklet will be very similar to the Dementia Roadmap published by DSHS a few years ago. It is to be used as a resource for patients, their families and practitioners when a patient has been diagnosed with a serious or life-threatening illness. Hard copies must be available for distribution no later than September 30, 2020. More to come! Palliative Care-Rural Health Integration Advisory Team (PC-RHIAT): I am still participating on the advisory team for the Community Engagement Workgroup and attended a strategic planning meeting on November 6. To learn more about the Washington Rural Palliative Care Initiative please visit : https://waportal.org/partners/home/washington-rural-palliative-care-initiative Long-Term Care Workforce Development Steering Committee: Julie Ferguson, Advanced Health Care and I have been appointed to the Curriculum and Testing Committees for reviewing and assessing what would be in a core curriculum for all types of certified nursing assistants and have been participating in monthly workgroup meetings. Background: In 2019, the legislature re-convened the Nursing Care Quality Assurance Commission (NCQAC) LTC Workforce committee to address key recommendations by providing detailed plans to improve availability and use of workforce-related data and make updates and revisions to training, and testing. The legislature also directed the committee to develop recommendations for skilled nursing facility staffing models and address deficiencies in resident care. Meeting Agenda and Materials

Health Care Authority

Adult Palliative Care Rules: Update: The recommendations of the Bree Collaborative Palliative Care Workgroup have recently been submitted to the Health Care Authority to incorporate into their palliative care rulemaking. The department will come up with a new draft to review after they see what is in the report. I am hoping that the new draft will be out sometime in January 2020 and the rulemaking process will start up again!

Home Health Rates Methodology: SB 5828 regarding matching Medicare and Medicaid rates for home health did not pass during the 2019 legislative session, but we plan to re-run the bill in the 2020 legislative session. There was a workgroup established over the summer to discuss the issue and come up with solutions. There will be a Report to the Legislature in the near future on the workgroup deliberations and recommendations. Senator Cleveland has offered to continue sponsorship in the Senate, and Rep Tharinger will be the sponsor of a companion bill in the House.

Department of Revenue (DOR)

Interestingly, a new bill has been proposed by Senator Becker for the next legislative session related to E2SHB 2158 Creating a workforce education investment to train Washington students for Washington. E2SHB 2158 has a 20% health professions B & O tax increase, from 1.5% to 1.8% and goes into effect in 2021. Home health and hospice agencies were somehow included in the original bill raising the B & O tax, but home care agencies were not. Many private duty home care agencies have home health licenses. In reviewing SB 6059 Exempting health care-related services from the business and occupation surcharge, I have a question sent in to Senator Becker regarding the strikethrough in Section 1 (z)(gg) “Providing a range of outpatient services, such as family planning, diagnosis and treatment of mental health disorders and alcohol and other substance abuse, and other general or specialized outpatient care by businesses with medical staff”.

I am wondering if the strikethrough in (gg) also cover home health and hospice agencies as “outpatient services” or  “general or specialized outpatient care” by businesses with medical staff? Our home health and hospice agencies would very much like to be exclude from the current B & O tax increase and would be very supportive of this bill if our agencies were included. If this is not intended to include home health and hospice agencies, I have asked Senator Becker to consider an amendment that would remove home health and hospice agencies from the B & O surcharge. I look forward to hearing the clarification regarding whether home health and hospice would be covered with this legislative proposal! DOR released the information on who is impacted on November 13^th, see below.

Workforce Education Surcharge: Beginning with business activities occurring on or after Jan.1, 2020, a surcharge applies to the amount of tax payable under the Service and Other Activities B&O tax classification by businesses primarily engaged in one or more specified activities. The surcharge is in addition to the Service and Other Activities B&O tax rate of 1.5%, for an effective rate of 1.8%. The department has created an Excel workbook to help businesses determine if the surcharge applies to income subject to B&O tax under the Service and Other Activities classification. The workbook aggregates the 43 specified activities into the 13 industry groups shown above. Review the activities that fall into each of these 13 industry groups to determine if the surcharge applies to your business. Note for annual filers: The first return the surcharge is applied to is your Annual 2020 return, which is due by April 15, 2021.

Labor and Industries Issues

Executive, Administrative, and Professional (“EAP” or “white collar”) exemptions from the Minimum Wage Act: The Department of Labor & Industries (L&I) released their employment rules that determine which workers in Washington are required by law to be paid at least minimum wage, earn overtime pay, and receive paid sick leave on Dec. 11, 2019.   Here is the press release:

“The Washington State Department of Labor & Industries (L&I) today announced rules changes that will restore overtime protection to tens of thousands of workers and create a fair minimum salary level for workers who don’t receive overtime pay.

The new rules use a formula based on the state minimum wage to determine the minimum salary a worker must receive to be exempt from overtime. The changes will be phased in starting July 1, 2020, and will be fully implemented by January 2028.

Beginning July 1, the state minimum salary threshold will increase to $675 a week ($35,100 a year) for all businesses, which is 1.25 times the state’s minimum wage. The threshold will increase incrementally until 2028 when it is expected to reach approximately $1,603 a week (about $83,356 a year) for an overtime exempt worker, 2.5 times the minimum wage.

In addition, the adopted rules also update the job duties tests that are used, with the salary threshold, to determine if an employee can be exempt from overtime. During the rulemaking process, L&I received 2,266 comments from the public and took testimony from 182 people at seven public hearings held around the state in July and August.

You can learn more about the process to change the rules at www.Lni.wa.gov/OvertimeRulemaking.

If an employee believes their rights have been violated, they can file a complaint at www.Lni.wa.gov/workers-rights/workplace-complaints/worker-rights-complaints. For more information, contact Tim Church, L&I Public Affairs manager, at 360-902-5673 or [email protected].

DSHS Issues

2SHB 1087 Long-Term Care Trust Act Implementation: This will be an ongoing issue over the next few years as it is implemented.Provides benefits for long-term services and supports to qualified individuals who need assistance with at least three activities of daily living. Establishes eligibility requirements for the Trust Program for persons who pay a premium of 0.58 percent of $100 (a little over a nickel) of a person’s wages for a specific amount of time. Here is a good fact sheet on the impacts of the bill: https://www.agingwashington.org/files/2019/02/2019-Long-Term-Care-Trust-Act-Factsheet.pdf

Public Policy Updates

Bree Collaborative Palliative Care Workgroup: Ginny Weir, Bree Collaborative Director, announced that our Palliative Care recommendations have been adopted by the Bree Collaborative! Our next step is to send them to the Health Care Authority for their review and approval. We have posted the report on our website here. You can also refer to our palliative care website here: https://www.breecollaborative.org/topic-areas/previous-topics/palliative-care/

WA State Dementia Collaborative: They are creating a “First Responder Toolkit” to help reduce ER admissions and public awareness campaigns at DOH to let people know what resources are available. They are also working on a legal Alzheimer package for advance directives and other important considerations. I am still on the Health and Medical Subcommittee. Here is a link to the website outlining the activities of the collaborative: https://www.dshs.wa.gov/altsa/dementia-action-collaborative. If anyone wants to order some more Dementia Roadmaps for your agency, please go to: www.dshs.wa.go/altsa/dementa-action-collaborative