Yesterday marked the end of the 2022 Legislative session. This year the legislature has made significant investments in long-term care. Nearly all provider types will see substantial increases in their rates and help stabilize access and choice for older adults. Additionally, we saw very few bills passed that would impact long-term care. Below is the final session recap.
Supplemental Operating Budget
Reduce Occupancy Penalty: The legislature has included a reduced occupancy penalty of 75% when setting the indirect care rate component. This was a LeadingAge funding priority to avoid the unjust impact of a loss of revenue caused by LHJ holds on admission and staffing shortages and the subsequent loss in funding two years later when earlier (2020) reported Medicaid days are used in setting the IDC rate. An occupancy penalty lowered from 90% to 75% results in an increase of just over $8 to the indirect care rate component. GF-S $12.89 Total Funds $25.78 million
Nursing Home Rate Increase: The Senate moved to adopt the House position on funding for SNFs to raise wages to low-wage workers in certain job categories. This is accomplished by raising the direct care and indirect care medians from 105% to 111% for direct care and from 90% to 92% for indirect care. The direct care growth cap is also raised from 130% to 165%. DSHS is directed to work with stakeholders to develop a verification process to demonstrate how providers have used this increased funding (difference between funding at 105% of direct care median and funding at 111% and difference between 90% and 92%) to increase the targeted wages. Wage increases provided as of January 1, 2022, and forward will be included in the verification process. There will be a mechanism created for the state to recover any funds that were not spent in accordance with the verification process. The final budget importantly states it is their intent that this funding will be continued forward into the next fiscal biennium. The budget dial rate (weighted average) is adjusted from $279.84 to $319.82, an increase of nearly $40 ppd. GF-S $24.13 million Total Funds $48.27 million
Assisted Living Facility Rates: The budget increases funding for assisted living to 68% of the model. This includes SDC clients. We are working to model what the rate increases will look like at this funding level. However, this increases rates, on average, nearly $14. Also included is one-time funding from April 2022 through December 2022 to complete a report that reviews and summarizes discharge regulations and notification practices for assisted living providers. While this funding still gives one of the largest increases to assisted living providers, it falls short of what is needed to catch up from years of stagnant rates. The failure to more fully invest Assisted Living continues to leave these settings vulnerable as they face ever increasing inflationary costs not seen in over 40 years. We advocated for funding to be set at 77% of the model which was not reflected in either of the three budgets. The House had included the highest level of investment in Medicaid rates at 74% of the full funding cost of the methodology, however, they were unable to hold the line when compromising with the Senate. We will continue this work with DSHS in the interim to include more funding in their agency request and we will have focused conversations with key Senators during the interim. GF-S $15.9 million, Total $33.28 million
The budget increases the Adult Day rate by the amount of the COVID add-on ($11.08), essentially making the add-on permanent. Thank you to everyone who reached out to the committee chairs and their own legislators as neither the House or the Senate initial budgets had included funding relief for adult day! GF-S $438,000, Total
COVID rate add-ons: The budget has included funding for the COVID add-ons. These add-ons continue and are gradually decreased by 20% every two quarters beginning July 1, 2022. The amounts listed here are for all provider types that are receiving COVID add-ons. GF-S $130 million, Total $273 million
Rapid Response Teams: Also included in the budget is one-time funding to continue the Rapid Response Teams. GF-S $12 million, Total $26.3 million
CCRCs ~ The budget includes one-time funding for the Office of the Insurance Commissioner to assess federal and state laws and regulations and provide recommendations on creating a legal framework with which CCRCs may achieve heightened consumer protections through shared state agency regulatory oversight by the office of the insurance commissioner. The report is due to the legislature no later than December 1, 2022. GF-S $250,000
Bills impacting LTC
HB 1124 - Concerning nurse delegation of glucose monitoring, glucose testing, and insulin injections. This bill will allow registered nurses to delegate blood glucose monitoring regardless of care settings. In skilled nursing facilities it must be a Medication Assistant Endorsed NAC who is delegated to preform those tasks.
HB 1732 - Delaying the implementation of the long-term services and supports trust program by 18 months. This bill delays the collection of the payroll premiums for the LTSS Trust Program (WA CARES) until July 1, 2023 and delays the ability to access approved services until July 1, 2026.
HB 1733 - Establishing voluntary exemptions to the long-term services and supports trust program for certain populations. The bill establishes exemptions from the payment of premiums under the Long-term Services and Supports Trust Program for certain veterans, spouses, and registered domestic partners of military service members, nonimmigrant temporary workers, and employees who work in Washington and maintain a primary residence outside of Washington.
HB 1872 - Establishing the care worker center to promote caregiving professions. The bill would establish a care worker center to elevate care workers as a respected sector of the workforce and look to increase retention and recruitment. The center would first focus on caregivers working in childcare, long-term care, and those working with individuals with disabilities. The care center would establish online resources for caregivers as well as gather data on our workforce, including turnover rates and trends.
HB 1877 - Addressing expired certifications for certain health professions. Would allow for certifications that have been expired for less than five years to be reinstated.
HB 1868 - Improving worker safety and patient care in health care facilities by addressing staffing needs, overtime, meal and rest breaks, and enforcement. This bill would mandate very prescriptive staffing ratios for all hospitals. While the bill directly targeted hospitals, LeadingAge Washington was opposed because we believe there are serious downstream impacts on our sector. We hope this bill will not be reintroduced next year. But instead, legislators focus on more efforts in increase our workforce.
One of our priority issues for the 2022 session was to address price gauging from nurse staffing agencies. Unfortunately, we were unable to get a bill introduced. Both the House and Senate Health Care Committees had several contentious bills already in the queue and limited time in a short session to address other issues such as this. We will continue to work with legislators, DOH and DSHS in the interim and come back next year with regulatory controls after more thoroughly vetting provider experiences with predatory pricing practices. This is a critical issue for long-term care as the practices of these staffing agencies have only exacerbated our workforce crisis and driven up unreimbursed operating costs. Twelve states have already introduced or passed legislation to address agency price gouging. Washington must follow so we can continue to meet the needs of older adults and establish fair and reasonable practice standards, particularly during public health emergencies.