January 5, 2024
Greetings!

On Monday, the Washington State Legislature will convene in Olympia for a 60-day session. Legislators will be asked to pass a supplemental operating budget that will update last year’s operating plan, and will also be asked to act on policy issues on a myriad of subjects.

We have been fully engaged in working on key priorities for our members, and since last summer have met with state agency leaders, key legislators, and their staff to prepare for this year’s legislative work.  
Supplemental Budget 

Washington’s budget is developed on a two-year cycle. In odd-numbered years the Legislature adopts a two-year plan, and then updates that plan in even numbered years. As such, 2024 is a budget update year and a supplemental budget will be adopted before the Legislature adjourns in 60 days. To accommodate the short timeline, the legislature will work quickly to reduce and prioritize the number of considerations. Next week the House Appropriations and Senate Ways and Means Committees will hold public hearings to allow the public to weigh in on the Governor’s supplemental proposal. The House and Senate will release their own budget proposals, likely in early February. 

Assisted Living Priorities: While there was some improvement to assisted living Medicaid funding in last year’s proposal, we are working with legislators now to help them understand that additional investments are necessary. Until July 1, 2023, the legislature only allocated funding to cover 68 percent of labor costs. Last year’s operating plan increased funding to 79 percent of cost, but that rate still does not adequately cover labor costs. We are asking the Legislature to do more on assisted living Medicaid funding. 

Here is where our efforts will be focused in 2024: 

  • Fund the assisted living labor rate so that providers can compete for workers. The current assisted living Medicaid rate only reimburses wages at 79 percent of the benchmarked labor cost. DSHS recommended increasing the funding to 95 percent of labor costs. Governor Inslee’s December plan failed to address the funding shortfall for the assisted living workforce. 
  • Improve specialized dementia care funding. The current reimbursement rate for specialized dementia care services does not adequately address the resources required to serve clients who have special care needs related to dementia. DSHS recommended increasing the add-on rate from $43.48 to $60/per resident day. Governor Inslee’s proposal partially funded the recommendation by increasing the daily add-on rate to $55. 
 
We appreciate those providers who will be joining us to testify about the Governor’s budget during public hearings next week. If you would like to learn more, please reach out to Eric Negomir. 

Skilled Nursing Facility Priorities: We deeply appreciate the Legislature’s work on skilled nursing facility funding in the 2023-2025 state operating budget. The Legislature acknowledged the importance of skilled nursing facilities in our health care continuum in Washington and made an investment to close the gap on Medicaid funding shortfalls. For the 2024 legislative session we are supporting state agency request legislation that allows DSHS the flexibility to convert the acuity data used to set Medicaid rates to the CMS Patient-Driven Payment Model (PDPM). Our goal is to work closely with the department to ensure we avoid tremendous rates swings with the implementation of PDPM data. We are seeking a multi-year implementation strategy that is informed by data and clinical expertise and experience.
Policy Legislation on Residents Rights Misses the Mark for Community-Based Care 
 
House Bill 1859 (AL/ESF): 

Legislation was introduced last session by Rep. Tarra Simmons (D-26) that would extend federal skilled nursing facility residents’ rights requirements to Washington community-based LTC settings including assisted living, adult family homes, and enhanced services facilities. The bill was at the request of the Washington State LTC Ombuds program after DSHS and the Governor denied the Ombud’s petition for rulemaking on appeal rights. We agree with the assessment that the Department lacked rulemaking authority and we fundamentally support the goal to allow residents to appeal discharges from community-based settings with the Office of Administrative Hearings. However, we oppose this legislation as currently drafted. We have communicated our concerns to the Governor’s Office, DSHS, the LTC Ombuds, and bill sponsors. 

The LTC Ombuds has offered amending language, but there remain fundamental differences in our positions. We have worked with our colleagues at LeadingAge and with Lane Powell to draft and offer alternate legislative language and are now engaged in stakeholder discussions with the LTC Ombuds, DSHS, and the Governor’s Office on the issue. It remains to be seen if we can come to agreement; there are fundamental areas where we cannot support the LTC Ombuds position, including creating a 90-day period to file an appeal on a discharge. Our concern is that delaying appropriate discharges for individuals who are a danger to themselves, others or staff creates tremendous risk. We are also opposed to resetting the 90-day discharge appeal timeframe when there is a change of discharge location, and we believe it is critical to have expedited hearings when non-payment is the issue. 
Please Share Your Experiences – Resident Discharges
 
Our work is to help the Legislature understand that the issue of resident discharges is nuanced and careful. To that end, I would truly appreciate it if you could take time now to fill out this brief survey that describes some of the situations your teams have encountered that require an expeditious discharge. We are seeking case studies that will be used in our legislative outreach efforts. Please make it a priority to provide us with your stories. 
The WHCA team and I are proud to represent you in the halls of the legislature, and with the key agencies that have authority over issues impacting delivery of quality long term care. Your work is more important than ever.