Health Care Policy / Memo



66th Legislature 2019 Regular Session

Passed by the House April 23, 2019 Yeas 55 Nays 41

Speaker of the House of Representatives

Passed by the Senate April 16, 2019 Yeas 26 Nays 22

President of the Senate


I, Bernard Dean, Chief Clerk of the House of Representatives of the State of Washington, do hereby certify that the attached is SECOND SUBSTITUTE HOUSE BILL 1087 as passed by the House of Representatives and the Senate on the dates hereon set forth.

Chief Clerk

Approved FILED

Governor of the State of Washington

Secretary of State State of Washington

AN ACT Relating to long-term services and supports; amending RCW1 74.39A.076, 18.88B.041, and 44.44.040; reenacting and amending RCW2 43.79A.040; adding a new section to chapter 43.09 RCW; and adding a3 new title to the Revised Code of Washington to be codified as Title4 50B RCW.5


NEW SECTION. Sec. 1. The legislature finds that:7 (1) Long-term care is not covered by medicare or other health8

insurance plans, and the few private long-term care insurance plans9 that exist are unaffordable for most people, leaving more than ninety10 percent of seniors uninsured for long-term care. The current market11 for long-term care insurance is broken: In 2002, there were one12 hundred two companies offering long-term care insurance coverage, but13 today that number is only twelve.14

(2) The majority of people over sixty-five years of age will need15 long-term services and supports within their lifetimes. The senior16 population has doubled in Washington since 1980, to currently over17 one million, and will more than double again by 2040. Without access18 to insurance, seniors must rely on family care and spend their life19 savings down to poverty levels in order to access long-term care20 through medicaid. Middle class families are at the greatest risk21


AS AMENDED BY THE SENATE Passed Legislature - 2019 Regular Session

State of Washington 66th Legislature 2019 Regular Session By House Appropriations (originally sponsored by Representatives Jinkins, MacEwen, Cody, Harris, Tharinger, Slatter, Kloba, Ryu, Macri, DeBolt, Bergquist, Doglio, Robinson, Stanford, Stonier, Frame, and Leavitt) READ FIRST TIME 02/18/19.

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because most have not saved enough to cover long-term care costs.1 When seniors reach the point of needing assistance with eating,2 dressing, and personal care, they must spend down to their last3 remaining two thousand dollars before they qualify for state4 assistance, leaving family members in jeopardy for their own future5 care needs. In Washington, more than eight hundred fifty thousand6 unpaid family caregivers provided care valued at eleven billion7 dollars in 2015. Furthermore, family caregivers who leave the8 workforce to provide unpaid long-term services and supports lose an9 average of three hundred thousand dollars in their own income and10 health and retirement benefits.11

(3) Paying out-of-pocket for long-term care is expensive. In12 Washington, the average cost for medicaid in-home care is twenty-four13 thousand dollars per year and the average cost for nursing home care14 is sixty-five thousand dollars per year. These are costs that most15 seniors cannot afford.16

(4) Seniors and the state will not be able to continue their17 reliance on family caregivers in the near future. Demographic shifts18 mean that fewer potential family caregivers will be available in the19 future. Today, there are around seven potential caregivers for each20 senior, but by 2030 that ratio will decrease to four potential21 caregivers for each senior.22

(5) Long-term services and supports comprise approximately six23 percent of the state operating budget, and demand for these services24 will double by 2030 to over twelve percent. This will result in an25 additional six billion dollars in increased near-general fund costs26 for the state by 2030.27

(6) An alternative funding mechanism for long-term care access in28 Washington state could relieve hardship on families and lessen the29 burden of medicaid on the state budget. In addition, an alternative30 funding mechanism could result in positive economic impact to our31 state through increased state competition and fewer Washingtonians32 leaving the workforce to provide unpaid care.33

(7) The average aging and long-term supports administration34 medicaid consumer utilizes ninety-six hours of care per month. At35 current costs, a one hundred dollars per day benefit for three36 hundred sixty-five days would provide complete financial relief for37 the average in-home care consumer and substantial relief for the38 average facility care consumer for a full year or more.39

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(8) Under current caseload and demographic projections, an1 alternative funding mechanism for long-term care access could save2 the medicaid program eight hundred ninety-eight million dollars in3 the 2051-2053 biennium.4

(9) As the state pursues an alternative funding mechanism for5 long-term care access, the state must continue its commitment to6 promoting choice in approved services and long-term care settings.7 Therefore, any alternative funding mechanism program should be8 structured such that:9

(a) Individuals are able to use their benefits for long-term care10 services in the setting of their choice, whether in the home, a11 residential community-based setting, or a skilled nursing facility;12

(b) The choice of provider types and approved services is the13 same or greater than currently available through Washington's14 publicly funded long-term services and supports;15

(c) Transitions from private and public funding sources for16 consumers are seamless;17

(d) Long-term care health status data is collected across all18 home and community-based settings; and19

(e) Program design focuses on the need to provide meaningful20 assistance to middle class families.21

(10) The creation of a long-term care insurance benefit of an22 established dollar amount per day for three hundred sixty-five days23 for all eligible Washington employees, paid through an employee24 payroll premium, is in the best interest of the state of Washington.25

NEW SECTION. Sec. 2. The definitions in this section apply26 throughout this chapter unless the context clearly requires27 otherwise.28

(1) "Account" means the long-term services and supports trust29 account created in section 11 of this act.30

(2) "Approved service" means long-term services and supports31 including, but not limited to:32

(a) Adult day services;33 (b) Care transition coordination;34 (c) Memory care;35 (d) Adaptive equipment and technology;36 (e) Environmental modification;37 (f) Personal emergency response system;38 (g) Home safety evaluation;39

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(h) Respite for family caregivers;1 (i) Home delivered meals;2 (j) Transportation;3 (k) Dementia supports;4 (l) Education and consultation;5 (m) Eligible relative care;6 (n) Professional services;7 (o) Services that assist paid and unpaid family members caring8

for eligible individuals, including training for individuals9 providing care who are not otherwise employed as long-term care10 workers under RCW 74.39A.074;11

(p) In-home personal care;12 (q) Assisted living services;13 (r) Adult family home services; and14 (s) Nursing home services.15 (3) "Benefit unit" means up to one hundred dollars paid by the16

department of social and health services to a long-term services and17 supports provider as reimbursement for approved services provided to18 an eligible beneficiary on a specific date. The benefit unit must be19 adjusted annually at a rate no greater than the Washington state20 consumer price index, as determined solely by the council. Any21 changes adopted by the council shall be subject to revision by the22 legislature.23

(4) "Commission" means the long-term services and supports trust24 commission established in section 4 of this act.25

(5) "Council" means the long-term services and supports trust26 council established in section 5 of this act.27

(6) "Eligible beneficiary" means a qualified individual who is28 age eighteen or older, residing in the state of Washington, was not29 disabled before the age of eighteen, has been determined to meet the30 minimum level of assistance with activities of daily living necessary31 to receive benefits through the trust program, as established in this32 chapter, and who has not exhausted the lifetime limit of benefit33 units.34

(7) "Employee" has the meaning provided in RCW 50A.04.010.35 (8) "Employer" has the meaning provided in RCW 50A.04.010.36 (9) "Employment" has the meaning provided in RCW 50A.04.010.37 (10) "Long-term services and supports provider" means an entity38

that meets the qualifications applicable in law to the approved39 service they provide, including a qualified or certified home care40

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aide, licensed assisted living facility, licensed adult family home,1 licensed nursing home, licensed in-home services agency, adult day2 services program, vendor, instructor, qualified family member, or3 other entities as registered by the department of social and health4 services.5

(11) "Premium" or "premiums" means the payments required by6 section 9 of this act and paid to the employment security department7 for deposit in the account created in section 11 of this act.8

(12) "Program" means the long-term services and supports trust9 program established in this chapter.10

(13) "Qualified family member" means a relative of an eligible11 beneficiary qualified to meet requirements established in state law12 for the approved service they provide that would be required of any13 other long-term services and supports provider to receive payments14 from the state.15

(14) "Qualified individual" means an individual who meets the16 duration of payment requirements, as established in this chapter.17

(15) "State actuary" means the office of the state actuary18 created in RCW

(16) "Wages" has the meaning provided in RCW 50A.04.010, except20 that all wages are subject to a premium assessment and not limited by21 the commissioner of the employment security department, as provided22 under RCW 50A.04.115.23

NEW SECTION. Sec. 3. (1) The health care authority, the24 department of social and health services, the office of the state25 actuary, and the employment security department each have distinct26 responsibilities in the implementation and administration of the27 program. In the performance of their activities, they shall actively28 collaborate to realize program efficiencies and provide persons29 served by the program with a well-coordinated experience.30

(2) The health care authority shall:31 (a) Track the use of lifetime benefit units to verify the32

individual's status as an eligible beneficiary as determined by the33 department of social and health services;34

(b) Ensure approved services are provided through audits or35 service verification processes within the service provider payment36 system for registered long-term services and supports providers and37 recoup any inappropriate payments;38

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(c) Establish criteria for the payment of benefits to registered1 long-term services and supports providers under section 8 of this2 act;3

(d) Establish rules and procedures for benefit coordination when4 the eligible beneficiary is also funded for medicaid and other long-5 term services and supports, including medicare, coverage through the6 department of labor and industries, and private long-term care7 coverage; and8

(e) Adopt rules and procedures necessary to implement and9 administer the activities specified in this section related to the10 program.11

(3) The department of social and health services shall:12 (a) Make determinations regarding an individual's status as an13

eligible beneficiary under section 7 of this act;14 (b) Approve long-term services and supports eligible for payment15

as approved services under the program, as informed by the16 commission;17

(c) Register long-term services and supports providers that meet18 minimum qualifications;19

(d) Discontinue the registration of long-term services and20 supports providers that: (i) Fail to meet the minimum qualifications21 applicable in law to the approved service that they provide; or (ii)22 violate the operational standards of the program;23

(e) Disburse payments of benefits to registered long-term24 services and supports providers, utilizing and leveraging existing25 payment systems for the provision of approved services to eligible26 beneficiaries under section 8 of this act;27

(f) Prepare and distribute written or electronic materials to28 qualified individuals, eligible beneficiaries, and the public as29 deemed necessary by the commission to inform them of program design30 and updates;31

(g) Provide customer service and address questions and32 complaints, including referring individuals to other appropriate33 agencies;34

(h) Provide administrative and operational support to the35 commission;36

(i) Track data useful in monitoring and informing the program, as37 identified by the commission; and38

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(j) Adopt rules and procedures necessary to implement and1 administer the activities specified in this section related to the2 program.3

(4) The employment security department shall:4 (a) Collect and assess employee premiums as provided in section 95

of this act;6 (b) Assist the commission, council, and state actuary in7

monitoring the solvency and financial status of the program;8 (c) Perform investigations to determine the compliance of premium9

payments in section 9 of this act in coordination with the same10 activities conducted under the family and medical leave act, chapter11 50A.04 RCW, to the extent possible;12

(d) Make determinations regarding an individual's status as a13 qualified individual under section 6 of this act; and14

(e) Adopt rules and procedures necessary to implement and15 administer the activities specified in this section related to the16 program.17

(5) The office of the state actuary shall:18 (a) Beginning January 1, 2024, and biennially thereafter, perform19

an actuarial audit and valuation of the long-term services and20 supports trust fund. Additional or more frequent actuarial audits and21 valuations may be performed at the request of the council;22

(b) Make recommendations to the council and the legislature on23 actions necessary to maintain trust solvency. The recommendations24 must include options to redesign or reduce benefit units, approved25 services, or both, to prevent or eliminate any unfunded actuarially26 accrued liability in the trust or to maintain solvency; and27

(c) Select and contract for such actuarial, research, technical,28 and other consultants as the actuary deems necessary to perform its29 duties under this act.30

NEW SECTION. Sec. 4. (1) The long-term services and supports31 trust commission is established. The commission's recommendations and32 decisions must be guided by the joint goals of maintaining benefit33 adequacy and maintaining fund solvency and sustainability.34

(2) The commission includes:35 (a) Two members from each of the two largest caucuses of the36

house of representatives, appointed by the speaker of the house of37 representatives;38

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(b) Two members from each of the two largest caucuses of the1 senate, appointed by the president of the senate;2

(c) The commissioner of the employment security department, or3 the commissioner's designee;4

(d) The secretary of the department of social and health5 services, or the secretary's designee;6

(e) The director of the health care authority, or the director's7 designee, who shall serve as a nonvoting member;8

(f) One representative of the organization representing the area9 agencies on aging;10

(g) One representative of a home care association that represents11 caregivers who provide services to private pay and medicaid clients;12

(h) One representative of a union representing long-term care13 workers;14

(i) One representative of an organization representing retired15 persons;16

(j) One representative of an association representing skilled17 nursing facilities and assisted living providers;18

(k) One representative of an association representing adult19 family home providers;20

(l) Two individuals receiving long-term services and supports, or21 their designees, or representatives of consumers receiving long-term22 services and supports under the program;23

(m) One member who is a worker who is, or will likely be, paying24 the premium established in section 9 of this act and who is not25 employed by a long-term services and supports provider; and26

(n) One representative of an organization of employers whose27 members collect, or will likely be collecting, the premium28 established in section 9 of this act.29

(3)(a) Other than the legislators and agency heads identified in30 subsection (2) of this section, members of the commission are31 appointed by the governor for terms of two years, except that the32 governor shall appoint the initial members identified in subsection33 (2)(f) through (n) of this section to staggered terms not to exceed34 four years.35

(b) The secretary of the department of social and health36 services, or the secretary's designee, shall serve as chair of the37 commission. Meetings of the commission are at the call of the chair.38 A majority of the voting members of the commission shall constitute a39 quorum for any votes of the commission. Approval of sixty percent of40

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those voting members of the commission who are in attendance is1 required for the passage of any vote.2

(c) Members of the commission and the subcommittee established in3 subsection (6) of this section must be compensated in accordance with4 RCW 43.03.250 and must be reimbursed for their travel expenses while5 on official business in accordance with RCW 43.03.050 and

(4) Beginning January 1, 2021, the commission shall propose7 recommendations to the appropriate executive agency or the8 legislature regarding:9

(a) The establishment of criteria for determining that an10 individual has met the requirements to be a qualified individual as11 established in section 6 of this act or an eligible beneficiary as12 established in section 7 of this act;13

(b) The establishment of criteria for minimum qualifications for14 the registration of long-term services and supports providers who15 provide approved services to eligible beneficiaries;16

(c) The establishment of payment maximums for approved services17 consistent with actuarial soundness which shall not be lower than18 medicaid payments for comparable services. A service or supply may be19 limited by dollar amount, duration, or number of visits. The20 commission shall engage affected stakeholders to develop this21 recommendation;22

(d) Changes to rules or policies to improve the operation of the23 program;24

(e) Providing a recommendation to the council for the annual25 adjustment of the benefit unit in accordance with sections 2 and 5 of26 this act;27

(f) A refund of premiums for a deceased qualified individual with28 a dependent who is an individual with a developmental disability who29 is dependent for support from a qualified individual. The qualified30 individual must not have been determined to be an eligible31 beneficiary by the department of social and health services. The32 refund shall be deposited into an individual trust account within the33 developmental disabilities endowment trust fund for the benefit of34 the dependent with a developmental disability. The commission shall35 consider:36

(i) The value of the refund to be one hundred percent of the37 current value of the qualified individual's lifetime premium payments38 at the time that certification of death of the qualified individual39 is submitted, less any administrative process fees; and40

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(ii) The criteria for determining whether the individual is1 developmentally disabled. The determination shall not be based on2 whether or not the individual with a developmental disability is3 receiving services under Title 71A RCW, or another state or local4 program;5

(g) Assisting the state actuary with the preparation of regular6 actuarial reports on the solvency and financial status of the program7 and advising the legislature on actions necessary to maintain trust8 solvency. The commission shall provide the office of the state9 actuary with all actuarial reports for review. The office of the10 state actuary shall provide any recommendations to the commission and11 the legislature on actions necessary to maintain trust solvency;12

(h) For the January 1, 2021, report only, recommendations on13 whether and how to extend coverage to individuals who became disabled14 before the age of eighteen, including the impact on the financial15 status and solvency of the trust. The commission shall engage16 affected stakeholders to develop this recommendation; and17

(i) For the January 1, 2021, report only, the commission shall18 consult with the office of the state actuary on the development of an19 actuarial report of the projected solvency and financial status of20 the program. The office of the state actuary shall provide any21 recommendations to the commission and the legislature on actions22 necessary to achieve trust solvency.23

(5) The commission shall monitor agency administrative expenses24 over time. Beginning November 15, 2020, the commission must annually25 report to the governor and the fiscal committees of the legislature26 on agency spending for administrative expenses and anticipated27 administrative expenses as the program shifts into different phases28 of implementation and operation. The November 15, 2025, report must29 include recommendations for a method of calculating future agency30 administrative expenses to limit administrative expenses while31 providing sufficient funds to adequately operate the program. The32 agency heads identified in subsection (2) of this section may advise33 the commission on the reports prepared under this subsection, but34 must recuse themselves from the commission's process for review,35 approval, and submission to the legislature.36

(6) The commission shall establish an investment strategy37 subcommittee consisting of the members identified in subsection38 (2)(a) through (d) of this section as voting members of the39 subcommittee. In addition, four members appointed by the governor who40

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are considered experienced and qualified in the field of investment1 shall serve as nonvoting members. The subcommittee shall provide2 guidance and advice to the state investment board on investment3 strategies for the account, including seeking counsel and advice on4 the types of investments that are constitutionally permitted.5

NEW SECTION. Sec. 5. (1) The long-term services and supports6 council is established. The council includes the members identified7 in section 4(2)(a) through (e) of this act and the director of the8 office of financial management, or the director's designee.9

(2) On an annual basis, the council must determine adjustments to10 the benefit unit as provided in the definition of "benefit unit" in11 section 2 of this act to assure benefit adequacy and solvency of the12 long-term services and supports trust account established in section13 11 of this act. In determining adjustments to the benefit unit, the14 council must review the state actuary's actuarial audit and valuation15 of the trust account, any recommendations by the state actuary and16 commission, data on relevant economic indicators and program costs,17 and sustainability.18

(3) The director of the office of financial management, or the19 director's designee, shall serve as chair of the council. The council20 must meet at least once annually to determine adjustments to the21 benefit unit as defined in section 2 of this act. Additional meetings22 of the council are at the call of the chair. A majority of the voting23 members of the council shall constitute a quorum for any votes of the24 council. Approval of sixty percent of the members of the council who25 are in attendance is required for the passage of any vote. The26 council may adopt rules for the conduct of meetings, including27 provisions for meetings and voting to be conducted by telephonic,28 video, or other conferencing process.29

(4) Members of the council must be compensated in accordance with30 RCW 43.03.250 and must be reimbursed for their travel expenses while31 on official business in accordance with RCW 43.03.050 and

NEW SECTION. Sec. 6. (1) The employment security department33 shall deem a person to be a qualified individual as provided in this34 chapter if the person has paid the long-term services and supports35 premiums required by section 9 of this act for the equivalent of36 either:37

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(a) A total of ten years without interruption of five or more1 consecutive years; or2

(b) Three years within the last six years.3 (2) When deeming a person to be a qualified individual, the4

employment security department shall require that the person have5 worked at least five hundred hours during each of the ten years in6 subsection (1)(a) of this section and each of the three years in7 subsection (1)(b) of this section.8

NEW SECTION. Sec. 7. (1) Beginning January 1, 2025, approved9 services must be available and benefits payable to a registered long-10 term services and supports provider on behalf of an eligible11 beneficiary under this section.12

(2) A qualified individual may become an eligible beneficiary by13 filing an application with the department of social and health14 services and undergoing an eligibility determination which includes15 an evaluation that the individual requires assistance with at least16 three activities of daily living. The department of social and health17 services must engage sufficient qualified assessor capacity,18 including via contract, so that the determination may be made within19 forty-five days from receipt of a request by a beneficiary to use a20 benefit.21

(3)(a) An eligible beneficiary may receive approved services and22 benefits through the program in the form of a benefit unit payable to23 a registered long-term services and supports provider.24

(b) An eligible beneficiary may not receive more than the dollar25 equivalent of three hundred sixty-five benefit units over the course26 of the eligible beneficiary's lifetime.27

(i) If the department of social and health services reimburses a28 long-term services and supports provider for approved services29 provided to an eligible beneficiary and the payment is less than the30 benefit unit, only the portion of the benefit unit that is used shall31 be taken into consideration when calculating the person's remaining32 lifetime limit on receipt of benefits.33

(ii) Eligible beneficiaries may combine benefit units to receive34 more approved services per day as long as the total number of35 lifetime benefit units has not been exceeded.36

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NEW SECTION. Sec. 8. (1) Benefits provided under this chapter1 shall be paid periodically and promptly to registered long-term2 services and supports providers.3

(2) Qualified family members may be paid for approved personal4 care services in the same way as individual providers, through a5 licensed home care agency, or through a third option if recommended6 by the commission and adopted by the department of social and health7 services.8

NEW SECTION. Sec. 9. (1) Beginning January 1, 2022, the9 employment security department shall assess for each individual in10 employment with an employer a premium based on the amount of the11 individual's wages. The initial premium rate is fifty-eight12 hundredths of one percent of the individual's wages. Beginning13 January 1, 2024, and biennially thereafter, the premium rate shall be14 set by the pension funding council at a rate no greater than fifty-15 eight hundredths of one percent. In addition, the pension funding16 council must set the premium rate at the lowest amount necessary to17 maintain the actuarial solvency of the long-term services and18 supports trust account created in section 11 of this act in19 accordance with recognized insurance principles and designed to20 attempt to limit fluctuations in the premium rate. To facilitate the21 premium rate setting the office of the state actuary must perform a22 biennial actuarial audit and valuation of the fund and make23 recommendations to the pension funding council.24

(2)(a) The employer must collect from the employees the premiums25 provided under this section through payroll deductions and remit the26 amounts collected to the employment security department.27

(b) In collecting employee premiums through payroll deductions,28 the employer shall act as the agent of the employees and shall remit29 the amounts to the employment security department as required by this30 chapter.31

(3) Nothing in this chapter requires any party to a collective32 bargaining agreement in existence on October 19, 2017, to reopen33 negotiations of the agreement or to apply any of the responsibilities34 under this chapter unless and until the existing agreement is35 reopened or renegotiated by the parties or expires.36

(4)(a) Premiums shall be collected in the manner and at such37 intervals as provided in this chapter and directed by the employment38 security department.39

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(b) To the extent feasible, the employment security department1 shall use the premium assessment, collection, and reporting2 procedures in chapter 50A.04 RCW.3

(5) The employment security department shall deposit all premiums4 collected in this section in the long-term services and supports5 trust account created in section 11 of this act.6

(6) Premiums collected in this section are placed in the trust7 account for the individuals who become eligible for the program.8

(7) If the premiums established in this section are increased,9 the legislature shall notify each qualified individual by mail that10 the person's premiums have been increased, describe the reason for11 increasing the premiums, and describe the plan for restoring the12 funds so that premiums are returned to fifty-eight hundredths of one13 percent of the individual's wages.14

(8) An employee who demonstrates that the employee has long-term15 care insurance is exempt from the premium assessment in this section.16

NEW SECTION. Sec. 10. (1) Beginning January 1, 2022, any self-17 employed person, including a sole proprietor, independent contractor,18 partner, or joint venturer, may elect coverage under this chapter.19 Those electing coverage under this subsection are responsible for20 payment of one hundred percent of all premiums assessed to an21 employee under section 9 of this act. The self-employed person must22 file a notice of election in writing with the employment security23 department, in the manner required by the employment security24 department in rule. The self-employed person is eligible for benefits25 after paying the long-term services and supports premium for the time26 required under section 6 of this act.27

(2) A self-employed person who has elected coverage may withdraw28 from coverage, at such times as the employment security department29 may adopt by rule, by filing a notice of withdrawal in writing with30 the employment security department, with the withdrawal to take31 effect not sooner than thirty days after filing the notice with the32 employment security department.33

(3) The employment security department may cancel elective34 coverage if the self-employed person fails to make required payments35 or file reports. The employment security department may collect due36 and unpaid premiums and may levy an additional premium for the37 remainder of the period of coverage. The cancellation must be38

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effective no later than thirty days from the date of the notice in1 writing advising the self-employed person of the cancellation.2

(4) Those electing coverage are considered employers or employees3 where the context so dictates.4

(5) For the purposes of this section, "independent contractor"5 means an individual excluded from the definition of "employment" in6 section 2(8) of this act.7

(6) The employment security department shall adopt rules for8 determining the hours worked and the wages of individuals who elect9 coverage under this section and rules for enforcement of this10 section.11

NEW SECTION. Sec. 11. (1) The long-term services and supports12 trust account is created in the custody of the state treasurer. All13 receipts from employers under section 9 of this act must be deposited14 in the account. Expenditures from the account may be used for the15 administrative activities of the department of social and health16 services, the health care authority, and the employment security17 department. Benefits associated with the program must be disbursed18 from the account by the department of social and health services.19 Only the secretary of the department of social and health services or20 the secretary's designee may authorize disbursements from the21 account. The account is subject to the allotment procedures under22 chapter 43.88 RCW. An appropriation is required for administrative23 expenses, but not for benefit payments. The account must provide24 reimbursement of any amounts from other sources that may have been25 used for the initial establishment of the program.26

(2) The revenue generated pursuant to this chapter shall be27 utilized to expand long-term care in the state. These funds may not28 be used either in whole or in part to supplant existing state or29 county funds for programs that meet the definition of approved30 services.31

(3) The moneys deposited in the account must remain in the32 account until expended in accordance with the requirements of this33 chapter. If moneys are appropriated for any purpose other than34 supporting the long-term services and supports program, the35 legislature shall notify each qualified individual by mail that the36 person's premiums have been appropriated for an alternate use,37 describe the alternate use, and state its plan for restoring the38

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funds so that premiums are not increased and benefits are not1 reduced.2

NEW SECTION. Sec. 12. (1) The department of social and health3 services shall have the state investment board invest the funds in4 the account. The state investment board has the full power to invest,5 reinvest, manage, contract, sell, or exchange investment money in the6 account. All investment and operating costs associated with the7 investment of money shall be paid under RCW 43.33A.160 and With the exception of these expenses, the earnings from the9 investment of the money shall be retained by the accounts.10

(2) All investments made by the state investment board shall be11 made with the degree of judgment and care required under RCW12 43.33A.140 and the investment policy established by the state13 investment board.14

(3) As deemed appropriate by the state investment board, money in15 the account may be commingled for investment with other funds subject16 to investment by the state investment board.17

(4) Members of the state investment board may not be considered18 an insurer of the funds or assets and are not liable for any action19 or inaction.20

(5) Members of the state investment board are not liable to the21 state, to the account, or to any other person as a result of their22 activities as members, whether ministerial or discretionary, except23 for willful dishonesty or intentional violations of law. The state24 investment board in its discretion may purchase liability insurance25 for members.26

(6) The authority to establish all policies relating to the27 account, other than the investment policies as provided in28 subsections (1) through (3) of this section, resides with the29 department of social and health services acting in accordance with30 the principles set forth in this chapter. With the exception of31 expenses of the state investment board under subsection (1) of this32 section, disbursements from the account shall be made only on the33 authorization of the department of social and health services or its34 designee, and moneys in the account may be spent only for the35 purposes specified in this chapter.36

(7) The state investment board shall routinely consult and37 communicate with the department of social and health services on the38

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investment policy, earnings of the accounts, and related needs of the1 program.2

NEW SECTION. Sec. 13. (1) Determinations made by the health3 care authority or the department of social and health services under4 this chapter, including determinations regarding functional5 eligibility or related to registration of long-term services and6 supports providers, are subject to appeal in accordance with chapter7 34.05 RCW. In addition, the standards and procedures adopted for8 these appeals must address the following:9

(a) Timelines;10 (b) Eligibility and benefit determination;11 (c) Judicial review; and12 (d) Fees.13 (2) Determinations made by the employment security department14

under this chapter are subject to appeal in accordance with the15 appeal procedures under chapter 50A.04 RCW. The employment security16 department shall adopt standards and procedures for appeals for17 persons aggrieved by any determination or redetermination made by the18 department. The standards and procedures must be consistent with19 those adopted for the family and medical leave program under chapter20 50A.04 RCW and must address topics including:21

(a) Premium liability;22 (b) Premium collection;23 (c) Judicial review; and24 (d) Fees.25

NEW SECTION. Sec. 14. The department of social and health26 services must:27

(1) Seek access to medicare data from the federal centers for28 medicare and medicaid services to analyze the potential savings in29 medicare expenditures due to the operation of the program;30

(2) Apply for a demonstration waiver from the federal centers for31 medicare and medicaid services to allow for the state to share in the32 savings generated in the federal match for medicaid long-term33 services and supports and medicare due to the operation of the34 program;35

(3) Submit a report, in compliance with RCW 43.01.036, on the36 status of the waiver to the office of financial management and the37 appropriate committees of the legislature by December 1, 2022.38

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NEW SECTION. Sec. 15. Beginning December 1, 2026, and annually1 thereafter, and in compliance with RCW 43.01.036, the commission must2 report to the legislature on the program, including:3

(1) Projected and actual program participation;4 (2) Adequacy of premium rates;5 (3) Fund balances;6 (4) Benefits paid;7 (5) Demographic information on program participants, including8

age, gender, race, ethnicity, geographic distribution by county,9 legislative district, and employment sector; and10

(6) The extent to which the operation of the program has resulted11 in savings to the medicaid program by avoiding costs that would have12 otherwise been the responsibility of the state.13

NEW SECTION. Sec. 16. Any benefits used by an individual under14 this chapter are not income or resources for any determinations of15 eligibility for any other state program or benefit, for medicaid, for16 a state-federal program, or for any other means-tested program.17

NEW SECTION. Sec. 17. Nothing in this chapter creates an18 entitlement for a person to receive, or requires a state agency to19 provide, case management services including, but not limited to, case20 management services under chapter 74.39A RCW.21

NEW SECTION. Sec. 18. A new section is added to chapter 43.0922 RCW to read as follows:23

By December 1, 2032, the state auditor must conduct a24 comprehensive evaluation of the long-term services and supports trust25 program established in chapter 50B.--- RCW (the new chapter created26 in section 23 of this act) and deliver a report, including a27 conclusion and recommendations for improvement to the legislature28 regarding:29

(1) Program operations, including the performance of the long-30 term services and supports trust commission established in section 431 of this act;32

(2) Program financial status, including solvency, the value of33 the benefit provided, and the financial balance of program benefits34 to costs;35

(3) The overall efficacy of the program, based on the established36 goals under this act including, but not limited to:37

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(a) Delaying middle class families' need to spend to poverty to1 receive medicaid-funded long-term care;2

(b) Strengthening the state economy through improving workforce3 participation;4

(c) Reducing the caseload and expenditures of the state medicaid5 program on long-term care; and6

(d) Obtaining shared savings through a medicaid demonstration7 waiver.8

Sec. 19. RCW 74.39A.076 and 2018 c 220 s 1 are each amended to9 read as follows:10

(1) Beginning January 7, 2012, except for long-term care workers11 exempt from certification under RCW 18.88B.041(1)(a):12

(a) A biological, step, or adoptive parent who is the individual13 provider only for ((his or her)) the person's developmentally14 disabled son or daughter must receive twelve hours of training15 relevant to the needs of adults with developmental disabilities16 within the first one hundred twenty days after becoming an individual17 provider.18

(b) A spouse or registered domestic partner who is a long-term19 care worker only for a spouse or domestic partner, pursuant to the20 long-term services and supports trust program established in chapter21 50B.--- RCW (the new chapter created in section 23 of this act), must22 receive fifteen hours of basic training, and at least six hours of23 additional focused training based on the care-receiving spouse's or24 partner's needs, within the first one hundred twenty days after25 becoming a long-term care worker.26

(c) A person working as an individual provider who (i) provides27 respite care services only for individuals with developmental28 disabilities receiving services under Title 71A RCW or only for29 individuals who receive services under this chapter, and (ii) works30 three hundred hours or less in any calendar year, must complete31 fourteen hours of training within the first one hundred twenty days32 after becoming an individual provider. Five of the fourteen hours33 must be completed before becoming eligible to provide care, including34 two hours of orientation training regarding the caregiving role and35 terms of employment and three hours of safety training. The training36 partnership identified in RCW 74.39A.360 must offer at least twelve37 of the fourteen hours online, and five of those online hours must be38 individually selected from elective courses.39

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(((c))) (d) Individual providers identified in (((c))) (d)(i) or1 (ii) of this subsection must complete thirty-five hours of training2 within the first one hundred twenty days after becoming an individual3 provider. Five of the thirty-five hours must be completed before4 becoming eligible to provide care. Two of these five hours shall be5 devoted to an orientation training regarding an individual provider's6 role as caregiver and the applicable terms of employment, and three7 hours shall be devoted to safety training, including basic safety8 precautions, emergency procedures, and infection control. Individual9 providers subject to this requirement include:10

(i) An individual provider caring only for ((his or her)) the11 individual provider's biological, step, or adoptive child or parent12 unless covered by (a) of this subsection; and13

(ii) A person working as an individual provider who provides14 twenty hours or less of care for one person in any calendar month.15

(2) In computing the time periods in this section, the first day16 is the date of hire.17

(3) Only training curriculum approved by the department may be18 used to fulfill the training requirements specified in this section.19 The department shall only approve training curriculum that:20

(a) Has been developed with input from consumer and worker21 representatives; and22

(b) Requires comprehensive instruction by qualified instructors.23 (4) The department shall adopt rules to implement this section.24

Sec. 20. RCW 18.88B.041 and 2015 c 152 s 1 are each amended to25 read as follows:26

(1) The following long-term care workers are not required to27 become a certified home care aide pursuant to this chapter:28

(a)(i)(A) Registered nurses, licensed practical nurses, certified29 nursing assistants or persons who are in an approved training program30 for certified nursing assistants under chapter 18.88A RCW, medicare-31 certified home health aides, or other persons who hold a similar32 health credential, as determined by the secretary, or persons with33 special education training and an endorsement granted by the34 superintendent of public instruction, as described in RCW35 28A.300.010, if the secretary determines that the circumstances do36 not require certification.37

(B) A person who was initially hired as a long-term care worker38 prior to January 7, 2012, and who completes all of ((his or her)) the39

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training requirements in effect as of the date ((he or she)) the1 person was hired.2

(ii) Individuals exempted by (a)(i) of this subsection may obtain3 certification as a home care aide without fulfilling the training4 requirements in RCW 74.39A.074(1)(d)(ii) but must successfully5 complete a certification examination pursuant to RCW 18.88B.031.6

(b) All long-term care workers employed by community residential7 service businesses.8

(c) An individual provider caring only for ((his or her)) the9 individual provider's biological, step, or adoptive child or parent.10

(d) A person working as an individual provider who provides11 twenty hours or less of care for one person in any calendar month.12

(e) A person working as an individual provider who only provides13 respite services and works less than three hundred hours in any14 calendar year.15

(f) A long-term care worker providing approved services only for16 a spouse or registered domestic partner, pursuant to the long-term17 services and supports trust program established in chapter 50B.---18 RCW (the new chapter created in section 23 of this act).19

(2) A long-term care worker exempted by this section from the20 training requirements contained in RCW 74.39A.074 may not be21 prohibited from enrolling in training pursuant to that section.22

(3) The department shall adopt rules to implement this section.23

Sec. 21. RCW 43.79A.040 and 2018 c 260 s 28, 2018 c 258 s 4, and24 2018 c 127 s 6 are each reenacted and amended to read as follows:25

(1) Money in the treasurer's trust fund may be deposited,26 invested, and reinvested by the state treasurer in accordance with27 RCW 43.84.080 in the same manner and to the same extent as if the28 money were in the state treasury, and may be commingled with moneys29 in the state treasury for cash management and cash balance purposes.30

(2) All income received from investment of the treasurer's trust31 fund must be set aside in an account in the treasury trust fund to be32 known as the investment income account.33

(3) The investment income account may be utilized for the payment34 of purchased banking services on behalf of treasurer's trust funds35 including, but not limited to, depository, safekeeping, and36 disbursement functions for the state treasurer or affected state37 agencies. The investment income account is subject in all respects to38 chapter 43.88 RCW, but no appropriation is required for payments to39

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financial institutions. Payments must occur prior to distribution of1 earnings set forth in subsection (4) of this section.2

(4)(a) Monthly, the state treasurer must distribute the earnings3 credited to the investment income account to the state general fund4 except under (b), (c), and (d) of this subsection.5

(b) The following accounts and funds must receive their6 proportionate share of earnings based upon each account's or fund's7 average daily balance for the period: The 24/7 sobriety account, the8 Washington promise scholarship account, the Gina Grant Bull memorial9 legislative page scholarship account, the Washington advanced college10 tuition payment program account, the Washington college savings11 program account, the accessible communities account, the Washington12 achieving a better life experience program account, the community and13 technical college innovation account, the agricultural local fund,14 the American Indian scholarship endowment fund, the foster care15 scholarship endowment fund, the foster care endowed scholarship trust16 fund, the contract harvesting revolving account, the Washington state17 combined fund drive account, the commemorative works account, the18 county enhanced 911 excise tax account, the toll collection account,19 the developmental disabilities endowment trust fund, the energy20 account, the fair fund, the family and medical leave insurance21 account, the fish and wildlife federal lands revolving account, the22 natural resources federal lands revolving account, the food animal23 veterinarian conditional scholarship account, the forest health24 revolving account, the fruit and vegetable inspection account, the25 future teachers conditional scholarship account, the game farm26 alternative account, the GET ready for math and science scholarship27 account, the Washington global health technologies and product28 development account, the grain inspection revolving fund, the29 Washington history day account, the industrial insurance rainy day30 fund, the juvenile accountability incentive account, the law31 enforcement officers' and firefighters' plan 2 expense fund, the32 local tourism promotion account, the low-income home rehabilitation33 revolving loan program account, the multiagency permitting team34 account, the northeast Washington wolf-livestock management account,35 the pilotage account, the produce railcar pool account, the regional36 transportation investment district account, the rural rehabilitation37 account, the Washington sexual assault kit account, the stadium and38 exhibition center account, the youth athletic facility account, the39 self-insurance revolving fund, the children's trust fund, the40

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Washington horse racing commission Washington bred owners' bonus fund1 and breeder awards account, the Washington horse racing commission2 class C purse fund account, the individual development account3 program account, the Washington horse racing commission operating4 account, the life sciences discovery fund, the Washington state5 heritage center account, the reduced cigarette ignition propensity6 account, the center for childhood deafness and hearing loss account,7 the school for the blind account, the Millersylvania park trust fund,8 the public employees' and retirees' insurance reserve fund, the9 school employees' benefits board insurance reserve fund, (([the]))10 the public employees' and retirees' insurance account, (([the])) the11 school employees' insurance account, the long-term services and12 supports trust account, and the radiation perpetual maintenance fund.13

(c) The following accounts and funds must receive eighty percent14 of their proportionate share of earnings based upon each account's or15 fund's average daily balance for the period: The advanced right-of-16 way revolving fund, the advanced environmental mitigation revolving17 account, the federal narcotics asset forfeitures account, the high18 occupancy vehicle account, the local rail service assistance account,19 and the miscellaneous transportation programs account.20

(d) Any state agency that has independent authority over accounts21 or funds not statutorily required to be held in the custody of the22 state treasurer that deposits funds into a fund or account in the23 custody of the state treasurer pursuant to an agreement with the24 office of the state treasurer shall receive its proportionate share25 of earnings based upon each account's or fund's average daily balance26 for the period.27

(5) In conformance with Article II, section 37 of the state28 Constitution, no trust accounts or funds shall be allocated earnings29 without the specific affirmative directive of this section.30

Sec. 22. RCW 44.44.040 and 2011 1st sp.s. c 12 s 7 are each31 amended to read as follows:32

The office of the state actuary shall have the following powers33 and duties:34

(1) Perform all actuarial services for the department of35 retirement systems, including all studies required by law.36

(2) Advise the legislature and the governor regarding pension37 benefit provisions, and funding policies and investment policies of38 the state investment board.39

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(3) Consult with the legislature and the governor concerning1 determination of actuarial assumptions used by the department of2 retirement systems.3

(4) Prepare a report, to be known as the actuarial fiscal note,4 on each pension bill introduced in the legislature which briefly5 explains the financial impact of the bill. The actuarial fiscal note6 shall include: (a) The statutorily required contribution for the7 biennium and the following twenty-five years; (b) the biennial cost8 of the increased benefits if these exceed the required contribution;9 and (c) any change in the present value of the unfunded accrued10 benefits. An actuarial fiscal note shall also be prepared for all11 amendments which are offered in committee or on the floor of the12 house of representatives or the senate to any pension bill. However,13 a majority of the members present may suspend the requirement for an14 actuarial fiscal note for amendments offered on the floor of the15 house of representatives or the senate.16

(5) Provide such actuarial services to the legislature as may be17 requested from time to time.18

(6) Provide staff and assistance to the committee established19 under RCW

(7) Provide actuarial assistance to the law enforcement officers'21 and firefighters' plan 2 retirement board as provided in chapter 2,22 Laws of 2003. Reimbursement for services shall be made to the state23 actuary under RCW 39.34.130 and section 5(5), chapter 2, Laws of24 2003.25

(8) Provide actuarial assistance to the committee on advanced26 tuition payment pursuant to chapter 28B.95 RCW, including27 recommending a tuition unit price to the committee on advanced28 tuition payment to be used in the ensuing enrollment period.29 Reimbursement for services shall be made to the state actuary under30 RCW

(9) Provide actuarial assistance to the long-term services and32 supports trust commission pursuant to chapter 50B.--- RCW (the new33 chapter created in section 23 of this act). Reimbursement for34 services shall be made to the state actuary under RCW

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NEW SECTION. Sec. 23. Sections 1 through 17 of this act1 constitute a new chapter in a new title to be codified as Title 50B2 RCW.3

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  • Section 1.
  • Section 2.
  • Section 3.
  • Section 4.
  • Section 5.
  • Section 6.
  • Section 7.
  • Section 8.
  • Section 9.
  • Section 10.
  • Section 11.
  • Section 12.
  • Section 13.
  • Section 14.
  • Section 15.
  • Section 16.
  • Section 17.
  • Section 18.
  • Section 19.
  • Section 20.
  • Section 21.
  • Section 22.
  • Section 23.