Department of Social and Health Services - Long Term Care
| Annual FTEs | General Fund State | Other Funds | Total Funds | |
|---|---|---|---|---|
| (Dollars in Thousands) | ||||
| Estimated Expenditures | 1,996.5 | 2,285,528 | 3,029,299 | 5,314,827 |
| 2019-21 Maintenance Level | 2,320.4 | 2,655,552 | 3,496,903 | 6,152,455 |
| Difference from 2017-19 | 323.9 | 370,024 | 467,604 | 837,628 |
| % Change from 2017-19 | 16.2% | 16.2% | 15.4% | 15.8% |
2019-21 Policy Other Changes |
||||
| Abuse Registry | 1.0 | 170 | 72 | 242 |
| Updated Facility Definition | (66.5) | (10,714) | (4,927) | (15,641) |
| Automatic Voter Registration | 0.50 | 42 | 41 | 83 |
| Supported Living Investigators | 5.4 | (2,330) | 4,408 | 2,078 |
| Electronic Visit Verification | 0.0 | 5,451 | 7,012 | 12,463 |
| IT Systems Modernization | 14.0 | 200 | 200 | 400 |
| Targeted Vendor Rate Increase | 0.0 | 26,378 | 31,016 | 57,394 |
| Increase In-Home PNA | 0.0 | 10,868 | 13,819 | 24,687 |
| ESF Capacity Mental Health | 0.0 | 14,893 | 14,896 | 29,789 |
| Adult Family Homes Award/Agreement | 0.0 | 29,194 | 36,390 | 65,584 |
| In-Home Care Providers Agreement | 0.0 | 48,772 | 62,298 | 111,070 |
| Agency Provider Parity | 0.0 | 8,874 | 11,297 | 20,171 |
| BH: Additional Enhanced Discharge | 32.2 | 34,898 | 31,328 | 66,226 |
| Kinship Care Support Program | 0.0 | 500 | 0 | 500 |
| ADRC Business Case Grant | 0.0 | 0 | 128 | 128 |
| Leased Facilities One-Time Costs | 0.0 | 4,278 | 3,818 | 8,096 |
| 2019-21 Policy Other Changes Total | (13.4) | 171,474 | 211,796 | 383,270 |
2019-21 Policy Comp Changes |
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| State Public Employee Benefits Rate | 0.0 | 32 | 26 | 58 |
| WFSE General Government | 0.0 | 10,662 | 9,173 | 19,835 |
| State Rep Employee Benefits Rate | 0.0 | 147 | 126 | 273 |
| Non-Rep General Wage Increase | 0.0 | 1,907 | 1,586 | 3,493 |
| Non-Rep Premium Pay | 0.0 | 208 | 180 | 388 |
| Non-Rep Targeted Pay Increases | 0.0 | 185 | 140 | 325 |
| SEIU 1199 General Government | 0.0 | 1,698 | 1,515 | 3,213 |
| Orca Transit Pass - Outside CBAs | 0.0 | 22 | 20 | 42 |
| PERS & TRS Plan 1 Benefit Increase | 0.0 | 233 | 201 | 434 |
| Non-Rep Salary Schedule Revision | 0.0 | 118 | 51 | 169 |
| State Tax - Wellness Gift Card | 0.0 | 2 | 2 | 4 |
| 2019-21 Policy Comp Changes Total | 0.0 | 15,214 | 13,020 | 28,234 |
2019-21 Policy Transfers Changes |
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| Orca Transit Pass Funding Transfer | 0.0 | (286) | (256) | (542) |
| Health Coalition FSA Fund Transfer | 0.0 | (90) | 0 | (90) |
| 2019-21 Policy Transfers Changes Total | 0.0 | (376) | (256) | (632) |
| Total Policy Changes | (13.4) | 186,312 | 224,560 | 410,872 |
| 2019-21 Policy Level | 2,307.0 | 2,841,864 | 3,721,463 | 6,563,327 |
| Difference from 2017-19 | 310.5 | 556,336 | 692,164 | 1,248,500 |
| % Change from 2017-19 | 15.6% | 24.3% | 22.8% | 23.5% |
Policy Changes
Abuse Registry
Funding is provided for the department to make statutory changes to implement a process to review and reconsider the permanent prohibition placed on certain individuals from providing long-term care services.
Updated Facility Definition
Section 9016(6) of Second Engrossed Substitute House Bill (2ESHB) 1388 expands the definition of a “facility” to include any other facility licensed or certified by the Department of Health (DOH). The expanded definition includes 14,281 community acute care hospital beds and 4,900 residential treatment facility beds which were not previously included in the Adult Protective Services (APS) workload. This step corresponds with agency request legislation to remove the expanded facility types. The department missed this change and didn’t request an increased appropriation during the 2018 legislative session. This step is a reversal of a separate maintenance level step which provides funding for the department to conduct the necessary investigations. DOH has historically and will continue to inspect and investigate the expanded facility types.
Automatic Voter Registration
Funding is provided for staffing and information technology impacts associated with the implementation of automatic voter registration, consistent with Chapter 110, Laws of 2018.
Supported Living Investigators
Fee authority is provided for supported living providers sufficient to cover oversight and investigation costs for clients residing in supported living settings. Provider rates are increased to cover the cost of the fee, which is eligible for federal matching funds, resulting in a net General Fund-State savings when combining the Developmental Disabilities Administration and Aging and Long-Term Support Administration.
Electronic Visit Verification
Funding is provided to comply with the federal "21st Century Cures Act," which requires states to implement an Electronic Visit Verification (EVV) system by January 1, 2020 or receive a federal match rate reduction that escalates from 0.25 percent in 2020 up to one percent by 2024. An EVV system will electronically report and verify information about the delivery of personal care services, such as the date and time, service type and location.
IT Systems Modernization
Funding is provided for the department to purchase network switches which are outdated, out of warranty, and past their expected useful life of five years.
Targeted Vendor Rate Increase
Funding is provided to increase certain contracted provider rates in order to maintain client access and choice, and to promote cost-efficient delivery of care across the entire system. The increases are for nursing homes, assisted living facilities, and critical nursing services.
Increase In-Home PNA
Funding is provided to decrease the amount some Medicaid clients are required to contribute to the cost of their in-home personal care. This will allow the clients to retain more of their income, or increase their Personal Needs Allowance (PNA), for housing and other expenses that are necessary for them to remain in their homes rather than move to more expensive residential settings.
ESF Capacity Mental Health
Funding is provided for increased payment rates and capacity for long-term care services provided in Enhanced Services Facilities (ESF).
Adult Family Homes Award/Agreement
Funding is provided for a wage and benefit increase to workers who provide in-home personal care services and are employed by private agencies. The increase corresponds to the salary and wage component of the in-home care agreement for individual providers.
In-Home Care Providers Agreement
Funding is provided for an agreement with individual providers of in-home personal care services, which includes increases to the wage scale; increases in contributions to the health care, training and retirement trusts; and an increase in paid time off.
Agency Provider Parity
Funding is provided for a wage and benefit increase to workers who provide in-home personal care services and are employed by private agencies. The increase corresponds to the salary and wage component of the in-home care agreement for individual providers.
BH: Additional Enhanced Discharge
Funding is provided for additional community placement beds for discharging patients out of the state psychiatric hospitals. Specific placement options include enhanced service facilities, adult family homes, skilled nursing facilities, shared supportive housing, assisted living facilities, specialized dementia, and state-operated living alternatives. This item is part of the Governor's statewide behavioral health (BH) reform package.
Kinship Care Support Program
Funding is provided for the Kinship Care Support Program which assists low-income caregivers with short-term financial supports to meet children’s urgent needs and provide greater stability for children. Program funds can be used to purchase goods such as beds, clothing, safety items or supplies, and services when no other resources are available.
ADRC Business Case Grant
Increased federal authority is provided for the ADRC/NWD System business case development grant awarded for the period of September 2018 through August 2019.
Leased Facilities One-Time Costs
One-time funding is provided for costs related to relocation and projects to support the DSHS Six-Year Facilities Plan and to support 145 offices and client service centers statewide.
State Public Employee Benefits Rate
Health insurance funding is provided for state employees who are not represented by a union, who are covered by a bargaining agreement that is not subject to financial feasibility determination, or who are not part of the coalition of unions for health benefits. The insurance funding rate is $977 per employee per month for fiscal year 2020 and $978 per employee per month for fiscal year 2021.
WFSE General Government
Funding is provided for a collective bargaining agreement with the Washington Federation of State Employees - General Government. The agreement includes a general wage increase of 3 percent, effective July 1, 2019; a general wage increase of 3 percent, effective July 1, 2020; premium, shift, and other special pay changes, and increases in targeted job classifications. Employee insurance included in the agreement is displayed in a separate item.
State Rep Employee Benefits Rate
This provides health insurance funding as part of the master agreements for employees who bargain for health benefits as part of a coalition of unions. The insurance funding rate is $977 per employee per month for fiscal year 2020 and $978 per employee per month for fiscal year 2021.
Non-Rep General Wage Increase
Funding is provided for wage increases for state employees who are not represented by a union or who are covered by a bargaining agreement that is not subject to financial feasibility determination. It is sufficient for a general wage increase of 3 percent, effective July 1, 2019, and a general wage increase of 3 percent, effective July 1, 2020. This item includes both general government and higher education workers.
Non-Rep Premium Pay
Funding is provided for increases in premium pay for state employees who are not represented by a union or who are covered by a bargaining agreement that is not subject to financial feasibility determination. Funding is sufficient to support changes in shift differential, call back and standby pay, as well as a 5 percent increase for employees working in King County.
Non-Rep Targeted Pay Increases
Funding is provided for classified state employees who are not represented by a union for pay increases in specific job classes in alignment with other employees.
SEIU 1199 General Government
Funding is provided for a collective bargaining agreement with the Service Employees’ International Union Local 1199 NW. The agreement includes a general wage increase of 3 percent, effective July 1, 2019; a general wage increase of 3 percent, effective July 1, 2020; premium pay changes; and increases in targeted job classifications. Employee insurance included in the agreement is displayed in a separate item.
Orca Transit Pass - Outside CBAs
This funds transit passes (ORCA cards) for state employees (outside of higher education) in King, Pierce, and Snohomish counties, other than those in certain collective bargaining agreements.
PERS & TRS Plan 1 Benefit Increase
For eligible Public Employees' and Teachers' Retirement Systems Plan 1 members, this item provides a one-time, ongoing increase of 3 percent, up to a maximum of $62.50 per month.
Non-Rep Salary Schedule Revision
This funds a revised salary schedule for non-represented employees in information technology jobs, in alignment with other state employees.
State Tax - Wellness Gift Card
Some employees are eligible to earn a $25 gift card after completing a health risk assessment. This item provides funding to agencies to pay the employer's share of Social Security and Medicare taxes on gift cards for additional employees who are eligible for the gift cards.
Orca Transit Pass Funding Transfer
This moves funding for employee transit passes from agencies to WSDOT, which administers the program. The transfer includes both funding added in 2019-21 for expanded access, as well as funding that was provided in the 2017-19 budget.
Health Coalition FSA Fund Transfer
This moves funding for negotiated medical flexible spending arrangements (FSA) from individual agency budgets. It will be provided to the Health Care Authority, which will administer the benefit.
