Continuing care oversight

AN ACT Relating to adopting the department of social and health 1
services report recommendations addressing a regulatory oversight 2
plan for continuing care retirement communities; amending RCW 3
18.390.010, 18.390.030, 18.390.040, and 18.390.080; adding a new 4
chapter to Title 18 RCW; creating a new section; and providing 5
expiration dates. 6
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:7
Sec. 1. RCW 18.390.010 and 2016 c 183 s 1 are each amended to 8
read as follows: 9
The definitions in this section apply throughout this chapter 10
unless the context clearly requires otherwise. 11
(1) "Additional fee" means an amount that a continuing care 12
retirement community may require a contractual resident or member to 13
pay in accordance with a residency agreement for services made 14
available but not covered by the entrance fee, application fee, or 15
rental or lease payments. This includes, but is not limited to, 16
additional meals, use of a carport or similar infrastructure, and 17
health care services not covered by the entrance fee or residency 18
agreement.19
H-1198.1
HOUSE BILL 1889
State of Washington 69th Legislature 2025 Regular Session
By Representatives Macri, Callan, Parshley, Goodman, Fitzgibbon, and
Pollet
Read first time 02/07/25. Referred to Committee on Health Care &
Wellness.
p. 1 HB 1889
(2) "Application fee" means a fee charged to an individual or 1
individuals prior to the execution of a residency agreement, apart 2
from an entrance fee. 3
(((2))) (3) "Care" means nursing, medical, or other health-4
related services, protection or supervision, assistance with 5
activities of daily living, or any combination of those services.6
(((3))) (4) "Continuing care" means directly providing or 7
indirectly making available, upon payment of an entrance fee and 8
under a residency agreement, housing and care for a period of greater 9
than one year. 10
(((4))) (5) "Continuing care retirement community" means an 11
entity that ((agrees to provide continuing )) provides care to a 12
resident throughout their life and as their care needs change under a 13
residency agreement. "Continuing care retirement community" does not 14
include an assisted living facility licensed under chapter 18.20 RCW 15
that does not directly, or through a contractual arrangement with a 16
separately owned and incorporated skilled nursing facility, offer or 17
provide services under chapter 74.42 RCW. 18
(((5))) (6) "Department" means the department of social and 19
health services. 20
(((6))) (7) "Entrance fee" means an initial or deferred transfer 21
to a continuing care retirement community of a sum of money or other 22
property made or promised to be made as full or partial consideration 23
for acceptance of one or more residents in a continuing care 24
retirement community. "Entrance fee" does not include deposits of ten 25
thousand dollars or less or any amount that is based on rental or 26
lease payments of one month or more. 27
(((7))) (8) "Noncontractual resident" means a person who lives in 28
a continuing care retirement community without a residency agreement 29
that outlines health care services covered by their entrance fee. 30
"Noncontractual residents" typically pay for all health care services 31
received on a fee-for-service basis.32
(9) "Prospective resident" means a person who has completed an 33
application for admission to a continuing care retirement community 34
and makes a refundable deposit to reserve a unit, excluding 35
applicable administrative fees. 36
(((8))) (10) "Residency agreement" means a contract between a 37
continuing care retirement community and a resident for the provision 38
of ((continuing care )) ongoing health care and assistance with 39
activities of daily living as the resident requires them for a period 40
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of greater than one year. A "residency agreement" must include 1
language that guarantees certain health and long-term care services 2
to the resident based on the entrance fee or fee-for-service of the 3
resident. "Residency agreements" must also include language outlining 4
when a portion of the entrance fee will be returned to the resident 5
based on termination or unavailability of contracted services.6
(((9))) (11) "Resident" means a person who enters into a 7
residency agreement with a continuing care retirement community or 8
who is designated in a residency agreement to be a person being 9
provided with continuing care. 10
Sec. 2. RCW 18.390.030 and 2016 c 183 s 3 are each amended to 11
read as follows: 12
(1) ((An)) Beginning July 1, 2027, an applicant for a 13
registration as a continuing care retirement community must submit 14
the following materials to the department: 15
(a) A written application to the department providing all 16
necessary information on a form provided by the department;17
(b) ((Information about the licensed )) Proof of licensure for the 18
assisted living facility and proof of licensure and certification for 19
the nursing facility component of the continuing care retirement 20
community ((and, if the continuing care retirement community operates 21
a nursing home, information about that component )) when a continuing 22
care retirement community operates an assisted living facility, a 23
skilled nursing facility, or both, as part of their services to 24
residents; 25
(c) Copies of any residency agreements that the continuing care 26
retirement community intends to use for the certification period;27
(d) A copy of the disclosure statement that includes current 28
information required by RCW 18.390.060; 29
(e)(((i) Except as provided in (e)(ii) of this subsection, copies 30
of audited financial statements for the two most recent fiscal years. 31
The audited financial statement for the most current period may not 32
have been prepared more than eighteen months prior to the date that 33
the continuing care retirement community applied for its current 34
registration;35
(ii) If the continuing care retirement community:36
(A) Has obtained financing, but has been in operation less than 37
two years, a copy of the audited financial statement for the most 38
current period, if available, and an independent accountant's report 39
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opinion letter that has evaluated the financial feasibility of the 1
continuing care retirement community; or 2
(B) Has not obtained financing, a summary of the actuarial 3
analysis for the new continuing care retirement community stating 4
that the continuing care retirement community is in satisfactory 5
actuarial balance)) Audited financial statements that, at a minimum, 6
detail:7
(i) The financial resources of the continuing care retirement 8
community that is available to care for current residents;9
(ii) An adequate expected fee structure to support new residents 10
and prospective residents; and11
(iii) Positive projected cash and investment balances over 10 12
years including revenue and expenses from all known sources, 13
including any fees of residents and noncontractual residents;14
(f) An attestation by a management representative of the 15
continuing care retirement community that the continuing care 16
retirement community is in compliance with the disclosure 17
notification requirements of RCW 18.390.060; ((and))18
(g) Payment of any registration fees associated with the 19
department's cost of registering continuing care retirement 20
communities; and21
(h) An implementation plan that outlines, at a minimum:22
(i) How the continuing care retirement community residents and 23
noncontractual residents will be notified of decisions made by the 24
continuing care retirement community that may impact the solvency of 25
the continuing care retirement community;26
(ii) How the continuing care retirement community will involve 27
residents in day-to-day business operations of the continuing care 28
retirement community; and29
(iii) How the continuing care retirement community will ensure 30
resident and noncontractual resident participation on the continuing 31
care retirement community board of directors. 32
(2) The department shall contract with an organization with the 33
expertise to provide actuarial analysis of continuing care retirement 34
communities based on the documents described in subsection (1)(e) of 35
this section and the actuarial standards board most current standards 36
of practice.37
(3) The department shall base its decision to issue a 38
registration on ((the completeness of the application. If an 39
application is incomplete, the department shall inform the applicant 40
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and give the applicant an opportunity to supplement its submission. 1
An applicant may appeal a decision of the department to deny an 2
application for registration)):3
(a) An evaluation of the comprehensive actuarial study that 4
determines a reasonable expectation that the continuing care 5
retirement community will be able to provide contracted services over 6
a 10-year period;7
(b) Verification that any licensed portions of the continuing 8
care retirement community are in good standing with relevant 9
regulating entities; and10
(c) Verification that the residency agreements, disclosure 11
statements, and the implementation plan meet the requirements of this 12
chapter. 13
(((3))) (4) The department shall issue the registration or denial 14
within ((sixty)) 60 days of the receipt of a complete application ((, 15
payment of fees, submission of disclosures, residency agreements, and 16
the attestation. The department's failure to timely issue a 17
registration may not cause a delay in the change of ownership and 18
ongoing operation of the continuing care retirement community)).19
(a) Nothing in this section shall be construed as preventing the 20
department from asking for additional documentation from the 21
continuing care retirement community as needed or by request of the 22
contractor to support actuarial analysis or department review.23
(b) In the event the department issues a denial of registration, 24
the continuing care retirement community will have the right to an 25
administrative appeal. If the continuing care retirement community 26
had a valid registration from the department at the time of 27
application, the continuing care retirement community may continue to 28
operate until a decision on the appeal is issued, but the continuing 29
care retirement community may not enter into any new residency 30
agreements with residents until the appeal overturns the department 31
decision. 32
(((4))) (5) Registration is valid for two years.33
(((5))) (6) Registration is not transferable. 34
(((6))) (7) Materials submitted pursuant to this section are not 35
subject to disclosure under the public records act, chapter 42.56 36
RCW. 37
Sec. 3. RCW 18.390.040 and 2016 c 183 s 4 are each amended to 38
read as follows: 39
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(1) The department shall: 1
(a) Register an entity that submits a complete application that 2
includes all of the materials required and meets the standards 3
outlined in RCW 18.390.030; 4
(b) ((Review the disclosure statements submitted by applicants 5
for an initial or renewal registration to operate a continuing care 6
retirement community for completeness;7
(c))) Establish and collect a fee that is sufficient to cover the 8
department's costs associated with administering the requirements of 9
this chapter; and 10
(((d))) (c) Create and maintain an online listing that is readily 11
available to the public of the names and addresses of continuing care 12
retirement communities that are registered with the department.13
(2) The ((department's registration activities consist of 14
reviewing an application for completeness and do not signify that the 15
department has otherwise issued a certification or license to the 16
continuing care retirement community or any of its component parts. )) 17
department shall adopt rules to implement this chapter.18
NEW SECTION. Sec. 4. (1) For continuing care retirement 19
communities operating under a valid registration issued prior to July 20
1, 2025, the registration shall be considered valid by the department 21
of social and health services until September 30, 2027, if the 22
continuing care retirement community applies for a new registration 23
as outlined in RCW 18.390.030 by July 1, 2027.24
(2) The department of social and health services shall not accept 25
applications or issue registrations for new continuing care 26
retirement communities before July 1, 2027. 27
(3) This section expires December 31, 2027. 28
Sec. 5. RCW 18.390.080 and 2016 c 183 s 8 are each amended to 29
read as follows: 30
(1) The legislature finds that the ((violation of the title 31
protection requirements of RCW 18.390.050, the failure of a 32
continuing care retirement community to register with the department 33
under RCW 18.390.020, the failure of a continuing care retirement 34
community to comply with the disclosure statement delivery and 35
content requirements under RCW 18.390.060, and the failure of a 36
continuing care retirement community to comply with the resident 37
expectations established under RCW 18.390.070 are matters vitally 38
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affecting the public interest for the purpose of applying the 1
consumer protection act, chapter 19.86 RCW. A violation of the title 2
protection requirements under RCW 18.390.050, registration 3
requirement under RCW 18.390.020, the disclosure statement delivery 4
and content requirements under RCW 18.390.060, and the resident 5
expectations requirements under RCW 18.390.070 are not reasonable in 6
relation to the development and preservation of business and are an 7
unfair or deceptive act in trade or commerce and an unfair method of 8
competition for the purpose of applying the consumer protection act, 9
chapter 19.86 RCW. 10
(2) The attorney general shall provide notice to the management 11
of the continuing care retirement community of submitted complaints 12
including the name of the complainant to allow the community to take 13
corrective action. Except for violations of the title protection 14
requirements of RCW 18.390.050 and the failure of a continuing care 15
retirement community to register with the department under RCW 16
18.390.020, the attorney general shall limit its application of the 17
consumer protection act in subsection (1) of this section to those 18
cases in which a pattern of complaints, submitted by affected 19
parties, or other activity that, when considered together, 20
demonstrate a pattern of similar conduct that, without enforcement, 21
likely establishes an unfair or deceptive act in trade or commerce 22
and an unfair method of competition. )) practices covered by this 23
chapter are matters vitally affecting the public interest for the 24
purpose of applying the consumer protection act, chapter 19.86 RCW. A 25
violation of this chapter is not reasonable in relation to the 26
development and preservation of business and is an unfair or 27
deceptive act in trade or commerce and an unfair method of 28
competition for the purpose of applying the consumer protection act, 29
chapter 19.86 RCW.30
(2) This chapter may be enforced by the attorney general under 31
the consumer protection act, chapter 19.86 RCW.32
NEW SECTION. Sec. 6. There is created the office of the state 33
senior independent living ombuds. The department of commerce shall 34
contract with a private nonprofit organization to provide senior 35
independent living ombuds services to residents in the independent 36
living units of continuing care retirement communities as specified 37
by the state and according to the needs of continuing care retirement 38
community independent living residents. The department of commerce 39
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shall ensure that all program and staff support necessary to enable 1
the ombuds to effectively protect the interest of the continuing care 2
retirement community independent living residents and their families 3
is provided by the nonprofit organization that contracts to provide 4
senior independent living ombuds services. The senior independent 5
living ombuds shall have the following powers and duties:6
(1) To provide services for coordinating the activities of senior 7
independent living ombuds throughout the state; 8
(2) Carry out such other activities as the department of commerce 9
deems appropriate; 10
(3) Establish procedures for coordinating with the office of the 11
state long-term care ombuds and the office of the developmental 12
disabilities ombuds, where relevant to ensure the needs of mutual 13
clients or shared communities are met; 14
(4) Establish a statewide uniform reporting system to collect, 15
track, and analyze data relating to complaints and conditions in 16
senior independent living of continuing care retirement communities 17
for the purpose of identifying and resolving significant problems, 18
with provision for submission of such data to the department of 19
commerce and the legislature, on at least an annual basis;20
(5) Develop and offer educational information, resources, and 21
tools for self-advocacy by independent living residents of continuing 22
care retirement communities; and 23
(6) Establish procedures to ensure that any files maintained by 24
ombuds programs shall be disclosed only at the discretion of the 25
ombuds having authority over the disposition of such files, except 26
that the identity of any complainant or resident of a continuing care 27
retirement community shall not be disclosed by such ombuds unless:28
(a) Such complainant or resident, or the complainant's or 29
resident's legal representative, consents in writing to such 30
disclosure; or 31
(b) Such disclosure is required by court order.32
NEW SECTION. Sec. 7. (1) Any senior independent living ombuds 33
authorized by this chapter or a local governmental authority shall 34
have training, experience, or both, in the following areas:35
(a) Gerontology or other related social services programs;36
(b) The legal system; and 37
(c) Dispute or problem resolution techniques, including 38
investigation, mediation, and negotiation. 39
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(2) A senior independent living ombuds may not have been employed 1
by or participated in the management of any senior independent 2
housing or continuing care retirement community within the past year.3
(3) No senior independent living ombuds or any immediate family 4
member of the ombuds shall have, or have had within the past year, 5
any significant ownership or investment interest in one or more 6
continuing care retirement community units. 7
(4) A senior independent living ombuds shall not be assigned to a 8
continuing care retirement community in which an immediate family 9
member of that ombuds resides. 10
NEW SECTION. Sec. 8. Every continuing care retirement community 11
provider shall post in a conspicuous location in every building 12
containing any senior independent living unit a notice of the name, 13
address, and phone number of the office of the appropriate senior 14
independent living ombuds and a brief description of the services 15
provided by the office. The form of the notice shall be approved by 16
the office of the state senior independent living ombuds.17
NEW SECTION. Sec. 9. A senior independent living ombuds shall:18
(1) Identify, investigate, and resolve complaints made by or on 19
behalf of senior independent living residents in a continuing care 20
retirement community relating to administrative action, inaction, or 21
decisions which may adversely affect the health, safety, welfare, and 22
rights of these individuals; 23
(2) Monitor the development and implementation of federal, state, 24
and local laws, rules, regulations, and policies with respect to 25
senior independent living in continuing care retirement communities 26
in this state; 27
(3) Provide information as appropriate to residents, resident 28
representatives, and others regarding the rights of residents, and to 29
public agencies regarding the problems of individuals residing in 30
senior independent living units in a continuing care retirement 31
community; and 32
(4)(a) Provide for training volunteers and promoting the 33
development of citizen organizations to participate in the ombuds 34
program. 35
(b) A trained volunteer senior independent living ombuds, in 36
accordance with the policies and procedures established by the state 37
senior independent living ombuds program, shall inform residents, 38
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their representatives, and others about the rights of residents, and 1
may identify, investigate, and resolve complaints made by or on 2
behalf of residents relating to action, inaction, or decisions, that 3
may adversely affect the health, safety, welfare, and rights of these 4
individuals. 5
NEW SECTION. Sec. 10. The office of the state senior 6
independent living ombuds shall develop referral procedures for all 7
senior independent living ombuds programs to refer any complaint to 8
any appropriate federal, state, or local government agency.9
NEW SECTION. Sec. 11. (1) The office of the state senior 10
independent living ombuds shall develop procedures governing the 11
right of entry of all senior independent living ombuds to continuing 12
care retirement community buildings containing any senior independent 13
living units and shall have access to residents with provisions made 14
for privacy for the purpose of hearing, investigating, and resolving 15
complaints of, and rendering advice to, residents at any time deemed 16
necessary and reasonable by the state ombuds to effectively carry out 17
the provisions of this chapter.18
(2) Nothing in this chapter restricts, limits, or increases any 19
existing right of any organizations or individuals not described in 20
subsection (1) of this section to enter or provide assistance to 21
senior independent living residents in a continuing care retirement 22
community. 23
(3) Nothing in this chapter restricts any right or privilege of 24
any senior independent living resident in a continuing care 25
retirement community to receive visitors of their choice.26
NEW SECTION. Sec. 12. (1) No senior independent living ombuds 27
is liable for good faith performance of responsibilities under this 28
chapter.29
(2) No discriminatory, disciplinary, or retaliatory action may be 30
taken against any continuing care retirement community employee, 31
resident, or volunteer, for any communication made, or information 32
given or disclosed, to aid a senior independent living ombuds in 33
carrying out its duties and responsibilities, unless the same was 34
done maliciously or without good faith. This subsection is not 35
intended to infringe on the rights of the employer to supervise, 36
discipline, or terminate an employee for other reasons.37
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(3) All communications by a senior independent living ombuds, if 1
reasonably related to the requirements of the responsibilities of 2
that individual under this chapter and done in good faith, are 3
privileged and that privilege shall serve as a defense to any action 4
in libel or slander. 5
(4) A representative of the state office of the senior 6
independent living ombuds is exempt from being required to testify in 7
court as to any confidential matters except as the court may deem 8
necessary to enforce this chapter. 9
NEW SECTION. Sec. 13. All records and files of a senior 10
independent living ombuds relating to any complaint or investigation 11
made pursuant to carrying out the duties of the ombuds and the 12
identities of complainants, witnesses, or residents shall remain 13
confidential unless disclosure is authorized by the resident or the 14
guardian or legal representative of the resident. No disclosures may 15
be made outside the office of the state senior independent living 16
ombuds without the consent of any named witnesses, resident, or 17
complainant unless the disclosure is made without the identity of any 18
of these individuals being disclosed.19
NEW SECTION. Sec. 14. (1) The senior independent living ombuds 20
shall convene a work group to study the data needs related to the 21
oversight of continuing care retirement communities with respect to 22
their independent living residents and to analyze the resulting data. 23
The purpose of the work group shall be to enhance the understanding 24
about continuing care retirement communities including:25
(a) Addressing the lack of a single source of information related 26
to continuing care retirement community resident complaints which is 27
needed to track what issues may exist and what is the volume and 28
frequency of those issues; 29
(b) Identifying how the experience of the independent living 30
residents in continuing care retirement communities in Washington 31
state compare to the continuing care retirement community residents 32
in other states; and 33
(c) Evaluating and developing a reliable set of data in order to 34
inform oversight decisions. 35
(2) The work group shall: 36
(a) Define what type of data should be collected and is needed 37
for regulatory monitoring and oversight, which may include but is not 38
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limited to performing research and conducting gap analysis between 1
current and future states; 2
(b) Define data output requirements such as the occurrence and 3
frequency with which the data may be published; 4
(c) Define report requirements such as data reporting standards 5
and governance; 6
(d) Identify demographic data on continuing care retirement 7
community residents, specifically those residents residing in the 8
independent living sections; and 9
(e) Identify trends of experiences from continuing care 10
retirement community residents, specifically those residents residing 11
in the independent living section. 12
(3) The senior independent living ombuds may collaborate with the 13
department of social and health services to request that the 14
applicants for an initial or renewal registration as a continuing 15
care retirement community provide additional data as part of the 16
registration process to ensure the work group has adequate 17
information to complete the duties of the work group.18
(4) The senior independent living ombuds shall consult with the 19
office of the attorney general as needed to understand the complaint 20
data from the consumer resource center. 21
(5) By October 1, 2028, the senior independent living ombuds 22
shall submit a report to the appropriate committees of the 23
legislature outlining the findings and recommendations of the work 24
group. 25
(6) This section expires January 1, 2030. 26
NEW SECTION. Sec. 15. The department of commerce shall adopt 27
rules necessary to carry out this chapter.28
NEW SECTION. Sec. 16. Sections 6 through 15 of this act 29
constitute a new chapter in Title 18 RCW.30
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