Washington Senior Referral Agencies Frequently Asked Questions

What Is the Referral Agency Act?
Senior placement or referral agencies in the State of Washington are subject to the requirements of the Elder and Vulnerable Adult Referral Agency Act of 2011 (the “Referral Agency Act”), chapter 18.330 of the Revised Code of Washington. Under that law, referral agencies are required to meet minimum standards of conduct to protect vulnerable adults and to promote better integration of care.¹ Failure to comply with the Referral Agency Act is a consumer protection violation.²

What Agencies Must Comply With the Referral Agency Act?
Any person or business operating a referral agency in Washington is required to comply with the Referral Agency Act.³ The Act applies to anyone who receives a fee of any kind for placing or referring vulnerable adults to care providers in Washington.⁴ Referrals include providing the name of a provider to the client, or providing the name of a client to the provider.⁵

Covered providers include care services such as in-home care agencies, individual providers, private duty aides, private duty nursing, or home health; as well as supportive housing providers such as adult family homes, assisted living communities, nursing facilities, or continuing care retirement communities.⁶ Any person who requires care services or who receives services from a covered provider is a vulnerable adult protected by the Referral Agency Act.⁷

Covered fees may be money or any other thing of value received by the agency, whether directly or indirectly, and regardless of whether the fee is paid by the vulnerable adult client, his or her family, or the care provider receiving the referral.⁸ The law applies to both for-profit and non-profit organizations, except to those providing referrals on a purely voluntary basis and receiving nothing in return.⁹ The agency cannot charge a fee when providing a referral for a service that will be paid for, in part or in whole, by public assistance.¹⁰

Can Referral Agencies Provide Free Information To Vulnerable Adults?
Yes. A referral agency may provide people with general information such as the types of services available in an area without going through the intake and disclosure process. If a referral is made to a specific facility, or if the agency requests or is paid a fee for providing the information, the agency must follow the requirements of the Referral Agency Act.¹¹

What Information Is A Referral Agency Required To Know About Its Clients?
Referral agencies are required to use a standardized intake form to collect information from the client, client representative, or health care professional.¹² The form must contain the client’s medical history, medications, diagnoses, cognitive issues, sleeping habits, behaviors or symptoms requiring special care, assistance required with activities of daily living, activity preferences, language and cultural needs, financial situation, living situation, and preferences including preferred provider location.¹³ The agency must collect that information prior to making any referrals.¹⁴

What Information Is A Referral Agency Required To Know About Providers?
A referral agency must collect and maintain records on every provider to which it provides referrals. The information collected must include the provider’s license number, services provided, sources of payment accepted, languages spoken, activities available, behavioral needs that can or cannot be met, and other special care or services that may be available.¹⁵ The information must be updated annually.¹⁶ For supportive housing providers, the agency must also check the provider’s current survey enforcement status no more than 30 days prior to referring a client to that provider.¹⁷ Any provider enforcement history must be disclosed in writing to the client.¹⁸

What Disclosures Must Referral Agencies Provide To Its Clients?
Prior to making any referral, a referral agency must provide its client (the vulnerable adult or his/her representative or family member) with a written disclosure that includes a clear description of the services to be provided, a description of who is paying the agency’s fee, the amount of the fee or how it will be calculated, a statement of how frequently the agency tours provider facilities, a disclosure of any conflict of interest, and a description of the client’s legal rights.¹⁹

How Do Referral Agencies Handle Conflicts of Interest?
An agency’s conflicts of interest must be disclosed to clients. Referral agencies have a conflict of interest when they refer a client to a provider that shares an ownership interest with the agency, its personnel, or the personnel’s immediate family. When making such a referral, the agency must disclose the conflict of interest to the client and explain the nature of the ownership interest.²⁰ The agency must also provide the client with at least one alterative referral for which the agency has no conflict of interest.²¹

Can Referral Agencies Work Exclusively With A Particular Provider?
No. Referral agencies cannot create exclusive agreements with either providers or clients. Any agreement entered into between an agency and a provider must allow either party to cancel the agreement, and must specify how any pending fees or commissions will be paid upon cancellation of the contract.²²

What Kind of Insurance Must Referral Agencies Maintain?
Referral agencies must maintain a minimum of one million dollars in general and professional liability insurance coverage.²³

What Records Must A Referral Agency Keep?
Referral agencies must keep records of all referrals for six years.²⁴ The records must include information about the client, the services sought, where the client was referred, the likely duration of the placement, the cost of those services, the fee charged by the agency, all intake and disclosure forms, and any contract with the provider.²⁵ The records are subject to state law protections for health care information.²⁶

How Do Referral Agencies Handle Confidential Client Information?
A referral agency may handle a variety of confidential information about its clients. Clients must be notified that the client’s authorization is required for the agency to obtain or disclose confidential health care information about the client.²⁷ The disclosure of confidential health care information by a medical provider to a referral agency requires specific written authorization signed by the client or his or her authorized representative, and is subject to detailed requirements under federal and state law.²⁸ If the agency makes referrals by giving the client’s name to potential providers, the agency must be authorized to do so by the client or the client’s representative.²⁹

Are Senior Referral Professionals Subject To Background Checks?
Yes. All owners, operators, and employees of a referral agency must pass a background check every two years. A person is disqualified from providing referral services if he or she has certain criminal convictions, or any finding of abuse, neglect, financial exploitation, or abandonment of a child or vulnerable adult.³⁰

Are Placement Agency Employees Mandated Reporters?
Yes. All owners, operators, and employees of referral agencies are required to report suspected abuse, neglect, or exploitation to DSHS Adult Protective Services.³¹