SENATE FLOOR AMENDMENT


FLOOR AMENDMENT NO. 15                   DATE: March 9, 1999     

TO:  S.B. No. 131, S.D. 2



     Senate Bill No. 131, S.D. 2, is amended as follows:

     1.  By amending page 1, lines 11-16 to read:

     "The purpose of this part and parts II, III, and IV of this
Act are to increase the number of long-term care insurance
policies in effect in Hawaii and to conform Hawaii's long-term
care insurance statutes to the Model Long Term Care Act of 1998.
     This part and parts II, III, and IV of this Act also enact
the Long-Term Care Insurance Model Act of 1998, of the National
Association of Insurance Commissioners."

     2.  By amending page 58 , lines 9-11 to read:

     "(i)  The provisions of this section shall apply to any
long-term care policy issued or delivered in this State after the
effective date of this part and parts I, III, and IV of this
Act."

     3.  By amending page 79, lines 18-21 to read:

     "SECTION 7.  The insurance commissioner shall request the
Internal Revenue Service for a ruling on whether this part and
parts I, II, and IV of this Act conform to the Health Insurance
Portability and Accountability Act of 1996, P.L. No. 104-191, as
amended."

     4.  By redesignating part VII as part IV.

     5.  By amending page 80, lines 12-17 to read:

     "SECTION 11.  If the provisions of this part or parts I, II,
and III of this Act, or the application thereof to any person or
circumstance is held invalid, the invalidity does not affect
other provisions or applications of these parts which can be
given effect without the invalid provision or application, and to
this end the provisions of these parts are severable."

     6.  By adding a new part V consisting of Sections 12, 13,
and 14 to read as follows:

                             "PART V
     SECTION 12.  The legislature finds that the long term care
ombudsman program is a federally mandated program which is funded
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through the Older Americans Act of 1965.  The program is charged
with the responsibility of serving as an advocate for 6,780
residents living in 46 licensed nursing facilities and 542 adult
residential care homes; especially those who may be unable or
afraid to speak for themselves.  Situated within the executive
office on aging, this statewide program requires the ombudsman to
visit all facilities.  The program is currently staffed by two
full-time program specialists.
     The program's primary function is to respond, investigate
and assist in resolving complaints and requests for information
or assistance.  Outreach to residents in these facilities and
homes is an essential component of the program since the
residents served are usually frail and dependent with physical,
mental, or emotional needs.  Often, their dependency on others
for care presents the potential for reluctance in speaking out
when they are the recipients of inappropriate care.  Outreach to
these residents is particularly crucial in order to assure them
that they do have external supports should they need them.
     It was recently pointed out at the Governor's Conference on
Adult Residential Care Homes that the long term care options in
Hawaii are expanding.  There is an increase in assisted living
and expanded care facilities.  While there is much supervision
and family involvement in nursing homes, in a care home the only
supervision is from the care home operator.  Current regulations
require the department of health to notify the care home operator
one month in advance before surveying the home for renewal of its
license.  Presently the long term care ombudsman is the only one
allowed to enter a care home without an appointment. 
     Some of these homes are now receiving special waivers to
accept residents at a higher acuity level who are also less
likely to be able to speak for themselves.  In order to assure
proper services for these elderly residents, the long term care
ombudsman program's jurisdiction will increase.
     As the State's elderly population continues to grow, the two
full-time staff members of the program will be unable to provide
the necessary outreach services.  Forty-six states have developed
a successful volunteer component to their long term care
ombudsman programs.  The American Association of Retired Persons
has developed a training manual specifically for the long term
care ombudsman program which many states have used as a starting
point.  According to the Legal Counsel for the Elderly's 1995
Report, "the presence and work of the volunteers make a major
contribution towards the enhancement of the quality of life for
residents of long term care facilities."
     The purpose of this part is to appropriate funds to
establish a long term care volunteer ombudsman program to ensure
that quality outreach services are provided to the increasing
number of elderly people residing in long term care facilities in
the State.
     SECTION 13.  There is appropriated out of the general
revenues of the State of Hawaii the sum of $90,721, or so much
thereof as may be necessary for fiscal year 1999-2000, to
establish a long term care volunteer ombudsman program, to
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include but not be limited to a volunteer coordinator, clerk
steno, ground and air travel, training, and miscellaneous
volunteer reimbursements.
     SECTION 14.  The sum appropriated shall be expended by the
department of health for the purposes of this part."

     7.  By adding a new part VI consisting of Sections 15, 16,
and 17 to read as follows:

                            "PART VI
     SECTION 15.  The legislature finds that long-term care is a
critical issue of particular importance to Hawaii, where there is
a shortage of nursing home beds, and where home and
community-based programs are fragmented and non-existent in some
areas.  To address these growing concerns, the State needs to
examine alternative ways to administer long-term care, which will
minimize the need for new long-term care beds and control
ever-increasing costs, while providing a more favorable
environment for Hawaii's elderly.
     The legislature further finds that one viable option is the
non-institutional means of providing long-term care.
Establishing such a long-term care demonstration project will
offer Medicaid recipients the opportunity for home and
community-based services, and address the need to decrease the
burden on the State, hospitals, nursing facilities, and the
elderly and their families.
     The legislature believes that the State's MedQuest program
has demonstrated that savings can be accomplished in an acute
care Medicaid program by using managed care companies to deliver
high quality care.  A comparable model for long-term care would
be based on an integration of home and community-based services
and long-term nursing facility care and acute care systems,
respect for the dignity of the elderly, integration of financing
and delivery of services, consumer involvement in planning and
monitoring, and improvements in the quality of care.
     The 1998 legislature appropriated $40,000 to begin the
development of a managed long-term care demonstration project,
with matching funds of $40,000 to be provided by the federal
government.  Much remains to be done on this vital project.
     The purpose of this part is to continue the design and
implementation of a managed long-term care demonstration project.
     SECTION 16.  There is appropriated out of the general
revenues of the State of Hawaii the sum of $        , or so much
thereof as may be necessary for fiscal year 1999-2000, to
establish a long-term care managed care waiver; provided that the
funds shall be used to:
     (1)  Review and update current information gathered to date
          on state Medicaid managed care programs for the
          provision of long-term care services; and
     (2)  Develop a planning document for the design and
          implementation of a Medicaid managed long-term care
          demonstration project, to include:
          (A)  Identification of preliminary resource needs;
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          (B)  Development of a workplan for the design and
               implementation of a Medicaid managed long-term
               care demonstration project; and
          (C)  Development of a list of changes to current
               infrastructure that may be necessary to
               accommodate a Medicaid managed long-term care
               demonstration project.
     SECTION 17.  The sum appropriated shall be expended by the
department of human services for the purposes of this part."

     8.  By redesignating sections 12 and 13 as sections 18 and
19, respectively, and by designating these sections as part VII.

     9.  By amending new section 19 to read:

     "SECTION 19.  This Act shall take effect on July 1, 1999."


Offered by:_____________________       (    ) Carried

                                       (    ) Failed to Carry

                                       (    ) Withdrawn