REPORT TITLE:
Long-Term Residential Care


DESCRIPTION:
Establishes an information and referral process; makes
appropriation to the Executive Office on Aging to implement
statewide initial information and referral screening; requires
use of uniform assessment tool.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
THE SENATE                              S.B. NO.           2490
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO LONG-TERM RESIDENTIAL CARE.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  The legislature finds that Hawaii's citizens are
 
 2 faced with an overwhelming financial burden of caring for their
 
 3 elderly and disabled residents whose needs will continue to grow
 
 4 as the population ages.  The cost of nursing home care is
 
 5 currently the highest of all types of long-term care and is
 
 6 continuing to escalate.  Consequently, long-term residential care
 
 7 has become a realistic and cost-effective alternative.
 
 8      Unfortunately, the organization and regulation of long-term
 
 9 residential care facilities in Hawaii are fragmented.  This tends
 
10 to reduce cost-effectiveness and hampers the operational
 
11 effectiveness of residential care services.  The lack of overall
 
12 direction and guidance at the state level is reflected in the
 
13 fragmented structure of state regulation for a plethora of
 
14 residential care category types in both the Hawaii Revised
 
15 Statutes and the Hawaii administrative rules.
 
16      The legislature further finds that there is a lack of
 
17 uniformity in the collection of patient data common across care
 
18 facility types that makes it difficult or impossible for long-
 
19 term care agencies and providers to share that data when
 

 
Page 2                                                     
                                     S.B. NO.           2490
                                                        
                                                        

 
 1 necessary, to work for the benefit of the patient.  This lack of
 
 2 uniformity also imposes unnecessary and wasteful redundancy of
 
 3 effort on both patients and providers.
 
 4      The legislature further finds that there is no one, simple,
 
 5 uniform way for a person who needs long-term care to easily and
 
 6 quickly access the appropriate care.  An information and referral
 
 7 system would provide a simple and uniform, yet sophisticated and
 
 8 comprehensive way to allow people easy access into the long-term
 
 9 residential care system.
 
10      Act 339, Session Laws of Hawaii 1997, created a two-year
 
11 joint legislative committee on long-term care financing.
 
12 Subsequently, House Concurrent Resolution No. 225, H.D. 1,
 
13 S.D. 1, 1998, required the joint committee to create a
 
14 subcommittee to study long-term residential care facilities.
 
15      The recommendations of the subcommittee included:
 
16      (1)  Improving the regulatory environment to reduce
 
17           fragmentation in the adult long-term residential care
 
18           industry by consolidating and simplifying
 
19           organizational categories of facilities, increasing
 
20           uniformity of regulation across facility types, and
 
21           promoting parity of provider reimbursement for similar
 
22           services provided regardless of facility type;
 
23      (2)  The use of a uniform assessment tool across facility
 

 
Page 3                                                     
                                     S.B. NO.           2490
                                                        
                                                        

 
 1           types; and
 
 2      (3)  The implementation of an information and referral
 
 3           process for all adult long-term residential care
 
 4           facilities in the State, which is being addressed by
 
 5           the department of health by administrative rule.
 
 6      SECTION 2.  Chapter 321, Hawaii Revised Statutes, is amended
 
 7 by adding five new sections to be appropriately designated and to
 
 8 read as follows:
 
 9      "§321-A  Social model.  The department of health shall
 
10 develop and adopt a social model of health care with respect to
 
11 the operation of adult residential care facilities under this
 
12 part to:
 
13      (1)  Ensure the health, safety, welfare, and civil rights of
 
14           individuals placed in all adult residential care
 
15           facilities regulated under this part;
 
16      (2)  Protect a person's right to choose an appropriate
 
17           setting;
 
18      (3)  Respect the facility provider's right to not accept a
 
19           potential resident based on the provider's good faith
 
20           belief that the provider is not qualified to provide
 
21           the required adequate or appropriate care;
 
22      (4)  Comply with applicable federal laws and regulations;
 
23           and
 

 
Page 4                                                     
                                     S.B. NO.           2490
                                                        
                                                        

 
 1      (5)  Provide penalties for the failure to comply with any
 
 2           rule.
 
 3      §321-B  Inventory.  The department of health shall maintain
 
 4 a current inventory of vacancies in all licensed adult
 
 5 residential care facilities.  The inventory shall include
 
 6 information on the:
 
 7      (1)  Name, address, and phone number of the facility having
 
 8           the vacancy and the number of vacancies;
 
 9      (2)  Type of bed, patient, or level of care, as applicable,
 
10           of each vacancy;
 
11      (3)  Date on which each vacancy occurred or is expected to
 
12           occur; and
 
13      (4)  Any other information deemed relevant by the
 
14           department.
 
15 The department may rely upon phone calls or facsimile
 
16 transmittals with providers for taking an inventory.  The
 
17 inventory shall be updated monthly.
 
18      §321-C  Standard admission procedure; exception.  To the
 
19 extent practicable, the department of health shall establish a
 
20 standard admission procedure for all adult residential care
 
21 facilities; provided that, in the director's discretion, the
 
22 director may establish a separate admission procedure for the
 
23 facilities within a particular facility category; provided that
 

 
Page 5                                                     
                                     S.B. NO.           2490
                                                        
                                                        

 
 1 the categories shall be established by rule adopted by the
 
 2 department.  If a separate admission procedure is established,
 
 3 the procedure shall apply uniformly to all facility types within
 
 4 that particular facility category.  The standard admission
 
 5 procedure shall require the use of uniform data elements that
 
 6 include the appropriate medical and personal history of the
 
 7 patient as well as the level of care needed by the patient prior
 
 8 to the patient's referral and admission to any adult residential
 
 9 care facility.
 
10      §321-D  Uniform assessment tool.  (a)  To implement the
 
11 standard admission procedure under section 321-C, the department
 
12 of health shall employ, as a uniform assessment tool, a scaled-
 
13 down version of the medicaid waiver program's social and health
 
14 assessment forms for all residential care facilities other than
 
15 basic category adult residential care homes.  The purpose of the
 
16 uniform assessment tool is to help reduce system fragmentation,
 
17 increase system efficiency and effectiveness, enhance quality of
 
18 care, and make the system more consumer-friendly.
 
19      (b)  The department shall also employ the one-page form
 
20 currently being used by the department termed "Level of Care
 
21 Evaluation", as updated from time to time, for all basic category
 
22 adult residential care homes to assure the correct placement of
 
23 only non-nursing facility level residents.
 

 
Page 6                                                     
                                     S.B. NO.           2490
                                                        
                                                        

 
 1      (c)  The data elements in the uniform assessment tool in
 
 2 subsection (a) and the one-page tool in subsection (b) shall be
 
 3 standardized to reduce the need to obtain identical data
 
 4 subsequently, and to allow different providers to access and
 
 5 share standard information, as necessary.  The data elements
 
 6 shall be consistent with the two-page information and referral
 
 7 screening form, administered at the time of entry, termed the
 
 8 "Coordinated Screening Form", that is recommended for use in the
 
 9 long-term care information and referral process under section
 
10 321-E.
 
11      (d)  The:
 
12      (1)  Uniform assessment tool in subsection (a);
 
13      (2)  One-page tool in subsection (b); and
 
14      (3)  Two-page information and referral screening form in
 
15           subsection (c) and the long-term information and
 
16           referral process;
 
17 are meant to be flexible tools to be modified as required from
 
18 time to time without the need for further legislative amendment
 
19 to this part.  Nothing in sections 321-A to 321-E shall prevent
 
20 any agency or care provider regulated under this part from
 
21 obtaining any additional data, as necessary, to appropriately
 
22 assess a resident or potential resident or to plan for their
 
23 care.
 

 
Page 7                                                     
                                     S.B. NO.           2490
                                                        
                                                        

 
 1      §321-E  Long-term care information and referral.  Subject to
 
 2 legislative appropriations, the department of health shall
 
 3 establish an information and referral process that shall serve
 
 4 all potential clients of adult residential care facilities under
 
 5 this part, namely, the elderly, the non-elderly under age sixty,
 
 6 and disabled persons of all ages.  The information and referral
 
 7 process shall include a uniform initial information and referral
 
 8 screening using a tool to be developed by the executive office on
 
 9 aging."
 
10      SECTION 3.  Section 46-15.3, Hawaii Revised Statutes, is
 
11 amended to read as follows:
 
12      "[[]§46-15.3[]]  Regulation of adult [family boarding home
 
13 and care home.] residential care facilities.  (a)  For the
 
14 purpose of regulation under a county's life safety code, building
 
15 code, fire code, or any other ordinance of similar purpose, a
 
16 licensed adult [family boarding home or licensed care home which
 
17 provides living accommodations for:
 
18      (1)  The operator of the home and operator's family; and
 
19      (2)  Up to five other persons, not more than two of whom are
 
20           incapable of self-preservation because of age or
 
21           physical or mental limitations;]
 
22 residential care facility shall be deemed a single-family
 
23 dwelling occupied by a family.
 

 
Page 8                                                     
                                     S.B. NO.           2490
                                                        
                                                        

 
 1      (b)  For the purpose of this section:
 
 2      "Adult residential care facility" means those facilities
 
 3 specified under section 321-E(a).
 
 4      "Building code" means an ordinance the purpose of which is
 
 5 to provide minimum standards to safeguard life or limb, health,
 
 6 property, and public welfare by regulating and controlling the
 
 7 design, construction, quality of materials, use and occupancy,
 
 8 location, and maintenance of all buildings and structures within
 
 9 the county's jurisdiction and certain equipment specifically
 
10 regulated by the ordinance.
 
11      "Fire code" means an ordinance adopted under section 132-3
 
12 or an ordinance intended to prescribe regulations consistent with
 
13 recognized good practice for the safeguarding to a reasonable
 
14 degree of life and property from the hazards of fire and
 
15 explosion arising from the storage, handling, and use of
 
16 hazardous substances, materials, and devices and from conditions
 
17 hazardous to life or property in the use or occupancy of
 
18 buildings or premises.
 
19      ["Licensed adult family boarding home" means an adult family
 
20 boarding home licensed under chapter 346, part IV.
 
21      "Licensed care home" means a care home licensed under
 
22 section 321-15.6.]
 
23      "Life safety code" means an ordinance the purpose of which
 

 
Page 9                                                     
                                     S.B. NO.           2490
                                                        
                                                        

 
 1 is to establish minimum requirements that will provide a
 
 2 reasonable degree of safety from fire in buildings and
 
 3 structures."
 
 4      SECTION 4.  There is appropriated out of the general
 
 5 revenues of the State of Hawaii the sum of $          , or so
 
 6 much thereof as may be necessary for fiscal year 2000-2001, to be
 
 7 expended as follows:
 
 8      (1)  An augmentation of the executive office on aging's
 
 9           Aging Network to perform initial information and
 
10           referral screening for all persons aged sixty and
 
11           older;
 
12      (2)  The executive office on aging to expand its screening
 
13           and referral program to coordinate the establishment
 
14           and operation of similar services to be provided by
 
15           ASK-2000, or other information and referral providers
 
16           as appropriate, for clients under age sixty.  The
 
17           development of this expansion shall begin in July,
 
18           2001, and full operation shall begin in July, 2002;
 
19      (3)  A subcontract by the executive office on aging with
 
20           ASK-2000, or other information and referral providers
 
21           to provide similar supplementary initial information
 
22           and referral screening for all potential clients under
 
23           age sixty.  The development of this supplementary
 

 
Page 10                                                    
                                     S.B. NO.           2490
                                                        
                                                        

 
 1           service shall begin in July, 2001, and full operation
 
 2           shall begin in July, 2002; and
 
 3      (4)  One-time startup costs and annual operating costs.
 
 4      SECTION 5.  There is appropriated out of the general
 
 5 revenues of the State of Hawaii the sum of $          , or so
 
 6 much thereof as may be necessary for fiscal year 2000-2001, to
 
 7 implement the functions and responsibilities relating to section
 
 8 2 of this Act.
 
 9      SECTION 6.  The sums appropriated shall be expended by the
 
10 department of health.
 
11      SECTION 7.  If any provision of this Act, or the application
 
12 thereof to any person or circumstance is held invalid, the
 
13 invalidity does not affect other provisions or applications of
 
14 the Act which can be given effect without the invalid provision
 
15 or application, and to this end the provisions of this Act are
 
16 severable.
 
17      SECTION 8.  In codifying the new sections added by this Act,
 
18 the revisor of statutes shall substitute appropriate section
 
19 numbers for the letters used to designate the new sections in
 
20 this Act.
 
21      SECTION 9.  Until administrative rules are adopted for
 
22 purposes of this Act, existing administrative rules relating to
 
23 existing homes and facilities shall remain in effect.
 

 
Page 11                                                    
                                     S.B. NO.           2490
                                                        
                                                        

 
 1      SECTION 10.  Statutory material to be repealed is bracketed.
 
 2 New statutory material is underscored.
 
 3      SECTION 11.  This Act shall take effect upon its approval;
 
 4 provided that sections 4, 5, and 6 shall take effect on July 1,
 
 5 2000.
 
 6 
 
 7                           INTRODUCED BY:  _______________________