REPORT TITLE:
Long-Term Residential Care


DESCRIPTION:
Consolidates and provides for uniform regulation of various adult
residential care facilities and promotes parity of reimbursement
for services provided.  Establishes an information and referral
process through appropriations to the DOH to fund the executive
office on aging to implement a statewide initial information and
referral screening.  Requires use of a uniform assessment tool.
Effective 7/1/99.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
THE SENATE                              S.B. NO.           856
TWENTIETH LEGISLATURE, 1999                                
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
 

 
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 1 necessary, to work for the benefit of the patient.  This lack of
 
 2 uniformity also imposes an unnecessary and wasteful redundancy of
 
 3 effort on both patients and providers.
 
 4      Finally, the legislature 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, consisting of an information and referral system, can
 
 8 provide a simple and uniform, yet sophisticated and comprehensive
 
 9 way to allow people easy access into the the long-term
 
10 residential care system.
 
11      Act 339, Session Laws of Hawaii 1997, created a two-year
 
12 joint legislative committee on long-term care financing.
 
13 Subsequently, House Concurrent Resolution No. 225, H.D. 1,
 
14 S.D. 1, 1998, required the joint committee to create a
 
15 subcommittee to study long-term residential care facilities.  The
 
16 purpose of this Act is to implement the recommendations of the
 
17 subcommittee in the three areas discussed above regarding:
 
18      (1)  Improving the regulatory environment to reduce
 
19           fragmentation in the adult long-term residential care
 
20           industry by consolidating and simplifying
 
21           organizational categories of facilities, increasing
 
22           uniformity of regulation across facility types, and
 
23           promoting parity of provider reimbursement for similar
 

 
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 1           services provided regardless of facility type;
 
 2      (2)  The use of a uniform assessment tool across facility
 
 3           types; and
 
 4      (3)  The implementation of an information and referral
 
 5           process for all adult long-term residential care
 
 6           facilities in the State.
 
 7      SECTION 2.  Chapter 321, Hawaii Revised Statutes, is amended
 
 8 by adding a new part to be appropriately designated and to read
 
 9 as follows:
 
10           "PART    . ADULT RESIDENTIAL CARE FACILITIES
 
11      §321-A Findings.  The legislature finds that adult
 
12 residential care facilities serve a significant role in the long-
 
13 term care of Hawaii's residents.  Compared to institutional
 
14 nursing home care, these facilities provide a less restrictive
 
15 and a more home-like environment while providing care at a much
 
16 lower cost.  Therefore, it is in the best interest of the people
 
17 of the State to maximize the use of adult residential care
 
18 facilities.
 
19      The purpose of this Act is to implement as state policy, a
 
20 rational and equitable consolidation, streamlining, and
 
21 reorganization of the adult residential care facilities in the
 
22 State in order to allow their collective operation as a unified
 
23 system rather than as fragmented care units, and to provide for
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1 more uniform regulation in order to reduce inefficiency and
 
 2 ineffectiveness in the fragmentation of service delivery, and to
 
 3 enhance ease of access to the system.
 
 4      §321-B Definitions.  Whenever used in this part, unless the
 
 5 context requires otherwise:
 
 6      "Adult foster home for persons with developmental
 
 7 disabilities" means a private residential home providing care on
 
 8 a twenty-four-hour basis for adults with developmental
 
 9 disabilities.  To be certified, an adult foster home for adults
 
10 with developmental disabilities shall have not more than two
 
11 adults with developmental disabilities at the same time, who are
 
12 unrelated to the foster family.
 
13      "Adult residential care home" means any facility providing
 
14 twenty-four-hour living accommodations, for a fee, to adults
 
15 unrelated to the family, who require at least minimal assistance
 
16 in the activities of daily living, personal care services,
 
17 protection, and health care services, but who do not need the
 
18 professional health services provided in an intermediate, skilled
 
19 nursing, or acute care facility.  A "type I adult residential
 
20 care home" means a  group living facility consisting of five or
 
21 fewer unrelated persons.  A "type II adult residential care home"
 
22 means a group living facility consisting of six or more persons
 
23 including, but not limited to, the mentally ill, as defined in
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1 section 334-1; elders, as defined under sections 201G-1 and
 
 2 201G-151; the handicapped, meaning individuals with a physical
 
 3 disability as defined under section 515-2; the developmentally
 
 4 disabled, meaning persons with developmental disabilities as
 
 5 defined under section 333F-1; or totally disabled persons,
 
 6 meaning persons totally disabled as defined under section 235-1;
 
 7 who are not related to the home operator or facility staff.
 
 8      "Adult waiver foster family home" means a facility providing
 
 9 twenty-four-hour living accommodations, including personal care
 
10 and homemaker services, for one or two adults unrelated to the
 
11 family living in the home, and who have been admitted to the
 
12 residential alternatives community care medicaid waiver program.
 
13      "Developmental disabilities domiciliary home" means a
 
14 private residential home for not more than five individual adults
 
15 with developmental disabilities or mental retardation who are
 
16 unable to live independently and who require twenty-four-hour
 
17 supervision or care, but do not require licensed nursing care.
 
18 For the purposes of this definition, "developmental disabilities"
 
19 shall be as defined under section 333F-1; and "mental
 
20 retardation" shall be as defined under section 333F-1.
 
21      "Expanded adult foster home for persons with developmental
 
22 disabilities" means a private residential home providing care on
 
23 a twenty-four-hour basis for not more than two adults with
 

 
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 1 developmental disabilities who require nursing care for more than
 
 2 eight hours a day.
 
 3      "Expanded adult residential care home" means any facility
 
 4 providing twenty-four-hour living accommodations for a fee to
 
 5 adults unrelated to the operator or staff of the home, who
 
 6 require at least minimal assistance in the activities of daily
 
 7 living, personal care services, protection, and health care
 
 8 services, and who may need the professional health services
 
 9 provided in an intermediate or skilled nursing facility.  The
 
10 primary caregiver shall be qualified to provide care to nursing
 
11 facility level individuals who have been admitted to a medicaid
 
12 waiver program, or persons who pay for care from private funds
 
13 and have been certified as a nursing facility level resident.  A
 
14 "type I expanded adult residential care home" means a group
 
15 living facility consisting of five or fewer persons unrelated to
 
16 the operator or facility staff of the home, with no more than two
 
17 nursing facility level residents.  A "type II expanded adult
 
18 residential care home" means a group living facility consisting
 
19 of six or more persons unrelated to the operator or facility
 
20 staff, with no more than twenty per cent of the home's licensed
 
21 capacity who are nursing facility level residents; provided that
 
22 additional nursing facility level residents may be allowed at the
 
23 discretion of the department.
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1      "Expanded developmental disabilities domiciliary home" means
 
 2 a private residential home for not more than five individual
 
 3 adults with developmental disabilities or mental retardation who
 
 4 are unable to live independently and who require twenty-four-hour
 
 5 supervision or care that calls for provision of medical care for
 
 6 more than eight hours a day.
 
 7      §321-C Adult residential care facilities; two facility
 
 8 categories.  All adult residential care facilities in the State
 
 9 shall be placed in one of the following two facility categories
 
10 as follows:
 
11      (1)  Basic residential care category ("basic category"):
 
12           (A)  Adult residential care homes, type I and type II;
 
13           (B)  Developmental disabilities domiciliary homes; and
 
14           (C)  Adult foster homes for persons with developmental
 
15                disabilities; and
 
16      (2)  Expanded nursing facility level residential care
 
17           category ("expanded category"):
 
18           (A)  Expanded adult residential care homes, type I and
 
19                type II;
 
20           (B)  Developmental disabilities domiciliary homes;
 
21           (C)  Adult foster homes for persons with developmental
 
22                disabilities; and
 
23           (E)  Adult waiver foster homes for the elderly.
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1      §321-D  Social model.  The department shall develop and
 
 2 adopt a social model of health care with respect to the operation
 
 3 of adult residential care facilities under this part to:
 
 4      (1)  Ensure the health, safety, welfare, and civil rights of
 
 5           individuals placed in all adult residential care
 
 6           facilities regulated under this part;
 
 7      (2)  Protect a person's right to choose an appropriate
 
 8           setting;
 
 9      (3)  Respect the facility provider's right to not accept a
 
10           potential resident based on the provider's good faith
 
11           belief that the provider is not qualified to provide
 
12           the required adequate or appropriate care;
 
13      (4)  Comply with applicable federal laws and regulations;
 
14           and
 
15      (5)  Provide penalties for the failure to comply with any
 
16           rule.
 
17      §321-E Regulation by department; uniformity of application
 
18 of rules; exceptions; licensing; when; rules.  (a)  All adult
 
19 residential care facilities under this part shall be regulated
 
20 uniformly by the department of health.
 
21      (b)  The director shall adopt rules in accordance with
 
22 chapter 91 to regulate all adult residential care facilities
 
23 uniformly under this part, including licensing of facilities.
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1 Except for the exceptions contained in this part that require a
 
 2 provision of law or rule to apply only to a specific type of
 
 3 facility, or care providers in a specific type of facility, in
 
 4 any of the three facility categories, this part and all rules
 
 5 adopted by the department shall apply uniformly to all adult
 
 6 residential care facilities across the three facility categories
 
 7 under this part; provided that, at the discretion of the
 
 8 director, the director may further adopt specific rules that
 
 9 apply only to the facilities grouped within a facility category,
 
10 if the director determines that inherently different
 
11 characteristics and needs exist within a facility category which
 
12 require separate rules that would not appropriately apply to any
 
13 other facility category.  If the director adopts separate rules
 
14 for a facility category under this subsection, those rules shall
 
15 apply uniformly to all facilities within the affected facility
 
16 category.
 
17      (c)  The department shall license all adult residential care
 
18 facilities under this part two years after the adoption of rules.
 
19 The department shall adopt rules in accordance with chapter 91 to
 
20 implement the purpose of this section.
 
21      §321-F Parity of reimbursement; state policy; comprehensive
 
22 review of reimbursement rates.  (a)  It shall be the policy of
 
23 the State, unless otherwise provided by law to the contrary, to
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1 reimburse equally, to the greatest extent practicable, operators
 
 2 of adult residential care facilities under this part, for the
 
 3 services they provide, based on the nature of the services
 
 4 themselves and the patient's need for these services, without
 
 5 regard to the facility category or the specific facility type, as
 
 6 described in section 321-C, in which the services are delivered.
 
 7      (b)  To provide the foundation upon which to base parity of
 
 8 reimbursement, the department of human services, with the
 
 9 assistance of the department of health and the adult residential
 
10 care industry, shall conduct a comprehensive review of all
 
11 services provided by all adult residential care facilities under
 
12 this part in order to determine existing rates of reimbursement
 
13 for these delivered services.  The department of human services
 
14 shall complete this review and report its findings to the
 
15 legislature and the director of health no later than October 30,
 
16 1999.
 
17      §321-G Training.  The department may provide consultations
 
18 with and provide training and education for operators and staff
 
19 of any facility licensed under this part, in conjunction with any
 
20 licensing thereof, and shall adopt rules in accordance with
 
21 chapter 91.
 
22      §321-H  Inventory.  The department shall maintain a current
 
23 inventory of vacancies in the adult residential care homes and
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1 expanded adult residential care homes.
 
 2      §321-I Standard admission procedure; exception.  To the
 
 3 extent practicable, the department shall establish a standard
 
 4 admission procedure for all adult residential care facilities
 
 5 under this part; provided that, in the director's discretion, the
 
 6 director may establish a separate admission procedure for the
 
 7 facilities within a particular facility category, as described in
 
 8 section 321-C.  If such a separate admission procedure is
 
 9 established, the procedure shall apply uniformly to all facility
 
10 types within that particular facility category.  The standard
 
11 admission procedure shall require the use of uniform data
 
12 elements that include the appropriate medical and personal
 
13 history of the patient as well as the level of care needed by the
 
14 patient prior to the patient's referral and admission to any
 
15 adult residential care facility.
 
16      §321-J Uniform assessment tool.  To implement the standard
 
17 admission procedure under section 321-I, the department shall
 
18 employ, as a uniform assessment tool, the scaled-down version of
 
19 the medicaid waiver program's social and health assessment forms,
 
20 as fashioned by the joint legislative committee on long-term care
 
21 created by Act 339, Session Laws of Hawaii 1997, as updated from
 
22 time to time, for all residential care facilities other than
 
23 basic category adult residential care homes.  The purpose of the
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1 uniform assessment tool is to help reduce system fragmentation,
 
 2 increase system efficiency and effectiveness, enhance quality of
 
 3 care, and to make the system more consumer-friendly.
 
 4      (b)  The department shall also employ the one-page form
 
 5 currently being used by the department termed "Level of Care
 
 6 Evaluation", as updated from time to time, for all basic category
 
 7 adult residential care homes to assure the correct placement of
 
 8 only non-nursing facility level residents.
 
 9      (c)  The data elements in the uniform assessment tool in
 
10 subsection (a) and the one-page tool in subsection (b) shall be
 
11 standardized to reduce the need to obtain identical data
 
12 subsequently, and to allow different providers to access and
 
13 share standard information, as necessary.  The data elements
 
14 shall be consistent with the two-page information and referral
 
15 screening form, administered at the time of entry, termed the
 
16 "Coordinated Screening Form", that is recommended for use in the
 
17 information and referral process under section 321-K.
 
18      (d)  The:
 
19      (1)  Uniform assessment tool in subsection (a);
 
20      (2)  One-page tool in subsection (b); and
 
21      (3)  Two-page information and referral screening form in
 
22           subsection (c) and section 321-K;
 
23 are meant to be flexible tools to be modified as required from
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1 time to time without the need for further legislative amendment
 
 2 to this part.  Nothing in this part shall prevent any agency or
 
 3 care provider regulated under this part from obtaining any
 
 4 additional data, as necessary, in order to appropriately assess a
 
 5 resident or potential resident or to plan for their care.
 
 6      §321-K Long-term care information and referral.  (a)  The
 
 7 legislature finds that many individuals who potentially require
 
 8 long-term residential care may not be able to adequately
 
 9 articulate their needs nor be able to successfully search out and
 
10 navigate the existing fragmented system of residential care in
 
11 Hawaii which, at times, admittedly confuses even those in the
 
12 residential care industry.  What is needed is a simple, quick,
 
13 uniform, professional, consumer-friendly, and accurate process
 
14 for individuals to access the residential care system in the form
 
15 of an information and referral process that provides information
 
16 and referral screening for potential clients of long-term
 
17 residential care.
 
18      (b)  Subject to legislative appropriations, the department
 
19 shall establish an information and referral process that shall
 
20 serve all potential clients of adult residential care facilities
 
21 under this part, namely, the elderly, the non-elderly under age
 
22 sixty, and disabled persons of all ages.  The information and
 
23 referral process shall include the conduct of a uniform initial
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1 information and referral screening using the tool as developed by
 
 2 the single entry point coordinating committee, December, 1996.
 
 3      §321-L Authority for licensure.  (a)  The department shall
 
 4 adopt rules in accordance with chapter 91 to license the
 
 5 different types of facilities listed in this section.
 
 6      (b)  Basic residential care category ("basic category")
 
 7 shall comprise:
 
 8      (1)  Adult residential care homes:
 
 9           (A)  Type I facilities to allow group living by five or
 
10                fewer unrelated persons; and
 
11           (B)  Type II facilities to allow group living by six or
 
12                more persons including, but not limited to, the
 
13                mentally ill, as defined in section 334-1; elders,
 
14                as defined under sections 201G-1 and 201G-151; the
 
15                handicapped, meaning individuals with a physical
 
16                disability as defined under section 515-2; the
 
17                developmentally disabled, meaning persons with
 
18                developmental disabilities as defined under
 
19                section 333F-1; or totally disabled persons,
 
20                meaning persons totally disabled as defined under
 
21                section 235-1; who are not related to the home
 
22                operator or facility staff;
 
23      (2)  Developmental disabilities domiciliary homes.  The
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1           department shall:
 
 2           (A)  Establish criteria for licensure of homes under
 
 3                this section, including inspections, registration,
 
 4                fees, qualifications of operators and staff, and
 
 5                other factors necessary to ensure the safe and
 
 6                appropriate operation of each home;
 
 7           (B)  Protect the health, safety, and civil rights of
 
 8                persons residing in the homes;
 
 9           (C)  Provide for plans of care which include community
 
10                integration and training of persons residing in
 
11                the licensed homes;
 
12           (D)  Provide for the licensure of homes of up to five
 
13                persons who are developmentally disabled or
 
14                mentally retarded, and who are not related to the
 
15                home operator or facility staff;
 
16           (E)  Establish penalties for the failure to comply with
 
17                any rule; and
 
18           (F)  Establish criteria for training of operators and
 
19                staff of any home licensed under this section.
 
20           The rate of payment for residents in basic category
 
21           developmental disabilities domiciliary homes shall be
 
22           determined on the same basis as domiciliary care homes
 
23           as provided in section 346-53; and 
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1      (3)  Adult foster homes for persons with developmental
 
 2           disabilities:
 
 3           (A)  The department of health shall adopt rules to
 
 4                license adult foster homes for persons with
 
 5                developmental disabilities for individuals
 
 6                requiring this type of care beyond the eighteenth
 
 7                birthday;
 
 8           (B)  To accommodate residents of a foster boarding home
 
 9                for children with developmental disabilities who
 
10                reach the age of eighteen years, where the home is
 
11                certified as a foster boarding home for children
 
12                under section 346-17, the director of health may
 
13                waive the two-adult limit for licensure of that
 
14                home as an adult foster home for persons with
 
15                developmental disabilities, provided that the
 
16                number of foster children and adults in such a
 
17                home shall not exceed five and no new adults may
 
18                be admitted into the home while there are any
 
19                foster children residing in the home;
 
20           (C)  The department of health shall adopt rules in
 
21                accordance with chapter 91 prescribing standards
 
22                of condition and competence of operation for adult
 
23                foster homes for persons with developmental
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1                disabilities; and
 
 2           (D)  The rate of payment for adult foster homes for
 
 3                persons with developmental disabilities shall be
 
 4                determined on the same basis as basic category
 
 5                adult residential care homes as provided under
 
 6                section 346-53.
 
 7      (c)  Expanded nursing facility level residential care
 
 8 category ("expanded category") to comprise:
 
 9      (1)  Expanded adult residential care homes:
 
10           (A)  Type I facilities to allow group living by five or
 
11                fewer unrelated persons with no more than two
 
12                nursing facility level residents; and
 
13           (B)  Type II facilities to allow group living by six or
 
14                more persons unrelated to the operator or facility
 
15                staff of the home; provided that no more than
 
16                twenty per cent of the home's licensed capacity
 
17                may be filled by persons who are nursing facility
 
18                level residents and the director, at the
 
19                director's discretion, may allow additional
 
20                nursing facility level residents.
 
21           Expanded adult residential care homes may admit an
 
22           individual who has been living immediately prior to
 
23           admission in the individual's own home, a hospital, or
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1           other care setting, and who has been either admitted to
 
 2           a medicaid waiver program and determined by the
 
 3           department of human services to require nursing
 
 4           facility level care to manage the individual's
 
 5           physical, mental, and social functions, or a private-
 
 6           paying individual certified by a physician or advanced
 
 7           practice registered nurse as needing a nursing facility
 
 8           level of care.
 
 9           The department of health shall adopt rules in
 
10           accordance with chapter 91 to allow admissions to
 
11           expanded adult residential care homes by level of care
 
12           and to define and standardize these levels of care.
 
13           The rules and standards shall provide for appropriate
 
14           and adequate requirements for knowledge and training of
 
15           expanded adult residential care home operators and
 
16           their employees;
 
17      (2)  Expanded developmental disabilities domiciliary homes;
 
18      (3)  Expanded adult foster homes for persons with
 
19           developmental disabilities; and
 
20      (4)  Adult waiver foster family homes."
 
21      SECTION 3.  Section 46-15.3, Hawaii Revised Statutes, is
 
22 amended to read as follows:
 
23      "[[]§46-15.3[]]  Regulation of adult [family boarding home
 

 
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 1 and care home.] residential care facilities.  (a)  For the
 
 2 purpose of regulation under a county's life safety code, building
 
 3 code, fire code, or any other ordinance of similar purpose, a
 
 4 licensed adult [family boarding home or licensed care home]
 
 5 residential acre facility which provides living accommodations
 
 6 for:
 
 7      (1)  The operator of the home and operator's family; and
 
 8      (2)  Up to five other persons, not more than two of whom are
 
 9           incapable of self-preservation because of age or
 
10           physical or mental limitations;
 
11 shall be deemed a single-family dwelling occupied by a family.
 
12      (b)  For the purpose of this section:
 
13      "Adult residential care facility" is as defined under
 
14 section 321-B.
 
15      "Building code" means an ordinance the purpose of which is
 
16 to provide minimum standards to safeguard life or limb, health,
 
17 property, and public welfare by regulating and controlling the
 
18 design, construction, quality of materials, use and occupancy,
 
19 location, and maintenance of all buildings and structures within
 
20 the county's jurisdiction and certain equipment specifically
 
21 regulated by the ordinance.
 
22      "Fire code" means an ordinance adopted under section 132-3
 
23 or an ordinance intended to prescribe regulations consistent with
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1 recognized good practice for the safeguarding to a reasonable
 
 2 degree of life and property from the hazards of fire and
 
 3 explosion arising from the storage, handling, and use of
 
 4 hazardous substances, materials, and devices and from conditions
 
 5 hazardous to life or property in the use or occupancy of
 
 6 buildings or premises.
 
 7      ["Licensed adult family boarding home" means an adult family
 
 8 boarding home licensed under chapter 346, part IV.
 
 9      "Licensed care home" means a care home licensed under
 
10 section 321-15.6.]
 
11      "Life safety code" means an ordinance the purpose of which
 
12 is to establish minimum requirements that will provide a
 
13 reasonable degree of safety from fire in buildings and
 
14 structures."
 
15      SECTION 4.  Section 321-15.7, Hawaii Revised Statutes, is
 
16 amended to read as follows:
 
17      "§321-15.7  Penalty.  Any person who intentionally operates
 
18 an adult residential care [home] facility or hospice without a
 
19 license shall be guilty of a misdemeanor."
 
20      SECTION 5.  Section 321-11, Hawaii Revised Statutes, is
 
21 amended to read as follows:
 
22      "§321-11  Subjects of health rules, generally.  The
 
23 department pursuant to chapter 91 may adopt rules that it deems
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1 necessary for the public health and safety respecting:
 
 2      (1)  Nuisances, foul or noxious odors, gases, vapors, waters
 
 3           in which mosquitoes breed or may breed, sources of
 
 4           filth, and causes of sickness or disease, within the
 
 5           respective districts of the State, and on board any
 
 6           vessel;
 
 7      (2)  Adulteration and misbranding of food or drugs;
 
 8      (3)  Location, air space, ventilation, sanitation, drainage,
 
 9           sewage disposal, and other health conditions of
 
10           buildings, courts, construction projects, excavations,
 
11           pools, watercourses, areas, and alleys;
 
12      (4)  Privy vaults and cesspools;
 
13      (5)  Fish and fishing;
 
14      (6)  Interments and dead bodies;
 
15      (7)  Disinterments of dead human bodies, including the
 
16           exposing, disturbing, or removing of these bodies from
 
17           their place of burial, or the opening, removing, or
 
18           disturbing after due interment of any receptacle,
 
19           coffin, or container holding human remains or a dead
 
20           human body or a part thereof and the issuance and terms
 
21           of permits for the aforesaid disinterments of dead
 
22           human bodies;
 
23      (8)  Cemeteries and burying grounds;
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1      (9)  Laundries, and the laundering, sanitation, and
 
 2           sterilization of articles including linen and uniforms
 
 3           used by or in the following businesses and professions:
 
 4           barber shops, manicure shops, beauty parlors,
 
 5           electrology shops, restaurants, soda fountains, hotels,
 
 6           rooming and boarding houses, bakeries, butcher shops,
 
 7           public bathhouses, midwives, masseurs, and others in
 
 8           similar calling, public or private hospitals, and
 
 9           canneries and bottling works where foods or beverages
 
10           are canned or bottled for public consumption or sale;
 
11           provided that nothing in this chapter shall be
 
12           construed as authorizing the prohibiting of laundering,
 
13           sanitation, and sterilization by those conducting any
 
14           of these businesses or professions where the laundering
 
15           or sterilization is done in an efficient and sanitary
 
16           manner;
 
17     (10)  Hospitals, freestanding surgical outpatient facilities,
 
18           skilled nursing facilities, intermediate care
 
19           facilities, adult residential care [homes, adult foster
 
20           homes,] facilities under part    , assisted living
 
21           facilities, special treatment facilities and programs,
 
22           home health agencies, hospices, freestanding birthing
 
23           facilities, adult day health centers, [independent
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1           group residences,] and therapeutic living programs, but
 
 2           excluding youth shelter facilities unless clinical
 
 3           treatment of mental, emotional, or physical disease or
 
 4           handicap is a part of the routine program or
 
 5           constitutes the main purpose of the facility, as
 
 6           defined in section 346-16 under "child [care] caring
 
 7           institution".  [For the purpose of this paragraph,
 
 8           "adult foster home" has the same meaning as provided in
 
 9           section 321-11.2];
 
10     (11)  Hotels, rooming houses, lodging houses, apartment
 
11           houses, and tenements[, and residences for persons with
 
12           developmental disabilities including, but not limited
 
13           to, those built under federal funding];
 
14     (12)  Laboratories;
 
15     (13)  Any place or building where noisome or noxious trades
 
16           or manufacturers are carried on, or intended to be
 
17           carried on;
 
18     (14)  Milk;
 
19     (15)  Poisons and hazardous substances, the latter term
 
20           including but not limited to any substance or mixture
 
21           of substances which:
 
22           (A)  Is corrosive;
 
23           (B)  Is an irritant;
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1           (C)  Is a strong sensitizer;
 
 2           (D)  Is inflammable; or
 
 3           (E)  Generates pressure through decomposition, heat, or
 
 4                other means,
 
 5           if the substance or mixture of substances may cause
 
 6           substantial personal injury or substantial illness
 
 7           during or as a proximate result of any customary or
 
 8           reasonably foreseeable handling or use, including
 
 9           reasonably foreseeable ingestion by children;
 
10     (16)  Pig and duck ranches;
 
11     (17)  Places of business, industry, employment, and commerce,
 
12           and the processes, materials, tools, machinery, and
 
13           methods of work done therein; and places of public
 
14           gathering, recreation, or entertainment;
 
15     (18)  Any restaurant, theater, market, stand, shop, store,
 
16           factory, building, wagon, vehicle, or place where any
 
17           food, drug, or cosmetic is manufactured, compounded,
 
18           processed, extracted, prepared, stored, distributed,
 
19           sold, offered for sale, or offered for human
 
20           consumption or use;
 
21     (19)  Foods, drugs, and cosmetics, and the manufacture,
 
22           compounding, processing, extracting, preparing,
 
23           storing, selling, and offering for sale, consumption,
 

 
Page 25                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1           or use of any food, drug, or cosmetic;
 
 2     (20)  Devices as defined in section 328-1;
 
 3     (21)  Sources of ionizing radiation;
 
 4     (22)  Medical examination, vaccination, revaccination, and
 
 5           immunization of school children.  No child shall be
 
 6           subjected to medical examination, vaccination,
 
 7           revaccination, or immunization, whose parent or
 
 8           guardian objects in writing thereto on grounds that the
 
 9           requirements are not in accordance with the religious
 
10           tenets of an established church of which the parent or
 
11           guardian is a member or adherent, but no objection
 
12           shall be recognized when, in the opinion of the
 
13           department, there is danger of an epidemic from any
 
14           communicable disease;
 
15     (23)  Disinsectization of aircraft entering or within the
 
16           State as may be necessary to prevent the introduction,
 
17           transmission, or spread of disease or the introduction
 
18           or spread of any insect or other vector of significance
 
19           to health;
 
20     (24)  Fumigation, including the process by which substances
 
21           emit or liberate gases, fumes, or vapors which may be
 
22           used for the destruction or control of insects, vermin,
 
23           rodents, or other pests, which, in the opinion of the
 

 
Page 26                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1           department, may be lethal, poisonous, noxious, or
 
 2           dangerous to human life;
 
 3     (25)  Ambulances and ambulance equipment;
 
 4     (26)  Development, review, approval, or disapproval of
 
 5           management plans submitted pursuant to the Asbestos
 
 6           Hazard Emergency Response Act of 1986, Public Law
 
 7           99-519; and
 
 8     (27)  Development, review, approval, or disapproval of an
 
 9           accreditation program for specially trained persons
 
10           pursuant to the Residential Lead-Based Paint Hazard
 
11           Reduction Act of 1992, Public Law 102-550.
 
12      The department may require any certificates, permits, or
 
13 licenses that it may deem necessary to adequately regulate the
 
14 conditions or businesses referred to in this section."
 
15      SECTION 6.  Section 321-15.1, Hawaii Revised Statutes, is
 
16 amended as follows:
 
17      1.  By repealing the definition of "adult residential care
 
18 home".
 
19      [""Adult residential care home" means any facility providing
 
20 twenty-four-hour living accommodations, for a fee, to adults
 
21 unrelated to the family, who require at least minimal assistance
 
22 in the activities of daily living, personal care services,
 
23 protection, and health care services, but who do not need the
 

 
Page 27                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 professional health services provided in an intermediate, skilled
 
 2 nursing, or acute care facility."]
 
 3      2.  By repealing the definition of "expanded adult
 
 4 residential care home".
 
 5      [""Expanded adult residential care home" means any facility
 
 6 providing twenty-four-hour living accommodations, for a fee, to
 
 7 adults unrelated to the family, who require at least minimal
 
 8 assistance in the activities of daily living, personal care
 
 9 services, protection, and health care services, and who may need
 
10 the professional health services provided in an intermediate or
 
11 skilled nursing facility."]
 
12      SECTION 7.  Section 323D-2, Hawaii Revised Statutes, is
 
13 amended by amending the definition of "extended care adult
 
14 residential care home" to read as follows:
 
15      ""[Extended care] Expanded adult residential care home"
 
16 means [an adult residential care home] any facility providing
 
17 twenty-four-hour living [accommodation] accommodations for a
 
18 fee[, for] to adults unrelated to the [licensee.] operator or
 
19 facility staff of the home, who require at least minimal
 
20 assistance in the activities of daily living, personal care
 
21 services, protection, and health care services, and who may need
 
22 the professional health services provided in an intermediate or
 
23 skilled nursing facility.  The primary caregiver shall be
 

 
Page 28                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 qualified to provide care to nursing facility level individuals
 
 2 who have been admitted to a medicaid waiver program, or persons
 
 3 who pay for care from private funds and have been certified [for
 
 4 this type of facility.  There shall be two categories of extended
 
 5 care adult residential care homes, which shall be licensed in
 
 6 accordance with rules adopted by the department of health:
 
 7      (1)  Type I home" shall consist] as a nursing facility level
 
 8           resident.  A "type I expanded adult residential care
 
 9           home" means a group living facility consisting of five
 
10           or [less unrelated] fewer persons unrelated to the
 
11           operator or facility staff of the home, with no more
 
12           than two [extended care adult residential care home]
 
13           nursing facility level residents[; and
 
14      (2)  Type II home" shall consist].  A "type II expanded
 
15           adult residential care home" means a group living
 
16           facility consisting of six or more [unrelated persons
 
17           and one or more persons may be extended care adult
 
18           residential care home residents] persons unrelated to
 
19           the operator or facility staff of the home, with no
 
20           more than twenty per cent of the home's licensed
 
21           capacity who are nursing facility level residents;
 
22           provided that the director, at the director's
 
23           discretion, may allow additional nursing facility level
 

 
Page 29                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1           residents."
 
 2      SECTION 8.  Section 323D-54, Hawaii Revised Statutes, is
 
 3 amended to read as follows:
 
 4      "§323D-54  Exemptions from certificate of need requirements.
 
 5 Nothing in this part or rules with respect to the requirement for
 
 6 certificates of need applies to:
 
 7      (1)  Offices of physicians, dentists, or other practitioners
 
 8           of the healing arts in private practice as
 
 9           distinguished from organized ambulatory health care
 
10           facilities, except in any case of purchase or
 
11           acquisition of equipment attendant to the delivery of
 
12           health care service and the instruction or supervision
 
13           for any private office or clinic involving a total
 
14           expenditure in excess of the expenditure minimum;
 
15      (2)  Laboratories, [as defined in section 321-11(12),]
 
16           except in any case of purchase or acquisition of
 
17           equipment attendant to the delivery of health care
 
18           service and the instruction or supervision for any
 
19           laboratory involving a total expenditure in excess of
 
20           the expenditure minimum;
 
21      (3)  Dispensaries and first aid stations located within
 
22           business or industrial establishments and maintained
 
23           solely for the use of employees; provided such
 

 
Page 30                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1           facilities do not regularly provide inpatient or
 
 2           resident beds for patients or employees on a daily
 
 3           twenty-four-hour basis;
 
 4      (4)  Dispensaries or infirmaries in correctional or
 
 5           educational facilities;
 
 6      (5)  Dwelling establishments, such as hotels, motels, and
 
 7           rooming or boarding houses that do not regularly
 
 8           provide health care facilities or health care services;
 
 9      (6)  Any home or institution conducted only for those who,
 
10           pursuant to the teachings, faith, or belief of any
 
11           group, depend for healing upon prayer or other
 
12           spiritual means;
 
13      (7)  Dental clinics;
 
14      (8)  Nonpatient areas of care facilities such as parking
 
15           garages and administrative offices;
 
16      (9)  Bed changes that involve ten per cent or ten beds of
 
17           existing licensed bed types, whichever is less, of a
 
18           facility's total existing licensed beds within a two-
 
19           year period;
 
20     (10)  Projects that are wholly dedicated to meeting the
 
21           State's obligations under court orders, including
 
22           consent decrees, that have already determined that need
 
23           for the projects exists;
 

 
Page 31                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1     (11)  Replacement of existing equipment with its modern-day
 
 2           equivalent;
 
 3     (12)  Primary care clinics under the expenditure thresholds
 
 4           referenced in section 323D-2;
 
 5     (13)  Equipment and services related to that equipment, that
 
 6           are primarily invented and used for research purposes
 
 7           as opposed to usual and customary diagnostic and
 
 8           therapeutic care;
 
 9     (14)  Capital expenditures that are required:
 
10           (A)  To eliminate or prevent imminent safety hazards as
 
11                defined by federal, state, or county fire,
 
12                building, or life safety codes or regulations;
 
13           (B)  To comply with state licensure standards;
 
14           (C)  To comply with accreditation standards, compliance
 
15                with which is required to receive reimbursements
 
16                under Title XVIII of the Social Security Act or
 
17                payments under a state plan for medical assistance
 
18                approved under Title XIX of such Act;
 
19     (15)  [Extended care] All adult residential care [homes]
 
20           facilities under chapter 321, part    , and assisted
 
21           living facilities; or
 
22     (16)  Other facilities or services that the agency through
 
23           the statewide council chooses to exempt, by rules
 

 
Page 32                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1           pursuant to section 323D-62."
 
 2      SECTION 9.  Section 333F-2, Hawaii Revised Statutes, is
 
 3 amended by amending subsection (c) to read as follows:
 
 4      "(c)  Supports and services the department shall administer
 
 5 include, but shall not be limited to:
 
 6      (1)  Early identification and evaluation of persons with
 
 7           developmental disabilities or mental retardation;
 
 8      (2)  Development, planning, and implementation in
 
 9           coordination with other federal, state, and county
 
10           agencies, of service programs for persons with
 
11           developmental disabilities or mental retardation;
 
12      (3)  Development and provision of service programs in the
 
13           public or private sectors through chapter 42F or
 
14           chapter 103F, for persons with developmental
 
15           disabilities or mental retardation;
 
16      (4)  Establishment of a continuum of comprehensive services
 
17           and residential alternatives in the community to allow
 
18           persons with developmental disabilities or mental
 
19           retardation to live in the least restrictive,
 
20           individually appropriate environment;
 
21      (5)  Development and implementation of a program for single-
 
22           entry access by persons with developmental disabilities
 
23           or mental retardation to services provided under this
 

 
Page 33                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1           chapter as well as referral to, and coordination with,
 
 2           services provided in the private sector or under other
 
 3           federal, state, or county acts, and the development of
 
 4           an individualized service plan by an interdisciplinary
 
 5           team;
 
 6      (6)  Collaborative and cooperative services with public
 
 7           health and other groups for programs to prevent
 
 8           developmental disabilities or mental retardation;
 
 9      (7)  Informational and educational services to the general
 
10           public and to lay and professional groups;
 
11      (8)  Consultative services to the judicial branch of
 
12           government, educational institutions, and health and
 
13           welfare agencies whether the agencies are public or
 
14           private;
 
15      (9)  Provision of community residential alternatives for
 
16           persons with developmental disabilities or mental
 
17           retardation, that promote normalized living, inclusion,
 
18           and self-determination including [group homes and
 
19           homes], under chapter 321, part    :
 
20           (A)  Basic category developmental disabilities
 
21                domiciliary homes and adult foster homes for
 
22                persons with developmental disabilities;
 
23 _         (B)  Expanded category developmental disabilities
 

 
Page 34                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1                domiciliary homes and adult foster homes for
 
 2                persons with developmental disabilities; and
 
 3           (C)  Homes meeting ICF/MR standards;
 
 4     (10)  Provision of care at the skilled nursing level or in a
 
 5           skilled nursing facility, as individually appropriate;
 
 6     (11)  Provision of other programs, services, or facilities
 
 7           necessary to provide a continuum of care for persons
 
 8           with developmental disabilities or mental retardation;
 
 9     (12)  Provision of case management services independent of
 
10           the direct service provider; and
 
11     (13)  Development and maintenance of respite services in the
 
12           community for persons with developmental disabilities
 
13           or mental retardation."
 
14      SECTION 10.  Section 333F-22, Hawaii Revised Statutes, is
 
15 amended as follows:
 
16      1.  By amending subsections (a) to (c) to read:
 
17      "(a)  The department shall adopt rules pursuant to chapter
 
18 91 to assure the reputable and responsible character of an
 
19 applicant to operate an adult foster home for persons with
 
20 developmental disabilities or developmental disabilities
 
21 domiciliary home[,] under either the basic category or the
 
22 expanded category under chapter 321, part    , of existing
 
23 providers and their employees, of current and prospective
 

 
Page 35                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 employees of the applicant, and of new employees of the provider
 
 2 after certification or licensure, which shall provide for, but
 
 3 not be limited to, criminal history record checks.
 
 4      (b)  For the purposes of this section, "developmental
 
 5 disabilities domiciliary homes" [means any facility licensed
 
 6 under section 321-15.9 that provides twenty-four hour supervision
 
 7 or care, excluding licensed nursing care, for a fee, to not more
 
 8 than five adults with mental retardation or developmental
 
 9 disabilities as defined in this chapter; and "adult foster homes"
 
10 shall be as defined under section 321-11.2.] and "adult foster
 
11 homes for persons with developmental disabilities" shall be as
 
12 defined under section 321-B.
 
13      (c)  An applicant to operate [an] any adult foster home for
 
14 persons with developmental disabilities or developmental
 
15 disabilities domiciliary home shall submit to the department,
 
16 with the applicant's application for certification or licensure,
 
17 statements signed under penalty of perjury by the applicant and
 
18 all current and prospective employees of the applicant indicating
 
19 whether the applicant or any of the current or prospective
 
20 employees of the applicant have ever been convicted of a crime
 
21 other than a minor traffic violation involving a fine of $50 or
 
22 less and providing consent to the department to conduct a
 
23 criminal history record check and to obtain other criminal
 

 
Page 36                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 history record information for verification.  The applicant and
 
 2 current or prospective employees of the applicant shall also be
 
 3 fingerprinted for the purpose of a national criminal history
 
 4 record check."
 
 5      2.  By amending subsection (g) to read:
 
 6      "(g)  The department may revoke a current license or
 
 7 certification or deny an application for a license or
 
 8 certification to operate an adult foster home for persons with
 
 9 developmental disabilities or developmental disabilities
 
10 domiciliary home under rules adopted pursuant to chapter 91 if
 
11 the existing provider or employee of an existing provider,
 
12 applicant, current or prospective employee of the applicant,
 
13 provider, or new employee of the provider refuses to submit to
 
14 the department statements indicating criminal convictions,
 
15 refuses to provide consent to the department to conduct a
 
16 criminal history record check or obtain other criminal history
 
17 record information for verification, refuses to be fingerprinted,
 
18 has been convicted of a crime other than a minor traffic
 
19 violation involving a fine of $50 or less; or if the department
 
20 finds that the criminal history record of the existing provider
 
21 or employee of an existing provider, applicant, current or
 
22 prospective employee of the applicant, provider, or new employee
 
23 of the provider may pose a risk to the health, safety, or well-
 

 
Page 37                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 being of persons with developmental disabilities or mental
 
 2 retardation living in the home."
 
 3      SECTION 11.  Section 346-53, Hawaii Revised Statutes, is
 
 4 amended by amending subsection (c) to read as follows:
 
 5      "(c)  The director, pursuant to chapter 91, shall determine
 
 6 the rate of payment for domiciliary care provided to recipients
 
 7 eligible either for [Federal Supplementary] federal Supplemental
 
 8 Security Income, or public assistance in accordance with state
 
 9 standards, or both.  The director shall provide for level of care
 
10 payment as follows:
 
11      (1)  For [those] basic category type I adult residential
 
12           care homes [classified as facility type I], the state
 
13           supplemental payment shall not exceed $521.90; and 
 
14      (2)  For [those] basic category type II adult residential
 
15           care homes [classified as facility type II], the state
 
16           supplementary payment shall not exceed $629.90.
 
17      If the operator does not provide the quality of care
 
18 consistent with the needs of the individual to the satisfaction
 
19 of the department, the department may remove the recipient to
 
20 another facility.
 
21      The department shall handle abusive practices under this
 
22 section in accordance with chapter 91.
 
23      Nothing in this subsection allows the director to remove a
 

 
Page 38                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 recipient from an adult residential care home or other similar
 
 2 institution if the recipient does not desire to be removed and
 
 3 the operator is agreeable to the recipient remaining, except
 
 4 where the recipient requires a higher level of care than
 
 5 provided, or where the recipient no longer requires any
 
 6 domiciliary care."
 
 7      SECTION 12.  Section 346-53.4, Hawaii Revised Statutes, is
 
 8 amended to read as follows:
 
 9      "[[]§346-53.4[]]  Reimbursement to expanded [adult
 
10 residential care home operators.] nursing facility level
 
11 residential care category ("expanded category").  Qualified
 
12 expanded [adult residential care] category home operators under
 
13 section [321-15.62] 321-L who accept residents certified by the
 
14 department [as requiring skilled nursing facility level care]
 
15 shall be reimbursed based on the severity of the resident's
 
16 disability."
 
17      SECTION 13.  Section 518-3, Hawaii Revised Statutes, is
 
18 amended to read as follows:
 
19      "[[]§518-3[]]  Invalidity of certain restrictive covenants.
 
20 It is the public policy of the State to establish community
 
21 residences in residential areas.  Therefore, any restrictive
 
22 covenant or other private legal impediment made by any person,
 
23 association, firm, or corporation which directly or indirectly
 

 
Page 39                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 prevents or restricts the establishment in an area zoned for
 
 2 residential use of a facility licensed by the State as an adult
 
 3 residential care home as defined under section [321-15.1;] 321-B;
 
 4 intermediate care facility/mental retardation-community as
 
 5 defined under section 46-4(d); or special treatment facility as
 
 6 defined under section 334-1, shall be void and unenforceable as
 
 7 to such community residences."
 
 8      SECTION 14.  Section 321-11.2, Hawaii Revised Statutes, is
 
 9 repealed.
 
10      ["§321-11.2  Adult foster homes.(a)  The department of
 
11 health is authorized to certify adult foster homes for
 
12 developmentally disabled individuals requiring such care beyond
 
13 the eighteenth birthday.  "Adult foster home" means a private
 
14 home providing care on a twenty-four hour basis for adults with
 
15 developmental disabilities.  To be certified, an adult foster
 
16 home shall have not more than two adults with developmental
 
17 disabilities at the same time, who are unrelated to the foster
 
18 family.  To accommodate residents of a foster boarding home for
 
19 children with developmental disabilities who reach the age of
 
20 eighteen years, where the home is certified as a foster boarding
 
21 home for children under section 346-17, the director of health
 
22 may waive the two adult limit for certification of that home as
 
23 an adult foster home, provided that:  (1) the number of foster
 

 
Page 40                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 children and adults in such dually certified home shall not
 
 2 exceed five, and (2) no new adults may be admitted into the home
 
 3 while there are any foster children residing in the home.
 
 4      (b)  The rules of the department of human services adopted
 
 5 under authority of section 346-17, which prescribe the standards
 
 6 of conditions and competence of operation of child foster
 
 7 boarding homes shall apply to adult foster homes.
 
 8 Notwithstanding chapter 91, to the contrary, the rules shall be
 
 9 considered adopted by the department of health on July 1, 1986,
 
10 for the purpose of regulating adult foster care homes and shall
 
11 be valid until the department of health adopts rules pursuant to
 
12 chapter 91.  The department of health shall adopt rules pursuant
 
13 to chapter 91 necessary for the purposes of this section.
 
14      (c)  Rate of payment for adult foster homes is to be
 
15 determined on the same basis as domiciliary care homes as
 
16 provided under section 346-53."]
 
17      SECTION 15.  Section 321-15.6, Hawaii Revised Statutes, is
 
18 repealed.
 
19      ["§321-15.6  Adult residential care homes; licensing.(a)
 
20 All adult residential care homes shall be licensed to ensure the
 
21 health, safety, and welfare of the individuals placed therein.
 
22      (b)  The director shall adopt rules regarding adult
 
23 residential care homes in accordance with chapter 91 which shall
 

 
Page 41                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 be designed to:
 
 2      (1)  Protect the health, safety, and civil rights of persons
 
 3           residing in facilities regulated;
 
 4      (2)  Provide for the licensing of adult residential care
 
 5           homes; provided that the rules shall allow group living
 
 6           in two categories of adult residential care homes as
 
 7           licensed by the department of health:
 
 8           (A)  Type I allowing group living by five or fewer
 
 9                unrelated persons; and
 
10           (B)  Type II allowing six or more persons including but
 
11                not limited to the mentally ill, elders, the
 
12                handicapped, the developmentally disabled, or
 
13                totally disabled persons who are not related to
 
14                the home operator or facility staff.
 
15           For purposes of this section:
 
16                "Mentally ill person" means a mentally ill person
 
17           as defined under section 334-1.
 
18                "Elder" means an elder as defined under sections
 
19           201G-1 and 201G-151.
 
20                "Handicapped person" means an individual with a
 
21           physical handicap as defined under section 515-2.
 
22                "Developmentally disabled person" means a person
 
23           with developmental disabilities as defined under
 

 
Page 42                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1           section 333F-1.
 
 2                "Totally disabled person" means a person totally
 
 3           disabled as defined under section 235-1;
 
 4      (3)  Comply with applicable federal laws and regulations of
 
 5           Title XVI of the Social Security Act, as amended; and
 
 6      (4)  Provide penalties for the failure to comply with any
 
 7           rule.
 
 8      (c)  The department may provide for the training of and
 
 9 consultations with operators and staff of any facility licensed
 
10 under this section, in conjunction with any licensing thereof,
 
11 and shall adopt rules to ensure that adult residential care home
 
12 operators shall have the needed skills to provide proper care and
 
13 supervision in a home environment as required under department
 
14 rules.
 
15      (d)  The department shall establish a standard admission
 
16 policy and procedure which shall require the provision of
 
17 information that includes the appropriate medical and personal
 
18 history of the patient as well as the level of care needed by the
 
19 patient prior to the patient's referral and admission to any
 
20 adult residential care home facility.  The department shall
 
21 develop appropriate forms and patient summaries for this purpose.
 
22      (e)  The department shall maintain an inventory of all
 
23 facilities licensed under this section and shall maintain a
 

 
Page 43                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 current inventory of vacancies therein to facilitate the
 
 2 placement of individuals in such facilities.
 
 3      (f)  The department shall develop and adopt a social model
 
 4 of health care to ensure the health, safety, and welfare of
 
 5 individuals placed in adult residential care homes.  The model of
 
 6 care shall be designed to protect the health, safety, civil
 
 7 rights, and rights of choice of the persons to reside in a
 
 8 nursing facility or in home- or community-based care."]
 
 9      SECTION 16.  Section 321-15.61 , Hawaii Revised Statutes, is
 
10 repealed.
 
11      ["[§321-15.61]  Adult residential care homes expanded
 
12 admissions.(a)  Adult residential care homes may admit an
 
13 individual who has been living immediately prior to admission in
 
14 the individual's own home, a hospital, or other care setting, and
 
15 who has been either:
 
16      (1)  Admitted to a medicaid waiver program and determined by
 
17           the department of human services to require nursing
 
18           facility level care to manage the individual's
 
19           physical, mental, and social functions; or
 
20      (2)  A private-paying individual certified by a physician or
 
21           advanced practice registered nurse as needing a nursing
 
22           facility level of care.
 
23      (b)  The department of health shall adopt rules in
 

 
Page 44                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 accordance with chapter 91 to expand admissions to adult
 
 2 residential care homes by level of care and to define and
 
 3 standardize these levels of care.  The rules and standards shall
 
 4 provide for appropriate and adequate requirements for knowledge
 
 5 and training of adult residential care home operators and their
 
 6 employees."]
 
 7      SECTION 17.  Section 321-15.62, Hawaii Revised Statutes, is
 
 8 repealed.
 
 9      ["[§321-15.62]  Expanded adult residential care homes;
 
10 licensing.(a)  All expanded adult residential care homes shall
 
11 be licensed to ensure the health, safety, and welfare of the
 
12 individuals placed therein.
 
13      (b)  The director shall adopt rules regarding expanded adult
 
14 residential care homes in accordance with chapter 91 which shall
 
15 be a social model designed to:
 
16      (1)  Protect the health, safety, civil rights, and rights of
 
17           choice of the persons to reside in a nursing facility
 
18           or in home- or community-based care;
 
19      (2)  Provide for the licensing of expanded adult residential
 
20           care homes for persons who are certified by the
 
21           department of human services, a physician, advanced
 
22           practice registered nurse, or registered nurse case
 
23           manager as requiring skilled nursing facility level or
 

 
Page 45                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1           intermediate care facility level of care who have no
 
 2           financial relationship with the home care operator or
 
 3           facility staff; provided that the rules shall allow
 
 4           group living in two categories of expanded adult
 
 5           residential care homes as licensed by the department of
 
 6           health:
 
 7           (A)  Type I home shall consist of five or less
 
 8                residents with no more than two nursing facility
 
 9                level residents; and
 
10           (B)  Type II home shall consist of six or more
 
11                residents, with no more than twenty per cent of
 
12                the home's licensed capacity as nursing facility
 
13                level residents; provided that more nursing
 
14                facility level residents may be allowed at the
 
15                discretion of the department.
 
16      (3)  Comply with applicable federal laws and regulations of
 
17           Title XVI of the Social Security Act, as amended; and
 
18      (4)  Provide penalties for the failure to comply with any
 
19           rule.
 
20      (c)  The department may provide for the training of and
 
21 consultations with operators and staff of any facility licensed
 
22 under this section, in conjunction with any licensing thereof,
 
23 and shall adopt rules to ensure that expanded adult residential
 

 
Page 46                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1 care home operators shall have the needed skills to provide
 
 2 proper care and supervision in a home environment as required
 
 3 under department rules.
 
 4      (d)  The department shall establish a standard admission
 
 5 policy and procedure which shall require the provision of
 
 6 information that includes the appropriate medical and personal
 
 7 history of the patient as well as the level of care needed by the
 
 8 patient prior to the patient's referral and admission to any
 
 9 expanded adult residential care home facility.  The department
 
10 shall develop appropriate forms and patient summaries for this
 
11 purpose.
 
12      (e)  The department shall maintain an inventory of all
 
13 facilities licensed under this section and shall maintain a
 
14 current inventory of vacancies therein to facilitate the
 
15 placement of individuals in such facilities."]
 
16      SECTION 18.  Section 321-15.9, Hawaii Revised Statutes, is
 
17 repealed.
 
18      ["[§321-15.9]  Developmental disabilities domiciliary homes.
 
19 (a)  The department of health is authorized to license
 
20 developmental disabilities domiciliary homes for individuals with
 
21 developmental disabilities or mental retardation who are unable
 
22 to live independently and who require supervision or care, but do
 
23 not require care by licensed nurses in a domiciliary setting.
 

 
Page 47                                                    
                                     S.B. NO.           856
                                                        
                                                        

 
 1      (b)  For the purposes of this section, "developmental
 
 2 disabilities" shall be as defined under section 333E-2; and
 
 3 "mental retardation" shall be as defined under section 333F-1.
 
 4      (c)  The director shall adopt rules regarding developmental
 
 5 disabilities domiciliary homes in accordance with chapter 91
 
 6 which shall be designed to:
 
 7      (1)  Establish criteria for licensure of homes, including
 
 8           inspections, registration, fees, qualifications of
 
 9           operators and staff, and other factors necessary to
 
10           ensure the safe and appropriate operation of each home;
 
11      (2)  Protect the health, safety, and civil rights of persons
 
12           residing in the homes;
 
13      (3)  Provide for plans of care which include community
 
14           integration and training of persons residing in the
 
15           licensed homes;
 
16      (4)  Provide for the licensure of homes of up to five
 
17           persons who are developmentally disabled or mentally
 
18           retarded, and who are not related to the home operator
 
19           or facility staff;
 
20      (5)  Establish penalties for the failure to comply with any
 
21           rule; and
 
22      (6)  Establish criteria for training of operators and staff
 
23           of any facility licensed under this section.
 

 
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 1      (d)  Rules adopted under this section shall be enforced by
 
 2 the director.
 
 3      (e)  The department shall maintain a registry of all
 
 4 facilities licensed under this section and a current inventory of
 
 5 vacancies to facilitate the placement of individuals in these
 
 6 facilities.
 
 7      (f)  The rate of payment for residents in the developmental
 
 8 disabilities domiciliary homes shall be determined on the same
 
 9 basis as domiciliary care homes as provided under section
 
10 346-53."] 
 
11      SECTION 19.  There is appropriated out of the general
 
12 revenues of the State of Hawaii the sum of $          , or so
 
13 much thereof as may be necessary for fiscal year 1999-2000, and
 
14 the sum of $          , or so much thereof as may be necessary
 
15 for fiscal year 2000-2001, to implement an information and
 
16 referral process for the adult residential care facilities system
 
17 in Hawaii under chapter 321, part    .  The appropriations shall
 
18 be expended to fund:
 
19      (1)  An augmentation of the executive office on aging's
 
20           Aging Network to perform initial information and
 
21           referral screening for all persons aged sixty and
 
22           older;
 
23      (2)  The executive office on aging to expand its screening
 

 
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 1           and referral program to coordinate the establishment
 
 2           and operation of similar services to be provided by
 
 3           ASK-2000, or other information and referral providers
 
 4           as appropriate, for clients under age sixty.  The
 
 5           development of this expansion shall begin in July, 1999
 
 6           and full operation shall begin in July, 2000;
 
 7      (3)  A subcontract by the executive office on aging with
 
 8           ASK-2000, or other information and referral providers
 
 9           to provide similar supplementary initial information
 
10           and referral screening for all potential clients under
 
11           age sixty.  The development of this supplementary
 
12           service shall begin in July, 1999, and full operation
 
13           shall begin in July, 2000; and
 
14      (4)  One-time startup costs and annual operating costs.
 
15      SECTION 20.  The sums appropriated shall be expended by the
 
16 department of health for the purposes of this Act.
 
17      SECTION 21.  If any provision of this Act, or the
 
18 application thereof to any person or circumstance is held
 
19 invalid, the invalidity does not affect other provisions or
 
20 applications of the Act which can be given effect without the
 
21 invalid provision or application, and to this end the provisions
 
22 of this Act are severable.
 
23      SECTION 22.  In codifying the new part added to chapter 321,
 

 
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                                     S.B. NO.           856
                                                        
                                                        

 
 1 Hawaii Revised Statutes, by section 2 of this Act, the revisor of
 
 2 statutes shall substitute appropriate section numbers for the
 
 3 letters used in the new sections' designations in this Act.
 
 4      SECTION 23.  Statutory material to be repealed is bracketed.
 
 5 New statutory material is underscored.
 
 6      SECTION 24.  This Act shall take effect on July 1, 1999,
 
 7 except that the following four sections shall take effect on
 
 8 July 2, 1999:
 
 9      (1)  Section 6 amending section 321-15.1, Hawaii Revised
 
10           Statutes, repealing the definition of "expanded adult
 
11           residential care home";
 
12      (2)  Section 12 amending section 346-53.4, Hawaii Revised
 
13           Statutes, relating to reimbursement to expanded adult
 
14           residential care home operators;
 
15      (3)  Section 16 repealing section 321-15.61, Hawaii Revised
 
16           Statutes, relating to adult residential care homes
 
17           expanded admissions; and
 
18      (4)  Section 17 repealing section 321-15.62, Hawaii Revised
 
19           Statutes, relating to adult expanded residential care
 
20           homes licensing.
 
21 
 
22                              INTRODUCED BY:______________________