Report Title:
Long-Term Care; Single Agency; Single Entry Point
Description:
Creates Hawaii long-term care agency to administer all long-term care services to elders. Creates single point entry system and continuum of services. Provides tax credit for LTC premiums. Transfers certain programs and staff from DOH, DHS, and EOA to the agency. Appropriation. Effective 7/1/03. (SD1)
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THE SENATE |
S.B. NO. |
1534 |
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TWENTY-FIRST LEGISLATURE, 2001 |
S.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to long-term care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that the future of long-term care for Hawaii's senior population is one of the most critical health issues facing Hawaii in the 21st century. The rapid growth of the elderly population will result in extraordinary demands on the delivery of long-term care services, which is currently fragmented and uncoordinated as documented in a study conducted by the legislative reference bureau in 1995, entitled Long-Term Care: A Single Entry Point for Three Populations.
Fragmentation of the long-term care services delivery system has come about mostly as a function of how legislation on the federal, state, and local levels has evolved historically. Many programs and agencies at the federal, state, and local levels fund some home care services, creating a highly fragmented financing and delivery system. At the federal level, funding for elderly home care services is available from Medicare, Medicaid, the social services block grant, the Department of Veterans Affairs, and the Older Americans Act. Each program has its own eligibility requirements, benefit coverage, regulations regarding provider participation, administrative structure, and service delivery mechanisms. The result is that it is difficult to coordinate a comprehensive set of long-term care services. More than eighty federal, state, and local government programs offer direct or indirect assistance to persons with long-term care needs. Help may be in the form of cash, in-kind assistance, or goods and services.
Unfortunately, the existence of multiple funding sources has resulted in the proliferation of different, often confusing and frustrating sets of eligibility requirements and program designs. In specific terms, some of the service and system difficulties can be described as follows:
(1) Service providers have developed and apply different service definitions and standards;
(2) There is irregular or little coordination of services among the majority of providers;
(3) Standardized service records and complete client information are not available on a statewide basis;
(4) Access to services is often limited due to geographical constraints, particularly on the neighbor islands and in the rural Oahu communities, and to the fact that many services are not widely advertised or located in such resources as the telephone book;
(5) Eligibility requirements vary by program and are inconsistent across the board;
(6) There is a lack of public awareness and understanding of long-term care services and programs; and
(7) Provision of services is often fragmented and adequate follow-up is lacking.
To overcome the problem of service fragmentation, the system of long-term care in Hawaii must be integrated. To carry out this integration, the legislature finds that it is in the interest of all the people of the State to place all long-term programs and services in the State for the elderly population under one agency.
The legislature further finds that there is a need to establish a single entry point system for persons who need long-term care services. A single entry point involves three components: uniform central access, uniform screening and assessments for multiple purposes, including eligibility and cost containment, and provision of appropriate services through case management. A single entry point is an inherently integrative process. However, it does not necessarily require all eligible individuals seeking care to enter through a single, physical, geographic location. A single entry point system could take advantage of a single local or regional agency with multiple locations statewide. Alternatively, the system could use multiple agencies, which can continue to provide their own respective services while participating in a single standardized and integrated entry process. This standardized process can be developed interactively and with the cooperation of all parties involved in the provision of long-term care. This system can then be administered and overseen by a single umbrella agency for long-term care.
Simply having all long-term programs under one departmental structure however, does not guarantee an integrated long-term care system in Hawaii. Part and parcel of this integrated single entry point system is the provision and deployment of a long-term care information and referral system that can serve to both educate the general public by raising awareness of long-term care issues and to assist in channeling potential consumers of long-term care to and through the single entry point system.
The purpose of this Act is to create a single agency to administer all long-term care programs and services for the elderly population in the State. It is a further purpose of this Act to create and implement a single entry point system and process, administered by the single long-term care agency, to integrate and facilitate entry and access to long-term care services in Hawaii for consumers needing long-term care.
SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:
"Chapter
LONG-TERM CARE
PART I. hAWAII LONG-TERM CARE SYSTEM
§ -1 Definitions. As used in the chapter, unless the context clearly requires otherwise,
"Activities of daily living" means at least the following: bathing, continence, dressing, eating, toileting, and transferring.
"Adult day care center" means a facility that offers a program for six or more individuals, of social and health-related services provided during the day in a community group setting for the purpose of supporting frail, impaired elderly, or other disabled adults who can benefit from care in a group setting outside the home.
"Adult residential care home" means any facility providing twenty-four-hour living accommodations, for a fee, to adults unrelated to the family, who require at least minimal assistance in the activities of daily living, personal care services, protection, and health care services, but who do not need the professional health services provided in an intermediate, skilled nursing, or acute care facility.
"Agency" means the Hawaii long-term care agency.
"Assisted living facility" means a type of housing in which health care services and personalized support services that are designed to respond to individual needs are provided to promote choice, responsibility, independence, privacy, dignity, and individuality.
"Director" means the director of human services.
"Expanded adult residential care home" means any facility providing twenty-four-hour living accommodations, for a fee, to adults unrelated to the family, who require at least minimal assistance in the activities of daily living, personal care services, protection, and health care services, and who may need the professional health services provided in an intermediate or skilled nursing facility.
"Hawaii long-term care system" or "system" means a statewide system that encompasses a continuum of long-term care services that are provided to individuals in the State, wherein an individual is eligible for services based on functional need rather than on the individual's categorical status as an elder.
"Home and community-based services" means a broad range of services, including personal care, homemaking, and chore services provided to address an individual's limitations in activities of daily living.
"Home care agency" means an agency licensed by the State to do business in Hawaii that provides home care services such as personal care, personal assistance, chore, homemaker, and nursing services in the individual's home.
"Long-term care facility" means any skilled nursing facility as defined in section 1861(j) of the Social Security Act, as amended, any intermediate care facility as defined in section 1905(c) of the Social Security Act, as amended, any nursing home as defined in section 1908(e) of the Social Security Act, as amended, and any other similar adult care facility licensed by the State serving elders.
"Manager" means the manager of the Hawaii long-term care agency.
"Respite care" means short-term care provided to meet the needs, ranging from simple to complex, of an elder in order to afford relief to the elder's usual family and other caregivers.
§ -2 Hawaii long-term care system. (a) Excluding services provided to persons with developmental disabilities and mental retardation pursuant to chapter 333F, which are provided under the auspices of the department of health, the Hawaii long-term care system shall comprise the continuum of long-term care services provided to elders in the State. Although persons with developmental disabilities and mental retardation may receive some similar services and may share some living arrangement facilities with elders, the department of health shall retain responsibility for the provision of services to persons with developmental disabilities and mental retardation. The Hawaii long-term care agency shall cooperate with the department of health in any matter involving long-term care services to persons with developmental disabilities and mental retardation.
(b) The Hawaii long-term care system shall encompass the following facilities and the long-term care services provided by these facilities:
(1) Long-term care facilities;
(2) Adult residential care homes and expanded adult residential care homes;
(3) Assisted living facilities;
(4) Adult day health centers;
(5) Adult day care centers; and
(6) Home care agencies.
(c) The Hawaii long-term care system for elders in the State shall be shall developed, coordinated, consolidated, integrated, and administered by the Hawaii long-term care agency.
§ -3 Continuum of services. The Hawaii long-term care system shall provide a comprehensive continuum of long-term care services that ranges from medically-based institutional services provided in more restrictive settings such as long-term care facilities, to services provided in less restrictive settings such as adult and expanded adult residential care homes, to services provided in least restrictive settings such as assisted living facilities and consumers' own homes in which nonmedical home and community-based services are provided based on the individual's assessed functional needs.
§ -4 Single entry point system; process; rules. (a) The agency shall develop and implement a single entry point system to enable potential consumers of the Hawaii long-term care system to access services in the system.
(b) The agency shall adopt rules pursuant to chapter 91 as provided under section -12(11) to implement this section. In general, the single entry point system and process shall broadly consist of the following:
(1) Use of a statewide information and referral system, to be designed by the agency, to which potential consumers may initiate contact and which will guide the potential consumer through the next step in the entry process. The information and referral system may include use of a single dedicated toll-free telephone line which potential consumers may call to seek advice or entry into the system. Potential consumers shall be screened for persons with developmental disabilities or mental retardation requesting assistance, who shall be referred to the department of health for appropriate services. Screened individuals who may enter the system shall be instructed on how to proceed with the entry process, which precise process shall be determined by the agency. The agency shall use multiple geographic intake sites of either a single agency or of multiple agencies in each county to which potential consumers or their representatives may visit to complete the entry process. The agency shall be responsible for training all personnel who staff the intake sites in carrying out the intake process in a standard and uniform manner. If the potential consumer is physically unable to go to a system intake site, the agency shall consider alternate methods of intake, including on-site visits to a potential consumer's current place of abode to conduct the intake process;
(2) Use of a uniform and standardized screening process to determine eligibility to receive services, potential consumers' resources for purposes of cost containment, and any other factors the agency deems appropriate for screening;
(3) After initial screening, if a potential consumer is deemed eligible, use a uniform and standardized assessment tool or tools to evaluate the individual's social and medical needs and functional abilities in terms of activities of daily living;
(4) Based on the assessment, informing the potential consumer of the results of the assessment within a reasonable period after the assessment, as determined by the agency by rule;
(5) If the potential consumer agrees to continue with the process, further evaluation of the assessment and the individual by an evaluation team to be comprised of individuals as determined by the agency by rule; provided that the team shall include persons with experience in the care of elders such as physicians, nurses, social workers, and physical and rehabilitation therapists;
(6) Within a reasonable time after the start of an evaluation, as determined by the agency by rule, the completion by the evaluation team of the evaluation and the provision of notice to the potential consumer of the team's recommendations;
(7) The design of an individualized service plan by the evaluation team together with the individual, comprising the appropriate service or cluster of services from the continuum of long-term care services to be provided under this chapter;
(8) Upon agreement by the consumer on the individualized service plan, the assignment by the evaluation team of a case manager to the consumer, who shall coordinate the delivery of the appropriate services and perform follow-up monitoring to ensure that the required services are provided to the consumer. Regardless of whether institutionalization is recommended by the evaluation team as part of the consumer's individualized service plan, the case manager shall specifically ensure that the consumer is made aware of all home and community-based options and services as an alternative to institutionalization; and
(9) After a period of time, to be determined by the agency by rule, review and update of the consumer's individualized service plan by the evaluation team, the case manager, and the consumer, for appropriateness in order to account for any changes in the consumer's condition or functional needs.
(c) The agency shall be responsible for the overall administration of the single entry point system. However, the agency may either provide agency personnel to directly administer the information and referral process, screening, assessment, and evaluation activities, and provide a case manager pursuant to subsection (b), or arrange or contract to have any or all of these activities to be provided by a third party or parties. Alternatively, the agency may partner or contract with a third party or parties in which various activities are shared while retaining overall agency responsibility for the system. In any case, the agency shall be responsible for the development of the single entry point system and process and the training of any personnel who is involved in carrying out the activities under subsection (b).
§ -5 Supplementary activities. To supplement the consolidated and integrated delivery of the continuum of services provided under this chapter, the agency shall also:
(1) Encourage and assist in the development of informal networks of caregivers by providing respite care, as determined appropriate and necessary by the agency, to assist family and friends to care for elders;
(2) Educate the general public and promote the public's acceptance of personal responsibility with regard to meeting their own long-term care needs through the purchase of private long-term care insurance;
(3) Advocate for the inclusion by carriers offering long-term care insurance to the public of home and community-based services options in their long-term care insurance policies in order to reduce the overall cost of long-term care and to provide consumers with a wider choice of long-term care services that can assist them to lead more independent lives in least restrictive settings;
(4) Seek to expand existing or create new Medicaid waiver programs, with the cooperation of the department of human services, that will enable nonmedicaid patients to participate in long-term care programs funded by Medicaid moneys. The agency shall consider options that require individuals not eligible for Medicaid to pay premiums or fees on a sliding scale basis to receive long-term care services, which may be on a managed care basis;
(5) Investigate the feasibility of implementing a prospective Medicaid payment system rather than a cost-based reimbursement system for long-term care services in order to promote cost containment; and
(6) Investigate methods and incentives to encourage nursing homes to convert from an institutional to alternative community settings.
PART II. HAWAII LONG-TERM CARE AGENCY
§ -11 Hawaii long-term care agency established. (a) There is established the Hawaii long-term care agency within the department of human services. The agency shall be headed by the manager of the Hawaii long-term care agency, who shall be appointed by the governor.
(b) The manager shall have:
(1) Professional training in the field of social work, education, public health, and other related fields;
(2) Extensive direct experience in programs or services related to elders; and
(3) Recent experience in a supervisory, consultative, or administrative position.
The manager shall be nominated and appointed by the governor without regard to chapters 76 and 89. Effective January 1, 2003, the salary of the manager shall be $ a year. The manager shall be included in any benefit program generally applicable to the officers and employees of the State.
§ -12 Powers and duties of the agency. The agency shall have the following powers and duties:
(1) Manage and oversee the Hawaii long-term care system;
(2) Develop a comprehensive continuum of long-term care services for elders in the State within the Hawaii long-term care system, ranging from nonmedical home and community-based services to medically-based institutional nursing home care;
(3) Consolidate and integrate the delivery of long-term care services in the continuum of services to elders in the State within the Hawaii long-term care system;
(4) Develop and implement a single entry point system, to which potential consumers are channeled via an information and referral system, that uses a uniform and standardized screening and assessment tool or tools to assist elder long-term care consumers to gain access to and receive appropriate services from the Hawaii long-term care system;
(5) Notwithstanding any other law to the contrary, have authority to apply for, receive, administer, and disburse any grants, donations, and any other funding from any federal, state, or county source or from any private source, intended to provide long-term care services for elders in the State, including funds made available by the department of human services pursuant to section -23;
(6) Serve as the principal agency in state government solely responsible for the consolidated and integrated delivery of the continuum of long-term care services to elders, and for the performance, development, and control of all programs, policies, and activities on behalf of elders;
(7) Oversee, supervise, and direct the performance by the manager, the manager's subordinates, and any contracted entities relating to the consolidated and integrated delivery of the continuum of long-term care services to elders, and relating to activities in such areas as planning, evaluation, and coordination of elder programs;
(8) Assess the policies and practices of other agencies impacting on elders and conduct advocacy efforts for elders;
(9) Develop new legislation, programs, and policy initiatives to implement this chapter;
(10) Establish a clearinghouse for complaints of persons regarding services to elders, or operations of state and county agencies affecting elders, and investigate any complaints and refer complaints and the manager's findings to the appropriate agency for corrective action;
(11) Adopt, amend, and repeal rules pursuant to chapter 91, exempt from the public notice, public hearing, and gubernatorial approval requirements of chapter 91, to implement this chapter;
(12) Employ and retain any staff that may be necessary for the purposes of this chapter, in conformity with chapters 76 and 89;
(13) Contract for or grant any services that may be necessary for the purposes of this chapter, including a master contract with other state agencies receiving federal and state funds for programs and services for elders, and purchase of service agreements with appropriate agencies; and
(14) Set license fees for and license the operation of skilled nursing facilities, intermediate care facilities, adult residential care homes, expanded adult residential care homes, assisted living facilities, home care agencies, adult day health centers, and adult day care centers in their provision of long-term care services to individuals in the State.
§ -13 Department of human services; Medicaid waiver funds for long-term care; programs. Any other law to the contrary notwithstanding, the department of human services shall transfer to the Hawaii long-term care agency all Medicaid waiver funding to which the department is entitled that is intended for Medicaid waiver programs to provide home and community-based long-term care services. The department of human services may continue to act as the principal agency under law to receive this funding but shall transfer all such funds and authority over the disposition of these funds to the agency for the provision of long-term care services under this chapter. The agency shall have authority over existing waiver programs transferred to the agency from the department of human services and may expand those programs. The agency, with the cooperation of the department of human services, may create new waiver programs as the agency deems appropriate.
§ -14 Policy advisory board for long-term care. (a) There shall be a policy advisory board for long-term care, appointed by the governor under section 26-34. The board shall advise the manager in, but not limited to, the following areas:
(1) The maintenance of a consolidated and integrated Hawaii long-term care system;
(2) The development and integrated delivery of a comprehensive continuum of long-term care services to elders in the State, including the development and implementation of a single entry point system and process; and
(3) The identification of relevant long-term care issues and solutions.
(b) The board shall consist of fourteen members as follows:
(1) Nine ex-officio members comprising the following or their designees:
(A) Director of health;
(B) Director of human services;
(C) Director of education;
(D) Director of labor and industrial relations;
(E) Director of transportation;
(F) President of the University of Hawaii;
(G) Director of the office of consumer protection;
(H) Chairperson of the board of trustees of the employees' retirement system;
(2) Four members, of whom at least three shall be age sixty-five or older, from each of the counties who shall have interest in or knowledge of problems relating to aging; and
(3) By invitation, the Hawaii representative of the United States Department of Health, Education and Welfare.
Members shall serve for four years except that of the initial non ex-officio members, one member shall be appointed for a term of four years, one member for a term of three years, one member for a term of two years, and one member for a term of one year. The members shall serve without compensation, but shall be paid their necessary expenses in attending meetings and carrying out the responsibilities of the board. The chairperson shall be elected annually from among the members in paragraph (2). There shall be not less than six meetings of the board each year.
§ -15 Administrative and program support. (a) The manager may create a planning and administrative services office within the agency, which shall:
(1) Prepare and submit, under the manager's direction, programs and budgets to provide the consolidated and integrated delivery of a continuum of long-term care services to elders in the State that employs a single entry point system and process;
(2) Assist the manager to prepare an annual evaluation report on the implementation of this chapter for the governor and the legislature;
(3) Prepare appropriate and necessary studies and analysis;
(4) Maintain personnel records;
(5) Manage contracts and agreements entered into by the agency with public and private vendors, consultants, and suppliers;
(6) Monitor the purchase of service agreements with public and private providers of services;
(7) Render technical assistance to elder program service providers; and
(8) Establish and maintain reimbursement systems for services provided by agreement with federal, state, and county agencies, and private groups.
(b) The manager may create a community assistance and program management branch, which shall:
(1) Research and develop appropriate necessary legislation under the direction of the manager;
(2) Conduct public affairs programs on elder affairs programs, projects, and needs, including:
(A) Developing, preparing, and disseminating user-friendly informational materials to inform consumers of their choices regarding various long-term care options ranging from institutionalization to home and community-based care; and
(B) Developing a program to foster personal responsibility and to educate individuals as to the benefits of purchasing private long-term care insurance;
(3) Develop and implement recreational and cultural programs for elder persons;
(4) Design consumer satisfaction surveys and collect responses from consumers of the Hawaii long-term care system and collect other outcomes data as the agency deems appropriate and necessary to ensure that consumers' needs are met;
(5) Provide technical assistance and liaison with community groups, organizations, and independent programs of benefit to elders;
(6) Develop and implement active programs of consumer protection and pre-retirement counseling;
(7) Establish a statewide information and referral system as part of the single entry point system and process; and
(8) Develop and manage federally funded programs and special projects under the Federal Older Americans Act and other federal sources.
§ -16 Interests of consumers of system; agency to represent. (a) The agency shall represent the interests of the following in the State individually and as a class, as consumers of the Hawaii long-term care system:
(1) Residents of long-term care facilities;
(2) Residents of adult residential care homes and expanded adult residential care homes;
(3) Residents of assisted living facilities;
(4) Residents in their own or others' homes other than those under paragraph (3) who receive home care services from a home care agency or other service provider;
(5) Individuals receiving services in adult day health centers; and
(6) Individuals receiving services in adult day care centers,
to promote improvement in the quality of care received and the quality of life experienced by the individuals enumerated above.
(b) With respect to the agency's responsibility in subsection (a), the agency shall:
(1) Perform its duties either directly or by other arrangement executed by the manager with any public or private nonprofit organization;
(2) Investigate and resolve complaints made by or on behalf of the individuals enumerated in subsection (a) relating to acts which may adversely affect their health, safety, welfare, and rights;
(3) Monitor the development and implementation of federal, state, and county laws, regulations, and policies affecting the facilities enumerated in subsection (a);
(4) Provide information as appropriate to public agencies regarding the problems of older persons residing in or receiving services in facilities enumerated in subsection (a);
(5) Train volunteers or employees to serve institutionalized elders and to promote the development of citizen organizations to participate in advocacy programs; and
(6) Establish procedures for appropriate access by the agency to facilities enumerated in subsection (b) including access to patient records or portions thereof necessary for the agency to evaluate the merits of a specific complaint; provided that patient records shall be divulged only with the written consent of the patient or the patient's legal representative.
§ -17 State master plan for long-term care. The agency shall be responsible for the continued development, implementation, and continuous updating of a comprehensive master plan for long-term care that shall include:
(1) The consolidation and integration of the delivery of a continuum of long-term care services to elders in the State within the Hawaii long-term care system;
(2) Development and implementation of a single entry point system using a single information and referral system and a uniform and standardized screening and assessment tool or tools to assist elder long-term care consumers to gain access to and receive appropriate services from the Hawaii long-term care system;
(3) Compilation of basic demographic data on elders in the State;
(4) Identification of the physical, sociological, psychological, and economic needs of elders in the State; and
(5) Organization of administrative and program structure, including the use of facilities and personnel.
The state master plan for elders shall be developed in accordance with the requirements of the executive budget act.
§ -18 Recognition as responsible state agency. The Hawaii long-term care agency shall be the single state agency responsible for programs affecting senior citizens of this State.
§ -19 Powers of other departments and agencies; cooperation with the Hawaii long-term care agency. It shall be the duty and responsibility of each department, agency, officer, and employee of the State and of the counties to cooperate with and assist the agency in the performance of its powers and duties when necessary and appropriate, including providing information as the agency deems necessary.
§ -20 County functions. Each county may establish a county office on aging and a county council on aging pursuant to the Older Americans Act of 1965, as amended.
§ -21 Annual senior citizen's fair. Each county may hold an annual senior citizen's fair in its respective county. The county shall be responsible for the planning, organizing, and coordinating of the fair in every respect. The state policy advisory board for elder affairs may assist the county in any aspect upon request. Proceeds earned from this fair shall be deemed to be proceeds earned from casual sales as defined in chapter 237. The county shall distribute any proceeds to the various senior citizen organizations and individuals who participate in the fair in accordance with appropriate methods of distribution as determined by the county.
§ -22 State policy for senior centers. The agency shall establish state policy for senior centers. This policy shall include, but not be limited to:
(1) Establishment of comprehensive long range and immediate goals and objectives pursuant to this chapter;
(2) Establishment of state standards for the operation and maintenance of senior centers, and for effective monitoring by the agency of senior centers;
(3) Establishment of priorities for program implementation and of alternatives for program implementation; and
(4) Delineation of the separate and mutual roles, responsibilities, and authority of the State and of the several counties regarding the development and administration of senior centers and senior center programs."
SECTION 3. Chapter 235, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
§235- Long-term care tax credit. (a) There shall be allowed to each taxpayer, subject to the taxes imposed by this chapter, whose adjusted gross income is less than $ a long-term care tax credit which shall apply to the taxpayer's net income tax liability, if any, imposed by this chapter for the taxable year in which the credit is properly claimed. The tax credit shall be an amount equal to per cent of the cost of any long-term care insurance premium payments made by the taxpayer for the taxable year in which the payments were made.
(b) For the purpose of this credit, the "net income tax liability" means net income tax liability reduced by all other credits allowed under this chapter.
(c) If the tax credit under this section exceeds the taxpayer's income tax liability, the excess of the tax credit over liability may be used as a credit against the taxpayer's income tax liability in subsequent years until exhausted. All claims, including any amended claims, for tax credits under this section shall be filed on or before the end of the twelfth month following the close of the taxable year for which the credit may be claimed. Failure to comply with the foregoing provision shall constitute a waiver of the right to claim the credit."
SECTION 4. Chapter 321, Hawaii Revised Statutes, is amended:
1. By amending section 321-11 to read:
"§321-11 Subjects of health rules, generally. The department pursuant to chapter 91 may adopt rules that it deems necessary for the public health and safety respecting:
(1) Nuisances, foul or noxious odors, gases, vapors, waters in which mosquitoes breed or may breed, sources of filth, and causes of sickness or disease, within the respective districts of the State, and on board any vessel;
(2) Adulteration and misbranding of food or drugs;
(3) Location, air space, ventilation, sanitation, drainage, sewage disposal, and other health conditions of buildings, courts, construction projects, excavations, pools, watercourses, areas, and alleys;
(4) Privy vaults and cesspools;
(5) Fish and fishing;
(6) Interments and dead bodies;
(7) Disinterments of dead human bodies, including the exposing, disturbing, or removing of these bodies from their place of burial, or the opening, removing, or disturbing after due interment of any receptacle, coffin, or container holding human remains or a dead human body or a part thereof and the issuance and terms of permits for the aforesaid disinterments of dead human bodies;
(8) Cemeteries and burying grounds;
(9) Laundries, and the laundering, sanitation, and sterilization of articles including linen and uniforms used by or in the following businesses and professions: barber shops, manicure shops, beauty parlors, electrology shops, restaurants, soda fountains, hotels, rooming and boarding houses, bakeries, butcher shops, public bathhouses, midwives, masseurs, and others in similar calling, public or private hospitals, and canneries and bottling works where foods or beverages are canned or bottled for public consumption or sale; provided that nothing in this chapter shall be construed as authorizing the prohibiting of laundering, sanitation, and sterilization by those conducting any of these businesses or professions where the laundering or sterilization is done in an efficient and sanitary manner;
(10) Hospitals, freestanding surgical outpatient facilities, [skilled nursing facilities, intermediate care facilities, adult residential care homes,] adult foster homes, [assisted living facilities,] special treatment facilities and programs, [home health agencies,] hospices, freestanding birthing facilities, [adult day health centers,] independent group residences, and therapeutic living programs, but excluding youth shelter facilities unless clinical treatment of mental, emotional, or physical disease or handicap is a part of the routine program or constitutes the main purpose of the facility, as defined in section 346-16 under "child care institution". For the purpose of this paragraph, "adult foster home" has the same meaning as provided in section 321-11.2;
(11) Hotels, rooming houses, lodging houses, apartment houses, tenements, and residences for persons with developmental disabilities including, but not limited to, those built under federal funding;
(12) Laboratories;
(13) Any place or building where noisome or noxious trades or manufacturers are carried on, or intended to be carried on;
(14) Milk;
(15) Poisons and hazardous substances, the latter term including but not limited to any substance or mixture of substances which:
(A) Is corrosive;
(B) Is an irritant;
(C) Is a strong sensitizer;
(D) Is inflammable; or
(E) Generates pressure through decomposition, heat, or other means,
if the substance or mixture of substances may cause substantial personal injury or substantial illness during or as a proximate result of any customary or reasonably foreseeable handling or use, including reasonably foreseeable ingestion by children;
(16) Pig and duck ranches;
(17) Places of business, industry, employment, and commerce, and the processes, materials, tools, machinery, and methods of work done therein; and places of public gathering, recreation, or entertainment;
(18) Any restaurant, theater, market, stand, shop, store, factory, building, wagon, vehicle, or place where any food, drug, or cosmetic is manufactured, compounded, processed, extracted, prepared, stored, distributed, sold, offered for sale, or offered for human consumption or use;
(19) Foods, drugs, and cosmetics, and the manufacture, compounding, processing, extracting, preparing, storing, selling, and offering for sale, consumption, or use of any food, drug, or cosmetic;
(20) Devices as defined in section 328-1;
(21) Sources of ionizing radiation;
(22) Medical examination, vaccination, revaccination, and immunization of school children. No child shall be subjected to medical examination, vaccination, revaccination, or immunization, whose parent or guardian objects in writing thereto on grounds that the requirements are not in accordance with the religious tenets of an established church of which the parent or guardian is a member or adherent, but no objection shall be recognized when, in the opinion of the department, there is danger of an epidemic from any communicable disease;
(23) Disinsectization of aircraft entering or within the State as may be necessary to prevent the introduction, transmission, or spread of disease or the introduction or spread of any insect or other vector of significance to health;
(24) Fumigation, including the process by which substances emit or liberate gases, fumes, or vapors which may be used for the destruction or control of insects, vermin, rodents, or other pests, which, in the opinion of the department, may be lethal, poisonous, noxious, or dangerous to human life;
(25) Ambulances and ambulance equipment;
(26) Development, review, approval, or disapproval of management plans submitted pursuant to the Asbestos Hazard Emergency Response Act of 1986, Public Law 99-519; and
(27) Development, review, approval, or disapproval of an accreditation program for specially trained persons pursuant to the Residential Lead-Based Paint Hazard Reduction Act of 1992, Public Law 102-550.
The department may require any certificates, permits, or licenses that it may deem necessary to adequately regulate the conditions or businesses referred to in this section."
2. By amending section 321-15.1, Hawaii Revised Statutes, to repeal the definition of "adult residential care home".
[""Adult residential care home" means any facility providing twenty-four-hour living accommodations, for a fee, to adults unrelated to the family, who require at least minimal assistance in the activities of daily living, personal care services, protection, and health care services, but who do not need the professional health services provided in an intermediate, skilled nursing, or acute care facility."]
3. By amending section 321-15.6, Hawaii Revised Statutes, to read:
"§321-15.6 Adult residential care homes; licensing. (a) All adult residential care homes shall be licensed by the Hawaii long-term care agency under section -12(14) to ensure the health, safety, and welfare of the individuals placed therein.
(b) The [director] Hawaii long-term care agency shall adopt rules regarding adult residential care homes in accordance with [chapter 91] section -12(11) which shall be designed to:
(1) Protect the health, safety, and civil rights of persons residing in facilities regulated;
(2) Provide for the licensing of adult residential care homes; provided that the rules shall allow group living in two categories of adult residential care homes [as licensed by the department of health]:
(A) Type I allowing group living by five or fewer unrelated persons; and
(B) Type II allowing six or more persons including but not limited to the mentally ill, elders, the handicapped, the developmentally disabled, or totally disabled persons who are not related to the home operator or facility staff.
For purposes of this section ,"mentally ill person" means a mentally ill person as defined under section 334-1. "Elder" means an elder as defined under sections 201G-1 and 201G-151. "Handicapped person" means an individual with a physical handicap as defined under section 515-2. "Developmentally disabled person" means a person with developmental disabilities as defined under section 333F-1. "Totally disabled person" means a person totally disabled as defined under section 235-1;
(3) Comply with applicable federal laws and regulations of Title XVI of the Social Security Act, as amended; and
(4) Provide penalties for the failure to comply with any rule.
(c) The [department] Hawaii long-term care agency may provide for the training of and consultations with operators and staff of any facility licensed under this section, in conjunction with any licensing thereof, and shall adopt rules in accordance with chapter 91 and subject to section -12(11) to ensure that adult residential care home operators shall have the needed skills to provide proper care and supervision in a home environment [as required under department rules].
(d) The [department] Hawaii long-term care agency shall establish a standard admission policy and procedure under the single entry point system and process under chapter which shall require the provision of information that includes the appropriate medical and personal history of the patient as well as the level of care needed by the patient prior to the patient's referral and admission to any adult residential care home facility. The [department] Hawaii long-term care agency shall develop appropriate forms and patient summaries for this purpose.
(e) The [department] Hawaii long-term care agency shall maintain an inventory of all licensed facilities [licensed under this section] and shall maintain a current inventory of vacancies therein to facilitate the placement of individuals in such facilities.
(f) The [department] Hawaii long-term care agency shall develop and adopt a social model of health care to ensure the health, safety, and welfare of individuals placed in adult residential care homes. The model of care shall be designed to protect the health, safety, civil rights, and rights of choice of the persons to reside in a nursing facility or in [home-] home or community-based care."
4. By amending section 321-15.61, Hawaii Revised Statutes, to read:
"[[]§321-15.61[]] Adult residential care homes expanded admissions. (a) Adult residential care homes may admit an individual who has been living immediately prior to admission in the individual's own home, a hospital, or other care setting, and who has been either:
(1) Admitted to a medicaid waiver program and determined by the [department of human services] Hawaii long-term care agency to require nursing facility level care to manage the individual's physical, mental, and social functions; or
(2) A private-paying individual certified by a physician or advanced practice registered nurse as needing a nursing facility level of care.
(b) The [department of health] Hawaii long-term care agency shall adopt rules in accordance with chapter 91 and subject to section -12(11) to expand admissions to adult residential care homes by level of care and to define and standardize these levels of care. The rules and standards shall provide for appropriate and adequate requirements for knowledge and training of adult residential care home operators and their employees."
5. By amending section 321-15.62, Hawaii Revised Statutes, to read:
"[[]§321-15.62[]] Expanded adult residential care homes; licensing. (a) All expanded adult residential care homes shall be licensed by the Hawaii long-term care agency to ensure the health, safety, and welfare of the individuals placed therein.
(b) The [director] Hawaii long-term care agency shall adopt rules regarding expanded adult residential care homes in accordance with chapter 91 and subject to section -12(11) which shall be a social model designed to:
(1) Protect the health, safety, civil rights, and [rights] right of choice of [the persons] a person to reside in a nursing facility or [in home-] to receive home or community-based care;
(2) Provide for the licensing of expanded adult residential care homes for persons who are certified by the [department of human services,] the Hawaii long-term care agency, a physician, advanced practice registered nurse, or registered nurse case manager who has no financial relationship with the home care operator or facility staff, as requiring skilled nursing facility level or intermediate care facility level of care [who have no financial relationship with the home care operator or facility staff]; provided that the rules shall allow group living in two categories of expanded adult residential care homes [as licensed by the department of health]:
(A) Type I home shall consist of five or [less] fewer residents with no more than two nursing facility level residents; and
(B) Type II home shall consist of six or more residents, with no more than twenty per cent of the home's licensed capacity as nursing facility level residents; provided that more nursing facility level residents may be allowed at the discretion of the [department] Hawaii long-term care agency.
(3) Comply with applicable federal laws and regulations of Title XVI of the Social Security Act, as amended; and
(4) Provide penalties for the failure to comply with any rule.
(c) The [department] Hawaii long-term care agency may provide for the training of and consultations with operators and staff of any facility licensed under this section, in conjunction with any licensing thereof, and shall adopt rules to ensure that expanded adult residential care home operators shall have the needed skills to provide proper care and supervision in a home environment [as required under department rules].
(d) The [department] Hawaii long-term care agency shall establish a standard admission policy and procedure under the single entry point system and process under chapter which shall require the provision of information that includes the appropriate medical and personal history of the patient as well as the level of care needed by the patient prior to the patient's referral and admission to any expanded adult residential care home facility. The [department] shall develop appropriate forms and patient summaries for this purpose.
(e) The [department] Hawaii long-term care agency shall maintain an inventory of all facilities licensed under this section and shall maintain a current inventory of vacancies therein to facilitate the placement of individuals in such facilities."
6. Amending section 321-22, Hawaii Revised Statutes, to read:
"[[]§321-22[]] [Long term] Long-term care service development fund established. There is established in the treasury of the State a special fund to be known as the [long term] long-term care service development fund, which shall be administered by the [executive office on aging] Hawaii long-term care agency to provide grants to promote the establishment, reorganization, or expansion of businesses and nonprofit corporations offering community-based [long term] long-term care services on a fee-for-service basis and to provide funding for training and business plan development, including, but not limited to, workshops assisting providers on the development of their business plans, assistance with applications for grants, business management training, and other types of training."
7. Amending section 321-91, Hawaii Revised Statutes, to read:
"§321-91 Program of home health services. The [department of health] Hawaii long-term care agency is authorized to establish and administer a program to provide home health services, pursuant to the provisions of Title XVIII of the Social Security Act. Home health services shall mean ancillary paramedical services rendered in the patient's home, and shall include, but not be limited to, professional nursing care, physiotherapy, occupational therapy, speech and hearing therapy, medical social services, and home health aide services. The authority of the [department] Hawaii long-term care agency hereunder shall be liberally construed in order that the State may receive the maximum benefits of said Title XVIII."
8. Amending section 321-92, Hawaii Revised Statutes, to read:
"§321-92 Fees for services. The [department of health] Hawaii long-term care agency is authorized to establish, charge, and collect reasonable fees for services rendered under the program set forth in section 321-91."
9. Amending subsections (b) and (c) of section 321-93, Hawaii Revised Statutes, to read:
"(b) The [department] Hawaii long-term care agency shall include in its budgetary request for each upcoming fiscal period, the amounts necessary to effectuate the purposes of this part.
(c) All moneys received by the [department] Hawaii long-term care agency from charges and fees for services rendered under this part shall be deposited to the credit of the state general fund."
SECTION 5. Chapter 346, Hawaii Revised Statutes, is amended by:
1. Amending subsection (a) of section 346-41, Hawaii Revised Statutes, to read:
"(a) The director of [the department of] health, [department] the director of human services [and], the attorney general [of the State], and the Hawaii long-term care agency shall have the right to inspect all institutions and organizations in the State, whether public or private, to which payments are made by the state medical assistance program, directly or indirectly, or on account of the board and maintenance of persons admitted or committed thereto[.]; provided that the Hawaii long-term care agency's right to inspection shall be limited to facilities enumerated in section -2(a) with regard to provision of services within the Hawaii long-term care system. The authorized representatives of the director [or], the attorney general, or the Hawaii long-term care agency shall have the right of visitation and immediate access for inspection during business hours as often as may be necessary, to those portions of the facilities used or reasonably related to the board, care or treatment of [such] these persons for the purpose of determining the conditions, circumstances and surroundings under which [such] these persons admitted or committed are lodged, boarded, cared for and maintained."
2. Amending subsection (c) of section 346-53, Hawaii Revised Statutes, to read:
"(c) The [director] Hawaii long-term care agency, pursuant to chapter 91, and subject to section -12(11), shall determine the rate of payment for domiciliary care provided to recipients eligible either for Federal Supplementary Security Income, or public assistance in accordance with state standards, or both. The director shall provide for level of care payment as follows:
(1) For those adult residential care homes classified as facility type I, the state supplemental payment shall not exceed $521.90; and
(2) For those adult residential care homes classified as facility type II, the state supplementary payment shall not exceed $629.90.
If the operator does not provide the quality of care consistent with the needs of the individual to the satisfaction of the department, the [department] Hawaii long-term care agency may remove the recipient to another facility.
The [department] Hawaii long-term care agency shall handle abusive practices under this section in accordance with [chapter 91] section -16(b).
Nothing in this subsection allows the [director] Hawaii long-term care agency to remove a recipient from an adult residential care home or other similar institution if the recipient does not desire to be removed and the operator is agreeable to the recipient remaining, except where the recipient requires a higher level of care than provided, or where the recipient no longer requires any domiciliary care."
3. Amending section 346-53.4, Hawaii Revised Statutes, to read:
" [[]§346-53.4[]] Reimbursement to expanded adult residential care home operators. Qualified expanded adult residential care home operators under section 321-15.62 who accept residents certified by the [department] Hawaii long-term care agency as requiring skilled nursing facility level care shall be reimbursed based on the severity of the resident's disability."
4. Amending subsection (a) of section 346-64.5, Hawaii Revised Statutes, to read:
"(a) An applicant for chore services shall be eligible when the applicant meets program requirements for chore services and income eligibility standards as established by the department of human services. The department shall delegate to the Hawaii long-term care agency the authority to provide chore services under this section. Income eligibility standards shall include individuals who have been found eligible for medical assistance under the department's Medicaid program."
SECTION 6. Chapter 346D, Hawaii Revised Statutes, is amended by:
1. Amending its title to read:
"CHAPTER 346D
[[]LONG-TERM CARE PROGRAMS
UNDER THE HAWAII LONG-TERM CARE AGENCY[]]
2. Amending section 346D-1, Hawaii Revised Statutes, to add two new definitions to be appropriately inserted and to read as follows:
""Hawaii long-term care agency" or "agency" means the Hawaii long-term care agency created in chapter .
"Hawaii long-term care system" or "system" means the statewide system created in chapter that encompasses a continuum of long-term care services that are provided to individuals in the State, wherein an individual is eligible for services based on functional need rather than on the individual's categorical status as an elder."
3. Amending section 346D-2, Hawaii Revised Statutes, to amend its title and subsection (a) to read as follows:
"§346D-2 Establishment of medicaid home and community-based waiver programs within the Hawaii long-term care system. (a) Waiver programs [shall be] established [and administered] by the department of human services to provide comprehensive home and community-based services for aged, chronically ill, disabled, developmentally disabled, and mentally retarded individuals, who are certified as requiring acute, skilled nursing, intermediate care facility, or intermediate care facility for the mentally retarded level of care[ ] shall be transferred to and shall be administered by the Hawaii long-term care agency within the Hawaii long-term care system created in chapter . The department of human services shall retain the authority to apply for and establish further waiver programs that provide home and community-based long-term care; provided that the department first obtains approval from the Hawaii long-term care agency. However, upon establishment, any such waiver programs, together with the appropriate funding if any, shall be transferred to and shall be administered by the Hawaii long-term care agency. The Hawaii long-term care agency and the department of human services shall jointly and actively work to expand the use of medicaid waiver programs to provide home and community-based long-term care to eligible persons in the State."
4. Amending section 346D-3, Hawaii Revised Statutes, to read:
"§346D-3 Determination of eligibility for participation in a waiver program. (a) To qualify for participation in a waiver program, individuals shall:
(1) Be determined by the [department of human services] Hawaii long-term care agency to be eligible for federally-funded medicaid assistance;
(2) Be certified by the [department of human services] Hawaii long-term care agency, through the preadmission screening process, as part of the single entry point system and process established in chapter , to be in need of acute, skilled nursing facility, intermediate care facility, or intermediate care facility for the mentally retarded level of care; and
(3) Choose to remain in the community with the provision of home and community-based waiver program services as an alternative to institutionalization.
(b) Individuals approved for a waiver program shall [have] be provided the following as part of the single entry point system and process established in chapter :
(1) Comprehensive assessment of their health, functional, social, and environmental needs;
(2) Written individualized service plan that addresses the necessary safeguards to protect the health and welfare of the individual, and that reflects the individual's freedom of choice of providers and services;
(3) Budget based on the services defined in the individualized service plan; and
(4) Periodic review of their health, functional, and financial status to ensure continued eligibility for waiver program services."
5. Amending section 346D-7, Hawaii Revised Statutes, to read:
"[[]§346D-7[]] Rules. The [department of human services] Hawaii long-term care agency shall adopt rules in accordance with chapter 91, [for the purpose of] but exempt from the public notice, public hearing, and gubernatorial approval requirements of chapter 91, to implement this chapter."
6. Amending section 346D-8, Hawaii Revised Statutes, to read:
"§346D-8 Personnel exempt. The [department of human services] Hawaii long-term care agency may employ civil service and non-civil service personnel to service the waiver programs. The personnel employed for the waiver programs may be exempt from chapters 76 and [77] 89, as deemed appropriate by the [department of human services] Hawaii long-term care agency."
SECTION 7. Section 346E-1, Hawaii Revised Statutes, is amended by amending the definition of "nursing facility" to read:
""Nursing facility" means a nursing facility licensed under [sections 321-9 and 321-11] section -12(14) and any intermediate care facility for the mentally retarded persons licensed under [sections 321-9 and 321-11] section -12(14)."
SECTION 8. Chapter 349, Hawaii Revised Statutes, is repealed.
SECTION 9. (a) Notwithstanding section 10 regarding the transfer of officers and employees, the governor shall appoint the following no later than July 1, 2002:
(1) The manager of the Hawaii long-term care agency pursuant to section -11(a), Hawaii Revised Statutes; and
(2) The members of the policy advisory board for long-term care pursuant to section -14(b), Hawaii Revised Statutes.
(b) The directors of human services, health, and the executive office on aging and their respective staffs, and the policy advisory board for elder affairs shall assist the manager of the Hawaii long-term care agency and the policy board for long-term care in all respects as requested by the manager of the Hawaii long-term care agency and the policy board for long-term care during the period of transition between their respective appointments and July 1, 2003, the effective date of chapter , Hawaii Revised Statutes.
SECTION 10. All rights, powers, functions, and duties of the department of health with respect to licensing and inspection of certain facilities, of the department of human services with respect to Medicaid waiver home and community-based programs, adult and expanded adult residential care payments, and chore services, and of the executive office on aging, are transferred to the Hawaii long-term care agency.
All officers and employees whose functions are transferred by this Act shall be transferred with their functions and shall continue to perform their regular duties upon their transfer, subject to the state personnel laws and this Act.
No officer or employee of the State having tenure shall suffer any loss of salary, seniority, prior service credit, vacation, sick leave, or other employee benefit or privilege as a consequence of this Act, and such officer or employee may be transferred or appointed to a civil service position without the necessity of examination; provided that the officer or employee possesses the minimum qualifications for the position to which transferred or appointed; and provided that subsequent changes in status may be made pursuant to applicable civil service and compensation laws.
An officer or employee of the State who does not have tenure and who may be transferred or appointed to a civil service position as a consequence of this Act shall become a civil service employee without the loss of salary, seniority, prior service credit, vacation, sick leave, or other employee benefits or privileges and without the necessity of examination; provided that such officer or employee possesses the minimum qualifications for the position to which transferred or appointed.
If an office or position held by an officer or employee having tenure is abolished, the officer or employee shall not thereby be separated from public employment, but shall remain in the employment of the State with the same pay and classification and shall be transferred to some other office or position for which the officer or employee is eligible under the personnel laws of the State as determined by the head of the department or the governor.
SECTION 11. All appropriations, funds, records, equipment, machines, files, supplies, contracts, books, papers, documents, maps, and other personal property heretofore made, used, acquired, or held by the department of health with respect to licensing and inspection of certain facilities, the department of human services with respect to Medicaid waiver home and community-based programs, adult and expanded adult residential care payments, and chore services, and the executive office on aging, relating to the functions transferred to the Hawaii long-term care agency shall be transferred with the functions to which they relate.
SECTION 12. There is appropriated out of the general revenues of the State of Hawaii the sum of $ , or so much thereof as may be necessary for fiscal year 2002-2003, for expenses, including salary expenses during the period of transition between the appointment of the manager of the Hawaii long-term care system and July 1, 2003.
The sum appropriated shall be expended by the department of human services.
SECTION 13. All rules, policies, procedures, guidelines, and other material adopted or developed by the department of health with respect to licensing and inspection of certain facilities, by the department of human services with respect to Medicaid waiver home and community-based programs, adult and expanded adult residential care payments, and chore services, and by the executive office on aging with respect to elder affairs, shall remain in full force and effect until amended or repealed by the Hawaii long-term care agency pursuant to chapter 91, Hawaii Revised Statutes. In the interim, every reference to the department of health with respect to licensing and inspection of certain facilities, to the department of human services with respect to medicaid waiver home and community-based programs, adult and expanded adult residential care payments, and chore services, and to the executive office on aging, in those rules, policies, procedures, guidelines, and other material is amended to refer to the Hawaii long-term care agency or the manager of the Hawaii long-term care agency, as appropriate.
SECTION 14. The legislative reference bureau shall prepare proposed conforming legislation to make necessary amendments to statutes affected by the repeal of chapter 349, Hawaii Revised Statutes. The legislative reference bureau shall transmit such proposed legislation to the legislature not later than twenty days prior to the convening of the regular session of 2003.
SECTION 15. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 16
. This Act shall take effect on July 1, 2003 except that:(1) Section 3, which provides for a tax credit, upon approval, shall apply to taxable years beginning after December 31, 2002;
(2) Section 8, which repeals chapter 349, Hawaii Revised Statutes, shall take effect on June 30, 2003;
(3) Section 9, which provides for the governor's appointments, shall take effect upon approval; and
(4) Section 12, which makes an appropriation, shall take effect on July 1, 2002.