HB2912

SECTION 1. The legislature finds that the department of health has adopted rules in accordance with chapter 91, Hawaii Revised Statutes, to regulate adult residential care homes. Under section 321‑15.62, Hawaii Revised Statutes, a type I expanded adult residential care home normally allows five or fewer residents, with no more than two nursing facility level residents, to live within a home; except that the department of health, at its discretion, may allow more nursing facility level residents. Up to six residents may be allowed to live in the home, at the department's discretion. Furthermore, the primary caregiver or home operator must be a certified nurse aide who has completed a state-approved training program and other training as required by the department of health.

Under section 321‑15.62(c), Hawaii Revised Statutes, the department may provide for the training of operators and staff and is required to adopt rules to ensure that operators of expanded adult residential care homes have the needed skills to provide proper care and supervision in a home environment. Section 11‑101‑8, Hawaii Administrative Rules, (department of health) requires each type I expanded adult residential care home to have a primary caregiver, who must be a nurse aide, to reside in the home. This rule also requires a substitute caregiver to be on the premises in the absence of the primary caregiver. Current rules do not now allow the primary caregiver to be a nonresident of the home.

The purpose of this Act is to allow a health care organization that employs staff who meet or exceed the primary caregiver requirements for type I expanded adult residential care homes to be licensed as an operator of a type I expanded adult residential care home; provided that the health care organization staffs the care home with a nonresident registered nurse to supervise and monitor on-site staff and to ensure compliance with applicable department of health rules.

SECTION 2. Section 321-15.62, Hawaii Revised Statutes, is amended to read as follows:

"§321-15.62 Expanded adult residential care homes; licensing. (a) All expanded adult residential care homes shall be licensed to ensure the health, safety, and welfare of the individuals placed therein.

(b) The director of health shall adopt rules regarding expanded adult residential care homes in accordance with chapter 91 that shall implement a social model of health care designed to:

(1) Protect the health, safety, civil rights, and rights of choice of residents in a nursing facility or in 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, a physician, advanced practice registered nurse, or registered nurse case manager 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 the following two categories of expanded adult residential care homes as licensed by the department of health:

(A) A type I home shall consist of five or fewer residents with no more than two nursing facility level residents; provided that more nursing facility level residents may be allowed at the discretion of the department; and provided further that up to six residents may be allowed at the discretion of the department to live in a type I home; provided that the primary caregiver or home operator is a certified nurse aide who has completed a state-approved training program and other training as required by the department; and

(B) A 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;

provided further that the department shall exercise its discretion for a resident presently residing in a type I or type II home, to allow the resident to remain as an additional nursing facility level resident based upon the best interests of the resident. The best interests of the resident shall be determined by the department after consultation with the resident, the resident's family, primary physician, case manager, primary caregiver, and home operator;

(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 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 shall establish a standard admission policy and procedure [~~which~~] that 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 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.

(f) A hospital and medical services association operating as a mutual benefit society under chapter 432 or a health maintenance organization operating under chapter 432D may be licensed as an operator of a type I expanded adult residential care home if the mutual benefit society or health maintenance organization employs:

(1) Permanent staff who meet or exceed the requirements of a licensed operator of a type I expanded adult residential care home; and

(2) A nonresident registered nurse to staff the care home as the primary caregiver, to supervise and monitor on-site staff, and to ensure compliance with all applicable department of health rules;

provided that the nonresident registered nurse shall not act as the primary caregiver for more than type I expanded adult residential care homes at the same time."

SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	2912
TWENTY-FOURTH LEGISLATURE, 2008
STATE OF HAWAII