SB3255 HD2

SECTION 1. While virtually all of Hawaii's elders want to age‑in‑place at home rather than in a care home or institution, many elders will require a more intensive caregiving environment at the end of their lives. However, the costs of institutional care have escalated beyond the financial means of most elders. The State's portion of medicaid expenditures has increased steadily over the years and is projected to increase significantly as baby boomers begin to retire. As Hawaii's population ages, the number of frail and disabled individuals will also increase, placing a precipitous demand on the need for long-term care services.

The legislature finds that an array of services are necessary to meet the long-term care needs of Hawaii's elders. To make this possible, the following shall be the long-term care policy goals of the State of Hawaii:

(1) Creating a continuum of care, up to and including the end of life;

(2) Coordinating referral, case management, and service delivery through co-location and other means;

(3) Strengthening family caregiver support systems to encourage aging-in-place;

(4) Stimulating manpower development and training programs to expand the capacity of long-term care service providers;

(5) Developing financial mechanisms to help Hawaii's families meet the cost of long-term care;

(6) Seeking ways to create a better balance between public expenditures for institutional care and home- and community-based care;

(7) Fostering public understanding of caregiving issues; and

(8) Encouraging research and education on aging, long-term care, and related subjects through the University of Hawaii system.

The legislature further finds that it is necessary to develop new funding approaches for long-term care services, as well as services to assist elders to age‑in‑place to prevent the State from becoming fiscally liable for unsustainable costs under medicaid.

The purpose of this Act is to establish a long-term care commission to research what resources are necessary to meet state long-term care public policy goals and to recommend a program and funding mechanism that may provide long-term care services.

SECTION 2. (a) There is established a long-term care commission, which shall:

(1) Identify problems with current long-term care capacity, programs and services; and

(2) Develop a comprehensive plan that, when implemented, will ensure the availability of a full continuum of institutional and community-based services, including support for family caregivers. The commission shall also research public and private financing options and develop a second plan that details what financial resources, or mix of public and private financing, are necessary to address needed state long-term care reforms, as well as state public policy goals and services.

(b) The long-term care commission shall consist of:

(1) Five members appointed by the governor;

(2) Five members appointed by the president of the senate; and

(3) Five members appointed by the speaker of the house of representatives;

provided that all of the members shall be selected on the basis of their knowledge, interest, and experience in the following: research, policy development, and advocacy and service delivery relating to seniors or those with disabilities. Given the scope of the issues and activities to be considered by the commission, members shall also have expertise in business, economics, finance, and management, especially as they pertain to health care, long-term care, and social services. All of the members shall serve for two-year terms beginning on December 1, 2008, and ending on November 30, 2010.

(c) The commission shall elect from among its members a chairperson, who shall commence commission meetings, and a vice chairperson and shall adopt rules for the conduct of its work.

(d) The long-term care commission shall:

(1) Ensure that addressing the needs of the consumer is the paramount concern of policy development;

(2) Review available research, studies, and previously proposed programs relating to the financing and provision of a full continuum of long-term care services;

(3) Establish a set of policy goals and principles, to be proposed for enactment as statutory provisions, to guide the work of the long-term care commission and the development of policy related to long-term care financing and service delivery. In creating these policies and development of the plan to reform long-term care services, the commission shall include the following critical elements:

(A) Creating a full continuum of care infrastructure, including different forms of institutional, community-based, and home-care programs and services, up to and including the end of life;

(B) Ensuring that all consumers needing and using long-term care services of any kind can easily access such services;

(C) Providing consumers with timely access to comprehensive information, including information about cost and quality and about financing and service delivery options;

(D) Ensuring that health, long-term care, and social services are connected through the use of timely, standardized assessments, care planning, coordination, and case management. Special attention shall be given to pre-admission assessment and screening for those who need institutional services, smooth transitions between the current health and long-term care service systems, and between institutional services and the community- or home-care services;

(E) Improving the use of technology to enable the tracking of patients across various care settings;

(F) Strengthening informal family caregiver support systems to encourage aging-in-place;

(G) Stimulating manpower development and training programs to expand the capacity of long-term care service providers;

(H) Developing additional public and private financial mechanisms to help Hawaii's families and to conserve limited state resources to meet the costs of long-term care;

(I) Seeking ways to create a real balance between public expenditures for institutional care, care provided in community settings, as well as care in the home, based on the needs and preferences of those who use such services;

(J) Fostering public understanding of the risk of needing long-term care services, the cost of various levels and kinds of care, and caregiving issues; and

(K) Encouraging research and education on aging, long-term care, and related subjects through the University of Hawaii system;

(4) Prepare a five-year plan to accomplish the goals, including the recommendation of benchmarks to evaluate accomplishments for each year;

(5) Monitor federal legislation for changes that may impact the program and adjust the five-year plan accordingly;

(6) Collaborate with interested stakeholders, including community coalitions or organizations concerned with educating the public regarding long-term care; and

(7) Submit an interim report relating to the proposed system reforms, including the final public policy goals and principles, to the legislature no later than February 28, 2010, and a final report to the legislature no later than September 30, 2010. The final report shall include the final five-year plan, as well as how the reforms will be prioritized and phased in, and a description and final recommendations of how financing long-term care services can be achieved.

(e) The long-term care commission may:

(1) Conduct or initiate new studies as it deems necessary; and

(2) Contract with consultants to conduct the studies, including an actuarial study, as it deems necessary for the purpose of recommending any program to address long-term care financing issues. Any contract executed pursuant to this paragraph shall be exempt from chapter 103D, Hawaii Revised Statutes; provided that the long-term care commission shall endeavor to ensure transparency in the letting of the contract.

(f) The University of Hawaii at Manoa, college of social sciences public policy center, shall provide administrative support and staffing to facilitate the work of the long-term care commission.

SECTION 3. 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 2008-2009 for the long-term care commission to research what resources are necessary to provide a continuum of long-term care services for Hawaii's aging population and to recommend a program and funding mechanism that can provide these services pursuant to section 2 of this Act.

The sum appropriated shall be expended by the University of Hawaii to assist the long-term care commission for the purposes of this Act.

SECTION 4. This Act shall take effect on July 1, 2020, and shall be repealed on December 1, 2010; provided that section 3 of this Act shall take effect on July 1, 2020.

THE SENATE	S.B. NO.	3255
TWENTY-FOURTH LEGISLATURE, 2008		S.D. 2
STATE OF HAWAII		H.D. 2