Report Title:

Long-Term Care; Caregiver Reimbursement

Description:

Creates demonstration project to reimburse at-home long-term family caregivers on Kauai from 2006 to 2009 to functionally dependent or cognitively impaired relatives. Appropriates $       for FY 2006-2007 and $       for FY 2008-2009. Requires DOH to report on project annually. Repealed on 6/30/2009.

HOUSE OF REPRESENTATIVES

H.B. NO.

248

TWENTY-THIRD LEGISLATURE, 2005

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to long-term care.

 

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

SECTION 1. The need for personal care due to physical, sensory, cognitive, and self-care disabilities increases with age. By 2020, more than one in four individuals will be sixty years of age or older. As Hawaii's population ages, a considerable number of families will be providing higher levels of long-term care to frail and disabled older adults at home.

The legislature finds that the care provided annually by family caregivers for free has an estimated value of approximately $196,000,000,000. On the other hand, formal home care services are estimated to cost about $32,000,000,000 annually, and nursing home services cost about $83,000,000,000. Most people who need long-term care prefer to receive assistance and services at home and to stay in their communities, near family and friends, for as long as possible. Family caregivers provide over eighty per cent of home care services and over ninety per cent of all long-term care services. At least seventy-five per cent of all family care is provided by women. About two-thirds of older people living in the community rely solely on informal help, mainly from wives and adult daughters.

Families are an important part of the solution to serious long-term care system problems such as budget and workforce shortages. Family caregivers can relieve state spending on nursing home care. During times of fiscal discipline, family caregiving can be a way to reduce costs without hurting the people the State is trying to serve.

The legislature further finds that many states have implemented or expanded programs to assist family caregivers in providing care to elderly and disabled individuals who require long-term care. As long-term care costs continue to rise, it is in the interest of the State to assist family caregivers who provide day-to-day, long-term care for their relatives in the home by keeping those who require such care off medicaid and out of costly institutional care.

SECTION 2. (a) There is established within the department of health, for administrative purposes, a demonstration project for Kauai county to provide reimbursement to family caregivers who give free and continuing day-to-day care in the home to a qualified relative who is a functionally dependent person or who is suffering from cognitive impairments.

(b) To be eligible for reimbursement, a family caregiver shall:

(1) Apply to the department of health for reimbursement on a one-page form to be designed by the department of health;

(2) Not operate any type of nonprofit or for-profit care service for disabled or elder individuals;

(3) Obtain certification from a physician licensed under chapter 453 or 460, Hawaii Revised Statutes, or an advanced practice registered nurse recognized under section 457-8.5, Hawaii Revised Statutes, certifying that the qualified relative suffers from dementia or requires assistance with three or more activities of daily living, as defined in section 346C-l, Hawaii Revised Statutes. The written certification shall specify that the qualified relative:

(A) Is unable to perform, without substantial assistance from another individual, at least three of six activities of daily living for a period of at least ninety days due to a loss of functional capacity; or

(B) Requires substantial supervision to protect the qualified relative from threats to health and safety to self or others due to severe cognitive impairment; and

(4) Complete a caregiver educational training course certified by the department of health.

(c) To be eligible for reimbursement, the person receiving care shall not be eligible for medicaid, but shall have an annual income of no more than two hundred per cent of the federal poverty level for Hawaii in the year in which an application for reimbursement is made.

(d) Reimbursement to a family caregiver may be used to offset:

(1) The general expense of providing at-home care provided in person by the family caregiver, but shall not be used to purchase care from, or offset the expense of employing, a professional care provider not related to the qualified relative; or

(2) Expenses incurred in obtaining home modifications or assistive devices, as approved by the department, such as grab bars, safety devices, and wheelchair ramps, which help the qualified relative to carry out tasks required for daily living;

but in no case shall exceed $1,000 annually. Under no circumstances shall reimbursement made under this section be considered an obligation to replace lost wages of the family caregiver.

(e) For federal and state tax purposes:

(1) Family caregivers shall not be considered a household employee; and

(2) Qualified relatives shall not be considered an employer for household workers.

(f) The department of health shall not be held liable for the care provided to the qualified relative by the family caregiver.

(g) The department of health shall develop a sliding scale for reimbursement to ensure that an eligible family caregiver whose household income exceeds two hundred per cent of the federal poverty level for Hawaii shall pay some portion of the caregiver's out-of-pocket expenses described in subsection (d)(2).

(h) The department shall adopt rules in accordance with chapter 91, Hawaii Revised Statutes, regarding operating procedures and guidelines to implement this section, including guidelines that address reimbursement:

(1) To more than one eligible family caregiver in the same household; and

(2) For the care of more than one qualified relative in the same household.

(i) As used in this section, unless the context requires otherwise:

"Family caregiver" means a person who provides free and continuing day-to-day care in the home for a qualified relative.

"Functionally dependent person" means an individual who is certified to require assistance with three or more activities of daily living, as defined in section 346C-l, Hawaii Revised Statutes, for the period of time during which the family caregiver provides at-home care.

"Qualified relative" means the family caregiver's spouse or any person related to the family caregiver or caregiver's spouse as a grandparent, parent, son, daughter, aunt, uncle, brother, sister, or first cousin.

SECTION 3. The department of health shall submit:

(1) A progress report of its findings no later than twenty days prior the convening of the regular sessions of 2006, 2007, 2008, and 2009; and

(2) A final report no later than twenty days prior to the convening of the regular session of 2010.

SECTION 4. 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 2005-2006, and the sum of $         , or so much thereof as may be necessary for fiscal year 2006-2007, for reimbursement to family caregivers who provide at-home care to qualified relatives in Kauai county.

The sums appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 5. This Act shall take effect on July 1, 2005, and shall be repealed on June 30, 2009.

INTRODUCED BY:

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