Long-Term Residential Care

Establishes uniform assessment tool and information and referral
process; makes appropriation to the Executive Office on Aging to
implement statewide initial information and referral screening;
requires joint legislative committee on long-term care
subcommittee on residential care to report on study for adult
residential care facilities.   (SD2)

THE SENATE                              S.B. NO.           S.D. 2
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 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      The legislature further finds that there is no one, simple,
 9 uniform way for a person who needs long-term care to easily and
10 quickly access the appropriate care.  An information and referral
11 system would provide a simple and uniform, yet sophisticated and
12 comprehensive way to allow people easy access into the long-term
13 residential care system.
14      Act 339, Session Laws of Hawaii 1997, created a two-year
15 joint legislative committee on long-term care financing.
16 Subsequently, House Concurrent Resolution No. 225, H.D. 1,
17 S.D. 1, 1998, required the joint committee to create a
18 subcommittee to study long-term residential care facilities.
19      The recommendations of the subcommittee included:

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 1      (1)  Improving the regulatory environment to reduce
 2           fragmentation in the adult long-term residential care
 3           industry by consolidating and simplifying
 4           organizational categories of facilities, increasing
 5           uniformity of regulation across facility types, and
 6           promoting parity of provider reimbursement for similar
 7           services provided regardless of facility type;
 8      (2)  The use of a uniform assessment tool across facility
 9           types; and
10      (3)  The implementation of an information and referral
11           process for all adult long-term residential care
12           facilities in the State, which is being addressed by
13           the department of health by administrative rule.
14      Pursuant to Act 339, S.B. No. 856, 1999 Regular Session, was
15 introduced and was pending in conference committee.  Your
16 Committee believes that the provisions in S.B. No. 856, relating
17 to organizing the various residential care homes and facilities
18 into two categories of adult residential care facilities, has
19 merit and should be pursued by the department of health.
20      The purpose of this measure is to provide for an efficient,
21 streamlined, and accessible long-term care system.
22      SECTION 2.  Chapter 321, Hawaii Revised Statutes, is amended

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                                     S.B. NO.           S.D. 2

 1 by adding two new sections to be appropriately designated and to
 2 read as follows:
 3      "321-    Uniform assessment tool.  (a)  To implement the
 4 standard admission procedures, the department of health shall
 5 employ, as a uniform assessment tool, a scaled-down version of
 6 the Medicaid waiver program's social and health assessment forms
 7 for all licensed care homes regulated by the department.
 8      (b)  The department shall also employ the one-page form
 9 currently being used by the department termed "Level of Care
10 Evaluation", as updated from time to time, for all residential
11 care facilities regulated by the department to assure the correct
12 placement of only non-nursing facility level residents.
13      (c)  The data elements in the uniform assessment tool in
14 subsection (a) and the one-page tool in subsection (b) shall be
15 standardized to reduce the need to obtain identical data
16 subsequently, and to allow different providers to access and
17 share standard information, as necessary.  The data elements
18 shall be consistent with the two-page information and referral
19 screening form, administered at the time of entry, termed the
20 "Coordinated Screening Form", that is recommended for use in the
21 long-term care information and referral process under section
22 321-  .

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 1      (d)  The:
 2      (1)  Uniform assessment tool in subsection (a);
 3      (2)  One-page tool in subsection (b); and
 4      (3)  Two-page information and referral screening form in
 5           subsection (c) and the long-term information and
 6           referral process;
 7 are meant to be flexible tools to be modified as required from
 8 time to time without the need for further legislative amendment
 9 to this part.  Nothing in this section shall prevent any agency
10 or care provider regulated under this part from obtaining any
11 additional data, as necessary, to appropriately assess a resident
12 or potential resident or to plan for their care.
13      (e)  The purpose of the uniform assessment tool is to help
14 reduce system fragmentation, increase system efficiency and
15 effectiveness, enhance quality of care, and make the system more
16 consumer-friendly.
17      321-    Long-term care information and referral.  Subject
18 to legislative appropriations, the department of health shall
19 establish an information and referral process that shall serve
20 all potential clients of licensed care homes, namely, the
21 elderly, the non-elderly under age sixty, and disabled persons of
22 all ages.  The information and referral process shall include a

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 1 uniform initial information and referral screening using a tool
 2 to be developed by the executive office on aging."
 3      SECTION 3.  A study on reorganizing all adult residential
 4 care homes and facilities into a new "adult residential care
 5 facilities" category, for regulatory purposes, as contained in
 6 S.B. No. 856, H.D. 2, 1999 Regular Session, shall be conducted by
 7 the subcommittee on residential care of the joint legislative
 8 committee on long-term care, re-constituted as it was originally
 9 created under House Concurrent Resolution No. 225, Session Laws
10 of Hawaii 1998.  The study shall either recommend enactment of a
11 new adult residential care facilities model with two facility
12 categories and seven designated entities, or recommend an
13 alternative model with proposed legislation to reduce the
14 fragmentation, increase cost-effectiveness, and improve
15 operational effectiveness of residential care services.
16      For purposes of the study, the joint legislative committee
17 on long-term care, subcommittee on residential care, is
18 encouraged to solicit the input of organizations concerned with
19 long-term care and providers of long-term care, including
20 facilities, homes, and hospitals.
21      The joint legislative committee on long-term care,
22 subcommittee on residential care, shall report on its findings

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                                     S.B. NO.           S.D. 2

 1 and recommendations to the legislature no later than twenty days
 2 prior to the convening of the Regular Session of 2001.
 3      SECTION 4.  There is appropriated out of the general
 4 revenues of the State of Hawaii the sum of $          , or so
 5 much thereof as may be necessary for fiscal year 2000-2001, to be
 6 expended as follows:
 7      (1)  An augmentation of the executive office on aging's
 8           Aging Network to perform initial information and
 9           referral screening for all persons aged sixty and
10           older;
11      (2)  The executive office on aging to expand its screening
12           and referral program to coordinate the establishment
13           and operation of similar services to be provided by
14           ASK-2000, or other information and referral providers
15           as appropriate, for clients under age sixty.  The
16           development of this expansion shall begin in July,
17           2001, and full operation shall begin in July, 2002;
18      (3)  A subcontract by the executive office on aging with
19           ASK-2000, or other information and referral providers
20           to provide similar supplementary initial information
21           and referral screening for all potential clients under
22           age sixty.  The development of this supplementary

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 1           service shall begin in July, 2001, and full operation
 2           shall begin in July, 2002; and
 3      (4)  One-time startup costs and annual operating costs.
 4      SECTION 5.  The sum appropriated shall be expended by the
 5 department of health.
 6      SECTION 6.  New statutory material is underscored.
 7      SECTION 7.  This Act shall take effect upon its approval;
 8 provided that sections 4 and 5 shall take effect on July 1, 2000.