REPORT TITLE:
Long-Term Residential Care


DESCRIPTION:
Consolidates and provides for uniform regulation of various adult
residential care facilities and promotes parity of reimbursement
for services provided.  Establishes an information and referral
process through appropriations to the DOH to fund the executive
office on aging to implement a statewide initial information and
referral screening.  Requires use of a uniform assessment tool.
Effective 7/1/99.  (SD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        856
THE SENATE                              S.B. NO.           S.D. 1
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO LONG-TERM RESIDENTIAL CARE.



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

 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      Unfortunately, the organization and regulation of long-term
 
 9 residential care facilities in Hawaii are fragmented.  This tends
 
10 to reduce cost-effectiveness and hampers the operational
 
11 effectiveness of residential care services.  The lack of overall
 
12 direction and guidance at the state level is reflected in the
 
13 fragmented structure of state regulation for a plethora of
 
14 residential care category types in both the Hawaii Revised
 
15 Statutes and the Hawaii Administrative Rules.
 
16      The legislature further finds that there is a lack of
 
17 uniformity in the collection of patient data common across care
 
18 facility types that makes it difficult or impossible for long-
 
19 term care agencies and providers to share that data, when
 

 
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 1 necessary, to work for the benefit of the patient.  This lack of
 
 2 uniformity also imposes an unnecessary and wasteful redundancy of
 
 3 effort on both patients and providers.
 
 4      Finally, the legislature finds that there is no one, simple,
 
 5 uniform way for a person who needs long-term care to easily and
 
 6 quickly access the appropriate care.  An information and referral
 
 7 system can provide a simple and uniform, yet sophisticated and
 
 8 comprehensive way to allow people easy access into the long-term
 
 9 residential care system.
 
10      Act 339, Session Laws of Hawaii 1997, created a two-year
 
11 joint legislative committee on long-term care financing.
 
12 Subsequently, House Concurrent Resolution No. 225, H.D. 1,
 
13 S.D. 1, 1998, required the joint committee to create a
 
14 subcommittee to study long-term residential care facilities.  The
 
15 purpose of this Act is to implement the recommendations of the
 
16 subcommittee in the three areas discussed above regarding:
 
17      (1)  Improving the regulatory environment to reduce
 
18           fragmentation in the adult long-term residential care
 
19           industry by consolidating and simplifying
 
20           organizational categories of facilities, increasing
 
21           uniformity of regulation across facility types, and
 
22           promoting parity of provider reimbursement for similar
 
23           services provided regardless of facility type;
 

 
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 1      (2)  The use of a uniform assessment tool across facility
 
 2           types; and
 
 3      (3)  The implementation of an information and referral
 
 4           process for all adult long-term residential care
 
 5           facilities in the State.
 
 6      SECTION 2.  Chapter 321, Hawaii Revised Statutes, is amended
 
 7 by adding a new part to be appropriately designated and to read
 
 8 as follows:
 
 9           "PART    . ADULT RESIDENTIAL CARE FACILITIES
 
10      321-A Findings.  The legislature finds that adult
 
11 residential care facilities serve a significant role in the long-
 
12 term care of Hawaii's residents.  Compared to institutional
 
13 nursing home care, these facilities provide a less restrictive
 
14 and a more home-like environment while providing care at a much
 
15 lower cost.  Therefore, it is in the best interest of the people
 
16 of the State to maximize the use of adult residential care
 
17 facilities.
 
18      The purpose of this Act is to implement as state policy, a
 
19 rational and equitable consolidation, streamlining, and
 
20 reorganization of the adult residential care facilities in the
 
21 State in order to allow their collective operation as a unified
 
22 system rather than as fragmented care units, and to provide for
 
23 more uniform regulation in order to reduce inefficiency and
 

 
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 1 ineffectiveness in the fragmentation of service delivery, and to
 
 2 enhance ease of access to the system.
 
 3      321-B Definitions.  Whenever used in this part, unless the
 
 4 context requires otherwise:
 
 5      "Adult foster home for persons with developmental
 
 6 disabilities" means a private residential home providing care on
 
 7 a twenty-four-hour basis for adults with developmental
 
 8 disabilities, providing assistance to residents to increase or
 
 9 maintain their self-help and decision-making skills, and
 
10 promoting inclusion and self-determination.  To be certified, an
 
11 adult foster home for adults with developmental disabilities
 
12 shall have not more than two adults with developmental
 
13 disabilities at the same time, who are unrelated to the foster
 
14 family.
 
15      "Adult residential care home" means any facility providing
 
16 twenty-four-hour living accommodations, for a fee, to adults
 
17 unrelated to the family, who require at least minimal assistance
 
18 in the activities of daily living, personal care services,
 
19 protection, and health care services, but who do not need the
 
20 professional health services provided in an intermediate, skilled
 
21 nursing, or acute care facility.  A "type I adult residential
 
22 care home" means a group living facility consisting of five or
 
23 fewer unrelated persons.  A "type II adult residential care home"
 

 
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 1 means a group living facility consisting of six or more persons
 
 2 including, but not limited to, the mentally ill, as defined in
 
 3 section 334-1; elders, as defined under sections 201G-1 and
 
 4 201G-151; persons with a physical disability; the developmentally
 
 5 disabled, meaning persons with developmental disabilities as
 
 6 defined under section 333F-1; or totally disabled persons,
 
 7 meaning persons totally disabled as defined under section 235-1;
 
 8 who are not related to the home operator or facility staff.
 
 9      "Adult waiver foster family home" means a facility providing
 
10 twenty-four-hour living accommodations, including personal care
 
11 and homemaker services, for one or two adults unrelated to the
 
12 family living in the home, and who have been admitted to the
 
13 residential alternatives community care medicaid waiver program.
 
14      "Developmental disabilities domiciliary home" means a
 
15 private residential home for not more than five individual adults
 
16 with developmental disabilities or mental retardation who are
 
17 unable to live independently, who require twenty-four-hour
 
18 supervision or care, and who are not related to the home operator
 
19 or facility staff.  For the purposes of this definition,
 
20 "developmental disabilities" shall be as defined under section
 
21 333F-1; and "mental retardation" shall be as defined under
 
22 section 333F-1.
 
23      "Expanded adult foster home for persons with developmental
 

 
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 1 disabilities" means a private residential home providing care on
 
 2 a twenty-four-hour basis for not more than two adults with
 
 3 developmental disabilities who are unrelated to the foster
 
 4 family, with the primary caregiver qualified to provide care to
 
 5 residents who may require intermediate care facility for the
 
 6 mentally retarded level of care.
 
 7      "Expanded adult residential care home" means any facility
 
 8 providing twenty-four-hour living accommodations for a fee to
 
 9 adults unrelated to the home operator or facility staff, who
 
10 require at least minimal assistance in the activities of daily
 
11 living, personal care services, protection, and health care
 
12 services, and who may need the professional health services
 
13 provided in an intermediate or skilled nursing facility, with the
 
14 primary caregiver being qualified to provide care to nursing
 
15 facility level individuals who have been admitted to a medicaid
 
16 waiver program or to persons who pay for care from private funds
 
17 who have been certified as a nursing facility level resident.  A
 
18 "type I expanded adult residential care home" means a group
 
19 living facility consisting of five or fewer persons unrelated to
 
20 the operator or facility staff of the home, with no more than two
 
21 nursing facility level residents.  A "type II expanded adult
 
22 residential care home" means a group living facility consisting
 
23 of six or more persons unrelated to the operator or facility
 

 
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 1 staff, with no more than twenty per cent of the home's licensed
 
 2 capacity who are nursing facility level residents; provided that
 
 3 additional nursing facility level residents may be allowed at the
 
 4 discretion of the director of health.
 
 5      "Expanded developmental disabilities domiciliary home" means
 
 6 a private residential home for not more than five individual
 
 7 adults with developmental disabilities or mental retardation who
 
 8 are unable to live independently, who require twenty-four hour
 
 9 supervision or care, and who are unrelated to the family living
 
10 in the home, with the primary caregiver being qualified to
 
11 provide care to not more than two residents who may require
 
12 intermediate care facility for the mentally retarded level of
 
13 care.
 
14      321-C Adult residential care facilities; two facility
 
15 categories.  All adult residential care facilities in the State
 
16 shall be placed in one of the following two facility categories
 
17 as follows:
 
18      (1)  Basic residential care category ("basic category"):
 
19           (A)  Adult residential care homes, type I and type II;
 
20           (B)  Developmental disabilities domiciliary homes; and
 
21           (C)  Adult foster homes for persons with developmental
 
22                disabilities; and
 
23      (2)  Expanded nursing facility level residential care
 

 
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 1           category ("expanded category"):
 
 2           (A)  Expanded adult residential care homes, type I and
 
 3                type II;
 
 4           (B)  Developmental disabilities domiciliary homes;
 
 5           (C)  Adult foster homes for persons with developmental
 
 6                disabilities; and
 
 7           (E)  Adult waiver foster homes for the elderly.
 
 8      321-D  Social model.  The department shall develop and
 
 9 adopt a social model of health care with respect to the operation
 
10 of adult residential care facilities under this part to:
 
11      (1)  Ensure the health, safety, welfare, and civil rights of
 
12           individuals placed in all adult residential care
 
13           facilities regulated under this part;
 
14      (2)  Protect a person's right to choose an appropriate
 
15           setting;
 
16      (3)  Respect the facility provider's right to not accept a
 
17           potential resident based on the provider's good faith
 
18           belief that the provider is not qualified to provide
 
19           the required adequate or appropriate care;
 
20      (4)  Comply with applicable federal laws and regulations;
 
21           and
 
22      (5)  Provide penalties for the failure to comply with any
 
23           rule.
 

 
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 1      321-E Regulation by department; uniformity of application
 
 2 of rules; exceptions; licensing; rules.  (a)  All adult
 
 3 residential care facilities under this part shall be regulated
 
 4 uniformly by the department of health.
 
 5      (b)  The director shall adopt rules in accordance with
 
 6 chapter 91 to regulate all adult residential care facilities
 
 7 uniformly under this part, including licensing of facilities.
 
 8 Except for the exceptions contained in this part that require a
 
 9 provision of law or rule to apply only to a specific type of
 
10 facility or to care providers in a specific type of facility, in
 
11 any of the two facility categories under section 321-C, this part
 
12 and all rules adopted by the department shall apply uniformly to
 
13 all adult residential care facilities across the two facility
 
14 categories; provided that, at the discretion of the director, the
 
15 director may further adopt specific rules that apply only to the
 
16 facilities grouped within a facility category, if the director
 
17 determines that inherently different characteristics and needs
 
18 exist within a facility category which require separate rules
 
19 that would not appropriately apply to any other facility
 
20 category.  If the director adopts separate rules for a facility
 
21 category under this subsection, those rules shall apply uniformly
 
22 to all facilities within the affected facility category.
 
23      (c)  The department shall license all adult residential care
 

 
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 1 facilities under this part two years after the adoption of rules.
 
 2 The department shall adopt rules in accordance with chapter 91 to
 
 3 implement the purpose of this section.
 
 4      321-F Parity of reimbursement; state policy; comprehensive
 
 5 review of reimbursement rates.  (a)  It shall be the policy of
 
 6 the State, unless otherwise provided by law to the contrary, to
 
 7 reimburse equally, to the greatest extent practicable, operators
 
 8 of adult residential care facilities under this part, for the
 
 9 services they provide, based on the nature of the services
 
10 themselves and the patient's need for these services, without
 
11 regard to the facility category or the specific facility type, as
 
12 described in section 321-C, in which the services are delivered.
 
13      (b)  To provide the foundation upon which to base parity of
 
14 reimbursement, the department of human services, with the
 
15 assistance of the department of health and the adult residential
 
16 care industry, shall conduct a comprehensive review of all
 
17 services provided by all adult residential care facilities under
 
18 this part in order to determine existing rates of reimbursement
 
19 for these delivered services.  The department of human services
 
20 shall complete this review and report its findings to the
 
21 legislature and the director of health no later than October 30,
 
22 1999.
 
23      321-G Training.  The department may provide consultations
 

 
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 1 with and provide training and education for operators and staff
 
 2 of any facility licensed under this part, in conjunction with any
 
 3 licensing thereof, and shall adopt rules in accordance with
 
 4 chapter 91.
 
 5      321-H  Inventory.  The department shall maintain a current
 
 6 inventory of vacancies in all of the adult residential care
 
 7 facility categories licensed under this part.
 
 8      321-I Standard admission procedure; exception.  To the
 
 9 extent practicable, the department shall establish a standard
 
10 admission procedure for all adult residential care facilities
 
11 under this part; provided that, in the director's discretion, the
 
12 director may establish a separate admission procedure for the
 
13 facilities within a particular facility category, as described in
 
14 section 321-C.  If a separate admission procedure is established,
 
15 the procedure shall apply uniformly to all facility types within
 
16 that particular facility category.  The standard admission
 
17 procedure shall require the use of uniform data elements that
 
18 include the appropriate medical and personal history of the
 
19 patient as well as the level of care needed by the patient prior
 
20 to the patient's referral and admission to any adult residential
 
21 care facility.
 
22      321-J Uniform assessment tool.  (a)  To implement the
 
23 standard admission procedure under section 321-I, the department
 

 
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 1 shall employ, as a uniform assessment tool, the scaled-down
 
 2 version of the medicaid waiver program's social and health
 
 3 assessment forms, as fashioned by the joint legislative committee
 
 4 on long-term care created by Act 339, Session Laws of Hawaii
 
 5 1997, as updated from time to time, for all residential care
 
 6 facilities other than basic category adult residential care
 
 7 homes.  The purpose of the uniform assessment tool is to help
 
 8 reduce system fragmentation, increase system efficiency and
 
 9 effectiveness, enhance quality of care, and to make the system
 
10 more consumer-friendly.
 
11      (b)  The department shall also employ the one-page form
 
12 currently being used by the department termed "Level of Care
 
13 Evaluation", as updated from time to time, for all basic category
 
14 adult residential care homes to assure the correct placement of
 
15 only non-nursing facility level residents.
 
16      (c)  The data elements in the uniform assessment tool in
 
17 subsection (a) and the one-page tool in subsection (b) shall be
 
18 standardized to reduce the need to obtain identical data
 
19 subsequently, and to allow different providers to access and
 
20 share standard information, as necessary.  The data elements
 
21 shall be consistent with the two-page information and referral
 
22 screening form, administered at the time of entry, termed the
 
23 "Coordinated Screening Form", that is recommended for use in the
 

 
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 1 information and referral process under section 321-K.
 
 2      (d)  The:
 
 3      (1)  Uniform assessment tool in subsection (a);
 
 4      (2)  One-page tool in subsection (b); and
 
 5      (3)  Two-page information and referral screening form in
 
 6           subsection (c) and section 321-K;
 
 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 part shall prevent any agency or
 
10 care provider regulated under this part from obtaining any
 
11 additional data, as necessary, in order to appropriately assess a
 
12 resident or potential resident or to plan for their care.
 
13      321-K Long-term care information and referral.  (a)  The
 
14 legislature finds that many individuals who potentially require
 
15 long-term residential care may not be able to adequately
 
16 articulate their needs nor be able to successfully search out and
 
17 navigate the existing fragmented system of residential care in
 
18 Hawaii which, at times, admittedly confuses even those in the
 
19 residential care industry.  What is needed is a simple, quick,
 
20 uniform, professional, consumer-friendly, and accurate process
 
21 for individuals to access the residential care system in the form
 
22 of an information and referral process that provides information
 
23 and referral screening for potential clients of long-term
 

 
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 1 residential care.
 
 2      (b)  Subject to legislative appropriations, the department
 
 3 shall establish an information and referral process that shall
 
 4 serve all potential clients of adult residential care facilities
 
 5 under this part, namely, the elderly, the non-elderly under age
 
 6 sixty, and disabled persons of all ages.  The information and
 
 7 referral process shall include the conduct of a uniform initial
 
 8 information and referral screening using the tool as developed by
 
 9 the single entry point coordinating committee, December, 1996.
 
10      321-L Authority for licensure.  (a)  The department shall
 
11 adopt rules in accordance with chapter 91 to license adult foster
 
12 homes for persons with developmental disabilities, adult
 
13 residential care homes, adult waiver foster family homes,
 
14 developmental disabilities domiciliary homes, expanded adult
 
15 foster homes for persons with developmental disabilities,
 
16 expanded adult residential care homes, and expanded developmental
 
17 disabilities domiciliary homes.
 
18      (b)  In adopting rules for developmental disabilities
 
19 domiciliary homes, the department shall include the following in
 
20 the rules:
 
21      (1)  Criteria for licensure, including inspections,
 
22           registration, fees, qualifications of operators and
 
23           staff, and other factors necessary to ensure the safe
 

 
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 1           and appropriate operation of each home;
 
 2      (2)  Plans for care, which shall include community
 
 3           integration and training of residents of homes; and
 
 4      (3)  Criteria for the mandatory training of operators and
 
 5           staff of any home licensed under this subsection.
 
 6      (c)  In adopting rules for adult foster homes for persons
 
 7 with developmental disabilities, the department shall include the
 
 8 following in the rules:
 
 9      (1)  Criteria for licensure, including inspections,
 
10           registration, fees, qualifications of operators and
 
11           staff, and other factors necessary to ensure the safe
 
12           and appropriate operation of each home;
 
13      (2)  Plans for care, which shall include community
 
14           integration and training of residents of homes;
 
15      (3)  Allow one or more children who have developmental
 
16           disabilities, as defined in sections 333E-2 and 333F-1,
 
17           who stay in a foster boarding home certified under
 
18           section 346-17, to continue to live in that foster
 
19           boarding home when the child reaches age eighteen, if
 
20           the home becomes certified as an adult foster home for
 
21           persons with developmental disabilities by the time the
 
22           child reaches age eighteen; provided that the director
 
23           may waive the two adult limit for licensure of that
 

 
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 1           home as an adult foster home for persons with
 
 2           developmental disabilities; provided further that the
 
 3           number of foster children and adults in that home shall
 
 4           not exceed five; provided further that no adults shall
 
 5           be admitted into that home while foster children are
 
 6           still residing in the home as adults; and
 
 7      (4)  Criteria for the mandatory training of operators and
 
 8           staff of any home licensed under this subsection."
 
 9      SECTION 3.  Section 46-15.3, Hawaii Revised Statutes, is
 
10 amended to read as follows:
 
11      "[[]46-15.3[]]  Regulation of adult [family boarding home
 
12 and care home.] residential care facilities.  (a)  For the
 
13 purpose of regulation under a county's life safety code, building
 
14 code, fire code, or any other ordinance of similar purpose, a
 
15 licensed adult [family boarding home or licensed care home]
 
16 residential care facility which provides living accommodations
 
17 for:
 
18      (1)  The operator of the home and operator's family; and
 
19      (2)  Up to five other persons, not more than two of whom are
 
20           incapable of self-preservation because of age or
 
21           physical or mental limitations;
 
22 shall be deemed a single-family dwelling occupied by a family.
 
23      (b)  For the purpose of this section:
 

 
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 1      "Adult residential care facility" means any of the entities
 
 2 defined under section 321-B.
 
 3      "Building code" means an ordinance the purpose of which is
 
 4 to provide minimum standards to safeguard life or limb, health,
 
 5 property, and public welfare by regulating and controlling the
 
 6 design, construction, quality of materials, use and occupancy,
 
 7 location, and maintenance of all buildings and structures within
 
 8 the county's jurisdiction and certain equipment specifically
 
 9 regulated by the ordinance.
 
10      "Fire code" means an ordinance adopted under section 132-3
 
11 or an ordinance intended to prescribe regulations consistent with
 
12 recognized good practice for the safeguarding to a reasonable
 
13 degree of life and property from the hazards of fire and
 
14 explosion arising from the storage, handling, and use of
 
15 hazardous substances, materials, and devices and from conditions
 
16 hazardous to life or property in the use or occupancy of
 
17 buildings or premises.
 
18      ["Licensed adult family boarding home" means an adult family
 
19 boarding home licensed under chapter 346, part IV.
 
20      "Licensed care home" means a care home licensed under
 
21 section 321-15.6.]
 
22      "Life safety code" means an ordinance the purpose of which
 
23 is to establish minimum requirements that will provide a
 

 
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 1 reasonable degree of safety from fire in buildings and
 
 2 structures."
 
 3      SECTION 4.  Section 321-11, Hawaii Revised Statutes, is
 
 4 amended to read as follows:
 
 5      "321-11  Subjects of health rules, generally.  The
 
 6 department pursuant to chapter 91 may adopt rules that it deems
 
 7 necessary for the public health and safety respecting:
 
 8      (1)  Nuisances, foul or noxious odors, gases, vapors, waters
 
 9           in which mosquitoes breed or may breed, sources of
 
10           filth, and causes of sickness or disease, within the
 
11           respective districts of the State, and on board any
 
12           vessel;
 
13      (2)  Adulteration and misbranding of food or drugs;
 
14      (3)  Location, air space, ventilation, sanitation, drainage,
 
15           sewage disposal, and other health conditions of
 
16           buildings, courts, construction projects, excavations,
 
17           pools, watercourses, areas, and alleys;
 
18      (4)  Privy vaults and cesspools;
 
19      (5)  Fish and fishing;
 
20      (6)  Interments and dead bodies;
 
21      (7)  Disinterments of dead human bodies, including the
 
22           exposing, disturbing, or removing of these bodies from
 
23           their place of burial, or the opening, removing, or
 

 
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 1           disturbing after due interment of any receptacle,
 
 2           coffin, or container holding human remains or a dead
 
 3           human body or a part thereof and the issuance and terms
 
 4           of permits for the aforesaid disinterments of dead
 
 5           human bodies;
 
 6      (8)  Cemeteries and burying grounds;
 
 7      (9)  Laundries, and the laundering, sanitation, and
 
 8           sterilization of articles including linen and uniforms
 
 9           used by or in the following businesses and professions:
 
10           barber shops, manicure shops, beauty parlors,
 
11           electrology shops, restaurants, soda fountains, hotels,
 
12           rooming and boarding houses, bakeries, butcher shops,
 
13           public bathhouses, midwives, masseurs, and others in
 
14           similar calling, public or private hospitals, and
 
15           canneries and bottling works where foods or beverages
 
16           are canned or bottled for public consumption or sale;
 
17           provided that nothing in this chapter shall be
 
18           construed as authorizing the prohibiting of laundering,
 
19           sanitation, and sterilization by those conducting any
 
20           of these businesses or professions where the laundering
 
21           or sterilization is done in an efficient and sanitary
 
22           manner;
 
23     (10)  Hospitals, freestanding surgical outpatient facilities,
 

 
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 1           skilled nursing facilities, intermediate care
 
 2           facilities, adult residential care [homes, adult foster
 
 3           homes,] facilities under part    , assisted living
 
 4           facilities, special treatment facilities and programs,
 
 5           home health agencies, hospices, freestanding birthing
 
 6           facilities, adult day health centers, [independent
 
 7           group residences,] and therapeutic living programs, but
 
 8           excluding youth shelter facilities unless clinical
 
 9           treatment of mental, emotional, or physical disease or
 
10           handicap is a part of the routine program or
 
11           constitutes the main purpose of the facility, as
 
12           defined in section 346-16 under "child [care] caring
 
13           institution".  [For the purpose of this paragraph,
 
14           "adult foster home" has the same meaning as provided in
 
15           section 321-11.2];
 
16     (11)  Hotels, rooming houses, lodging houses, apartment
 
17           houses, and tenements[, and residences for persons with
 
18           developmental disabilities including, but not limited
 
19           to, those built under federal funding];
 
20     (12)  Laboratories;
 
21     (13)  Any place or building where noisome or noxious trades
 
22           or manufacturers are carried on, or intended to be
 
23           carried on;
 

 
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 1     (14)  Milk;
 
 2     (15)  Poisons and hazardous substances, the latter term
 
 3           including but not limited to any substance or mixture
 
 4           of substances which:
 
 5           (A)  Is corrosive;
 
 6           (B)  Is an irritant;
 
 7           (C)  Is a strong sensitizer;
 
 8           (D)  Is inflammable; or
 
 9           (E)  Generates pressure through decomposition, heat, or
 
10                other means,
 
11           if the substance or mixture of substances may cause
 
12           substantial personal injury or substantial illness
 
13           during or as a proximate result of any customary or
 
14           reasonably foreseeable handling or use, including
 
15           reasonably foreseeable ingestion by children;
 
16     (16)  Pig and duck ranches;
 
17     (17)  Places of business, industry, employment, and commerce,
 
18           and the processes, materials, tools, machinery, and
 
19           methods of work done therein; and places of public
 
20           gathering, recreation, or entertainment;
 
21     (18)  Any restaurant, theater, market, stand, shop, store,
 
22           factory, building, wagon, vehicle, or place where any
 
23           food, drug, or cosmetic is manufactured, compounded,
 

 
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 1           processed, extracted, prepared, stored, distributed,
 
 2           sold, offered for sale, or offered for human
 
 3           consumption or use;
 
 4     (19)  Foods, drugs, and cosmetics, and the manufacture,
 
 5           compounding, processing, extracting, preparing,
 
 6           storing, selling, and offering for sale, consumption,
 
 7           or use of any food, drug, or cosmetic;
 
 8     (20)  Devices as defined in section 328-1;
 
 9     (21)  Sources of ionizing radiation;
 
10     (22)  Medical examination, vaccination, revaccination, and
 
11           immunization of school children.  No child shall be
 
12           subjected to medical examination, vaccination,
 
13           revaccination, or immunization, whose parent or
 
14           guardian objects in writing thereto on grounds that the
 
15           requirements are not in accordance with the religious
 
16           tenets of an established church of which the parent or
 
17           guardian is a member or adherent, but no objection
 
18           shall be recognized when, in the opinion of the
 
19           department, there is danger of an epidemic from any
 
20           communicable disease;
 
21     (23)  Disinsectization of aircraft entering or within the
 
22           State as may be necessary to prevent the introduction,
 
23           transmission, or spread of disease or the introduction
 

 
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 1           or spread of any insect or other vector of significance
 
 2           to health;
 
 3     (24)  Fumigation, including the process by which substances
 
 4           emit or liberate gases, fumes, or vapors which may be
 
 5           used for the destruction or control of insects, vermin,
 
 6           rodents, or other pests, which, in the opinion of the
 
 7           department, may be lethal, poisonous, noxious, or
 
 8           dangerous to human life;
 
 9     (25)  Ambulances and ambulance equipment;
 
10     (26)  Development, review, approval, or disapproval of
 
11           management plans submitted pursuant to the Asbestos
 
12           Hazard Emergency Response Act of 1986, Public Law
 
13           99-519; and
 
14     (27)  Development, review, approval, or disapproval of an
 
15           accreditation program for specially trained persons
 
16           pursuant to the Residential Lead-Based Paint Hazard
 
17           Reduction Act of 1992, Public Law 102-550.
 
18      The department may require any certificates, permits, or
 
19 licenses that it may deem necessary to adequately regulate the
 
20 conditions or businesses referred to in this section."
 
21      SECTION 5.  Section 321-15.1, Hawaii Revised Statutes, is
 
22 amended as follows:
 
23      1.  By repealing the definition of "adult residential care
 

 
Page 24                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 home".
 
 2      [""Adult residential care home" means any facility providing
 
 3 twenty-four-hour living accommodations, for a fee, to adults
 
 4 unrelated to the family, who require at least minimal assistance
 
 5 in the activities of daily living, personal care services,
 
 6 protection, and health care services, but who do not need the
 
 7 professional health services provided in an intermediate, skilled
 
 8 nursing, or acute care facility."]
 
 9      2.  By repealing the definition of "expanded adult
 
10 residential care home".
 
11      [""Expanded adult residential care home" means any facility
 
12 providing twenty-four-hour living accommodations, for a fee, to
 
13 adults unrelated to the family, who require at least minimal
 
14 assistance in the activities of daily living, personal care
 
15 services, protection, and health care services, and who may need
 
16 the professional health services provided in an intermediate or
 
17 skilled nursing facility."]
 
18      SECTION 6.  Section 321-15.7, Hawaii Revised Statutes, is
 
19 amended to read as follows:
 
20      "321-15.7  Penalty.  Any person who intentionally operates
 
21 an adult residential care [home] facility or hospice without a
 
22 license shall be guilty of a misdemeanor."
 
23      SECTION 7.  Section 323D-2, Hawaii Revised Statutes, is
 

 
Page 25                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 amended by amending the definition of "extended care adult
 
 2 residential care home" to read as follows:
 
 3      ""[Extended care] Expanded adult residential care home"
 
 4 means [an adult residential care home] any facility providing
 
 5 twenty-four-hour living [accommodation] accommodations for a
 
 6 fee[, for] to adults unrelated to the [licensee.] operator or
 
 7 facility staff of the home, who require at least minimal
 
 8 assistance in the activities of daily living, personal care
 
 9 services, protection, and health care services, and who may need
 
10 the professional health services provided in an intermediate or
 
11 skilled nursing facility.  The primary caregiver shall be
 
12 qualified to provide care to nursing facility level individuals
 
13 who have been admitted to a medicaid waiver program, or persons
 
14 who pay for care from private funds and have been certified [for
 
15 this type of facility.  There shall be two categories of extended
 
16 care adult residential care homes, which shall be licensed in
 
17 accordance with rules adopted by the department of health:
 
18      (1)  Type I home" shall consist] as a nursing facility level
 
19           resident.  A "type I expanded adult residential care
 
20           home" means a group living facility consisting of five
 
21           or [less unrelated] fewer persons unrelated to the
 
22           operator or facility staff of the home, with no more
 
23           than two [extended care adult residential care home]
 

 
Page 26                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           nursing facility level residents[; and
 
 2      (2)  Type II home" shall consist].  A "type II expanded
 
 3           adult residential care home" means a group living
 
 4           facility consisting of six or more [unrelated persons
 
 5           and one or more persons may be extended care adult
 
 6           residential care home residents.] persons unrelated to
 
 7           the operator or facility staff of the home, with no
 
 8           more than twenty per cent of the home's licensed
 
 9           capacity who are nursing facility level residents;
 
10           provided that the director, at the director's
 
11           discretion, may allow additional nursing facility level
 
12           residents."
 
13      SECTION 8.  Section 323D-54, Hawaii Revised Statutes, is
 
14 amended to read as follows:
 
15      "323D-54  Exemptions from certificate of need requirements.
 
16 Nothing in this part or rules with respect to the requirement for
 
17 certificates of need applies to:
 
18      (1)  Offices of physicians, dentists, or other practitioners
 
19           of the healing arts in private practice as
 
20           distinguished from organized ambulatory health care
 
21           facilities, except in any case of purchase or
 
22           acquisition of equipment attendant to the delivery of
 
23           health care service and the instruction or supervision
 

 
Page 27                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           for any private office or clinic involving a total
 
 2           expenditure in excess of the expenditure minimum;
 
 3      (2)  Laboratories, [as defined in section 321-11(12),]
 
 4           except in any case of purchase or acquisition of
 
 5           equipment attendant to the delivery of health care
 
 6           service and the instruction or supervision for any
 
 7           laboratory involving a total expenditure in excess of
 
 8           the expenditure minimum;
 
 9      (3)  Dispensaries and first aid stations located within
 
10           business or industrial establishments and maintained
 
11           solely for the use of employees; provided such
 
12           facilities do not regularly provide inpatient or
 
13           resident beds for patients or employees on a daily
 
14           twenty-four-hour basis;
 
15      (4)  Dispensaries or infirmaries in correctional or
 
16           educational facilities;
 
17      (5)  Dwelling establishments, such as hotels, motels, and
 
18           rooming or boarding houses that do not regularly
 
19           provide health care facilities or health care services;
 
20      (6)  Any home or institution conducted only for those who,
 
21           pursuant to the teachings, faith, or belief of any
 
22           group, depend for healing upon prayer or other
 
23           spiritual means;
 

 
Page 28                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1      (7)  Dental clinics;
 
 2      (8)  Nonpatient areas of care facilities such as parking
 
 3           garages and administrative offices;
 
 4      (9)  Bed changes that involve ten per cent or ten beds of
 
 5           existing licensed bed types, whichever is less, of a
 
 6           facility's total existing licensed beds within a two-
 
 7           year period;
 
 8     (10)  Projects that are wholly dedicated to meeting the
 
 9           State's obligations under court orders, including
 
10           consent decrees, that have already determined that need
 
11           for the projects exists;
 
12     (11)  Replacement of existing equipment with its modern-day
 
13           equivalent;
 
14     (12)  Primary care clinics under the expenditure thresholds
 
15           referenced in section 323D-2;
 
16     (13)  Equipment and services related to that equipment, that
 
17           are primarily invented and used for research purposes
 
18           as opposed to usual and customary diagnostic and
 
19           therapeutic care;
 
20     (14)  Capital expenditures that are required:
 
21           (A)  To eliminate or prevent imminent safety hazards as
 
22                defined by federal, state, or county fire,
 
23                building, or life safety codes or regulations;
 

 
Page 29                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           (B)  To comply with state licensure standards;
 
 2           (C)  To comply with accreditation standards, compliance
 
 3                with which is required to receive reimbursements
 
 4                under Title XVIII of the Social Security Act or
 
 5                payments under a state plan for medical assistance
 
 6                approved under Title XIX of such Act;
 
 7     (15)  [Extended care] All adult residential care [homes]
 
 8           facilities under chapter 321, part    , and assisted
 
 9           living facilities; or
 
10     (16)  Other facilities or services that the agency through
 
11           the statewide council chooses to exempt, by rules
 
12           pursuant to section 323D-62."
 
13      SECTION 9.  Section 333F-2, Hawaii Revised Statutes, is
 
14 amended by amending subsection (c) to read as follows:
 
15      "(c)  Supports and services the department shall administer
 
16 include, but shall not be limited to:
 
17      (1)  Early identification and evaluation of persons with
 
18           developmental disabilities or mental retardation;
 
19      (2)  Development, planning, and implementation in
 
20           coordination with other federal, state, and county
 
21           agencies, of service programs for persons with
 
22           developmental disabilities or mental retardation;
 
23      (3)  Development and provision of service programs in the
 

 
Page 30                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           public or private sectors through chapter 42F or
 
 2           [chapter] 103F, for persons with developmental
 
 3           disabilities or mental retardation;
 
 4      (4)  Establishment of a continuum of comprehensive services
 
 5           and residential alternatives in the community to allow
 
 6           persons with developmental disabilities or mental
 
 7           retardation to live in the least restrictive,
 
 8           individually appropriate environment;
 
 9      (5)  Development and implementation of a program for single-
 
10           entry access by persons with developmental disabilities
 
11           or mental retardation to services provided under this
 
12           chapter as well as referral to, and coordination with,
 
13           services provided in the private sector or under other
 
14           federal, state, or county acts, and the development of
 
15           an individualized service plan by an interdisciplinary
 
16           team;
 
17      (6)  Collaborative and cooperative services with public
 
18           health and other groups for programs to prevent
 
19           developmental disabilities or mental retardation;
 
20      (7)  Informational and educational services to the general
 
21           public and to lay and professional groups;
 
22      (8)  Consultative services to the judicial branch of
 
23           government, educational institutions, and health and
 

 
Page 31                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           welfare agencies whether the agencies are public or
 
 2           private;
 
 3      (9)  Provision of community residential alternatives for
 
 4           persons with developmental disabilities or mental
 
 5           retardation, that promote normalized living, inclusion,
 
 6           and self-determination including [group homes and
 
 7           homes], under chapter 321, part    :
 
 8           (A)  Basic category developmental disabilities
 
 9                domiciliary homes and adult foster homes for
 
10                persons with developmental disabilities;
 
11 _         (B)  Expanded category developmental disabilities
 
12                domiciliary homes and adult foster homes for
 
13                persons with developmental disabilities; and
 
14           (C)  Homes meeting ICF/MR standards;
 
15     (10)  Provision of care at the skilled nursing level or in a
 
16           skilled nursing facility, as individually appropriate;
 
17     (11)  Provision of other programs, services, or facilities
 
18           necessary to provide a continuum of care for persons
 
19           with developmental disabilities or mental retardation;
 
20     (12)  Provision of case management services independent of
 
21           the direct service provider; and
 
22     (13)  Development and maintenance of respite services in the
 
23           community for persons with developmental disabilities
 

 
Page 32                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           or mental retardation."
 
 2      SECTION 10.  Section 333F-22, Hawaii Revised Statutes, is
 
 3 amended as follows:
 
 4      1.  By amending subsections (a) to (c) to read:
 
 5      "(a)  The department shall adopt rules pursuant to chapter
 
 6 91 to assure the reputable and responsible character of an
 
 7 applicant to operate an adult foster home for persons with
 
 8 developmental disabilities or developmental disabilities
 
 9 domiciliary home[,] under either the basic category or the
 
10 expanded category under chapter 321, part    , of existing
 
11 providers and their employees, of current and prospective
 
12 employees of the applicant, and of new employees of the provider
 
13 after certification or licensure, which shall provide for, but
 
14 not be limited to, criminal history record checks.
 
15      (b)  For the purposes of this section, "developmental
 
16 disabilities domiciliary homes" [means any facility licensed
 
17 under section 321-15.9 that provides twenty-four hour supervision
 
18 or care, excluding licensed nursing care, for a fee, to not more
 
19 than five adults with mental retardation or developmental
 
20 disabilities as defined in this chapter; and "adult foster homes"
 
21 shall be as defined under section 321-11.2.] and "adult foster
 
22 homes for persons with developmental disabilities" shall be as
 
23 defined under section 321-B.
 

 
Page 33                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1      (c)  An applicant to operate [an] any adult foster home for
 
 2 persons with developmental disabilities or developmental
 
 3 disabilities domiciliary home shall submit to the department,
 
 4 with the applicant's application for certification or licensure,
 
 5 statements signed under penalty of perjury by the applicant and
 
 6 all current and prospective employees of the applicant indicating
 
 7 whether the applicant or any of the current or prospective
 
 8 employees of the applicant have ever been convicted of a crime
 
 9 other than a minor traffic violation involving a fine of $50 or
 
10 less and providing consent to the department to conduct a
 
11 criminal history record check and to obtain other criminal
 
12 history record information for verification.  The applicant and
 
13 current or prospective employees of the applicant shall also be
 
14 fingerprinted for the purpose of a national criminal history
 
15 record check."
 
16      2.  By amending subsection (g) to read:
 
17      "(g)  The department may revoke a current license or
 
18 certification or deny an application for a license or
 
19 certification to operate an adult foster home for persons with
 
20 developmental disabilities or developmental disabilities
 
21 domiciliary home under rules adopted pursuant to chapter 91 if
 
22 the existing provider or employee of an existing provider,
 
23 applicant, current or prospective employee of the applicant,
 

 
Page 34                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 provider, or new employee of the provider refuses to submit to
 
 2 the department statements indicating criminal convictions,
 
 3 refuses to provide consent to the department to conduct a
 
 4 criminal history record check or obtain other criminal history
 
 5 record information for verification, refuses to be fingerprinted,
 
 6 has been convicted of a crime other than a minor traffic
 
 7 violation involving a fine of $50 or less; or if the department
 
 8 finds that the criminal history record of the existing provider
 
 9 or employee of an existing provider, applicant, current or
 
10 prospective employee of the applicant, provider, or new employee
 
11 of the provider may pose a risk to the health, safety, or well-
 
12 being of persons with developmental disabilities or mental
 
13 retardation living in the home."
 
14      SECTION 11.  Section 346-53, Hawaii Revised Statutes, is
 
15 amended by amending subsection (c) to read as follows:
 
16      "(c)  The director, pursuant to chapter 91, shall determine
 
17 the rate of payment for domiciliary care provided to recipients
 
18 eligible either for [Federal Supplementary] federal Supplemental
 
19 Security Income, or public assistance in accordance with state
 
20 standards, or both.  The director shall provide for level of care
 
21 payment as follows:
 
22      (1)  For [those] basic category type I adult residential
 
23           care homes [classified as facility type I], the state
 

 
Page 35                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           supplemental payment shall not exceed $521.90; and 
 
 2      (2)  For [those] basic category type II adult residential
 
 3           care homes [classified as facility type II], the state
 
 4           supplementary payment shall not exceed $629.90.
 
 5      If the operator does not provide the quality of care
 
 6 consistent with the needs of the individual to the satisfaction
 
 7 of the department, the department may remove the recipient to
 
 8 another facility.
 
 9      The department shall handle abusive practices under this
 
10 section in accordance with chapter 91.
 
11      Nothing in this subsection allows the director to remove a
 
12 recipient from an adult residential care home or other similar
 
13 institution if the recipient does not desire to be removed and
 
14 the operator is agreeable to the recipient remaining, except
 
15 where the recipient requires a higher level of care than
 
16 provided, or where the recipient no longer requires any
 
17 domiciliary care."
 
18      SECTION 12.  Section 346-53.4, Hawaii Revised Statutes, is
 
19 amended to read as follows:
 
20      "[[]346-53.4[]]  Reimbursement to expanded [adult
 
21 residential care home operators.] nursing facility level
 
22 residential care category ("expanded category").  Qualified
 
23 expanded [adult residential care] category home operators under
 

 
Page 36                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 section [321-15.62] 321-L who accept residents certified by the
 
 2 department [as requiring skilled nursing facility level care]
 
 3 shall be reimbursed based on the severity of the resident's
 
 4 disability."
 
 5      SECTION 13.  Section 518-3, Hawaii Revised Statutes, is
 
 6 amended to read as follows:
 
 7      "[[]518-3[]]  Invalidity of certain restrictive covenants.
 
 8 It is the public policy of the State to establish community
 
 9 residences in residential areas.  Therefore, any restrictive
 
10 covenant or other private legal impediment made by any person,
 
11 association, firm, or corporation which directly or indirectly
 
12 prevents or restricts the establishment in an area zoned for
 
13 residential use of a facility licensed by the State as an adult
 
14 residential care home as defined under section [321-15.1;] 321-B;
 
15 intermediate care facility/mental retardation-community as
 
16 defined under section 46-4(d); or special treatment facility as
 
17 defined under section 334-1, shall be void and unenforceable as
 
18 to such community residences."
 
19      SECTION 14.  Section 321-11.2, Hawaii Revised Statutes, is
 
20 repealed.
 
21      ["321-11.2  Adult foster homes.(a)  The department of
 
22 health is authorized to certify adult foster homes for
 
23 developmentally disabled individuals requiring such care beyond
 

 
Page 37                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 the eighteenth birthday.  "Adult foster home" means a private
 
 2 home providing care on a twenty-four hour basis for adults with
 
 3 developmental disabilities.  To be certified, an adult foster
 
 4 home shall have not more than two adults with developmental
 
 5 disabilities at the same time, who are unrelated to the foster
 
 6 family.  To accommodate residents of a foster boarding home for
 
 7 children with developmental disabilities who reach the age of
 
 8 eighteen years, where the home is certified as a foster boarding
 
 9 home for children under section 346-17, the director of health
 
10 may waive the two adult limit for certification of that home as
 
11 an adult foster home, provided that:  (1) the number of foster
 
12 children and adults in such dually certified home shall not
 
13 exceed five, and (2) no new adults may be admitted into the home
 
14 while there are any foster children residing in the home.
 
15      (b)  The rules of the department of human services adopted
 
16 under authority of section 346-17, which prescribe the standards
 
17 of conditions and competence of operation of child foster
 
18 boarding homes shall apply to adult foster homes.
 
19 Notwithstanding chapter 91, to the contrary, the rules shall be
 
20 considered adopted by the department of health on July 1, 1986,
 
21 for the purpose of regulating adult foster care homes and shall
 
22 be valid until the department of health adopts rules pursuant to
 
23 chapter 91.  The department of health shall adopt rules pursuant
 

 
Page 38                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 to chapter 91 necessary for the purposes of this section.
 
 2      (c)  Rate of payment for adult foster homes is to be
 
 3 determined on the same basis as domiciliary care homes as
 
 4 provided under section 346-53."]
 
 5      SECTION 15.  Section 321-15.6, Hawaii Revised Statutes, is
 
 6 repealed.
 
 7      ["321-15.6  Adult residential care homes; licensing.(a)
 
 8 All adult residential care homes shall be licensed to ensure the
 
 9 health, safety, and welfare of the individuals placed therein.
 
10      (b)  The director shall adopt rules regarding adult
 
11 residential care homes in accordance with chapter 91 which shall
 
12 be designed to:
 
13      (1)  Protect the health, safety, and civil rights of persons
 
14           residing in facilities regulated;
 
15      (2)  Provide for the licensing of adult residential care
 
16           homes; provided that the rules shall allow group living
 
17           in two categories of adult residential care homes as
 
18           licensed by the department of health:
 
19           (A)  Type I allowing group living by five or fewer
 
20                unrelated persons; and
 
21           (B)  Type II allowing six or more persons including but
 
22                not limited to the mentally ill, elders, the
 
23                handicapped, the developmentally disabled, or
 

 
Page 39                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1                totally disabled persons who are not related to
 
 2                the home operator or facility staff.
 
 3           For purposes of this section:
 
 4                "Mentally ill person" means a mentally ill person
 
 5           as defined under section 334-1.
 
 6                "Elder" means an elder as defined under sections
 
 7           201G-1 and 201G-151.
 
 8                "Handicapped person" means an individual with a
 
 9           physical handicap as defined under section 515-2.
 
10                "Developmentally disabled person" means a person
 
11           with developmental disabilities as defined under
 
12           section 333F-1.
 
13                "Totally disabled person" means a person totally
 
14           disabled as defined under section 235-1;
 
15      (3)  Comply with applicable federal laws and regulations of
 
16           Title XVI of the Social Security Act, as amended; and
 
17      (4)  Provide penalties for the failure to comply with any
 
18           rule.
 
19      (c)  The department may provide for the training of and
 
20 consultations with operators and staff of any facility licensed
 
21 under this section, in conjunction with any licensing thereof,
 
22 and shall adopt rules to ensure that adult residential care home
 
23 operators shall have the needed skills to provide proper care and
 

 
Page 40                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 supervision in a home environment as required under department
 
 2 rules.
 
 3      (d)  The department shall establish a standard admission
 
 4 policy and procedure which shall require the provision of
 
 5 information that includes the appropriate medical and personal
 
 6 history of the patient as well as the level of care needed by the
 
 7 patient prior to the patient's referral and admission to any
 
 8 adult residential care home facility.  The department shall
 
 9 develop appropriate forms and patient summaries for this purpose.
 
10      (e)  The department shall maintain an inventory of all
 
11 facilities licensed under this section and shall maintain a
 
12 current inventory of vacancies therein to facilitate the
 
13 placement of individuals in such facilities.
 
14      (f)  The department shall develop and adopt a social model
 
15 of health care to ensure the health, safety, and welfare of
 
16 individuals placed in adult residential care homes.  The model of
 
17 care shall be designed to protect the health, safety, civil
 
18 rights, and rights of choice of the persons to reside in a
 
19 nursing facility or in home- or community-based care."]
 
20      SECTION 16.  Section 321-15.9, Hawaii Revised Statutes, is
 
21 repealed.
 
22      ["[321-15.9]  Developmental disabilities domiciliary homes.
 
23 (a)  The department of health is authorized to license
 

 
Page 41                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 developmental disabilities domiciliary homes for individuals with
 
 2 developmental disabilities or mental retardation who are unable
 
 3 to live independently and who require supervision or care, but do
 
 4 not require care by licensed nurses in a domiciliary setting.
 
 5      (b)  For the purposes of this section, "developmental
 
 6 disabilities" shall be as defined under section 333E-2; and
 
 7 "mental retardation" shall be as defined under section 333F-1.
 
 8      (c)  The director shall adopt rules regarding developmental
 
 9 disabilities domiciliary homes in accordance with chapter 91
 
10 which shall be designed to:
 
11      (1)  Establish criteria for licensure of homes, including
 
12           inspections, registration, fees, qualifications of
 
13           operators and staff, and other factors necessary to
 
14           ensure the safe and appropriate operation of each home;
 
15      (2)  Protect the health, safety, and civil rights of persons
 
16           residing in the homes;
 
17      (3)  Provide for plans of care which include community
 
18           integration and training of persons residing in the
 
19           licensed homes;
 
20      (4)  Provide for the licensure of homes of up to five
 
21           persons who are developmentally disabled or mentally
 
22           retarded, and who are not related to the home operator
 
23           or facility staff;
 

 
Page 42                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1      (5)  Establish penalties for the failure to comply with any
 
 2           rule; and
 
 3      (6)  Establish criteria for training of operators and staff
 
 4           of any facility licensed under this section.
 
 5      (d)  Rules adopted under this section shall be enforced by
 
 6 the director.
 
 7      (e)  The department shall maintain a registry of all
 
 8 facilities licensed under this section and a current inventory of
 
 9 vacancies to facilitate the placement of individuals in these
 
10 facilities.
 
11      (f)  The rate of payment for residents in the developmental
 
12 disabilities domiciliary homes shall be determined on the same
 
13 basis as domiciliary care homes as provided under section
 
14 346-53."] 
 
15      SECTION 17.  Section 1 of Act 132, Session Laws of Hawaii
 
16 1998, is repealed.
 
17      ["SECTION 1.  Chapter 321, Hawaii Revised Statutes, is
 
18 amended by adding two new sections to be appropriately designated
 
19 and to read as follows:
 
20      "321-   Adult residential care homes expanded admissions.
 
21 (a)  Adult residential care homes may admit an individual who has
 
22 been living immediately prior to admission in the individual's
 
23 own home, a hospital, or other care setting, and who has been
 

 
Page 43                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 either:
 
 2      (1)  Admitted to a medicaid waiver program and determined by
 
 3           the department of human services to require nursing
 
 4           facility level care to manage the individual's
 
 5           physical, mental, and social functions; or
 
 6      (2)  A private-paying individual certified by a physician or
 
 7           advanced practice registered nurse as needing a nursing
 
 8           facility level of care.
 
 9      (b)  The department of health shall adopt rules in
 
10 accordance with chapter 91 to expand admissions to adult
 
11 residential care homes by level of care and to define and
 
12 standardize these levels of care.  The rules and standards shall
 
13 provide for appropriate and adequate requirements for knowledge
 
14 and training of adult residential care home operators and their
 
15 employees.
 
16      321-     Expanded adult residential care homes; licensing.
 
17 (a)  All expanded adult residential care homes shall be licensed
 
18 to ensure the health, safety, and welfare of the individuals
 
19 placed therein.
 
20      (b)  The director shall adopt rules regarding expanded adult
 
21 residential care homes in accordance with chapter 91 which shall
 
22 be a social model designed to:
 
23      (1)  Protect the health, safety, civil rights, and rights of
 

 
Page 44                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           choice of the persons to reside in a nursing facility
 
 2           or in home- or community-based care;
 
 3      (2)  Provide for the licensing of expanded adult residential
 
 4           care homes for persons who are certified by the
 
 5           department of human services, a physician, advanced
 
 6           practice registered nurse, or registered nurse case
 
 7           manager as requiring skilled nursing facility level or
 
 8           intermediate care facility level of care who have no
 
 9           financial relationship with the home care operator or
 
10           facility staff; provided that the rules shall allow
 
11           group living in two categories of expanded adult
 
12           residential care homes as licensed by the department of
 
13           health:
 
14           (A)  Type I home shall consist of five or less
 
15                residents with no more than two nursing facility
 
16                level residents; and
 
17           (B)  Type II home shall consist of six or more
 
18                residents, with no more than twenty per cent of
 
19                the home's licensed capacity as nursing facility
 
20                level residents; provided that more nursing
 
21                facility level residents may be allowed at the
 
22                discretion of the department.
 
23      (3)  Comply with applicable federal laws and regulations of
 

 
Page 45                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           Title XVI of the Social Security Act, as amended; and
 
 2      (4)  Provide penalties for the failure to comply with any
 
 3           rule.
 
 4      (c)  The department may provide for the training of and
 
 5 consultations with operators and staff of any facility licensed
 
 6 under this section, in conjunction with any licensing thereof,
 
 7 and shall adopt rules to ensure that expanded adult residential
 
 8 care home operators shall have the needed skills to provide
 
 9 proper care and supervision in a home environment as required
 
10 under department rules.
 
11      (d)  The department shall establish a standard admission
 
12 policy and procedure which shall require the provision of
 
13 information that includes the appropriate medical and personal
 
14 history of the patient as well as the level of care needed by the
 
15 patient prior to the patient's referral and admission to any
 
16 expanded adult residential care home facility.  The department
 
17 shall develop appropriate forms and patient summaries for this
 
18 purpose.
 
19      (e)  The department shall maintain an inventory of all
 
20 facilities licensed under this section and shall maintain a
 
21 current inventory of vacancies therein to facilitate the
 
22 placement of individuals in such facilities."]
 
23      SECTION 18.  There is appropriated out of the general
 

 
Page 46                                                    856
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 revenues of the State of Hawaii the sum of $          , or so
 
 2 much thereof as may be necessary for fiscal year 1999-2000, and
 
 3 the sum of $          , or so much thereof as may be necessary
 
 4 for fiscal year 2000-2001, to implement an information and
 
 5 referral process for the adult residential care facilities system
 
 6 in Hawaii under chapter 321, part    .  The appropriations shall
 
 7 be expended to fund:
 
 8      (1)  An augmentation of the executive office on aging's
 
 9           Aging Network to perform initial information and
 
10           referral screening for all persons aged sixty and
 
11           older;
 
12      (2)  The executive office on aging to expand its screening
 
13           and referral program to coordinate the establishment
 
14           and operation of similar services to be provided by
 
15           ASK-2000, or other information and referral providers
 
16           as appropriate, for clients under age sixty.  The
 
17           development of this expansion shall begin in July, 1999
 
18           and full operation shall begin in July, 2000;
 
19      (3)  A subcontract by the executive office on aging with
 
20           ASK-2000, or other information and referral providers
 
21           to provide similar supplementary initial information
 
22           and referral screening for all potential clients under
 
23           age sixty.  The development of this supplementary
 

 
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                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           service shall begin in July, 1999, and full operation
 
 2           shall begin in July, 2000; and
 
 3      (4)  One-time startup costs and annual operating costs.
 
 4      SECTION 19.  There is appropriated out of the general
 
 5 revenues of the State of Hawaii sum of $1,000,000, or so much
 
 6 thereof as may be necessary for fiscal year 2000-2001, to
 
 7 implement the functions and responsibilities of this Act.  
 
 8      SECTION 20.  The sums appropriated shall be expended by the
 
 9 department of health for the purposes of this Act.
 
10      SECTION 21.  If any provision of this Act, or the
 
11 application thereof to any person or circumstance is held
 
12 invalid, the invalidity does not affect other provisions or
 
13 applications of the Act which can be given effect without the
 
14 invalid provision or application, and to this end the provisions
 
15 of this Act are severable.
 
16      SECTION 22.  In codifying the new part added to chapter 321,
 
17 Hawaii Revised Statutes, by section 2 of this Act, the revisor of
 
18 statutes shall substitute appropriate section numbers for the
 
19 letters used in the new sections' designations in this Act.
 
20      SECTION 23.  Until such time as administrative rules are
 
21 adopted for purposes of this Act, existing administrative rules
 
22 based on statutory material that is amended or repealed under
 
23 this Act shall remain in effect.
 

 
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 1      SECTION 24.  Statutory material to be repealed is bracketed.
 
 2 New statutory material is underscored.
 
 3      SECTION 25.  This Act shall take effect on July 1, 1999,
 
 4 except that section 16 shall take effect on June 30, 1999.