THE SENATE

S.B. NO.

486

TWENTY-EIGHTH LEGISLATURE, 2015

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to human services.

 

 

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

 


Part I

     SECTION 1.  The legislature finds that intermediate care facilities offer individuals with intellectual and developmental disabilities a place to work and live.  Over the last few years, intermediate care facilities have seen a decrease in financial support; and existing medicaid payment rates, which took effect in 2008 and were based on 2005 cost reports, do not cover the daily costs incurred by intermediate care facilities in providing services to individuals with intellectual and developmental disabilities.  As a result, intermediate care facilities have suffered financially and have been operating at a loss.

     The legislature further finds that section 17-1739.2-17, Hawaii Administrative Rules, requires the department of human services to rebase inadequate and dated compensation rates, a process that uses a more recent cost report to update medicaid payment rates.  However, section 17-1739.2-17, Hawaii Administrative Rules, ignores wage changes, inflation, level of care requirements, and best practice standards and only requires that a provider shall not have its basic prospective payment system rates calculated by reference to the same base year for more than eight fiscal years.

     The legislature additionally finds that section 17‑1739.2‑14(c), Hawaii Administrative Rules, mandates inflation adjustments to the basic prospective payment system rates for years when the department of human services does not perform a rebasing of the rates.  However, there has not been an inflation adjustment to the basic prospective payment system rates for intermediate care facility residents since fiscal year 2011.

     The legislature also finds that intermediate care facilities receive a fixed per diem payment for each bed occupied.  However, if a resident is absent from the facility at midnight, with the exception of twelve days per year, the per diem payment is not made to the facility, even if the facility provided services to the resident for the majority of the day.  Uncompensated therapeutic and hospital related absences present a severe financial challenge to intermediate care facilities.

     The purpose of this part is to require the department of human services to reevaluate its administrative rebasing rules that establish intermediate care facility rates; rebase existing rates using the 2013 provider cost reports; establish a rebasing of basic prospective payment system rates every two fiscal years; increase intermediate care facility bed hold days from twelve to twenty-four days for therapeutic or hospitalization related absences; appropriate funds for any increase in basic prospective payment system rates; and appropriate funds to provide a retroactive reimbursement owed by the State to The Arc in Hawaii.

     SECTION 2.  The department of human services shall evaluate and consider an alternate methodology for establishing intermediate care facility rates to address the inadequacy of the existing system.  The department shall update prospective payment system rates for intermediate care facilities providing services to medicaid recipients with intellectual and developmental disabilities using provider cost reports from the base year ending June 30, 2013, to take effect on July 1, 2015.  The department shall adopt rules pursuant to chapter 91 to require rebasing using updated cost report data once every two fiscal years.

     SECTION 3.  The department of human services shall adopt rules pursuant to chapter 91 to establish that a medicaid recipient may reserve a bed at an intermediate care facility for a therapeutic or hospitalization related absence for no more than twenty-four days in a calendar year.

     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 2015-2016 and the same sum or so much thereof as may be necessary for fiscal year 2016-2017 for any increase in basic prospective payment system rates as provided for in section 2 of this Act.

     The sums appropriated shall be expended by the department of human services for the purposes of this part.

     SECTION 5.  There is appropriated out of the general revenues of the State of Hawaii the sum of $800,000 or so much thereof as may be necessary for fiscal year 2015-2016 and the same sum or so much thereof as may be necessary for fiscal year 2016-2017 to provide a retroactive reimbursement that is owed by the State to The Arc in Hawaii.

     The sums appropriated shall be expended by the department of human services for the purposes of this part.

PART II

     SECTION 6.  The legislature finds that developmental disability domiciliary homes are neighborhood homes where a caretaker provides room, board, and care for individuals with intellectual or developmental disabilities.  An individual with an intellectual or developmental disability who resides in a developmental disability domiciliary home pays for room, board, and care with the individual's own funds.  These funds include federal social security disability insurance, federal supplemental security income, and state supplemental security income supplement that is intended to cover the high costs associated with operating a developmental disability domiciliary home.

     The legislature further finds that state supplemental security income supplement offers critical financial assistance to individuals with an intellectual or developmental disability, as well as the operators of the developmental disability domiciliary homes.  However, the state supplemental security income supplement rate was last increased in 2008 to $651.90 per month, despite the consumer price index increasing an average of 2.28 per cent per year.

     The legislature additionally finds that under medicaid cost share, if a developmental disability domiciliary resident's income exceeds the income eligibility standard, the resident has to "spend down" or subtract all of the resident's income for medicaid medical expenses and home and community based services, not including room and board at a developmental disability domiciliary home, until the amount remaining satisfies the State's income eligibility standard of $469.  As a result, even the smallest increase in income can make a person ineligible for medicaid and provide a person with only $469 for housing, food, and other expenses each month.  This forces a developmental disability domiciliary home to either evict the resident or to absorb the cost.

     The purpose of this part is to ensure that individuals with intellectual and developmental disabilities continue to have access to developmental disability domiciliary homes by increasing the state supplemental security income supplement amount by $50; authorizing an annual inflation adjustment to the state supplemental security income supplement amount; disregarding benefit payments under title II of the federal Social Security Act if a payment results in a person losing federal supplemental security income or state supplemental security income; and appropriating funds for the state supplemental security income supplement amount increase.

     SECTION 7.  Section 346-53, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:

     "(c)  The director, pursuant to chapter 91, shall determine the rate of payment for domiciliary care, including care provided in licensed developmental disabilities domiciliary homes, community care foster family homes, and certified adult foster homes, to be provided to recipients who are eligible for Federal Supplementary Security Income or public assistance, or both.  The director shall provide for level of care payment as follows:

     (1)  Beginning on July 1, [2008,] 2015, for adult residential care homes classified as facility type I, licensed developmental disabilities domiciliary homes as defined under section 321-15.9, community care foster family homes as defined under section 321-481, and certified adult foster homes as defined under section 321-11.2, the state supplemental payment shall not exceed [$651.90;] $701.90; and

     (2)  Beginning on July 1, [2008,] 2015, for adult residential care homes classified as facility type II, the state supplemental payment shall not exceed [$759.90.] $809.90.

     If the operator does not provide the quality of care consistent with the needs of the individual to the satisfaction of the department, the department may remove the recipient to another facility.

     The department shall handle abusive practices under this section in accordance with chapter 91.

     Nothing in this subsection shall allow the director to remove a recipient from an adult residential care home or other similar institution if the recipient does not desire to be removed and the operator is agreeable to the recipient remaining, except where the recipient requires a higher level of care than provided or where the recipient no longer requires any domiciliary care.

     As the director deems appropriate, the state supplemental payment amounts shall be adjusted annually in reasonable and appropriate increments for inflation."

     SECTION 8.  The department of human services shall adopt rules pursuant to chapter 91 to disregard any excess countable income that a disabled adult receives that is over the medicaid income qualification standard if the excess countable income is a payment from additional benefits under title II of the federal Social Security Act that results in the loss of federal supplemental security income or state supplemental security income; provided that the same amount is disregarded for all disabled adults.

     SECTION 9.  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 2015-2016 and the same sum or so much thereof as may be necessary for fiscal year 2016-2017 for increases in level of care payments as provided for in section 7 of this Act.

     The sums appropriated shall be expended by the department of human services for the purposes of this part.

PART III

     SECTION 10.  The legislature finds that the department of health oversees the billing procedures for medicaid waiver home and community based adult day health services.  Providers are authorized to bill for services provided at an hourly rate but only in two blocks--a full day, which is six hours, or a half day, which is three hours.  If a participant receives services for more than three hours but fewer than six hours, the provider of full-day services may only bill for a half-day.  Similarly, if a participant receives fewer than three hours of services, the provider of half-day services may not collect any payment, despite services having been rendered and costs incurred.

     The purpose of this part is to ensure that providers of home and community based adult day health services are compensated for the services that they provide by allowing providers to bill for services in fifteen-minute increments rather than three-hour increments.

     SECTION 11.  The department of health shall adopt rules pursuant to chapter 91 to allow a provider of medicaid home and community based adult day health services to bill for services in fifteen-minute increments.

PART IV

     SECTION 12.  If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.

     SECTION 13.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 14.  This Act shall take effect on July 1, 2015.

 

INTRODUCED BY:

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Report Title:

Department of Human Services; The Arc; Administrative Rules; Intermediate Care Facilities; Developmental Disability Domiciliary Homes; Medicaid; Rates; Appropriation

 

Description:

Requires the department of human services to reevaluate administrative rebasing rules for establishing intermediate care facility rates and consider a more responsive methodology; requires existing system rates to be rebased; appropriates funds for any increase in basic prospective payment system rates; increases rebasing frequency to once every two fiscal years; appropriates funds to provide a retroactive reimbursement to The Arc in Hawaii; increases intermediate care facility bed hold days from twelve to twenty-four days for therapeutic and hospitalization absences; increases the state supplemental security income supplement amount by $50 and appropriates funds for increases in level of care payments; authorizes an annual inflation adjustment to the state supplemental security income supplement amount; disregards benefit payments under title II of the federal Social Security Act if a payment results in a person losing federal supplemental security income or state supplemental security income; and requires the Department of Health to authorize a provider of medicaid home and community based adult day health services to bill for services in fifteen-minute increments.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.