REPORT TITLE:
Long-Term Residential Care


DESCRIPTION:
(1)  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.
(2)  Establishes the adult residential care home personal injury
   and property damage compensation special fund to compensate
   the operators of adult residential care homes and other
   persons for personal injuries and property damage caused by
   residents who are placed in adult residential care homes by
   the State.
(3)  Requires DOH to stop licensing new Type I adult residential
   care homes on an island until the percentage of ARCH
   vacancies falls below 10% on that island but allows
   licensing on a case-by-case basis on neighbor islands that
   demonstrate a need for ARCHs.  Requires DHS, where
   appropriate, to encourage public-pay clients to use
   underutilized ARCHs. (SB856 HD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        856
THE SENATE                              S.B. NO.           S.D. 2
TWENTIETH LEGISLATURE, 1999                                H.D. 2
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 many regular Type I
 
 2 adult residential care homes are currently underutilized.  Some
 
 3 have only one, two, or three residents.  This low utilization
 
 4 rate does not allow the operators of these Type I adult
 
 5 residential care homes to take full advantage of economies of
 
 6 scale in providing time- and labor-intensive twenty-four-hour
 
 7 care for their clients and thus creates great financial pressure
 
 8 for the operators to remain in business.
 
 9      The legislature further finds that Hawaii's citizens are
 
10 faced with an overwhelming financial burden of caring for their
 
11 elderly and disabled residents whose needs will continue to grow
 
12 as the population ages.  The cost of nursing home care is
 
13 currently the highest of all types of long-term care and is
 
14 continuing to escalate.  Consequently, long-term residential care
 
15 has become a realistic and cost-effective alternative.
 
16      Unfortunately, the organization and regulation of long-term
 
17 residential care facilities in Hawaii are fragmented.  This tends
 
18 to reduce cost-effectiveness and hampers the operational
 
19 effectiveness of residential care services.  The lack of overall
 
20 direction and guidance at the state level is reflected in the
 

 
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 1 fragmented structure of state regulation for a plethora of
 
 2 residential care category types in both the Hawaii Revised
 
 3 Statutes and the Hawaii Administrative Rules.
 
 4      The legislature further finds that there is a lack of
 
 5 uniformity in the collection of patient data common across care
 
 6 facility types that makes it difficult or impossible for long-
 
 7 term care agencies and providers to share that data when
 
 8 necessary, to work for the benefit of the patient.  This lack of
 
 9 uniformity also imposes unnecessary and wasteful redundancy of
 
10 effort on both patients and providers.
 
11      The legislature further finds that there is no one, simple,
 
12 uniform way for a person who needs long-term care to easily and
 
13 quickly access the appropriate care.  An information and referral
 
14 system can provide a simple and uniform, yet sophisticated and
 
15 comprehensive way to allow people easy access into the long-term
 
16 residential care system.
 
17      Act 339, Session Laws of Hawaii 1997, created a two-year
 
18 joint legislative committee on long-term care financing.
 
19 Subsequently, House Concurrent Resolution No. 225, H.D. 1,
 
20 S.D. 1, 1998, required the joint committee to create a
 
21 subcommittee to study long-term residential care facilities.
 
22      The purpose of this Act is to implement the recommendations
 
23 of the subcommittee in the three areas discussed above regarding:
 

 
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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.
 
13      Additionally, this Act also:
 
14      (1)  Establishes the adult residential care home personal
 
15           injury and property damage compensation special fund to
 
16           compensate the operators of adult residential care
 
17           homes and other persons for personal injuries and
 
18           property damage caused by residents who are placed in
 
19           adult residential care homes by the State; and
 
20      (2)  Imposes a moratorium on the licensing of new basic
 
21           category Type I adult residential care homes and
 
22           requires the department of human services, where
 
23           appropriate, to encourage its public-pay clients to
 
24           enter existing underutilized homes.
 

 
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 1      SECTION 2.  Chapter 321, Hawaii Revised Statutes, is amended
 
 2 by adding a new part to be appropriately designated and to read
 
 3 as follows:
 
 4           "PART    . ADULT RESIDENTIAL CARE FACILITIES
 
 5      321-A Definitions.  Whenever used in this part, unless the
 
 6 context requires otherwise:
 
 7      "Adult foster home for persons with developmental
 
 8 disabilities" means a private residential home providing care on
 
 9 a twenty-four-hour basis for adults with developmental
 
10 disabilities who do not either display injurious behaviors or
 
11 need licensed nursing care.  To be certified, an adult foster
 
12 home for adults with developmental disabilities shall care for
 
13 not more than two adults with developmental disabilities at the
 
14 same time, and who are unrelated to the foster 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 home operator or facility staff, who require at
 
18 least minimal assistance in the activities of daily living,
 
19 personal care services, protection, and health care services, but
 
20 who do not need the professional health services provided in an
 
21 intermediate, skilled nursing, or acute care facility.  A "type I
 
22 adult residential care home" means a group living facility
 
23 consisting of five or fewer unrelated persons.  A "type II adult
 

 
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 1 residential care home" means a group living facility consisting
 
 2 of six or more persons including 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, who do not either display injurious
 
19 behaviors, or need licensed nursing care.  For the purposes of
 
20 this definition, "developmental disabilities" and "mental
 
21 retardation" shall be as defined under section 333F-1.
 
22      "Expanded adult foster home for persons with developmental
 
23 disabilities" means a private residential home providing care on
 

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

 
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 1 capacity who are nursing facility level residents; provided that
 
 2 additional nursing facility level residents may be allowed at the
 
 3 discretion of the director of health.
 
 4      "Expanded developmental disabilities domiciliary home" means
 
 5 a private residential home for not more than five individual
 
 6 adults with developmental disabilities or mental retardation who
 
 7 are unable to live independently, who require twenty-four-hour
 
 8 supervision or care, and who are unrelated to the family living
 
 9 in the home, with each caregiver being qualified to provide care
 
10 to not more than two residents who either display injurious
 
11 behaviors or are in need of licensed nursing care.
 
12      321-B Adult residential care facilities; two facility
 
13 categories.  All adult residential care facilities in the State
 
14 shall be placed in one of the following two facility categories
 
15 as follows:
 
16      (1)  Basic residential care category ("basic category"):
 
17           (A)  Adult residential care homes, type I and type II;
 
18           (B)  Developmental disabilities domiciliary homes; and
 
19           (C)  Adult foster homes for persons with developmental
 
20                disabilities; and
 
21      (2)  Expanded residential care category ("expanded
 
22           category"):
 

 
 
 
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 1           (A)  Expanded adult residential care homes, type I and
 
 2                type II;
 
 3           (B)  Expanded developmental disabilities domiciliary
 
 4                homes;
 
 5           (C)  Expanded adult foster homes for persons with
 
 6                developmental disabilities; and
 
 7           (D)  Adult waiver foster family homes.
 
 8      321-C  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-D 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-B, 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 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 the 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.
 

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

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

 
 
 
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 1      321-I Uniform assessment tool.  (a)  To implement the
 
 2 standard admission procedure under section 321-H, the department
 
 3 shall employ, as a uniform assessment tool, the scaled-down
 
 4 version of the medicaid waiver program's social and health
 
 5 assessment forms, as fashioned by the joint legislative committee
 
 6 on long-term care created by Act 339, Session Laws of Hawaii
 
 7 1997, as updated from time to time, for all residential care
 
 8 facilities other than basic category adult residential care
 
 9 homes.  The purpose of the uniform assessment tool is to help
 
10 reduce system fragmentation, increase system efficiency and
 
11 effectiveness, enhance quality of care, and to make the system
 
12 more consumer-friendly.
 
13      (b)  The department shall also employ the one-page form
 
14 currently being used by the department termed "Level of Care
 
15 Evaluation", as updated from time to time, for all basic category
 
16 adult residential care homes to assure the correct placement of
 
17 only non-nursing facility level residents.
 
18      (c)  The data elements in the uniform assessment tool in
 
19 subsection (a) and the one-page tool in subsection (b) shall be
 
20 standardized to reduce the need to obtain identical data
 
21 subsequently, and to allow different providers to access and
 
22 share standard information, as necessary.  The data elements
 
23 shall be consistent with the two-page information and referral
 

 
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 1 screening form, administered at the time of entry, termed the
 
 2 "Coordinated Screening Form", that is recommended for use in the
 
 3 information and referral process under section 321-J.
 
 4      (d)  The:
 
 5      (1)  Uniform assessment tool in subsection (a);
 
 6      (2)  One-page tool in subsection (b); and
 
 7      (3)  Two-page information and referral screening form in
 
 8           subsection (c) and section 321-J;
 
 9 are meant to be flexible tools to be modified as required from
 
10 time to time without the need for further legislative amendment
 
11 to this part.  Nothing in this part shall prevent any agency or
 
12 care provider regulated under this part from obtaining any
 
13 additional data, as necessary, to appropriately assess a resident
 
14 or potential resident or to plan for their care.
 
15      321-J  Long-term care information and referral.  Subject to
 
16 legislative appropriations, the department shall establish an
 
17 information and referral process that shall serve all potential
 
18 clients of adult residential care facilities under this part,
 
19 namely, the elderly, the non-elderly under age sixty, and
 
20 disabled persons of all ages.  The information and referral
 
21 process shall include the conduct of a uniform initial
 
22 information and referral screening using a tool to be developed
 
23 by the executive office on aging.
 

 
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 1      321-K Authority for licensure.  (a)  The department shall
 
 2 adopt rules in accordance with chapter 91 to license adult foster
 
 3 homes for persons with developmental disabilities, adult
 
 4 residential care homes, adult waiver foster family homes,
 
 5 developmental disabilities domiciliary homes, expanded adult
 
 6 foster homes for persons with developmental disabilities,
 
 7 expanded adult residential care homes, and expanded developmental
 
 8 disabilities domiciliary homes.
 
 9      (b)  In adopting rules for developmental disabilities
 
10 domiciliary homes, the department shall include the following in
 
11 the rules:
 
12      (1)  Criteria for licensure, including inspections,
 
13           registration, fees, qualifications of operators and
 
14           staff, and other factors necessary to ensure the safe
 
15           and appropriate operation of each home;
 
16      (2)  Plans for care, which shall include community
 
17           integration and training of residents of homes; and
 
18      (3)  Criteria for the mandatory training of operators and
 
19           staff of any home licensed under this subsection.
 
20      (c)  In adopting rules for adult foster homes for persons
 
21 with developmental disabilities, the department shall include the
 
22 following in the rules:
 

 
 
 
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 1      (1)  Criteria for licensure, including inspections,
 
 2           registration, fees, qualifications of operators and
 
 3           staff, and other factors necessary to ensure the safe
 
 4           and appropriate operation of each home;
 
 5      (2)  Plans for care, which shall include community
 
 6           integration and training of residents of homes;
 
 7      (3)  Provision to allow one or more children who have
 
 8           developmental disabilities, as defined in sections
 
 9           333E-2 and 333F-1, who stay in a foster boarding home
 
10           certified under section 346-17, to continue to live in
 
11           that foster boarding home when the child reaches age
 
12           eighteen, if the home becomes certified as an adult
 
13           foster home for persons with developmental disabilities
 
14           by the time the child reaches age eighteen; provided
 
15           that the director may waive the two-adult limit for
 
16           licensure of that home as an adult foster home for
 
17           persons with developmental disabilities; provided
 
18           further that the number of foster children and adults
 
19           in that home shall not exceed five; provided further
 
20           that no additional adults shall be admitted into that
 
21           home while foster children are still residing in the
 
22           home as adults; and
 

 
 
 
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 1      (4)  Criteria for the mandatory training of operators and
 
 2           staff of any home licensed under this subsection."
 
 3      SECTION 3.  Chapter 321, Hawaii Revised Statutes, is amended
 
 4 by adding a new section to be appropriately designated and to
 
 5 read as follows:
 
 6      "321-       Adult residential care home personal injury and
 
 7 property damage compensation special fund.  (a)  There is
 
 8 established in the state treasury the adult residential care home
 
 9 personal injury and property damage compensation special fund.
 
10      (b)  The purpose of the special fund shall be to:
 
11      (1)  Compensate the operators of basic and expanded adult
 
12           residential care homes and other persons for personal
 
13           injuries and property damage caused by residents who
 
14           are placed in adult residential care homes by the
 
15           State; provided that nothing in this section or chapter
 
16           351 shall be construed to prevent the operator of an
 
17           adult residential care home or any other person from
 
18           being awarded compensation under chapter 351; and
 
19      (2)  Offer training and education programs in handling
 
20           violent residents.
 
21      (c)  The special fund shall consist of moneys appropriated
 
22 by the legislature for the purposes of the special fund; and a
 
23 monthly contribution of $5 per resident deducted from state
 

 
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 1 payments to adult residential care homes prior to the
 
 2 disbursement of these payments.  For the purposes of this
 
 3 subsection, "resident" means an individual who has been placed in
 
 4 a basic or expanded adult residential care home by the State.
 
 5      (d)  The monthly contribution in subsection (c) shall be
 
 6 suspended by the director of finance when the unencumbered
 
 7 balance in the special fund exceeds $100,000, and shall be
 
 8 reinstated when the unencumbered balance in the special fund
 
 9 drops below $75,000.
 
10      (e)  Disbursements from the special fund shall be made by a
 
11 five-member ad hoc panel consisting of:
 
12      (1)  The director of human services or the director's
 
13           representative;
 
14      (2)  The director of health or the director's
 
15           representative;
 
16      (3)  One representative from a patient advocacy group or
 
17           patient advocacy agency appointed jointly by the
 
18           director of human services and the director of health;
 
19      (4)  One representative from an adult residential care home
 
20           organization appointed by the director of human
 
21           services; and
 
22      (5)  One representative from an adult residential care home
 
23           organization appointed by the director of health.
 

 
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 1      (f)  The ad hoc panel shall be chaired alternately by the
 
 2 director of health and director of human services, or their
 
 3 representatives; provided that the ad hoc panel shall be attached
 
 4 to the department of health for administrative purposes.
 
 5      (g)  The department of health shall adopt rules in
 
 6 accordance with chapter 91 to implement this section, including
 
 7 procedures to receive and pay claims for compensation, convene
 
 8 meetings of the ad hoc panel, and appoint representatives of
 
 9 patient advocacy groups, patient advocacy agencies, and adult
 
10 residential care home organizations."
 
11      SECTION 4.  Section 46-15.3, Hawaii Revised Statutes, is
 
12 amended to read as follows:
 
13      "[[]46-15.3[]]  Regulation of adult [family boarding home
 
14 and care home.] residential care facilities.  (a)  For the
 
15 purpose of regulation under a county's life safety code, building
 
16 code, fire code, or any other ordinance of similar purpose, a
 
17 licensed adult [family boarding home or licensed care home which
 
18 provides living accommodations for:
 
19      (1)  The operator of the home and operator's family; and
 
20      (2)  Up to five other persons, not more than two of whom are
 
21           incapable of self-preservation because of age or
 
22           physical or mental limitations;]
 
23 residential care facility shall be deemed a single-family
 
24 dwelling occupied by a family.
 

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

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

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

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

 
Page 23                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
Page 24                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
Page 25                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
Page 26                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1      SECTION 6.  Section 321-15.1, Hawaii Revised Statutes, is
 
 2 amended as follows:
 
 3      1.  By repealing the definition of "adult residential care
 
 4 home".
 
 5      [""Adult residential care home" means any facility providing
 
 6 twenty-four-hour living accommodations, for a fee, to adults
 
 7 unrelated to the family, who require at least minimal assistance
 
 8 in the activities of daily living, personal care services,
 
 9 protection, and health care services, but who do not need the
 
10 professional health services provided in an intermediate, skilled
 
11 nursing, or acute care facility."]
 
12      2.  By repealing the definition of "expanded adult
 
13 residential care home".
 
14      [""Expanded adult residential care home" means any facility
 
15 providing twenty-four-hour living accommodations, for a fee, to
 
16 adults unrelated to the family, who require at least minimal
 
17 assistance in the activities of daily living, personal care
 
18 services, protection, and health care services, and who may need
 
19 the professional health services provided in an intermediate or
 
20 skilled nursing facility."]
 
21      SECTION 7.  Section 321-15.7, Hawaii Revised Statutes, is
 
22 amended to read as follows:
 

 
 
 
Page 27                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1      "321-15.7  Penalty.  Any person who intentionally operates
 
 2 an adult residential care [home] facility or hospice without a
 
 3 license shall be guilty of a misdemeanor."
 
 4      SECTION 8.  Section 323D-2, Hawaii Revised Statutes, is
 
 5 amended by amending the definition of "extended care adult
 
 6 residential care home" to read as follows:
 
 7      ""[Extended care] Expanded adult residential care home"
 
 8 means [an adult residential care home] any facility providing
 
 9 twenty-four-hour living [accommodation] accommodations for a
 
10 fee[, for] to adults unrelated to the [licensee.] operator or
 
11 facility staff of the home, who require at least minimal
 
12 assistance in the activities of daily living, personal care
 
13 services, protection, and health care services, and who may need
 
14 the professional health services provided in an intermediate or
 
15 skilled nursing facility.  The primary caregiver shall be
 
16 qualified to provide care to nursing facility level individuals
 
17 who have been admitted to a medicaid waiver program, or persons
 
18 who pay for care from private funds and have been certified [for
 
19 this type of facility.  There shall be two categories of extended
 
20 care adult residential care homes, which shall be licensed in
 
21 accordance with rules adopted by the department of health:
 
22      (1)  Type I home shall consist] as a nursing facility level
 
23           resident.  A "type I expanded adult residential care
 

 
Page 28                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
Page 29                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
 
 
Page 30                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1      (6)  Any home or institution conducted only for those who,
 
 2           pursuant to the teachings, faith, or belief of any
 
 3           group, depend for healing upon prayer or other
 
 4           spiritual means;
 
 5      (7)  Dental clinics;
 
 6      (8)  Nonpatient areas of care facilities such as parking
 
 7           garages and administrative offices;
 
 8      (9)  Bed changes that involve ten per cent or ten beds of
 
 9           existing licensed bed types, whichever is less, of a
 
10           facility's total existing licensed beds within a two-
 
11           year period;
 
12     (10)  Projects that are wholly dedicated to meeting the
 
13           State's obligations under court orders, including
 
14           consent decrees, that have already determined that need
 
15           for the projects exists;
 
16     (11)  Replacement of existing equipment with its modern-day
 
17           equivalent;
 
18     (12)  Primary care clinics under the expenditure thresholds
 
19           referenced in section 323D-2;
 
20     (13)  Equipment and services related to that equipment, that
 
21           are primarily invented and used for research purposes
 
22           as opposed to usual and customary diagnostic and
 
23           therapeutic care;
 

 
Page 31                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
 
 
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                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
Page 33                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
Page 34                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
Page 35                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1 disabilities as defined in this chapter; and "adult foster homes"
 
 2 shall be as defined under section 321-11.2.] and "adult foster
 
 3 homes for persons with developmental disabilities" shall be as
 
 4 defined under section 321-B.
 
 5      (c)  An applicant to operate [an] any adult foster home for
 
 6 persons with developmental disabilities or developmental
 
 7 disabilities domiciliary home shall submit to the department,
 
 8 with the applicant's application for certification or licensure,
 
 9 statements signed under penalty of perjury by the applicant and
 
10 all current and prospective employees of the applicant indicating
 
11 whether the applicant or any of the current or prospective
 
12 employees of the applicant have ever been convicted of a crime
 
13 other than a minor traffic violation involving a fine of $50 or
 
14 less and providing consent to the department to conduct a
 
15 criminal history record check and to obtain other criminal
 
16 history record information for verification.  The applicant and
 
17 current or prospective employees of the applicant shall also be
 
18 fingerprinted for the purpose of a national criminal history
 
19 record check."
 
20      2.  By amending subsection (g) to read:
 
21      "(g)  The department may revoke a current license or
 
22 certification or deny an application for a license or
 
23 certification to operate an adult foster home for persons with
 

 
Page 36                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
Page 37                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
Page 38                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1      "[[]346-53.4[]]  Reimbursement to expanded [adult
 
 2 residential care home operators.] residential care category
 
 3 ("expanded category").  Qualified expanded [adult residential
 
 4 care] category home operators operating homes classified under
 
 5 section [321-15.62] 321-B(2) who accept residents certified by
 
 6 the department [as requiring skilled nursing facility level care]
 
 7 shall be reimbursed based on the severity of the resident's
 
 8 disability."
 
 9      SECTION 14.  Section 518-3, Hawaii Revised Statutes, is
 
10 amended to read as follows:
 
11      "[[]518-3[]]  Invalidity of certain restrictive covenants.
 
12 It is the public policy of the State to establish community
 
13 residences in residential areas.  Therefore, any restrictive
 
14 covenant or other private legal impediment made by any person,
 
15 association, firm, or corporation which directly or indirectly
 
16 prevents or restricts the establishment in an area zoned for
 
17 residential use of a facility licensed by the State as an adult
 
18 residential care home as defined under section [321-15.1;] 321-B;
 
19 intermediate care facility/mental retardation-community as
 
20 defined under section 46-4(d); or special treatment facility as
 
21 defined under section 334-1, shall be void and unenforceable as
 
22 to such community residences."
 

 
 
 
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                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1      SECTION 15.  Section 321-11.2, Hawaii Revised Statutes, is
 
 2 repealed.
 
 3      ["321-11.2  Adult foster homes.(a)  The department of
 
 4 health is authorized to certify adult foster homes for
 
 5 developmentally disabled individuals requiring such care beyond
 
 6 the eighteenth birthday.  "Adult foster home" means a private
 
 7 home providing care on a twenty-four hour basis for adults with
 
 8 developmental disabilities.  To be certified, an adult foster
 
 9 home shall have not more than two adults with developmental
 
10 disabilities at the same time, who are unrelated to the foster
 
11 family.  To accommodate residents of a foster boarding home for
 
12 children with developmental disabilities who reach the age of
 
13 eighteen years, where the home is certified as a foster boarding
 
14 home for children under section 346-17, the director of health
 
15 may waive the two adult limit for certification of that home as
 
16 an adult foster home, provided that:  (1) the number of foster
 
17 children and adults in such dually certified home shall not
 
18 exceed five, and (2) no new adults may be admitted into the home
 
19 while there are any foster children residing in the home.
 
20      (b)  The rules of the department of human services adopted
 
21 under authority of section 346-17, which prescribe the standards
 
22 of conditions and competence of operation of child foster
 
23 boarding homes shall apply to adult foster homes.
 

 
Page 40                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1 Notwithstanding chapter 91, to the contrary, the rules shall be
 
 2 considered adopted by the department of health on July 1, 1986,
 
 3 for the purpose of regulating adult foster care homes and shall
 
 4 be valid until the department of health adopts rules pursuant to
 
 5 chapter 91.  The department of health shall adopt rules pursuant
 
 6 to chapter 91 necessary for the purposes of this section.
 
 7      (c)  Rate of payment for adult foster homes is to be
 
 8 determined on the same basis as domiciliary care homes as
 
 9 provided under section 346-53."]
 
10      SECTION 16.  Section 321-15.6, Hawaii Revised Statutes, is
 
11 repealed.
 
12      ["321-15.6  Adult residential care homes; licensing.(a)
 
13 All adult residential care homes shall be licensed to ensure the
 
14 health, safety, and welfare of the individuals placed therein.
 
15      (b)  The director shall adopt rules regarding adult
 
16 residential care homes in accordance with chapter 91 which shall
 
17 be designed to:
 
18      (1)  Protect the health, safety, and civil rights of persons
 
19           residing in facilities regulated;
 
20      (2)  Provide for the licensing of adult residential care
 
21           homes; provided that the rules shall allow group living
 
22           in two categories of adult residential care homes as
 
23           licensed by the department of health:
 

 
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                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1           (A)  Type I allowing group living by five or fewer
 
 2                unrelated persons; and
 
 3           (B)  Type II allowing six or more persons including but
 
 4                not limited to the mentally ill, elders, the
 
 5                handicapped, the developmentally disabled, or
 
 6                totally disabled persons who are not related to
 
 7                the home operator or facility staff.
 
 8           For purposes of this section:
 
 9                "Mentally ill person" means a mentally ill person
 
10           as defined under section 334-1.
 
11                "Elder" means an elder as defined under sections
 
12           201G-1 and 201G-151.
 
13                "Handicapped person" means an individual with a
 
14           physical handicap as defined under section 515-2.
 
15                "Developmentally disabled person" means a person
 
16           with developmental disabilities as defined under
 
17           section 333F-1.
 
18                "Totally disabled person" means a person totally
 
19           disabled as defined under section 235-1;
 
20      (3)  Comply with applicable federal laws and regulations of
 
21           Title XVI of the Social Security Act, as amended; and
 
22      (4)  Provide penalties for the failure to comply with any
 
23           rule.
 

 
Page 42                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1      (c)  The department may provide for the training of and
 
 2 consultations with operators and staff of any facility licensed
 
 3 under this section, in conjunction with any licensing thereof,
 
 4 and shall adopt rules to ensure that adult residential care home
 
 5 operators shall have the needed skills to provide proper care and
 
 6 supervision in a home environment as required under department
 
 7 rules.
 
 8      (d)  The department shall establish a standard admission
 
 9 policy and procedure which shall require the provision of
 
10 information that includes the appropriate medical and personal
 
11 history of the patient as well as the level of care needed by the
 
12 patient prior to the patient's referral and admission to any
 
13 adult residential care home facility.  The department shall
 
14 develop appropriate forms and patient summaries for this purpose.
 
15      (e)  The department shall maintain an inventory of all
 
16 facilities licensed under this section and shall maintain a
 
17 current inventory of vacancies therein to facilitate the
 
18 placement of individuals in such facilities.
 
19      (f)  The department shall develop and adopt a social model
 
20 of health care to ensure the health, safety, and welfare of
 
21 individuals placed in adult residential care homes.  The model of
 
22 care shall be designed to protect the health, safety, civil
 
23 rights, and rights of choice of the persons to reside in a
 
24 nursing facility or in home- or community-based care."]
 

 
Page 43                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1      SECTION 17.  Section 321-15.9, Hawaii Revised Statutes, is
 
 2 repealed.
 
 3      ["[321-15.9]  Developmental disabilities domiciliary homes.
 
 4 (a)  The department of health is authorized to license
 
 5 developmental disabilities domiciliary homes for individuals with
 
 6 developmental disabilities or mental retardation who are unable
 
 7 to live independently and who require supervision or care, but do
 
 8 not require care by licensed nurses in a domiciliary setting.
 
 9      (b)  For the purposes of this section, "developmental
 
10 disabilities" shall be as defined under section 333E-2; and
 
11 "mental retardation" shall be as defined under section 333F-1.
 
12      (c)  The director shall adopt rules regarding developmental
 
13 disabilities domiciliary homes in accordance with chapter 91
 
14 which shall be designed to:
 
15      (1)  Establish criteria for licensure of homes, including
 
16           inspections, registration, fees, qualifications of
 
17           operators and staff, and other factors necessary to
 
18           ensure the safe and appropriate operation of each home;
 
19      (2)  Protect the health, safety, and civil rights of persons
 
20           residing in the homes;
 
21      (3)  Provide for plans of care which include community
 
22           integration and training of persons residing in the
 
23           licensed homes;
 

 
Page 44                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1      (4)  Provide for the licensure of homes of up to five
 
 2           persons who are developmentally disabled or mentally
 
 3           retarded, and who are not related to the home operator
 
 4           or facility staff;
 
 5      (5)  Establish penalties for the failure to comply with any
 
 6           rule; and
 
 7      (6)  Establish criteria for training of operators and staff
 
 8           of any facility licensed under this section.
 
 9      (d)  Rules adopted under this section shall be enforced by
 
10 the director.
 
11      (e)  The department shall maintain a registry of all
 
12 facilities licensed under this section and a current inventory of
 
13 vacancies to facilitate the placement of individuals in these
 
14 facilities.
 
15      (f)  The rate of payment for residents in the developmental
 
16 disabilities domiciliary homes shall be determined on the same
 
17 basis as domiciliary care homes as provided under section
 
18 346-53."] 
 
19      SECTION 18.  Section 1 of Act 132, Session Laws of Hawaii
 
20 1998, is repealed.
 
21      ["SECTION 1.  Chapter 321, Hawaii Revised Statutes, is
 
22 amended by adding two new sections to be appropriately designated
 
23 and to read as follows:
 

 
Page 45                                                    856
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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

 
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 1      (b)  The director shall adopt rules regarding expanded adult
 
 2 residential care homes in accordance with chapter 91 which shall
 
 3 be a social model designed to:
 
 4      (1)  Protect the health, safety, civil rights, and rights of
 
 5           choice of the persons to reside in a nursing facility
 
 6           or in home- or community-based care;
 
 7      (2)  Provide for the licensing of expanded adult residential
 
 8           care homes for persons who are certified by the
 
 9           department of human services, a physician, advanced
 
10           practice registered nurse, or registered nurse case
 
11           manager as requiring skilled nursing facility level or
 
12           intermediate care facility level of care who have no
 
13           financial relationship with the home care operator or
 
14           facility staff; provided that the rules shall allow
 
15           group living in two categories of expanded adult
 
16           residential care homes as licensed by the department of
 
17           health:
 
18           (A)  Type I home shall consist of five or less
 
19                residents with no more than two nursing facility
 
20                level residents; and
 
21           (B)  Type II home shall consist of six or more
 
22                residents, with no more than twenty per cent of
 
23                the home's licensed capacity as nursing facility
 

 
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 1                level residents; provided that more nursing
 
 2                facility level residents may be allowed at the
 
 3                discretion of the department.
 
 4      (3)  Comply with applicable federal laws and regulations of
 
 5           Title XVI of the Social Security Act, as amended; and
 
 6      (4)  Provide penalties for the failure to comply with any
 
 7           rule.
 
 8      (c)  The department may provide for the training of and
 
 9 consultations with operators and staff of any facility licensed
 
10 under this section, in conjunction with any licensing thereof,
 
11 and shall adopt rules to ensure that expanded adult residential
 
12 care home operators shall have the needed skills to provide
 
13 proper care and supervision in a home environment as required
 
14 under department rules.
 
15      (d)  The department shall establish a standard admission
 
16 policy and procedure which shall require the provision of
 
17 information that includes the appropriate medical and personal
 
18 history of the patient as well as the level of care needed by the
 
19 patient prior to the patient's referral and admission to any
 
20 expanded adult residential care home facility.  The department
 
21 shall develop appropriate forms and patient summaries for this
 
22 purpose.
 

 
 
 
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 1      (e)  The department shall maintain an inventory of all
 
 2 facilities licensed under this section and shall maintain a
 
 3 current inventory of vacancies therein to facilitate the
 
 4 placement of individuals in such facilities."]
 
 5      SECTION 19.  (a)  The department of health shall determine
 
 6 the number of existing basic category Type I adult residential
 
 7 care homes in the State that have any vacancy within their
 
 8 licensed capacity and shall specifically identify each such
 
 9 facility.  The department of health shall further determine, on
 
10 each island, the basic category Type I adult residential care
 
11 home:
 
12      (1)  Total bed capacity;
 
13      (2)  Total number of vacancies; and
 
14      (3)  Percentage of vacancies.
 
15      The department of health shall cease issuing licenses to
 
16 operate new basic category Type I adult residential care homes on
 
17 each island until the percentage of vacancies on each island
 
18 falls below ten per cent of the total bed capacity of basic
 
19 category Type I adult residential care homes on each island;
 
20 provided that the department may issue new licenses on a case-by-
 
21 case basis on the neighbor islands if there is a demonstrable
 
22 demand for such facilities.
 

 
 
 
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 1      (b)  The department of human services, where appropriate,
 
 2 shall encourage its clients, for whom the department makes
 
 3 reimbursement payments for residence in basic category Type I
 
 4 adult residential care homes but who have not yet been admitted,
 
 5 to enter those homes identified as having a vacancy by the
 
 6 department of health pursuant to this Act.
 
 7      (c)  This section shall not apply to expanded adult
 
 8 residential care homes.
 
 9      SECTION 20.  There is appropriated out of the general
 
10 revenues of the State of Hawaii the sum of $1 or so much thereof
 
11 as may be necessary for fiscal year 1999-2000 and the sum of $1
 
12 or so much thereof as may be necessary for fiscal year 2000-2001
 
13 to implement an information and referral process for the adult
 
14 residential care facilities system in Hawaii under chapter 321,
 
15 part    .  The appropriations shall be expended to fund:
 
16      (1)  An augmentation of the executive office on aging's
 
17           Aging Network to perform initial information and
 
18           referral screening for all persons aged sixty and
 
19           older;
 
20      (2)  The executive office on aging to expand its screening
 
21           and referral program to coordinate the establishment
 
22           and operation of similar services to be provided by
 
23           ASK-2000, or other information and referral providers
 

 
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 1           as appropriate, for clients under age sixty.  The
 
 2           development of this expansion shall begin in July, 1999
 
 3           and full operation shall begin in July, 2000;
 
 4      (3)  A subcontract by the executive office on aging with
 
 5           ASK-2000, or other information and referral providers
 
 6           to provide similar supplementary initial information
 
 7           and referral screening for all potential clients under
 
 8           age sixty.  The development of this supplementary
 
 9           service shall begin in July, 1999, and full operation
 
10           shall begin in July, 2000; and
 
11      (4)  One-time startup costs and annual operating costs.
 
12      SECTION 21.  There is appropriated out of the general
 
13 revenues of the State of Hawaii the sum of $1 or so much thereof
 
14 as may be necessary for fiscal year 2000-2001 to implement the
 
15 functions and responsibilities of sections 2 and 4 through 18 of
 
16 this Act.
 
17      SECTION 22.  There is appropriated out of the general
 
18 revenues of the State of Hawaii the sum of $1 or so much thereof
 
19 as may be necessary for fiscal year 1999-2000 to be paid into the
 
20 adult residential care home personal injury and property damage
 
21 compensation special fund created in section 3 of this Act.
 
22      SECTION 23.  The sums appropriated shall be expended by the
 
23 department of health for the purposes of this Act.
 

 
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 1      SECTION 24.  If any provision of this Act, or the
 
 2 application thereof to any person or circumstance is held
 
 3 invalid, the invalidity does not affect other provisions or
 
 4 applications of the Act which can be given effect without the
 
 5 invalid provision or application, and to this end the provisions
 
 6 of this Act are severable.
 
 7      SECTION 25.  In codifying the new part added to chapter 321,
 
 8 Hawaii Revised Statutes, by section 2 of this Act, the revisor of
 
 9 statutes shall substitute appropriate section numbers for the
 
10 letters used in the new sections' designations in this Act.
 
11      SECTION 26.  Until such time as administrative rules are
 
12 adopted for purposes of this Act, existing administrative rules
 
13 based on statutory material that is amended or repealed under
 
14 this Act shall remain in effect.
 
15      SECTION 27.  Statutory material to be repealed is bracketed.
 
16 New statutory material is underscored.
 
17      SECTION 28.  This Act shall take effect upon its approval;
 
18 provided that sections 3, 13, and 20 to 23 shall take effect on
 
19 July 1, 1999.