Honolulu, Hawaii
                                                     , 1999

                                   RE:  S.B. No. 856
                                        S.D. 1

Honorable Norman Mizuguchi
President of the Senate
Twentieth State Legislature
Regular Session of 1999
State of Hawaii


     Your Committee on Health and Human Services, to which was
referred S.B. No. 856 entitled: 


begs leave to report as follows:

     The purpose of this measure is to reorganize and streamline
adult residential care facilities.

     Your Committee received testimony in support of this measure
from the Department of Human Services (DHS), Department of Health
(DOH), Executive Office on Aging, State Planning Council on
Developmental Disabilities, Healthcare Association of Hawaii,
Policy Advisory Board for Elder Affairs, American Association of
Retired Persons, Hawaii Long Term Care Association, Alliance for
Residential Care Administrators, Hawaii Women Lawyers, and Big
Island ARCH Association.

     This measure is a recommendation of the Joint Legislative
Committee on Long-Term Care Financing (JLC), created pursuant to
Act 339, Session Laws of Hawaii (SLH) 1997.  House Concurrent
Resolution No. 225, SLH 1998, directed the JLC to create a
Subcommittee to study long-term care (LTC) residential facilities
in Hawaii.

     Your Committee finds that the need for adequate and decent
long-term residential care for Hawaii's elders is growing
immensely with the demand outstripping the supply.
Unfortunately, the organization and regulation of residential

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care facilities in Hawaii are fragmented.  This tends to reduce
cost-effectiveness and hampers operational effectiveness in the
delivery of residential care services.

     Your Committee further finds that there is a lack of overall
direction and guidance at the state level regarding the delivery
of LTC to Hawaii's residents.  Specifically, there is no vision
of how residential care facilities and services may be used to
alleviate the burden of LTC in Hawaii.  This is reflected in the
fragmented structure of regulation for a plethora of residential
care category types in the Hawaii Revised Statutes (HRS) and the
Hawaii Administrative Rules.

     This measure is intended to respond to a compelling need to
clearly define how residential care facilities and their services
can be utilized effectively and efficiently.  Your Committee
desires to improve the organizational structure and regulatory
processes based on a more rational, consolidated, and equitable
reorganization of the LTC residential care system, in order to
benefit consumers of the system.

     Your Committee has amended this measure by:

     (1)  Clarifying the definition of "adult foster home for
          persons with developmental disabilities" by adding
          assistance to residents to increase or maintain self-
          help and decision-making skills and promoting inclusion
          and self-determination;

     (2)  Deleting a reference to "handicapped" under the
          definition of "adult residential care home" and
          inserting "persons with a disability";

     (3)  Clarifying the definition of "developmental
          disabilities domiciliary home" by adding that residents
          not be related to the home operator or facility staff;

     (4)  Clarifying the definitions of "expanded adult foster
          home for persons with developmental disabilities" and
          "expanded developmental disabilities domiciliary home"
          by adding that residents not be related to the family
          living in the home and that the primary caregiver be
          qualified to care for more than two residents who may
          require intermediate care facility for the mentally
          retarded level of care;

     (5)  Changing a reference from "three" to "two" facility
          categories under section 321-E, in section 1 of the

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     (6)  Clarifying in section 321-H that the DOH shall maintain
          a current inventory of vacancies in all of the adult
          residential care facility categories, rather than only
          adult residential care homes and expanded adult
          residential care homes;

     (7)  Deleting the entire section 321-L relating to authority
          for licensure, and inserting provisions to require the
          DOH to adopt rules to license each of the entities
          defined in section 321-B with specific requirements for
          developmental disabilities domiciliary homes and adult
          foster homes for persons with developmental

     (8)  Clarifying the definition of "adult residential care
          facility" in section 46-15.3, HRS, to mean any of the
          entities defined under section 321-B of this measure;

     (9)  Deleting sections 16, 17, and 24 of the measure which
          repeal two statutory provisions and inserting a repeal
          of section 1 of Act 132, SLH 1998, which is the
          equivalent effect and is a more appropriate manner of

    (10)  Adding an appropriation of $1,000,000, for fiscal year
          2000-2001, for the DOH to implement the Act; 

    (11)  Providing that existing administrative rules continue
          in effect until new rules are adopted; and

    (12)  Making technical, nonsubstantive amendments.

     Your Committee intends that residents of LTC facilities not
have their lives disrupted when the new administrative rules take
effect if a home operator is found to be noncompliant with the
new rules.

     As affirmed by the record of votes of the members of your
Committee on Health and Human Services that is attached to this
report, your Committee is in accord with the intent and purpose
of S.B. No. 856, as amended herein, and recommends that it pass
Second Reading in the form attached hereto as S.B. No. 856,
S.D. 1, and be referred to the Committee on Ways and Means.

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                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Health and Human

                                   SUZANNE CHUN OAKLAND, Chair

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