Long-Term Care; Japan Model
Gives executive office on aging broad authority to create and implement Hawaii long-term care program based on Japanese model. Requires implementing legislation, including tax measures to be enacted by 6/30/2005 or otherwise repealed.
HOUSE OF REPRESENTATIVES
TWENTY-FIRST LEGISLATURE, 2001
STATE OF HAWAII
A BILL FOR AN ACT
relating to long-term care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that in April 2000, Japan instituted a new program of long-term care insurance for the care and assistance of the elderly. Japan has a population with the longest life expectancy in the world. With its population aging at a rapid pace, there is a pressing need for "kaigo" or nursing care for the elderly especially for those over age eighty-five. As Japanese parents grow progressively older, it has become more difficult for them to care for their even older parents or grandparents.
"Kaigo-Hoken" means "insurance for the care and assistance for the elderly" and the program of care is operated by local governments with half the cost borne by the national, prefectural, and city governments through public funding. The remaining cost is covered by insurance premiums paid by insured workers who are forty years of age and older. When services are actually used, the insured pays ten per cent of the cost.
Japan's system is starkly different from our own system of long-term care where the few who can afford long-term care pay entirely out-of-pocket and those who are not as affluent eventually spend down their assets and are maintained by Medicaid, burdening both the federal and the state governments with extremely high costs of long-term care.
The purpose of this Act is to grant broad authorization to the executive office on aging to establish a long-term care program for the elderly based on the Japanese model of "Kaigo-Hoken" but adapted to meet the needs of Hawaii's situation.
SECTION 2. Hawaii long-term care program; modification and adaptation of Kaigo-Hoken Japanese model; executive office on aging authorized to create and administer; program administrator; staff. (a) The executive office on aging is hereby granted broad authorization to create and administer a program of long-term care for Hawaii's elders based on the Japanese long-term care model of "Kaigo-Hoken" but with adaptations and modifications that, at the discretion of the director of the executive office on aging, are necessary to implement and administer the program in a practical manner in the State and to effectively serve the elders of Hawaii.
(b) The director of the executive office on aging is authorized to hire, without regard to chapters 76 and 89, Hawaii Revised Statutes, a program administrator for the Hawaii long-term care program. The program administrator shall be knowledgeable and have experience in the areas of health and long-term care for the elderly, and shall also preferably have knowledge of insurance matters and experience in administration. The director of the executive office on aging shall set the salary of the program administrator and shall have the power to dismiss the program administrator for cause.
(c) The program administrator shall hire all staff, subject to chapters 76 and 89, that the administrator believes are necessary to administer the Hawaii long-term care program.
SECTION 3. Hawaii long-term care program; basic elements; necessary modifications and adaptations. The Hawaii long-term care program shall be modified and adapted from the "Kaigo-Hoken" Japanese model and shall include the following basic elements:
(1) Eligibility and coverage of individuals, or as modified and adapted, shall include:
(A) All persons sixty-five years old and older who:
(i) Require round-the-clock residential care; and
(ii) Require assistance with activities or instrumental activities of daily living;
(B) All persons aged forty to sixty-four who have some form of health insurance, public or private who:
(i) Require round-the-clock residential care; and
(ii) Require assistance with activities or instrumental activities of daily living due to a set list of diseases to be determined by the program administrator;
(2) Participant premiums shall be paid, or as modified and adapted, by:
(A) Individuals sixty-five years old and older from retirement or pension payments, or in a method as modified by the program administrator; and
(B) Individuals aged forty to sixty-four who shall have premiums added to their existing health insurance premiums, or in a method as modified by the program administrator;
(3) Participant copayments shall be paid, or as modified and adapted, at a rate of ten per cent for all services received; provided that:
(A) Participants receiving residential care shall also pay for food; and
(B) If the program administrator deems the ten per cent copayment too high for an individual to pay, a ceiling may be set on the amount of the copayment; and
(C) The program administrator may also establish a copayment schedule for low-income individuals that requires copayment of less than ten per cent of the cost of service rendered;
(4) Long-term care services to be offered in the program, or as modified and adapted, shall include at least:
(A) Home visits that include:
(i) Homemaking and chore services;
(ii) Nursing services;
(iii) Rehabilitation services;
(iv) Personal care services;
(v) Medical advice from physicians, nurses, dentists, dental hygienists, and pharmacists, dieticians;
(B) Day care services including:
(i) Rehabilitation services;
(ii) Recreational activities;
(iii) Physical and other therapies; and
(iv) Provision of meals;
(C) Loans and financial assistance for:
(i) Purchase of assistive equipment such as wheelchairs, special beds, modified toilets, bathing chairs, etc.; and
(ii) Financing of home modifications such as installation of handrails and emergency call systems, widening of halls, grading of floors, etc.;
(D) Any other services that the program administrator determines are necessary and appropriate;
(5) System of application, intake, and evaluation of participants into the program, or as modified or adapted, shall include:
(A) Submission of initial application to any designated government office, including at the county level;
(B) A survey visit by a trained staff member to request information on the applicant's mental and physical conditions to be recorded for computer computation;
(C) Computer-aided computation of an estimate of the amount of time over which long-term care services are needed;
(D) Evaluation by a committee of physicians, nurses, social workers, and other health care specialists, based on the application and computer evaluation to reach a decision on determining the extent of need for long-term care services in terms of assistance with activities or instrumental activities of daily living, or residential round-the-clock care. The evaluation and decision shall be complete within thirty days of the date of initial application and an official participation notice and membership card is to be sent to the new participant.
(E) Provision of an appeal process if the applicant disagrees with the committee's evaluation and decision;
(F) An individual service plan, based on the committee's evaluation and decision and in consultation with the participant, shall be made by a case manager who shall determine the specific types of services required for each participant. The case manager shall ensure that all necessary services are provided, including either home care in the participant's home or in an institution. The participant may create an individual service plan provided that all services not provided under the program must be paid for by the participant;
(G) The status of the participant shall be re-examined every six months to determine whether the individual service plan should be changed;
(H) If assistance with activities of daily living is needed, the individual service plan shall indicate at which level assistance is needed. The program administrator may establish various levels or categories of assistance such as:
(i) Level 1: Day care twice a week;
(ii) Level 2: Various types of daily home-helper services;
(iii) Level 3: Various daily services including day care three times a week;
(iv) Level 4: Services twice a day, including home-helper services at night or early morning, nursing visits three times a week for cases requiring medical care, and daily services including day care four times a week for cases of senile dementia;
(v) Level 5: Services two or three times a day, including home-helper services at night or early morning, and nursing visits three times a week for cases requiring medical care, and daily services including day care five times a week for cases of senile dementia; and
(vi) Level 6: Services three or four times a day, including home-helper services at night or early morning, and nursing visits three times a week for cases requiring medical care, and daily services including day care seven times a week for cases of senile dementia;
(6) Allocation of costs to finance the long-term care program, or as modified and adapted, shall be as follows:
(A) State government: 37.5 per cent;
(B) County governments: 12.5 per cent;
(C) Premiums paid by participants aged forty to sixty-four: 33 per cent; and
(D) Premiums paid by participants aged sixty-five and older: 17 per cent;
(7) Method of financing government allocations, or as modified and adapted, shall be through imposition of a state long-term care tax on individual adjusted gross income.
SECTION 4. The director of the executive office on aging shall submit necessary proposed legislation to the legislature no later than twenty days prior to the convening of the regular session of 2002 to:
(1) Establish a means of financing for the Hawaii long-term care plan, including any necessary tax measures; and
(2) Establish the necessary statutory provisions and requirements of the Hawaii long-term care program.
SECTION 5. This Act shall take effect upon its approval; provided that sections 2 and 3 shall take effect on the date that the necessary legislation required under section 4 is enacted; and further provided that this Act shall be repealed on June 30, 2005 if the legislation required under section 4 is not enacted prior to June 30, 2005.