Report Title:

Long-Term Care; Family Caregivers; Reimbursement

Description:

Appropriates $     in FY 2004-2005 to DOH and $     to DHS to reimburse family caregivers who provide at-home care to qualified relatives. Sets eligibility and uses of reimbursement. Requires DHS and DOH to adopt rules.

THE SENATE

S.B. NO.

2225

TWENTY-SECOND LEGISLATURE, 2004

 

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 the care provided annually by family caregivers for free has an estimated value of approximately $196,000,000,000. On the other hand, formal home care services are estimated to cost about $32,000,000,000 annually, and nursing home services cost about $83,000,000,000. Most people who need long-term care prefer to receive assistance and services at home and to stay in their communities, near family and friends, for as long as possible. Family caregivers provide over eighty per cent of home care services and over ninety per cent of all long-term care services. At least seventy-five per cent of all family care is provided by women. About two-thirds of older people living in the community rely solely on informal help, mainly from wives and adult daughters. Caregiving itself has become harder for all family caregivers partly because those who need long-term care are living longer with chronic illness and disabilities.

Families can be an important part of the solution to serious long-term care system problems such as budget and workforce shortages. Family caregivers can relieve state spending on nursing home care. During times of fiscal discipline, family caregiving can be a way to reduce costs without hurting the people the State is trying to serve.

The legislature further finds that many states have implemented or expanded programs to assist family caregivers in providing care to elderly and disabled individuals who require long-term care. As long-term care costs continue to rise, it is in the interest of the State to assist family caregivers who provide day-to-day long-term care for their relatives in the home by keeping those who require such care off medicaid and out of costly nursing homes.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"321- Family caregiver reimbursement; definitions; eligibility; use; sliding scale; rules. (a) The department of health may provide reimbursement to a family caregiver who gives free and continuing day-to-day care in the home to a qualified relative who is a functionally dependent person or who is suffering from dementia, such as Alzheimer's disease.

(b) As used in this section, unless the context requires otherwise:

"Family caregiver" means a person who provides free and continuing day-to-day care in the home for a qualified relative.

"Functionally dependent person" means an individual who is certified to require assistance with         or more activities of daily living, as defined in section 346C-1, for the period of time during which the family caregiver provides at-home care.

"Qualified relative" means the family caregiver's spouse or any person related to the family caregiver or caregiver's spouse as a grandparent, parent, son, daughter, aunt, uncle, brother, sister, or first cousin.

(c) To be eligible for reimbursement, a family caregiver shall:

(1) Apply to the department of health for reimbursement on a one-page form to be jointly designed by the department of health and the department of human services;

(2) Not operate any type of nonprofit or for-profit care service for handicapped or elder individuals;

(3) Have an annual income less than        per cent of the federal poverty level for Hawaii in the year in which an application for reimbursement is made; and

(4) Obtain certification from a physician licensed under chapter 453 or 460, or an advanced practice registered nurse recognized under section 457-8.5, certifying that the qualified relative suffers from dementia or requires assistance with         or more activities of daily living, as defined in section 346C-1. The written certification shall specify that the qualified relative:

(A) Is unable to perform, without substantial assistance from another individual, at least         of six activities of daily living for a period of at least ninety days due to a loss of functional capacity; or

(B) Requires substantial supervision to protect the qualified relative from threats to health and safety to self or others due to severe cognitive impairment.

(d) Reimbursement to a family caregiver may be used to offset:

(1) The general expense of providing at-home care provided in person by the family caregiver, and shall not be used to purchase care from, or offset the expense of employing, a professional care provider not related to the qualified relative; or

(2) Expenses incurred in obtaining home modifications or assistive devices, as approved by the department, such as grab bars, safety devices, and wheelchair ramps, which help the qualified relative to carry out tasks required for daily living;

but in no case shall exceed $         annually. Under no circumstances shall reimbursement made under this section be considered an obligation to replace lost wages of the family caregiver.

(e) The department of health shall jointly develop with the department of human services a sliding scale for reimbursement to ensure that an eligible family caregiver whose household income exceeds two hundred per cent of the federal poverty level for Hawaii shall pay some portion of the caregiver's out-of-pocket expenses described in subsection (d)(2).

(f) The department shall adopt rules in accordance with chapter 91 regarding operating procedures and guidelines to implement this section, including guidelines that address reimbursement:

(1) To more than one eligible family caregiver in the same household; and

(2) For the care of more than one qualified relative in the same household.

The department of health shall collaborate with the department of human services to the extent possible to ensure that the rules adopted by the respective departments to implement reimbursement to family caregivers under this section and section 346D-    are not inconsistent."

SECTION 3. Chapter 346D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"346D- Family caregiver reimbursement; definitions; eligibility; use; sliding scale; rules. (a) The department of human services may provide reimbursement to a family caregiver who gives free and continuing day-to-day care in the home to a qualified relative who is a functionally dependent person or who is suffering from dementia, such as Alzheimer's disease.

(b) As used in this section, unless the context requires otherwise:

"Family caregiver" means a person who provides free and continuing day-to-day care in the home for a qualified relative.

"Functionally dependent person" means an individual who is certified to require assistance with         or more activities of daily living, as defined in section 346C-1, for the period of time during which the family caregiver provides at-home care.

"Qualified relative" means the family caregiver's spouse or any person related to the family caregiver or caregiver's spouse as a grandparent, parent, son, daughter, aunt, uncle, brother, sister, or first cousin.

(c) To be eligible for reimbursement, a family caregiver shall:

(1) Apply to the department of human services for reimbursement on a one-page form to be jointly designed by the department of human services and the department of health;

(2) Not operate any type of nonprofit or for-profit care service for handicapped or elder individuals;

(3) Have an annual income less than        per cent of the federal poverty level for Hawaii in the year in which an application for reimbursement is made; and

(4) Obtain certification from a physician licensed under chapter 453 or 460, or an advanced practice registered nurse recognized under section 457-8.5, certifying that the qualified relative suffers from dementia or requires assistance with         or more activities of daily living, as defined in section 346C-1. The written certification shall specify that the qualified relative:

(A) Is unable to perform, without substantial assistance from another individual, at least         of six activities of daily living for a period of at least ninety days due to a loss of functional capacity; or

(B) Requires substantial supervision to protect the qualified relative from threats to health and safety to self or others due to severe cognitive impairment.

(d) Reimbursement to a family caregiver may be used to offset:

(1) The general expense of providing at-home care provided in person by the family caregiver, and shall not be used to purchase care from, or offset the expense of employing, a professional care provider not related to the qualified relative; or

(2) Expenses incurred in obtaining home modifications or assistive devices, as approved by the department, such as grab bars, safety devices, and wheelchair ramps, which help the qualified relative to carry out tasks required for daily living;

but in no case shall exceed $         annually. Under no circumstances shall reimbursement made under this section be considered an obligation to replace lost wages of the family caregiver.

(e) The department of human services shall jointly develop with the department of health a sliding scale for reimbursement to ensure that an eligible family caregiver whose household income exceeds two hundred per cent of the federal poverty level for Hawaii shall pay some portion of the caregiver's out-of-pocket expenses described in paragraph (2) of subsection (d).

(f) The department of human services shall adopt rules in accordance with chapter 91 regarding operating procedures and guidelines to implement this section, including guidelines that address reimbursement:

(1) To more than one eligible family caregiver in the same household; and

(2) For the care of more than one qualified relative in the same household.

The department of human services shall collaborate with the department of health to the extent possible to ensure that the rules adopted by the respective departments to implement reimbursement to family caregivers under this section and section 321-    are not inconsistent."

SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $        , or so much thereof as may be necessary for fiscal year 2004-2005, for reimbursement to family caregivers who provide at-home care to qualified relatives pursuant to section 321-   .

The sum appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $        , or so much thereof as may be necessary for fiscal year 2004-2005, for reimbursement to family caregivers who provide at-home care to qualified relatives pursuant to section 346D-   .

The sum appropriated shall be expended by the department of human services for the purposes of this Act.

SECTION 6. New statutory material is underscored.

SECTION 7. This Act shall take effect upon its approval, except that sections 4 and 5 shall take effect on July 1, 2004.

INTRODUCED BY:

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