Report Title:

Consumer-Directed Care

Description:

Requires the department of human services to establish a consumer-directed care program that allows recipients of home and community-based services to select the services they need and to choose their providers, giving consumers more choices and greater control over the purchased long-term care they receive.

THE SENATE

S.B. NO.

2258

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to consumer-directed care.

 

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

SECTION 1. Chapter 346D, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part . consumer-directed care

§346D-A Definitions. For purposes of this part, unless the context otherwise requires:

"Budget allowance" means the amount of money available each month to a consumer to purchase needed long-term care services, based on the results of a comprehensive assessment of the consumer's health, functional, social, and environmental needs.

"Consultant" means an individual who provides technical assistance to consumers in meeting their responsibilities under this part.

"Consumer" means an individual who chooses to participate in the consumer-directed care program, meets the eligibility requirements, and receives an approved budget allowance.

"Department" means the department of human services.

"Fiscal intermediary" means an entity approved by the department that:

(1) Helps the consumer manage the consumer's budget allowance;

(2) Retains the funds;

(3) Processes employment information, if any, and tax information;

(4) Reviews records to ensure correctness;

(5) Writes paychecks to providers; and

(6) Delivers paychecks to the consumer for distribution to providers.

"Provider" means:

(1) A person who is licensed or otherwise permitted to provide services eligible for reimbursement under the consumer-directed care program for whom the consumer is not the employer of record; or

(2) A caregiver for whom the consumer is the employer of record.

"Representative" means an uncompensated individual who is designated by the consumer to assist in managing the consumer's budget allowance and needed services.

§346d-B Consumer-directed care; establishment. The department of human services shall establish a consumer-directed care program that shall be based on the principles of consumer choice and control. The department shall establish interagency cooperative agreements with and shall work with the executive office on aging and the department of health to implement and administer the program.

§346D-C Eligibility for participation in consumer-directed care program. An individual who is enrolled in a medicaid comprehensive home and community-based waiver program who is able to direct the person's own care or to designate an eligible representative is eligible to participate in the program.

§346D-D Budget allowances. (a) Consumers in the program shall receive a monthly budget allowance based on the results of a comprehensive assessment of the consumer's health, functional, social, and environmental needs and the financial resources of the program.

(b) A consumer shall receive the monthly budget allowance directly from a fiscal intermediary approved by the department.

(c) Participating agencies shall develop purchasing guidelines, approved by the department, to assist consumers in using the budget allowance to purchase needed cost-effective services.

§346D-E Eligible services. Consumers may use the budget allowance to pay for home and community-based services that meet the consumer's long-term care needs and that are a cost-efficient use of funds. Services may include:

(1) Personal care;

(2) Homemaking and chores, including housework; meals, shopping; and transportation;

(3) Home modifications and assistive devices that increase the consumer's independence or allow the consumer to avoid institutional placement;

(4) Assistance in taking self-administered medication;

(5) Day care and respite care services, including services provided by nursing home facilities or licensed adult day care facilities; and

(6) Personal care and support services provided in an assisted living facility.

§346D-F Consumer right to choose; providers. (a) Consumers shall have a right to choose the provider of service, and when and how the service is provided. Providers may include a consumer's neighbor, friend, spouse, or relative.

(b) If the consumer is the provider's employer, the consumer shall:

(1) Develop a job description;

(2) Select caregivers and submit information for a background check;

(3) Communicate needs, preferences, and expectations about the services to be purchased;

(4) Provide the fiscal intermediary with information necessary for provider payment and tax requirements; and

(5) Terminate employment of an unsatisfactory provider.

(c) If the consumer is the not the provider's employer, the consumer shall:

(1) Communicate needs, preferences, and expectations about the services to be purchased;

(2) Provide the fiscal intermediary with information necessary for provider payment and tax requirements; and

(3) Terminate employment of an unsatisfactory provider.

§346D-G Responsibilities of department. The department shall:

(1) Assess each consumer's functional needs and provide initial help and continuing assistance with the service plan;

(2) Offer the services of consultants to provide training, technical assistance, and support to the consumer;

(3) Conduct a background check for providers;

(4) Approve fiscal intermediaries; and

(5) Establish minimum qualifications for providers and caregivers, including serving as final arbiter of the fitness of any individual to be a provider.

§346D-H Fiscal intermediaries; responsibilities. A fiscal intermediary shall:

(1) Provide recordkeeping services;

(2) Retain the consumer-directed care funds;

(3) Process employment and tax information, if any;

(4) Issue paychecks to provider; and

(5) Deliver paychecks to the consumer for distribution.

§346D-I Background checks. (a) All individuals who provide care or seek to provide care under this part shall be subject to a background check in a manner to be determined by the department. Individuals not subject to certification or professional licensure may request an exemption from the background check.

(b) An individual who has completed a background check and is qualified for employment under this part and who has not been unemployed for more than one hundred eighty days after the background check is not subject to a subsequent background check. The individual shall attest, under penalty of perjury, to not having been convicted of a disqualifying offense after the background check has been completed.

§346D-J Rules; federal waivers. (a) To implement this part, the department of human services, executive office on aging, and the department of health may adopt and enforce rules adopted under chapter 91.

(b) The department shall take all necessary action to ensure state compliance with federal law and regulations and shall apply for any required federal waivers or waiver amendments necessary to implement the consumer-directed care program.

§346D-K Reviews; annual reports. (a) The department of human services, executive office on aging, and the department of human services, on an ongoing basis, shall each review and assess the implementation and maintenance of the consumer-direct care program.

(b) The department of human services shall submit an annual report to the legislature no less than twenty days prior to the convening of each regular session that includes each department's review of the program and contains recommendations to improve the consumer-directed care program."

SECTION 2. This Act shall take effect upon its approval.

INTRODUCED BY:

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