Long-Term Care; Family Caregiver Reimbursement
Establishes a pilot program to reimburse family caregivers of functionally dependent or cognitively impaired care recipients; appropriates funds for that purpose; sunsets in 2012.
TWENTY-FOURTH LEGISLATURE, 2007
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 need for personal care due to physical, sensory, cognitive, and self-care disabilities increases with age. By 2020, more than one in four individuals will be sixty years of age or older. As Hawaii's population ages a considerable number of frail and disabled older adults, as well as younger persons with disabilities, will rely on family members and others to provide them with higher levels of long-term care to enable them to remain at home.
People who need long-term care often 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 of older adults 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 caregiving is provided by women. About two-thirds of frail and disabled older adults living in the community rely solely on informal help, mainly from wives and adult daughters.
Family caregivers are an important part of the solution to serious long-term care system problems such as budget and workforce shortages. Family caregivers relieve state spending on nursing home care. During times of fiscal discipline, family caregiving is a way to reduce fiscal spending without compromising 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 care recipients in the home.
SECTION 2. (a) The department of health shall establish and administer a pilot program that provides reimbursement to family caregivers who provide free and continuing day-to-day care in the home of a qualified care recipient.
(b) 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 designed by the department of health;
(2) Provide free and continuing day-to-day care in the home of a qualified care recipient;
(3) Provide written certification from a physician licensed under chapter 453 or 460, Hawaii Revised Statutes, or an advanced practice registered nurse recognized under section 457-8.5, Hawaii Revised Statutes, that the qualified care recipient:
(A) Is unable to perform, without substantial assistance from another individual, at least two or more activities of daily living, as defined in section 346C-1, Hawaii Revised Statutes, for a period of at least ninety days due to a loss of functional capacity; or
(B) Requires substantial supervision to protect the qualified care recipient from threats to health and safety to self or others due to severe cognitive impairment such as dementia;
(4) Not operate any type of nonprofit or for-profit care service for disabled or elder individuals; and
(5) Complete a caregiver educational training course certified by the department of health.
(c) 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 up to $1,000 annually; or
(2) Up to $1,000 annually for expenses incurred in obtaining home modifications or assistive devices, as approved by the department of health, such as grab bars, safety devices, and wheelchair ramps that help the qualified care recipient carry out tasks required for daily living.
(d) Reimbursement to a family caregiver shall not:
(1) Be used to purchase care from, or offset the expense of employing, a professional care provider not related to the qualified care recipient; and
(2) Be considered an obligation to replace lost wages of the family caregiver.
(e) Nothing in this section shall be construed to create an employee or employer relationship between a family caregiver and a qualified care recipient.
(f) The department of health shall not be held liable for the care provided to the qualified care recipient by the family caregiver.
(g) The department of health shall develop 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 a portion of the family caregiver's out-of-pocket expenses described in subsection (c)(2).
(h) The department shall adopt rules in accordance with chapter 91, Hawaii Revised Statutes, regarding operating procedures and guidelines to implement this section, including guidelines that address reimbursement:
(1) To more than one eligible family caregiver; and
(2) For the care of more than one qualified care recipient.
(i) As used in this section, unless the context requires otherwise:
"Family caregiver" means a person, including a non-relative such as a friend or neighbor, who provides free and continuing day-to-day care in the home to a qualified care recipient.
"Qualified care recipient" means a person who:
(1) Is not eligible for medicaid;
(2) Has an annual income of no more than two hundred per cent of the federal poverty level for Hawaii in the year in which an application for reimbursement is made; and
(3) Is unable to perform, without substantial assistance from another individual, at least two or more activities of daily living, as defined in section 346C-1, Hawaii Revised Statutes, for a period of at least ninety days due to a loss of functional capacity; or
(4) Requires substantial supervision to protect the qualified care recipient from threats to health and safety to self or others due to severe cognitive impairment such as dementia.
SECTION 3. The department of health shall submit:
(1) A progress report of its findings no later than twenty days prior the convening of each regular legislative session in which the program is administered; and
(2) A final report no later than twenty days prior to the convening of the regular session of 2012.
SECTION 4. Section 235-7, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
"(a) There shall be excluded from gross income, adjusted gross income, and taxable income:
(1) Income not subject to taxation by the State under the Constitution and laws of the United States;
(2) Rights, benefits, and other income exempted from taxation by section 88-91, having to do with the state retirement system, and the rights, benefits, and other income, comparable to the rights, benefits, and other income exempted by section 88-91, under any other public retirement system;
(3) Any compensation received in the form of a pension for past services;
(4) Compensation paid to a patient affected with Hansen's disease employed by the State or the United States in any hospital, settlement, or place for the treatment of Hansen's disease;
(5) Except as otherwise expressly provided, payments made by the United States or this State, under an act of Congress or a law of this State, which by express provision or administrative regulation or interpretation are exempt from both the normal and surtaxes of the United States, even though not so exempted by the Internal Revenue Code itself;
(6) Any income expressly exempted or excluded from the measure of the tax imposed by this chapter by any other law of the State, it being the intent of this chapter not to repeal or supersede any such express exemption or exclusion;
(7) Income received by each member of the reserve components of the Army, Navy, Air Force, Marine Corps, or Coast Guard of the United States of America, and the Hawaii national guard as compensation for performance of duty, equivalent to pay received for forty-eight drills (equivalent of twelve weekends) and fifteen days of annual duty, at an:
(A) E-1 pay grade after eight years of service; provided that this subparagraph shall apply to taxable years beginning after December 31, 2004;
(B) E-2 pay grade after eight years of service; provided that this subparagraph shall apply to taxable years beginning after December 31, 2005;
(C) E-3 pay grade after eight years of service; provided that this subparagraph shall apply to taxable years beginning after December 31, 2006;
(D) E-4 pay grade after eight years of service; provided that this subparagraph shall apply to taxable years beginning after December 31, 2007; and
(E) E-5 pay grade after eight years of service; provided that this subparagraph shall apply to taxable years beginning after December 31, 2008;
(8) Income derived from the operation of ships or aircraft if the income is exempt under the Internal Revenue Code pursuant to the provisions of an income tax treaty or agreement entered into by and between the United States and a foreign country, provided that the tax laws of the local governments of that country reciprocally exempt from the application of all of their net income taxes, the income derived from the operation of ships or aircraft that are documented or registered under the laws of the United States;
(9) The value of legal services provided by a prepaid legal service plan to a taxpayer, the taxpayer's spouse, and the taxpayer's dependents;
(10) Amounts paid, directly or indirectly, by a prepaid legal service plan to a taxpayer as payment or reimbursement for the provision of legal services to the taxpayer, the taxpayer's spouse, and the taxpayer's dependents;
(11) Contributions by an employer to a prepaid legal
service plan for compensation (through insurance or otherwise) to the
employer's employees for the costs of legal services incurred by the employer's
employees, their spouses, and their dependents; [
(12) Amounts received in the form of a monthly
surcharge by a utility acting on behalf of an affected utility under section
269-16.3 shall not be gross income, adjusted gross income, or taxable income
for the acting utility under this chapter. Any amounts retained by the acting
utility for collection or other costs shall not be included in this exemption[
(13) Reimbursements paid to a family caregiver pursuant to section 2 of Act , Session Laws of Hawaii 2007."
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 2007-2008, and the same sum, or so much thereof as may be necessary for fiscal year 2008-2009, to provide reimbursement to family caregivers who provide at-home care to qualified care recipients.
The sums appropriated shall be expended by the department of health for the purposes of this Act.
SECTION 6. Upon passage of this Act, the revisor shall insert the act number of this Act into the amendment made to section 235-7(a), Hawaii Revised Statutes, in section 4 of this Act.
SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 8. This Act shall take effect on July 1, 2007, and shall be repealed on June 30, 2012; provided that section 235‑7(a), Hawaii Revised Statutes, is reenacted in the form in which it read on the day before the approval of this Act.