HB408 SD1

SECTION 1. Section 321-481, Hawaii Revised Statutes, is amended by amending the definition of "community care foster family home" to read as follows:

""Community care foster family home" or "home" means a home that:

(1) Is regulated by the department in accordance with rules that are equitable in relation to rules that govern expanded adult residential care homes;

(2) Is issued a certificate of approval by the department or its designee to provide, for a fee, twenty-four-hour living accommodations, including personal care and homemaker services, for not more than two adults at any one time, at least one of whom shall be a medicaid recipient, who are at the nursing facility level of care, who are unrelated to the foster family, and who are receiving the services of a licensed home and community-based case management agency; provided that:

(A) The department, in its discretion, may certify a home for a third adult who is at the nursing facility level of care and is a medicaid recipient; provided further that:

(i) The home has been certified and in operation for not less than one year;

(ii) The primary caregiver is a certified nurse aide, as defined in section 457A-1.5, who has completed a state-approved training program and other training as required by the department; and

(iii) The substitute caregiver is a nurse aide, as defined in section 457A-1.5, who has completed a state-approved training program and other training as required by the department;

(B) The department, in consultation with the department of human services, and in its discretion, and considering the past admission history and current client mix of the community care foster family home, may allow two private-pay individuals to be cared for in the same community care foster family home after considering the following relevant factors:

(i) The community care foster family home is certified for three or four beds;

(ii) The operator of the [~~three-bed~~] three- or four-bed community care foster family home has had a vacant medicaid bed for at least six months; provided that the operator shall not transfer out a medicaid or private-pay client from the community care foster family home in order to accept a private-pay individual;

(iii) The two private-pay individuals are in a relationship with each other as a married couple or in a civil union and one of the private-pay individuals is currently residing in the community care foster family home for at least six months;

(iv) The department, in its discretion, determines that no other adult residential care home, expanded adult residential care home, or health care facility within the area has an available opening and is capable of providing care to both private-pay individuals; and

(v) There are no medicaid recipients seeking placement in the community care foster family home that the married or civil union private-pay individuals are seeking to occupy;

(C) If the legal relationship of the marriage or civil union of the individuals ceases to exist, including but not limited to as a result of death or divorce, one of the two private-pay beds shall immediately, upon the death or the effective date of divorce, become a medicaid bed; and

(D) The department and its officers, employees, and agents, in exercising discretion and in considering any other factors that the department deems relevant to its decision, shall be immune from suit and liability in the exercise of its discretion under this section; and

(E) The department, in its discretion, may certify a home for a fourth adult who is at the nursing facility level of care, is a medicaid recipient, and has documented housing instability; provided further that:

(i) The home has been certified for three beds and in compliant operation for not less than one year;

(ii) The primary caregiver is a certified nurse aid, as defined in section 457A-1.5, who has completed a state-approved training program and other training as required by the department;

(iii) A second caregiver, who is a certified nurse aid, as defined in section 457A-1.5, who has completed a state-approved training program and other training as required by the department, is on duty from 7:00 a.m. to 7:00 p.m.;

(iv) Any substitute caregiver is a certified nurse aide, as defined in section 457A-1.5, who has completed a state-approved training program and other training as required by the department; and

(v) An evaluation and report shall be provided to the department from a qualified service provider and health care provider for each adult proposed to be the fourth client in a community care foster family home, pursuant to this paragraph;

provided further that a caregiver of a community care foster family home may submit a request to the department to increase the home's bed capacity from three to four only after all vacancies in community care foster family homes located on the same island are filled; and

(3) Does not include expanded adult residential care homes or assisted living facilities."

SECTION 2. The department of health and the governor's coordinator on homelessness shall submit a report of their findings and recommendations, including any proposed legislation, on the authorization to allow one additional individual who is a medicaid recipient to be cared for in the same community care foster family home, the benefits and impacts to homelessness, and the benefits and impacts to persons experiencing housing instability, as provided under section 1 of this Act, to the legislature no later than twenty days prior to the convening of the regular session of 2025.

SECTION 3. The department of health and the governor's coordinator on homelessness shall enter into a memorandum of agreement to implement this Act before the placement of any individual recommended for placement as a fourth adult in a certified community care foster family home pursuant to section 1 of this Act.

SECTION 4. It is not the intent of this Act to jeopardize the receipt of any federal aid. If this Act is found to be in conflict with federal requirements that are a prescribed condition for the allocation of federal funds to the State, this Act shall be deemed void.

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect July 1, 3000, and shall be repealed on June 30, 2027; provided that section 321‑481, Hawaii Revised Statutes, shall be reenacted in the form in which it read on the day before the effective date of this Act.

HOUSE OF REPRESENTATIVES	H.B. NO.	408
THIRTY-SECOND LEGISLATURE, 2023		H.D. 2
STATE OF HAWAII		S.D. 1