HAR §17-1418-3. Definitions

For the purpose of this chapter: “Activities of daily living” means eating, bed or chair transfer, or both, dressing, bathing, toileting and continence. “Adult foster care services” means services, • specified, in sectionl7-1418—5, provided by the department to individuals who meet the eligibility requirements specified in section 17—1418—4, and are in. • or are seeking placement in a domiciliary care home. “Domiciliary care hone” means any facility which provides twenty—four hour living accommodations and.,:; personal care services and appropriate health care, as needed, to adults unable to care for themselves by. persons unrelated to the recipient in licensed adult’ residential care homes or other care homes regulated ‘by the department of health.: A domiciliary care ‘home does not include special treatment, nursing, nor acute care’:” facilities. There are two types of’ licensed adult ‘ . . • residential care homes: . . . (1) Type I home for five or less residents; and ‘(2) Type II home for six or more residents. “Level of care” means the amount of supervision and assistance required by an individual to’ carry out” ‘ the activities of daily living, socializing, and meeting health care needs. , “Level of care I” means minimal care, supervision, and assistance are needed by.the individual who is able to manage most activities of daily living, socializing and health care needs independently. “Level of care II” means moderate care, supervision, and assistance are needed by the individual who is able to manage some physical, mental, health care, and social. functions but requires , : reminders, assistance, and supervision in performing several activities of daily livingS. , .• • “Level o’f care III” means considerable care,. • supervision, . and assistance are needed by the individual who is unable to manage many physical, mental, and social functions, activities of daily living,’ and health care needs without help. This level 1418—2 UNOFFICIAL §17—1418—4 includes recipients of services delivered by the developmentally disabled/mental retardation home and community-based services program “Special care needs individual” means a dothiciliary care facility resident who is certified by a physician for a higher than Level III care and is awaiting placement in a nursing facility providing the higher level of care “State supplemental payments” means state funded payments made to individuals who are current recipients of supplemental security income (SSI), or state funded aid to the aged, blind, and disabled (AABD), or general assistance (GA) payments and who are residents of domiciliary care homes These are provided by the state legislature through general fund appropriations • to provide payments for the special• care needs•. : . .. individual. [Eff 6/29/92; am and comp 4/17/95; am and comp 1215/97; comp 1/23/03 ] (Auth: HRS §S346— 14, 346—53) (Imp: HRS §S346—1, 346—14, 346—53, 321_ 15.1; 42 U.S.C. §1397a) §17-1418—4. Eliqibilityrequirernents. (a) In order to be eligible for adult foster care services, the individual shall meet one of the following requirements: . .. • (I) Income maintenance status as specified in section 17—1416—20(2) (A); or • (2) Without regard to income status for individuals who require protectivä services as specified in section 17—1416—20(?) (B 1 .. When the department determines that protection is no longer needed as speöified in section 17-1421-15, the recipient shall be assisted to apply for adult foster care services, and eligibility shall be established as specified in paragraph (1). • (b) In addition to meeting categorical eligibility requirements specified in subsection (a), the individual shall meet the following prqgrain eligibility requirements: (1) The individual requesting placement services shall: (A) Need assistance with placement; and (B) Have no other agency or resource available to provide the needed service; or (2) The individual requesting case management 1418—3 §17—1418—4 UNOFFICIAL services shall: : (A) Be a domiciliary care home resident, (B) Need assistance with adjustment problems to maintain the placement;. and (C) Have no other agency or resource available to provide the needed service. [Eff 6/29/92; am and comp 4/17/95; am 10/28/95; comp 12/5/97; comp . . 1/23/03 3 (Auth: I-iRS §346—14, 346—53) (Imp: FIRS §346-’-14, 346—53) §17-1418—5 Scope of services. . (a) Placement services include one or more of the following activities for the individual meeting eligibility requirements specified in section 17-1418-4: (1) Determination that domiciliary care home is appropriate; (2) Assistance to the individual in learning about, applying for, and receiving income - . entitlements such as social security benefits, state supplemental payments, veterans’ benefits, or financial assistance; (3) Placement into an appropriate domiciliary care home; and (4) Monitoring of the individual’s domiciliary care home placement to assist with adjustment and to maintain the placement, as appropriate. (b) Case management services inclUde one or more of the following activities for the individual meeting eligibility requirements specified in section 17-1418— 4: (1) Provision of services to the individual in placement and to the individual’s relatives and friends, indluding: (A) Counseling to resolve problems which made the individual’s placement necessary; and (B) Preparing and arranging with the individual, caregivers, and relatives . or friends for the individual’s return home or move to another out-of-home placement, including other long-term permanent care, as appropriate; and (2) Assistance to remain in aparticular domiciliary care home if the individual.: does. not wish to be moved and the operator is 1418—4 UNOFFICIAL §1.7-1418—6. agreeable to the individual remaining, except when (A) The, individual requires a higher level :•. ‘.•. of bare than the current home Is able to provide; or (B) ‘The individual no longer needs domiciliary care services (c) The services specified’in subsections (a)’and (b) shall be continued for a period not to exceed ninety calendar days after the department determines . . “ the individual’s placement to be stable. The ‘ ‘‘ department’s determination of stability shall include ‘ input from the individual and. home operator and be based on there being no problems which would inte±fere with the ‘individual continuing in the placement. [Eff 6/29/92; am,and comp 4/17/95; comp 12/5/97; comp 1/23/03 3 (Auth: MRS §346—14, 346—53) (Imp: HRS §S346—14, 346—53, 42 U.S.C. §1397c) §17—1418—6 Authorization of payments. (a) Monthly state supplemental payments for special care needs individuals shall be authorized for individuals who require higher than level of care III care and who, as determined by the department, meet the following conditions: .. (1) The individual shall be a resident of an adult domiciliary care home who at initial placement was appropriately evaluated as needing level of,care I, II, or III; (2) The individual’s condition has deteriorated following initial placement into domiciliary care and the individual has been identified as a level of care Iliresident certified by a physician as needing care in a nursing facility; and (3) The individual is put on a waiting list for placement in a nursing facility. (4) Exception: An individual approved for special care needs payments prior to July 19, 1982 and who does not meet the requirements of this subsection shall be exempt from meeting the requirements as long as the individual remains in the home in which the individual was first assessed as having special care needs. . However, all of the requirements of this subsection áhall be met when the followingoccurs: 1418—5 UNOFFICIAL §17—1418—6 (A) The individual transfers to another domiciliary care facility, or (B) The individual is temporarily admitted to a medical facility for treatment and is discharged to the same home the individual resided in prior to entering the medical facility (b) The department shall authorize state ‘ supplementalpayments on a full-month basis except when,. an individual is transferred within the month to another domiciliary care home. The department shall prorate state supplemental payments tc meet the ‘.,“ ‘:‘•‘ individual’s needs in both homes (c) A full month payment shall be made by the department for an eligible individual who is temporarily admitted to a medical facility for treatment or who goes home on a trial basis, on .‘ “ ...:. overnight visits or on an emergency. The individual’s ‘.“ absence from the domiciliary ‘care home cannot exceed ‘ ‘‘ ‘.:.‘‘ thirty days at any one time In addition: (1) The individual approved for special care .: ‘ ‘: needs payments after July 19, 1982 who is’ .‘ ‘.‘,•. temporarily admitted to:a medical.facility ,* ‘“‘ shall: ‘“ .‘‘, ‘ (A) Continue to have need for more than • domiciliary care upon discharge from the ‘ medical facility; and ‘ .. ,,,,,, • . (B) Return to the same domiciliary care home the individual resided in prior to entering the medical facility because ‘a’ vacancy in a more appropriate higher ‘:: •‘: , ‘ level facility is not availàble;or ‘ ‘‘• ‘. ‘ (2) The individual who was approved for special “ care needs payments prior to”July 19, 1982. ,. : , and who does not meet the requirements of :.. subsection (a) shall be discharged to the same domiciliary care home the individual ‘ resided in prior to being temporarily ‘ admitted to a medical facility. (d) State supplemental payments shall be payable by cash payments to the individual or legal guardian. (e) State supplemental payments for special care ‘ ‘ needs to individuals in domiciliary care homes shall not in any case exceed the amount appropriated by the state legislature. The eligibility period for the ‘ , special care state supplemental payment is effective ‘,, ‘ July 1, 1980. An individual who was placed after July 1, 1980 shall receive, special care needs payments.. ‘ ‘ :‘ •‘ 1418—6 UNOFFICIAL §17—1418—7 effective from the month the department determines the individual to be a special care needs individual and -: through the month the department revokes the special care need determination. (f) Effective October 1, 2002, state supplemental payments will not be approved for new recipients. • (g) Individuals approved to receiveS state supplemental payments prior to October 1, 2002, may continue to receive their payments. The conditions of subsections (a) through (e) shall, continue to be applied to and met by individuals receiving payments under this subsection. [Eff 6/29/92; am and comp • 4/17/95; am and comp 12/5/97, am and comp • 1/23/03 ] (Auth: FIRS §S346—l4, 346—53) (Imp: HRS §5346—14, 346—53)