| 47 | | - | SECTION 1. The legislature finds that concerns stemming from the spread of infection during the coronavirus disease 2019 pandemic and personal preferences create a strong demand for community-based care options for kupuna. In a 2021 quantitative research study conducted by AARP, among Hawaii residents aged forty-five years and older, seventy-five per cent said that having affordable long‑term care options in their community was an important independent living issue. Maintaining a connection with family and friends and the ability to continue to visit familiar health care providers is much easier when the State's kupuna can be cared for close to home. The legislature further finds that reimbursement rates that do not have medicare rates for equivalent services, such as all community‑based waiver services, are reviewed and determined by the department of human services at least every five years. The last review of home and community‑based reimbursement rates for residential services by the department of human services' med-QUEST division was conducted through a third-party study by the actuarial firm Milliman and reported on December 30, 2022. The study developed benchmark comparison rates for certain home and community-based services, including residential services provided in community care foster family homes and expanded adult residential care homes, in-home services, and case management services for home and community-based case management agencies. The legislature additionally finds that, for all provider types included in the study conducted by Milliman, current median direct care wages paid by the home and community-based services providers fell below the United States Bureau of Labor Statistics twenty-fifth percentile for those occupation codes and titles, except for licensed practical nurses, who fell just below the fiftieth percentile. Providers face significant wage pressures for registered nurses and certified nursing assistants and are competing with facilities, which are reimbursed at higher rates by medicaid, and private pay services for the same labor force. Most providers therefore relied on contracted registered nurses. Providers were not able to offer benefits, including health insurance, to their employees and relied on substitute caregivers who were sometimes unpaid, including families and friends of the providers. High inflation has also further increased costs for operators providing residential services in community care foster family homes and expanded adult residential care homes. The purpose of this Act is to appropriate funds to increase funding of certain medicaid home and community-based services, including adult day programs and residential services offered in community care foster family homes and expanded adult residential care homes. This Act also requires the department of human services to obtain the maximum federal matching funds available for the expenditure, which will result in a larger impact on reimbursements received by service providers. SECTION 2. 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 2024-2025 to increase the funding of certain medicaid home and community-based services, including adult day programs and residential services offered in community care foster family homes and expanded adult residential care homes; provided that the department of human services shall obtain the maximum federal matching funds available for this expenditure. The sum appropriated shall be expended by the department of human services for the purposes of this Act. SECTION 3. In accordance with section 9 of article VII of the Hawaii State Constitution and sections 37‑91 and 37‑93, Hawaii Revised Statutes, the legislature has determined that the appropriations contained in H.B. No. , will cause the state general fund expenditure ceiling for fiscal year 2024‑2025 to be exceeded by $ or per cent. In addition, the appropriation contained in this Act will cause the general fund expenditure ceiling for fiscal year 2024‑2025 to be further exceeded by $ or per cent. The combined total amount of general fund appropriations contained in only these two Acts will cause the state general fund expenditure ceiling for fiscal year 2024‑2025 to be exceeded by $ or per cent. The reasons for exceeding the general fund expenditure ceiling are that: (1) The appropriation made in this Act is necessary to serve the public interest; and (2) The appropriation made in this Act meets the needs addressed by this Act. SECTION 4. This Act shall take effect upon its approval. |
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| 47 | + | SECTION 1. The legislature finds that concerns stemming from the spread of infection during the COVID-19 pandemic and personal preferences create a strong demand for community-based care options for kupuna. In a 2021 quantitative research study conducted by AARP, among Hawaii residents aged forty-five years and older, seventy-five per cent said that having affordable long‑term care options in their community was an important independent living issue. Maintaining a connection with family and friends and the ability to continue to visit familiar health care providers is much easier when the State's kupuna can be cared for close to home. The legislature further finds that reimbursement rates that do not have medicare rates for equivalent services, such as all community‑based waiver services, are reviewed and determined by the department of human services at least every five years. The last review of home and community‑based reimbursement rates for residential services by the department of human services' med-QUEST division was conducted through a third-party study by the actuarial firm Milliman and reported on December 30, 2022. The study developed benchmark comparison rates for certain home and community-based services, including residential services provided in community care foster family homes and expanded adult residential care homes, in-home services, and case management services for home and community-based case management agencies. The legislature additionally finds that, for all provider types included in the study conducted by Milliman, current median direct care wages paid by the home and community-based services providers fell below the United States Bureau of Labor Statistics twenty-fifth percentile for those occupation codes and titles, except for licensed practical nurses, who fell just below the fiftieth percentile. Providers face significant wage pressures for registered nurses and certified nursing assistants and are competing with facilities, which are reimbursed at higher rates by medicaid, and private pay services for the same labor force. Most providers therefore relied on contracted registered nurses. Providers were not able to offer benefits, including health insurance, to their employees and relied on substitute caregivers who were sometimes unpaid, including families and friends of the providers. High inflation has also further increased costs for operators providing residential services in community care foster family homes and expanded adult residential care homes. The purpose of this Act is to appropriate funds to increase funding of certain medicaid home and community-based services, including adult day programs and residential services offered in community care foster family homes and expanded adult residential care homes. This Act also requires the department of human services to obtain the maximum federal matching funds available for the expenditure, which will result in a larger impact on reimbursements received by service providers. SECTION 2. 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 2024-2025 to increase the funding of certain medicaid home and community-based services, including adult day programs and residential services offered in community care foster family homes and expanded adult residential care homes; provided that the department of human services shall obtain the maximum federal matching funds available for this expenditure. The sum appropriated shall be expended by the department of human services for the purposes of this Act. SECTION 3. In accordance with section 9 of article VII of the Hawaii State Constitution and sections 37‑91 and 37‑93, Hawaii Revised Statutes, the legislature has determined that the appropriations contained in H.B. No. , will cause the state general fund expenditure ceiling for fiscal year 2024‑2025 to be exceeded by $ or per cent. In addition, the appropriation contained in this Act will cause the general fund expenditure ceiling for fiscal year 2024‑2025 to be further exceeded by $ or per cent. The combined total amount of general fund appropriations contained in only these two Acts will cause the state general fund expenditure ceiling for fiscal year 2024‑2025 to be exceeded by $ or per cent. The reasons for exceeding the general fund expenditure ceiling are that: (1) The appropriation made in this Act is necessary to serve the public interest; and (2) The appropriation made in this Act meets the needs addressed by this Act. SECTION 4. This Act shall take effect on July 1, 3000. |
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