HAWAII ADMINISTRATIVE RULES

TITLE 17

DEPARTMENT OF HUMAN SERVICES

SUBTITLE 9 ADULT AND COMMUNITY CARE PROGRAMS

CHAPTER 1454

REGULATION OF HOME AND COMMUNITY-BASED CASE MANAGEMENTAGENCIES AND COMMUNITY CARE FOSTER FAMILY HOMES

§17—1454—1§17—1454—2§17—1454—3§17—1454—4§17—1454—5

PurposeDefinitionsPenaltySeparabilityExceptions

Subchapter 1 General Requirements For Licensureand Certification

Required license or certificate ofapproval .1

ApplicationBackground checksDisposition of applicationIssuance of license or certificate ofapprovalMonitoring and investigationReporting changesRenewal of license or certificate ofapprQVal

§17—1454—11.1 Corrective action and sanctions§17-1454—12 Appeal§17—1454—13 Repealed§17—1454—13.1 Confidentiality of applicant and

recipient information§fl7—1454—l4 to 17—1454—17 (Reserved)

Subchapter 2

§17—1454—18§17—1454—19

Home and Community-Based CaseManagement Agency Requirements

PersonnelRepealed

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2628.

§17—1454—6

§17—1454—7§17—1454—7.1§17—1454—8§17—1454—9

§17—1454—9.1§17—1454—10§17—1454—11

§17—1454—1

§17—1454—20§17—1454—20.1

§17—1454—21

§17—1454—22§17—1454—23§17—1454—24§17—1454—25517—1454-25.1§17—1454—26§17—1454—27§17—1454—28§17—1454—29§17—1454—30S 17—1454—31§17—1454—32§S17—145433

§17—1454—37

§17—1454—37.1

§17—1454—38§17—1454—39§17—1454—40§27—1454—41§ 17—1454—42§17—1454—43§17—1454—44§17—1454—44.1§17—1454—45§17—1454—46§17—1454—47§17—1454—48§17—1454—48.1§17—1454—49§17—1454—49.1§17—1454—50§17—1454—51§17—1454—52

RecordsFiscal requirementsInsuranoe requirementsQuality assuranceRepealedRepealed

to 17—1454—36 (Reserved)

agenciesRepealedRepealedRepealedPersonnel and staffingClient eligibility requirementsClient care and servicesClient transfer and dischargeGrievanceFire safetyMedication and nutritionClient accountPhysical environmentQuality assuranceInsurance requirementsFiscal requirementsClient rightsRepealedRecords

(Reserved)

Administrative requirementsContracting with Residential CareFacilitiesApplication for case managementservicesService planService coordinationService monitoringReassessmentReduction and termination of servicesGrievance

Subchapter 3 Community Care Foster Family Home.Requirements

Operation of a community care fosterfamily homeContracting with case management

§517—1454—53 to 17—1454—56

§17-1454—1 Purpose. The purpose of this chapter

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§17—1454—2

is to establish the administrative provisions for thedepartment to license home and community-based casemanagement agencies and certify community care fosterfamily homes.

(1) Licensed home and community-based casemanagement agencies will be able to providecase management services to individuals incommunity care foster family homes, ormedicaid recipients in expanded adultresidential care homes, and assisted livingfacilities; and

(2). Certified community care foster family homeswill be able to provide, for a fee, livingaccommodations and other related services to;clients with nursing facility level of careneeds who are placed by licensed home andcommunity-basedcase management agencies.[Eff 2/11/02, amand comp FEB07 2005 1(Auth: MRS §S346—14, 346—334) (Imp: MRS§S346—14, 346—334)

§17—1454—2 Definitions. As used in this chapter:“Abuse” means actual or imminent physical injury,

psychological abuse, or neglect, sexual abuse,financial exploitation, negligent treatment, ormaltreatment, as further defined in section 346—22.2,MRS.

“Administrator” means the person who isresponsible for the daily management and operation of acase management agency and its compliance withprofessional and licensing requirements.

“Adult abuse perpetrator check” means a search todetermine whether an individual is known to thedepartment as a perpetrator of abuse as defined insection 346-222, NRS, by means of a search of theindividual’s name and birth date in the department’sadult protective service file.

“Adverse event” means any incident or event thatmay have quality of care implications for clients,including, but not limited to:

(1) All bodily injuries sustained by the client,regardless of cause or severity;

(2) All medication errors;(3) Major and unresolved conflicts between the

client and the primary caregiver, substitutecaregivers, contracted personnel, or otherhousehold members, as applicable;

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§17—1454—2

(4) The whereabouts of the client are unknown; or(5) Any protective service reports or

investigation involving the client or thefacility in which the client is residing.

• “Assisted living facility” means an assisted

•

•. living facility as defIned ‘in section.321-l5.l, HRS.“Authorized agent” means a person, institution,

• organization, or agency authorized by the department ofhuman services to issue licenses to hOme and community—based case management agencies and to monitor theseagencies for license compliance and quality assurance.The authorized agent shall perform these functions forthe department of human services and shall not at thesame time fuction as a home and commuity-based casemanagement agency or as the owner or operator of a

• residential care facility as defined in this section.“Case management” means the process of continuous

assessment of the. service needs of the client in acommunity care foster family home, expanded adultresidential care home, or assisted living facility, thedevelopment, review, and updating,. as .necessary, of theclient’s service plan, and the locating,, coordinating,and monitoring of an integrated and comprehensivecombinatioft of services necessary tocost. effectivelymaintain and support, and ensure the welfare of theclient in the community, on a.twenty-four hour basis.

• Case management is intended to%assist the client toaccess needed care and services on a timely basis andto prevent inappropriate institutionalization through athorough consiØeration of community-based alternatives.

“Case manager” means an individual other than andnot related to the caregiver that locates, coordinates,and monitors comprehensive services to meet a client’sneeds.

“Certificate of approval” or “certificate” meansthe certificate issued by the department whichauthorizes a person, agency; or organization to operatea community care foster family home.

“Client” means an individual who receives home andcommunity-based case management services to reside in acommunity care foster family home, expanded adultresidential care home, or assisted living facility.

“Community care/foster family home” or “home”means a home issued a certificate of approval by thedepartment to provide, for a fee, twenty-four-hourliving accommodations, including personal care andhomemaker services, for not more than two adults at anyone time, at least one of whom shall be a medicaid

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§17—1454—2

recipient, who are at the nursing facility level of

care are unrelated to the foster family, and are being

served in the home by a licensed home and community-

based case management agency. It does not inclüdê

expanded adult residential care homes and asisted

living facilities, which shall dontinue to be licensed

by the department of health.“Department” means the department of human

services, its designee when the context of the rule

refers to community care foster family homes, or its

authorized agent when the context of the rule refers to.

home and community—based case management agencies.

“Designee” means a person, institution,organization, or agency authorized by the departmentof

human services to issue certificates of approval to

community care foster family homes and to monitor these

homes for certificate compliance and quality assurance.

The deëignee shall perform these functions for the

department of human services and shall not at the. same

time function as a home and community-based casemanagement agency or as the owner or operator of aresidential care facility as defined in this section.

“Expanded adult residential care home” means any

facility providing twenty four hour livingaccoinmodations, for a fee, to adults unrelated to the

family, who require at least minimal assistance in the

activities of daily living, personal care services,

protection, and health care services., and who may need

the professional health services provided in an

intermediate care facility or skilled nursing facility.“Home and community-based case management agency”

or “case management agency” means a person, agency, or

organization that is licensed by the department to

locate, coordinate, and monitor comprehensive services

to meet the needs of clients whom the case management

agency serves in community care. foster family homes or,

Medicaid waiver service recipients in expanded adult

residential care homes, or assisted living facilities.

“Homemaker services” means those tasks performed

by the caregiver that healthy individuals would do for

themselves, including but not limited to laundry,

shopping, meal preparation, and keeping the client’s

room safe and sanitary. Housekeeping activities that

do not directly pertain to the client, such ashousehold maintenance and overall house cleaning, are

not homemaker services.“License” means an approval issued by the

department or its authorized agents for a person,

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§17—1454—2

• agency, or organization to operate as a home andcommunity—based case management agency.

“Licensed practiãal nurse” or “LPN” means anindividual licensed as a practical nurse by the Stateof Hawaii, pursuant to chapter 457, HRS.

• “Nurse aide” or “NA” means an individual who hassuccessfully completed an approved nurse.aide course,or has passed an approved equivalency test, or an

• individual who has oneyear of full—time employment asa nurse aide under the supervision of a registerednurse in a hospital,’ skilled nursing facility,intermediate care facility, or home health agency.

“Nursing facility level of care” means the levelof bare proflded at skilled nursing facilities wherethe resident would require daily skilled nursingservices on more than one shift per day or dailyrestorative skilled rehabilitative services or acombination of skilled nursing and rehabilitativeservices; or at intermediate care facilities where theresident would, require intermittent skilled nursing, adaily skilled nursing assessment, and twenty-four hour

• supervision.“Personal care” means aásistjng with activities of

daily living such as ambulating, mobility, transfer and• lifting, positioning and turning, bowel and, bladder

care, toileting, bathing, dressing; ‘grooming, feeding,exercise, medication assistance, range of motion, andmaintenance of health records.

“Physician” means a person who is licensed topractice medicine or osteopathy under chapter 453 or460, HRS.

“Primary caregiver” or “caregiver” means •theindividual who is directly responsible for thesupervision and care of the client.

“Reassessment” means the formal review of aclient’s status to determine if the client’s situationand functioning have changed since the initial or mostrecent assessment. The reassessment measures theprogress toward the goals established in a service planand ensures the client’s continued appropriateness forservices through a community care foster family home,expanded adult residential care home, or assistedliving facility.

“Registered nurse” or “RN” means an individual whois licensed as a registered nurse’ in the State ofHawaii, pursuant to chapter 457, HRS.

“Residential care facility” means a community carefoster family home, an expanded adult residential care

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§17—1454—5

home, or an assisted living facility.“Respite services” means temporary care in a

residential care facility or other facility licensed bythe State to care for individuals with nursing.facilitylevel care needs, to allpw the prinary caregiver relieffrom the care giving duties.

“Service plan”xneans a written plan that is basedupon a comprehensive assessment of the client,including a review of the client’s health, functional,psychosocial, and financial situations, which specifiesthe type, provider, amount, duration and frequency ofservices necessary to maintain the client in thecommunity as a cost-effective alternative toinstitutionalization.

“Substitute caregiver” means an individual who istrained and identified in the service plan to providedaily personal, care to clients in the absence of theprimary caregiver. [Eff 2/11/02, am and comp

FEB 01 2005 3 (Auth: §346—l4, 346—333, 346—334)(Imp: HP.S §346—14, 346—331 t9. 346—333, 346—334)

§17-1454-3 Penalty. Any person violating SLH2004, Act 153, or the rules in this chapter shall befined not more than $500 per eah sparate violation.Each day of each violation Shall constitute a separateviolation. An appeal of the department’s actions shall’not stay the imposition of a fine. [Eff 2/11/02, amand comp FEB 07 2005 3 (Auth: HRS §S346—14, 346—333,346—334) (Imp: HRS §S346—14, 346—336, 346—334)

§17—1454-4 5eparabi1iy. If any, section,subsection, paragraph, subparagraph, or clause of thischapter is for any reason held to be unconstitutionalor invalid, the remaining portions of this chapter

affected. [Eff 2/11/02, comprtb V I 3 (Auth: HRS §S346—14, 346—333, 346—

334) (Imp: HRS §346—l4, 346—333, 346—334)

§17—1454—5 Exceptions. Exceptions to therequirements of this chapter may be made at thedisctetion of the department. [Eff 2/11/02, comp

FEB 07 2005 3 (Auth: FIRS §346—14, 346—333, 346—334) (Imp: FIRS §346—14, 346—333, 346—334)

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§ 17—14 54 —6

SUBCHAPTER 1

GENERAL REQUIREMENTS FOR LICENSURE AND CERTIFICATION

§17—1454—6 Required license or certificate ofapproval. (a) Añ’ person, agency, or organizationthat wants to engage in locating, coordinating, andmonitoring comprehensive services to residents incommunity care foster family homes, or medicaid waiverservice recipients in expanded adult residential ca±ehomes and assisted living facilities, shall obtain alicense, from the department.

(b) Any person, agency,. or organization thatwants to operate a hqme as a community care fosterfamily home to provide, for a fee, twenty-four—hourliving accommodations, including personal care andhomemaker. services for adultth who have nursing facilitylevel of care needs and are not related to the personproviding the care, shall obtain a certificate ofapproval from the department.

(c) To be licensed as a home and .conimunity-basedcase management agency, a person, agency, ororganization shall:

(I) Comply with all applicable requirements inthis chapter;

(2) Not have had a previous license orcertificate to provide social or health careservices that was revoked within twelvemonths of the current application for alicense, except that this restriOtion shall

• not apply if the revocation was successfully•

. appealed; and(3) Not be certified or licensed to operate a:

(A) Community care’foster family home;(B) Adult residential care home;(C) Expanded adult residential care home; or(D) Assisted living facility.

(d) To be certified as a community care fosterfamily home, a person, agency, or organization shall:

(1) Comply with all applicable requirements in.this chapter; and

(2) Not have had a previous license orcertificate to provide social or health careservices that was revoked within twelvemonths of the current application for acertificate of approval, except that thisrestriction shall not apply if the revocation

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§17—1454—7

was successfully appealed.(e) The department shall provide orientation to

applicants, which shall include but is not limited to:the following, as appropriate: -

(1) The licensure or certification processes andrequirements;

(2) The services of home and community—based.casèmanagement agencies and community care fosterfamily homesi and

(3) The roles and responsibilities of case• management agencies and caregivers in the

provision of services to clients. (Eff• 2/11/02, am and camp FERo? 3 (Auth:.

FIRS §346—14, 346—333, ‘346-3 (Imp: FIRS§346—l4, 346—333, 346—334)

§17—1454-7 Appflcation. (a) Any person, agency,or organization that wants •to be licensed as a hore andcommunity—based case rnanagenent agency shall submit the.following to the department:

(1) A signed application form provided by thedepartment;

(2) A written statement of services to beprovided;

(3) Information relating to the ‘applicant’sorganization and administration;

(4) A signed financial statement that describesthe policies and procedures governinginternal controls of financial matters andincludes information on revenues and expensesfor the previous fiscal. year related toservices provided;

(5) Information on the number of staff membersand the staff members’ duties, educationalbackgrounds, and work experiences; and

(6) Background check documents, as provided insection 17—1454—7.1.

(b) Any person, agency, or organization thatwants to be certified as a community care foster familyhome shall:.

(1) Submit the following to the department:(A) A signed application form provided by

the department;(B) Documentation to verify that the primary

caregiver is a resident in the hone thatis to be a community care foster familyhome and is a NA, a LPN, or a RN with at

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§17—1454—7

least one year of experience in a homesetting;

• (C) Background check documents, as providedin section 17—1454—7.1; and p

• (2) Have a family system in the home that has thecapacity to meet the certificationrequirements and to provide services as acommunity care foster family home.(A) This determination shall be made through

a psychosocial assessment by the.department, incläding but not limited. tophysical and mental disabilities,problem solving skills, copingstrategies, and anger management thatwould prevent or limit the individualsfrom meeting the daily needs of clientson a twenty-four hour basis;

(B) A standardized tool thät relates tO therncare and needs of clients shall beutilized for the psychosocialassessment; and ‘

(C) The assessment shall be updated whenchanges occur in the caregiver’ shousehold or the client’s situation thatmay impact the life, health,, safety, orwelfare of, or. the provision of servicesto, the client.

Cc) The date of application shall be the date thedepartment receives all required forms and informationnecessary for the department to make a disposition,including, but not limited to:

(1) Background check information required undersection 17-1454—7.1; and

(2) Department of human service’s decisionregarding a request for exemption madepursuant to subsection l7-l4j—7.l(e). [Eff2/11/02, am and comp FEC 07 71135 ] (Auth:FIRS §346—l4, 346—333, 346—334) (Imp: HRSSS346—l4, 346—333, 346—334)

§17-1454-7.1 Background checks. (a) As acondition for licensure or certification, the operator,employees, and new employees of the case managementagenOy, or primary and substitute caregivers and otheradults residing in a home, except for clients, shall:

• (1) Be subject to criminal history record checksin accordance with section 846—2.7, FIRS;

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§17—1454—7.1

(2) Be subject to adult protective serviceperpetrator checks if the individual hasdirect contact with a client; and p

(3) Provide consent for the department to obtainother criminal history record information forverification 4nd information regarding adultprotective service perpetrator status;

(b) New employees of the case management agencyshall be fingerprinted within five working days ofemployment, for the purpose of complying with therequirements of this section.

(C) The department shall make a name inquiry intpthe criminal history recorçis for the first two years acase management agency is licensed or a home iscertified and annually or biennially thereafterdepending on the licensure status of the casemanagement agency or certification status of the home.:

(d) The department may, unless an exemption hasbeen granted by the department of human services:,

(1) Deny a license if:(A) A case management aency operator,

employee, or new employee has beenconvicted of a crime other than a minortraffic violation involving a fine of$50 or less;

(B) The department finds’ that the criminalhistory record of a case managementagency operator, employee, or newemployee poses a risk to the life,health, safety, or welfare of a client;

(C) A case management agency operator,employee, or new employee is aperpetrator of abuse as defined insection 346—222, HRS; oS

(0) The holder of or an applicant for alicense, or an employee of the agencyhas a certificate of approval to operatea community care foster family home, ora license from the department of healthto operate an adult residential carehome, expanded adult residential .carehome, or an assisted living facility;

(2) Deny a certificate of approval if:(A) A cäregiver, substitute caregiver, or

other adult residing in the communitycare foster family home, except foradults receiving care, has beenconvicted of a crime other than a minor

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§17’-1454—7. 1

traffic violation involving a fine of$50 or less;

(B) The department finds that the criminalhistory record of a caregiver,substitute caregiver, or other adult

• residing in the home, except for adultsreceiving care, poses a risk to thelife, health, safety, or welfare of a

• client; or(C) A caregiver, substitute caregiver, or

other adult residing in the communitycare foster family home, except foradults receiving care, is a perpetratorof abuse as defined in section 346—222,HRS.

(e) The results of a background check madepursuant to section (a) above shall be exempt fromconsideration by the department if an exemption hasbeen granted by the department of human services.Requests for exemptions must be:

(1) Submitted by the applicant for licensure orcertification, case management agency, or.home;

(2) In writing, on forms provided by thedepartment of human services; and

(3) Received by the department of human servicesno later then seven days after the date ofthe notification that the individual:(A) Has a conviction for a crime other than

a minor traffic violation involving afine of $50 or less;

(B) Has a criminal history record that posesa risk to the life, health, safety, orwelfare of a client; or

(C) Is a perpetrator of abuse as defined intqn6-222, HRS. [Eff and comp

rte C ) (Auth: HRS §346—l4,346—333, 346—334) (Imp: HRS §346—14,346—333, 346—334, 346—335)

§17-1454-S Disposition of application. (a) Thedepartment shall dispose of an application for alicense or a certificate of approval by the sixtiethday from the date of application.

(b) An evaluation of the applicationwill becarried out by the department and may include, but isnot limited to, one or more of the following:

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§17—1454—9

(1) Review of forms, documents, and informationsubmitted as required under section 17-1454-7;

(2) Review of administrative, fiscal, personnel,and client case records; and

(3) Service site visits to carry out one or moreof the following activities:(A) Inspect the premises;(B) Interview clients; and(C) Interview and observe individuals

providing services to clients.Cc) A standardized evaluation tool shall be used

to determine whether the applicant isin compliancewith the requirements for licensure or certification.

(d) The department shall dispose of theapplication by taking one of the following actions:

(1) A person, agency, or organization shall bedetermined eligible for a license or a -

certificate of approval when the departmentclearly establishes through its evaluationand records that’ the person, agency, ororganization meets all of the applicablerequirements established in this chapter forlicensure or certification; or

(2) A person, agency, or organization shall bedetermined ineligible for a license or acertificate of approval when the departmçntestablishes through its evaluation andrecords that the person, agency, ororganization does not meet the requirementsestablished itI1is chapter. (Eff 2/11/02,am and comp rtB u’7 20135 i (Auth: HRS§S346—14, 346—333, 346—334) (Imp: FIRS §346—14, 346—333, 346—334, 91—13.5)

§17-1454—9 Issuance of license or certificate ofapproval. (a) The department shall issue a license toa home and community-based case management agency thatis valid for:

(1) One year; or(2) Two years, when the case management agency

meets the following requirements:(A) Has been in operation and licensed for

at least one year as a home andcommunity-based case management agency;

(B) Is in full compliance with all licensingrequirements;

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§ 17—1454 —9

(C) Has had no major changes in theorganizational structure or in the casemanagement agency’s policies andprocedures regarding case managementservices;

CD) Operator, employees, and new employeeshave no criminal history record, oradult protective service perpetratorhistory that pose a risk to the life,health, safety, or welfare of clients;and

• (E) Has had no complaints that were•investigated and confirmed, and resultedin the development and implementation ofa corrective action plan.

• (b) The license shall:• (1) Specify the name and address’ of the case

management agency and be acornpahied by astatement outlihing the type of activitiesthe case management agency is licensed toprovide;

(2) Be non—transferable; and(3) Be conspicuously posted on the premises of

the case management agency.Cc) The department shall issue a certificate of

approval tO a community care foster family home that isvalid for:

Cl) One year; or(2) Two years, when the home.meets the following

requ,irements:(A) Has been certified and in operation for

at least one year as a community carefoster family home;

(B) Is in full compliance withailcertification requirements;

(C) Has had’ no changes in the householdcomposition;

CD) Has had no changes in the structure ofthe home;

CE) The caregivers and other adult householdmembers, except for clients receivingservices, have no criminal ‘historyrecord, or adult protective serviceperpetrator history that pOse a risk tothe life, health, Or safety, or welfareof clients; and

(F) Has had no complaints that wereinvestigated and confirmed, and resulted

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§17—1454—10

in the development and implementation ofa corrective action plan.

Cd) The certificate of approval shall:(1) Specify the name and address of the home and

be accompanied by a statement outlining thetype of activities the home is certified toprovide;

(2) Be non—transferable; and(3) Be conspicuously posted qn the premises of

tlnrr[Eff 2/11/02, am and comp3 (Auth: HRS §346—14, 346—

333, 346—334) (Imp: HRS §346—l4, 346—333,346—334)

§17-1454—9.1 Monitoring and investigation. (a)The department shall monitor case management agenciesand homes for compliance with applicable requirementsin this chapter and quality assurance:

(1) Annually when a case management agency orhome has a one—dear license or certificate;

(2) Biennially when a case management agency orhome has a two—year license or certificate;or

(3) Upon receipt of a complaint that a casemanagement agency or home is in violation ofapplicable requirements in this chapter..

(b) Monitoring may include, but is not limitedtOe. unannounced visits to review service deliverysites, records and files, and interviews with clients.

(c) The case management agency or home that isbeing monitored shall provide the department access toall records, files, and other materials concerningcompliance with the requirements for licensure orcertification.

(d) Any case management agency or home shall besubject to investigation by the department at any timeand in the manner, place, and form as determined by thedepartment. [Eff and comp FEB07 2005 3 (Auth: HRS§34E—14, 346—333, 346—334) (Imp: HRS §346—l4, 346—333, 346—334)

§17-1454-10 Reporting changes. The casemanagement agency or home shall immediately report tothe department changes that may affect the casemanagement agency’s or home’s ability to comply withthe applicable requirements of this chapter. Changes

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S17—1454-40

to be reported include, but are not limited to,changes:•

(1) That may pose a risk to the life, health,• safety, or welfare of the blient;

12) In the criminal history record and adultprotective service perpetrator history of theoperator or any employee of the casemanagement agency, or the primary caregiver,

• substitute caregiver, or other adults in thehome, except for clients receiving care;

(3) In the organizational structure of the casemanagement agency;

(4) In the household composition or structure ofthe home; and

(5) In the service delivery site. [Eff 2/11/02,am and comp E’ 01 21)05 ] (Auth: MRS§346—l4, 346—333, 346—334) (Imp: MRS §S346—14, 346—333, 346—334)

§17-1454-11 Renewal of license or. certificate ofapproval. (a) A license or certificate shall berenewed annually or biennially when the requirements ofsection 17—1454—9(a) (2) or 17—1454—9(c) (2.) are met.

(b) At least ninety days prior to the expirationdate of a current license or certificate, the casemanagement agency or home shall apply to the departmentfor renewal of the license or certificate, asappropriate.

Cc) The renewal application shall include, asapplicable:

(1) A completed application form provided by thedepartment;

(2) A current list of all:(A) Employees and subcontractors of the case.

management agency, including informationabout their duties, educationalbackgrounds, and work experiences; or

(B) Individuals residing or providing directservices to clients in the home,including information about theirresponsibilities and training;

(3) Background check documentation as provided insection 17—1454-7.1; and

(4) Descriptions of any major changes in policiesand procedures, organizational structure ofthe case managez.nent agency, location of theservice delivery site, structure of the home

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§17—1454—11.1

and h&asehold composition since the lastlicense or certificate was issued.

(d) The department shall evaluate the renewalapplication as provided in section 17—1454—8, todetermine whether the case management agency or home isin compliance with the applicable requirements of thischapter.

(e) The department shall dispose of the renewalapplication by taking one of the following actions:

(1) The case management agency or home shall bedetermined eligible for a renewal of itslicense or certificate when the departmentclearly establishes through its evaluationthat all of the applicable requirements ofthis chapter have been met. A license orcertificate shall be issued as provided insection 17—1454-9; or

(2) The base management agency or home shall bedetermined ineligible for a renewal of itslicense or certificate when ‘the departmentdetermines through it evaluation that theapplicable requirements for licensure orcertification have not been met.(A)’ The renewal application’shall be denied

and the case management agency or homeshall be informed of this decision’ inwriting; and

(B) The department shallfollow therequirements of ‘section 17—1454—11.1.

(f) A’ case management agency or home whoseapplication for a license or certificate renewal wasdenied because it did not comply with all of therequirements for licensure or certification may reapplyfor a renewal of its license or certificate if:

(1) Its current license or certificate was notrevoked;

(2) It has corrected all deficiencies identifiedby the department; and

(3) There is at least ninety days remaining onits current license or certificate. [Eff2/11/02, am and comp FEB 0721395 1 (Auth:HRS §5346—14, 346—333, 346—34) (Imp: FIRS§5346—14, 346—333, 346—334)

§17-1454—11.1 Corrective action and sanctions.(a) When the department determines that a case

management agency or home has failed or is unable to

1454—17

26 2&

§17—1454—11.1

comply with all of the applicable requirements of thischapter, the department shall notify the casemanagement agency or home in writing of the specificareas of noncompliance and may do one or more of thefollowing:

(1) Establish a specific time frame for thecorrection ot each area Of noncompliance;

(2) Require submission of a written correctiveaction plan from the case management agencyor home that addresses each area ofnoncompliance; or

(3) Suspend the admission of new clients by thecase management agency or home.

(b) When the identified areas of noncomplianceare not corrected. within the time specified in anaccepted plan of correction, th.e department may do oneor more of the following:

(1) Require the transfer of clients to anothercase management agency or residential carefacility;

(2) Revoke the license or certificate; or(3) Levy a fine as protided in section 17-1454-3.(c) A license or certificate shall be immediately

revoked when there is noncompliance, as determined bythe department, which poses an imminent and seriousrisk to the life, health, safety, or welfare of aclient.

(d)(1)

Upon revocation of a license or certificate:A case management agency shall;(A) Immediately notify its clients and the

residential care facilities in which theclients are provided services, of thesuspension or revocation;

(B) Cease providing case management servicesimmediately after existing clients havebeen:(i) Discharged from the program;

(ii) Transferred to another casemanagement agency;

(iii) Hospitalized; or(iv) Placed in a nursing facility;

(2) A home shall;(A) Immediately notify its clients or the

clients’ legal representatives, and theclients’ case managers of the suspensionor revocation; and

.

(B) Comply with appropriate provisions ofsection 17—1454-44.

1454—18

26 28

§17—1454—12

(e) A revoked license or certificate may bereinstated if the department deems that the casemanagement agency or the home is willing and able tocomply with applicable licensing or certificationrequirements only when a new application for a licenseor certificate is submitted to the department and theapplication is approved.

(f) An appeal of the department’s actions shall.not stay the suspension or revocation of the license orcertificate. [Eff and comp FEB 07 2tEj I (Auth:HRS §S346—14, 346—333, 346—334) (Imp: HRS §S346—14,346—333, 346—334) .

§17-1454—12 ppea1. (a) When the department’sdecision is to deny or revoke a license or certificate,or to levy a fine under the provisions in this chapter,the department shall:

(1) Provide a written notice to the person,agency or organizption whose license orcertificate is to be denied or revoked, or isbeing fined, by certified or registered mailto the last known address as may be shown inthe application, license, or certificate ofapproval; and

(2) Include in the notice a statement of thereasons for the proposed action andinformation that the applicant, licensee, orcertificate holder has the right to appealthe decision to the director of thedepartment, in writing, no later than thirtydays after the date of the notice of theproposed action.

(b) Upon receiving a timely written appeal thedirector of the department shall give notice of and anopportunity for a hearing before a hearing of ficér. Onthe basis of the evidence presented at the hearing, thehearing officer shall make the final decision of thedepartment as to whether the application, license, orcertificate shall be denied or revoked, or a finelevied.

(c) At any hearing provided for by this section,the applicant, licensee, or certificate holder may berepresented by counsel and shall have the right tocall, examine, and cross-examine witnesses. Evidencemay be received even though inadmissible under rules ofevidence applicable under court procedures.

(d) The hearing officer’s decision shall be in

1454—19

26 28

J

§17—1454—12

writing, shall contain findings of fact and rulings oflaw, and shall be mailed to the parties to theproceedings by certified or registered mail to the lastknown address as àhown on the application, license, or’certificate.

(e) Filing an appeal shall not stay thedepartment’s denial, suspension, or ;evocation of alicenáe or certificate or levjing of a fine. [Eff2/11/02, am and comp FEB 07 itti 3 (Auth: I4RS §5346—14, 346—333, 346—334) (Imp: HRS55346—14, 346—333, 346—334)

§17—1454—13 REPEALED. jEff 2/11/02, R FEB 0 7 2005

§17-1454—13.1 Confidentiality of applicant andrecipient information.. (a) All information relatingto individuals who apply for or receive home andcommunity-based case management and community carefoster family home services shall be confidential.

(b) Case management agencies and homes licensedor certified under this chapter will:

(1) Have written policies and procedures thatrelate to confidentialitj :and privacy rightsof applicants and rebipients;

(2) Safeguard all confidential information aboutapplicants and recipients of services;

(3) Inform clients about their confidentialitypractices;

(4) Respect client privacy rights;(5) Provide training to all employees, and for

homes, other adults in the home, on their• confidentiality policies and procedures and

client privacy rights.(c) Information about an applicant or recipient

shall not be used or disclosed unless;(1) The applicant, recipient or a legal

representative of the applicant or recipienthas authorized in writing the use ordisclosure of the information; or

(2) The use or disclosure is specificallypermitted under applicable federal or staterules or regulations. [Eff and comp

FEB 07 20 3 (Auth: HRS §5346-14, 346—333, 346—334) (Imp: HRS §5346—14, 346—333,346—334)

1454—20

12628

§17—1454—18

§S17—1454—14 to 17—1454—17 (Reserved)

SUBCHAPTER 2

HOME AND COMMUNITY-BASED CASE MANAGEMENT AGENCYREQUIREMENTS

§17—1454-18 Personnel. (a) The case managementagency shall be responsible for:

(1) Having sufficient personnel to provide case• management services to the client in a

±èsidential care facility; as provided inthis subchapter;

(2) Locating, selecting, assigning, supervising,• and training case management staff; 7

(3) Maintaining individual personnel files on allstaff assigned to provide case managementservices to clients. Th personnel filesshall provide evidence of:(A) Current Hawaii professional licenses, as

applicable;(B) Appropriate education and work

experience;•(C) Current job description;(0) Documentation of current blood borne

pathogen and infection control trainingand cardiopulmonary resuscitationtraining far personnel in direct contactwith a potential or current client;

(E) Current tuberculosis clearance thatcomplies with departmeflt of healthguidelines, for personnel in directcontact with a potential or currentclient;

(F) Current valid driver’s license andaccess to an insured vehicle, asapplicable;

(G) Orientationto the case managementprogram, including operationalprocedures, agency policies and

• procedures, and case managementresponsibilities; •

(H) A signed statement indicating theemployee’s understanding if the case

• management agency’s background check• policies; and

1454—212.6 2 &

§17—1454—18

(1) Current background checks and signedstatements, as provided in section 17—1454—7.1.

(4) Designating and authorizing an actingadministrator who shall be responsible forthe operation of the program in the absenceof the regular administrator. The departmentshall be notified in writing when suchdesignation is made, including the name andthe period during which the actingadministrator èhall be in charge. The aOtingadministrator shall be:(A) A staff member of the agency;(B) Qualified to carry out the

responsibilities of an actingadministrator;

(C) In compliance with personnelrequirements for licensur, aapplicable; and

(D) Assigned when the regular administratoris unable to perform the administrator’sregular duties for one or more days.

(b) The case management agency shall have staffwith a minimum of one year experience providing carecoordination for elderly or disabled individuals inhone and community-based settings, including but notlimited to:

(1) The development and review of service plans;and

(2) Locating, coordinating, and monitoringcomprehensive services to maintain andsupport individuals in the community.

(c) The case management agency shall employqualified staff to provide case management services.

(1) Case managers shall be a registered nurse ora social worker.(A) A registered nurse shall have:

Ii) Fulfilled the State’s licensingrequirements for nurses; and

• (ii) At least two years experience withclient care coordination

• responsibilities in the UnitedStates; and

(B) A social worker shall have:(i) Fulfilled the State’s licensing

requirements; and(ii) One year of experience with client

care coordination responsibilities

• 1454—22C,!o a’s

§17-1454—20

in the United States;(2) Case managers shall have:

(A) Knowledge of current professional casemanagement practices, standards,responsibilities, and procedures;

(B) Knowledge of the problems and needs ofthe targeted population, includingsocial, health, and psychosocial factorsaffecting optimal functioning of dlientsand their support systems;

(C) Knowledge of client’s rights, state andfederal laws, and regulations, such asthose relating to health services,confidentiality, and consent issues forthe targeted populations; and

(D) The skills and abilities to provide case.management services as provided in theserecruirements. [Eff 2Jll/02, am and comp

FEB 07 2005 j (Aith: FIRS §346—l4,346—333) (Imp: FIRS §S346—14, 346-333)

§17—1454—19 REPEALED. [Eff 2/11/02, R FEB 072005J

§17-1454—20 Administrative requirements. (a)The case management agency thhall have written policiesand procedures that are consistent with the applicablerequirements of this chapter and that relate to:.

(1) Overall program management, includingadministrative, personnel, quality assurancesuch as continuous quality improvement, riskmanagement, fiscal, assignment of an actingadministrator when the regular administratoris absent, anØ program reportingrequirements;

(2) Compliance with all applicable federal andstate laws, including but not limited tothose:(A) Pertaining to adult and child protective

servttces reporting; and(B) Prohibiting discrimination against any

person, on the grounds of race, color,national origin, religion, creed, sex,age, marital status, handicap, or arrestand court records;

(3) Having an alcohol and drug—free workplace;

1454—23

2623

§17—1454—20

26 28

FEB ($7

1454—24

I-IRS §346—l4,

(4) Services to clients, including the standardsand requirements for application,eligibility, admission, waitlisting,suspension, discharge, transfer andreadmission;

(5) Case management service responsibilities,• such as but not limited to:

(A) Assessment;(B) Development and authorization of service

plans;• (C) Service coordination;

(0) Monitoring;(E) Reassessment procedures;• (F) Client record and documentation

requirements;(G) Client budgetary procedures; and(H) Confidentiality and client rights;

(6) Access to case management agency aM clientrecords upon request by the department or the

• department’s designee; and(7) Cooperation with the department when

immediate removal of clients is necessary..(N The case management agency shall cooperate

with the department when it is being evaluated forcompliance with the licensing requirements, or thequality, adequacy and timeliness of seyc ovidedto clients. {Eff 2/11/02, am and compttP(Auth: HRS §346—14, 346—333) (Imp:346—333)

§17—1454-20.1 Contracting with Residential CareFacilities. The case management agency shall not enterinto any agreement or contract with a residential carefacility:

(1) If the residential care facility is acommunity care foster family home or expandedadult residential care home and the primarycaregiver, substitute caregiver, owner of theproperty, holder of the certificate orlicense, or any other adult in the facility,except for clients, is related in any way toa paid or unpaid member of the staff orofficer of the case management agency; or

(2) That requires the residential care facilityto accept th case management agency’sclients exclusively. (Eff and comp

I (Auth:. FIRS §346—l4, 346—

§17—1454—22

333) (Imp: NRS §346—14, 346—333)

§17—1454—21 pp1ication for case managementservices. The case management agency shall:

(1) Provide inforinationto individuals andagencies regarding its case managementservices, eligibility criteria, and itsapplication, admission, and other processes;

(2) Utilize a standardized intake tool to requestpertinent applicant information to determineeligibility for case management services;

(3) Ensure that all eligibility requirements for• the placement of an individual with nursingfacility level of care needs in a residentialcare facility are met prior to theindividual’s admission; V

(4) Use a standardized assessment tool to assessthe applicant’s needs prior to being acceptedas a client of the case management agency.This assessment shall include social andnursing evaluations that review the

V

individual’s health, functional, V

psychosocial, and financial situations. andV

options for residential care; and(5) Provide information about and referral to

other community resources, as appriate. V

[ff 2/11/02, am and comp FEB Oi IAJ ](Auth: }RS §346—14, 346—333) (Imp: HRS§S346—14, 346—333)

§17—1454—22 Service plan.V

(a) The service planshall be based upon comprehensive assessments of theindividual by appropriate case managers.

(b) The case management agency shall develop andauthorize a service plan prior to the individual’sadmission to a residential care facility. V

(c) The service plan shall be written in alanguage that is understandable to the individual, theindividual’s family, the individual’s legal V

representative, arid the primary and substitute V

caregivers.(d) The service plan shall:(1) Identify the problems and needs of the V

client, including any need to purchasespecialized medical equipment and supplies;

(2) Establish realistic measurable goals to be

1454—25

26 28

§17—1454—22

attained for each problem identified in thesocial and nursing assessments;

(3) Identify specific interventions and tasks tobe implemented to address each problem and toensure achievement of the goals specified icthe service plan;

(4) Identify specific types of services needed,the number of units, duration, and thefrequency of service provisioh;

(5) Specify the service provider or providers,primary and substitute, formal or informal,medicaid waiver or non-waiver, needed toaddress each problem and achieve each goal tosafely maintain and support the client in aresidential care facility;

(6) Be agreed to by the client or the client’slegal representative;

(7) Establish the frequency of case managercontacts, with a minimum frequency of once amonth face-to-face contacts with the client;

(8) Be reviewed, updated, and authorized,minimally once every six months or soonerwhen changes occur, to reflect the client’scurrent status and needs; and

(9) Include a transportation plan to meet thenon-medical transportation needs of theclient as provided in subsection 17-1454—41(b)(5). I

(e) . The case management agency shall ensure thata current service plan is in place when a client movesfrom one residential care facility to another, and thatif the client is moved into another community carefoáter family home, that the home has a current.certificate.

(f) When a client chooses to transfer from onecase management agency to another, a new service planshaal—br developed by the new case management agencychosen byjhe client. [Eff 2/11/02, am and comp

FEB 07 21193 1 (Auth: F{RS §346.-l4, .346—333) (Imp:F3RS §S346—14, 346—333)

§17-1454-23 Service coordination. (a) The casemanagement agency shall promote continuity of clientcare, appropriate integration, and utilization ofservices by:

(1) Authorizing, locating, and arranging forservices necessary: to implement the client’s

1454—2 6

26 28

§17—1454—23

service plan;(2) Providing. caregivers, prior to the admission

of the client, with all necessary forms,

records, and information about the client and

the client’s service plan to ensure timely

and quality service delivery;(3) Assuring that the caregivers have the

necessary.skills to implment the service

plan;(4) Referring clients to the primary caregiver

who, based on the case management agency’s

determination, has the ability to meet thehealth, welfare, and psychosocial needs of

the individual, including care needsidentified in a service plan; p

(5) Conducting or coordinating caregiver training

as necessary to ensure that the caregiversare skilled to care for the clients in their

residential care facilities;(6) Coordinatinghospital discharge, respite,

home transfers, transfers between casemanagement agencies, and other services’ as

appropriate;() Using only appropriately licensed or

certified residential care facilities;(8) Advocating for clients;(9) Facilitating and mediating the resolution of

conflicts that may arise between clients and

service providers;(10) Arranging and participating in client care

conferences, as appropriate; and(11) Assisting the ôlient or the client’s family

with obtaininga legal representative, such

as a guardian, when necessary andappropriate. -,

(b) When two clients are served by different case

management agencies and may possibly reside in the same

residential care facility, the quality of services and

compatibility of the clients who may share the

residential care facility shall .be ensured.

(1) Each client’s case management agency shall:

(A) Obtain a written consent from its client

for the release of the client’sinformation for the purposes of thissection;

(B) Share and discuss its client’sassessment and service plan with thecase management agency for the other

1454—27

2628

§17—1454—23

client for the purpose of ensuring thequality of services and compatibility ofthe clients;

(C) Keep the shared information confidentialand use it only for the purpose of thissection; and

(0) Not use or disclose the informationobtained for this section except asallowed under sectiOn 17—1454—13.1.

(2) Placement of the two clients together shalloccur onJ.y after all parties, including bothcase management agencies, the primarycaregiver of the residential care facility inwhich the placement shall be made, and bothclients, have agreed to the placement; and

(3) Any person who fails to safeguardconfidential information or who violatesrules governing the confidential nature ofapplicant and recipient informatiOn may beprosecuted for a violation, as provided inchapter 17—1401. [Eff 2/11/02, am and comp

FEB 07 2005 3 (Auth: ERS §346—i4, 346—333) (Imp: FIRS §346—14, 346—333)

§17—1454—24 Service rnonitoriq. (a) The casemanagement agency shall provide continuing, regularcontact with the client, caregiver, and other serviceproviders to ensure that:

(1) Services are being provided in accordancewith the service plan and continue to meetthe client’s needs;

(2) The caregiver and residential care facilityenvironment continue to meet the client’sneeds;

(3) Sufficient progress is made towards achievingdesired goals and outcomes; and

(4) All of the client’s rights, as provided insection 17-1454—50, are met.

(b) The service monitoring process shall include:(1) Face—to—face contact with the client at least

once a month, with more frequent contactsdepending on the client’s condition and thecaregiver’s capability. The frequency ofthis contact shall be specified in theservic,e plan;

(2) Regular RN monitoring of the client who has amedically complex condition, as determined by

1454—28

Q628

§17—1454—24

a physician or RN. The frequency of thismonitoring shall be specified in the serviceplan;

(3) Ongoing evaluation of the client’s response.to and satisfaction with services provided’and follow—up as needed;

(4) Ongoing evaluation of the appropriateness,timeliness, adequacy, and quality ofservices, caregivers, and home-likeenvironment provided;

(5) Ongoing evaluation of the caregiver’s status,behavior, and skills competency; substitutecaregiver coverage and skills competency; andother caregiver responsibilities, such aschild care or employment, to identify areasthat may necessitate case managementintervention;

(6) Assessment for, review, and follow—upactivities on, all reports’of unusualoccurrences involving the client, such asadverse events and inappropriate’ or lack ofclient supervision; ‘ ‘

(7) Follow—up activities to assure thatsubstandard care and unsafe practices orconditions have improved, or.to arrange foralternative placement, as provided in section17—1454—44; . , ‘ ,.

(8) Assurance that a qualified caregiver isphysically available to the client twenty-four hours a day, seven days a week;

(9) Facilitating and documenting conflictresolution of client complaints or grievances

‘about services, service providers, as well asconflicts between contracted personnel andthe client;

(10) Monitoring and documenting continued medicaideligibility for medicaid waiver servicerecipients; and

(11) Reporting to the department any concerns thecase management agency may have about thehome in which a client has been placed,including but not limited to:(A) Changes in the composition of the

household; and(B) Inappropriate activities on the

premises. [Eff 2/11/02, am and compFEB 07 mc ] (Auth: ‘HRS §346—l4,

346—333) ‘(Ymp: I-IRS §S346—14, 346—333)

1454—29

26 2B

§ 17.—i 454—25

§17—1454—25 Reassessment. (a) The casemanagement agency shall conduct face to fabereassessments every six months or sooner, asappropriate, and shall use standardized assessmenttools to reevaluate the client’s:

(1) Diagnosis, health, functional, psychosocial,financial and environmental needs; and

(2) Compliance with the client’s service plan.(b) The case management agency shall have the

client’s physician re—certify the client’s level ofcare on an annual basis or more frequently as needed.The medioaid medical consultant shall approve the recertification for the client who is arecipient. fEff 2/11/02, am and comp 7(Auth: FIRS §S346—14, 346—333) (Imp: HRS §S346—14,346—333)

§17—1454—25.1 Reduction and termnation ofservices. The case management agencish&IY reduce orterminate its services to a client, as appropriate,when:

(1) Friends or relatives of the client express.willingness and are able to care for theclient without charge.;

(2) A service provider refuses to providerequested services or the service providercontract is cancelled and no other optionsare available;

(3) The client no longer needs nursing facilitylevel of care;

(4) The client or the client’s legalrepresentative chooses institutional care inlieu of community—based services;

(5) The client’s case manager determines that theservices necessary to assure the health andwelfare of a client cannot be providedthrough placement in a residential carefacility. Termination can occur afteranother viable alternative has been arrangedfor the client;

(6) The client moves out Qf the state of Hawaii;(7) The client or the client’s legal

representative voluntarily requeststermination from the program; or

(8) The client dies. (Eff and campFEB 07 2005 1 (Auth: I-IRS §346—l4, 346—

333) (Imp: HRS §346—l4, 346—333)

1454—30

26 2 S

§17—1454—27

§17—1454—26 Grievance. The case managementagency shall have policies and procedures by andthrough which a client may present grievances about theoperation or services of the case management agency.The policies shall include a provision that a clientmay choose to present any grievance directly to thedepartment of human services, The case managementagency shall: I

(1) Inform the client or theclient’s legalrepresentative of the grievance policies andprocedures and the right to appeal in agrievance situation;

(2) ?covide a written copy of the grievanceb1icies and procedures to the client or theclient’s legal representative, which includesthe names and telephone numbers of theindividuals who shall be contacted in orderto report a grievance;

3) Obtain signed acknowledgewents from theclient, or. the client’s legal representative’’that the grievance policies and procedureswere reviewed; and

(4) Ensure that operators of residential carefacilities serving the case managementagency’s clients are aware of and comply withthe case management agency’s policies andprocedures for clients’ grievances. [Eff f2/11/02, am and àomp Fff807 2 3 (Auth:MRS §S346—14, 346—333) (lmp:’’HRS §346—14,346—333)

§17—1454—27 Records. (a) The case managementagency shall maintain individual client records in amanner which ensures legibility, order, and timelysigning and datihg of each entry in black ink.

(b) Client records shall be kept in detail to:(1) Permit effective professional review; and(2) Provide information for necessary follow—up

and care for the client.(c) Client records shall contain:(1) Information relating to the client’s status

regarding application, eligibility,termination, admission, suspension,, transfer,or discharge activities;’

(2) Information documenting the case managementagency’ a efforts to find an, appropriate matchbetween a residential care facility and the

1454—31

26 28

§17—1454—27

individual applying for case managementservices;

(3) Information documenting the case managementagency’s assessment, ‘service planning,service coordination, monitoring, andreassessment activities;

(4) The initial skill competency of caregivers toperform the tasks necessary forimplementation of each service plan and careof clients. Updates shall be documented asappropriate;

(5) All information and actions taken in responsewhen changes occur in a client’s behavior andfunctioning which may necessitate more orless services or other types of. intervention.and update of the service plan; and

(6) Written documentation of the case managementagency’s:(A) Assessment of all verbal and written

reports regarding the client receivedfrom the residential care facility,other agencies or from the client’sfamily or l&gal representative;

(B) Use of the assessment to determine what’action, if any, is needed;

(C) Actions undertaken, based on the reportsand assessment; and

CD) Final disposition of the situationreported,. as jpicable. . [Eff 2/11/02,am and comp Ftb u7 2005, ] (Auth: fiRS§346—14, 346—333) (Imp: HRS §346—l4,346—333)

§17—1454—28 Fiscal requirements. (a) The casemanagement agency shall have adequate resources tofinance the operating costs of administration,maintenance, personnel, and to conduct its programs,including the provision of case management services inaccordance with the provisions of this chapter..

(b) The case management agency shall maintainfiscal records, documents and other evidence thatsufficiently and properly reflect all funds received,and’ all direct and indirect expenditures of any naturerelated to the case management agency’s operation.

(c) All fiscal related material shall bemaintained by the case management agency in accordancewith generally accepted accounting principles, in a

1454—32 .

2628

§17—1454—30

• form conducive to sound and efficient fiscal managementand audit. fEff 2/11/02, am and compfts 07 2flflS ](Auth: MRS §S346-14, 346—333) (Imp: FIRS §346—14,

• 346—333)

§17—1454—29 Insurance requirements. The casemanagement agency ihall obti3Tn, maintaifi, and keep inforce through an insurance company authorized to dobusiness in the State, or that meets the requirementsof section 431:8—301, HRS, if.using an insurancecompany not authorized to do business in the State ofHawaii, the following liability insurance, asappropriate:

(1) General; .

. p

(2) Automobile; and(3) Errors and omissions.(b) All policies shall contain an endorsement

that such insurance may not be cancelled except uponthirty—calendar—days written notice to the State. [Eff2/11/02, am, and comp FEB 07 Th ] (Auth: FIRS §S346—14, 346—333) (Imp: MRS §346—14, 346—333)

§17—1454—30 Quality assurance. (a) The casemanagement agency shall have internal policies andprocedures for continuous quality improvement. Theprogram shall include at least annual monitoring of thecase management agency’s compliance with licensingrequirements, and plans for corrective action measuresand their implementation dates, as appropriate.

(b) The case management agency shall haveinternal risk management policies and procedures thatprovide for ongçing monitoring and assessment ofreports of adverse events, and analysis for trends inadverse events. The policies and proóedures shallrequire:

(1) All service providers serving the client toverbally report adverse events to the casemanagement agency within twenty-four hours ofthe occurrence.

(2) A written report to be sent to the casemanagement agency within seventy-two hours,excluding weekends and holidays, followingthe verbal report required in paragraph (1).

(3) An evaluation of each report of adverse eventby the case management agency to determinethe appropriateness of actions taken and

1454—33

26 28

§17—1454—30

completion of the report and follow—upprocess;

(4) A copy of the original report and a summaryto be provided to the department of the case•management agency’s evaluation of any reportof adverse events and any action taken by thecase management agency, including adjustmentsto the client’s service plan, as appropriate.The original report and summary shall bereceived by the department within seventy-twohours, excluding weekends and holidays, afterthe case management agency receives a written.report of adverse event; and

(5) Quarterly assessment of reports of adverseevents by the case management agency todetermine trends and to document preventativeactions taken when significant trends arenoted.

Cc) The case management agency shall. havepolicies and procedures requiring all service providersserving the client to inform the case management agencyof any changes occurring inthe client’s behavior andfunctioning that may necessitate a change and update ofthe client’s service plan.

(1) The case management agency shall require averbal report from all service providersserving the client within twenty-four hoursof the occurrence of any of the following:(A) Changes in the client’s condition

requiring emergency treatment;(B). Hospitalization of the client;

• (C) Environmental changes or disastersaffecting the delivery of, services toclient; and

(D) Death of the client.If any of the preceding events alsoconstitutes an adverse event, therequirements of subsection (b) (1) shall beapply.

(2) A written report shall be sent to the casemanagement agency within seventy-two hours,excluding weekends and holidays, followingthe verbal report required in paragraph (1).

(3) The case management agency shall haveprocedures for handling reports required inparagraph Cl).

(d) The case management agency shall be subjectto investigation by the department at any time. The

1454—34

2628

§17—1454—37

investigation may be announced or unannounced and mayinclude, but is not limited to, one or more of thefollowing:

(1) Reviews of administr&tive, fiscal, personnel,and client records;

(2)- Inspection of service sites; -

(3) Service site visits to interview clients andto observe personnel and sub—contractorsproviding services; and

(4) Interviews with case management personnel,and service -cjontractors. [Eff 2/11/02,am and comp rco u? 2115 j (Auth: HRS§S346—14, 346—333) (Imp: HRS §S346—14, 346—333)

-.

§17—1454—31 REPEALED. [EU 2/11/02,R FEB 072005

- §17—1454—32 REPEALED. [EU 2/11/02, R FEB 077005

§17—1454—33 to 17—1454—36 (Reserved).

SUBCHAPTER 3

COMMUNITY CARE FOSTER FAMILY HOME REQUIREMENTS

§17-1454—37 Operation of a community care fosterfamily hone. Any person, agency, or organization thatwants to operate a home as a community care fosterfamily home shall obtain a certificate of approval frqmthe department. The person, agency, or organizationshall:

(1) Not have had a previous certificate orlicense to provide residential, social, orhealth care services that was revoked and notsuccessfully appealed within twelve months ofthe current application for a certificate ofapproval to operate a community care fosterfamily home; and

(2) Comply with all applicable requirements setforth in this chapter. [Eff 2/11102, an andcomp FEB 0? am 3 (Auth: HRS §346—l4,

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346—333) (Imp HRS §346—14, 346—334)

§17—1454—37. 1 Contracting with case managementagencies. A home shall not enter into any agreement orcontract with a case management agency:

(1) If the primary caregiver, ‘substitutecaregiver, owner of the property, holder ofthe certificate, or any other adult in thehome, except for clients, is related in anyway to a paid or unpaid member of the staffor officer of the case management agency; or

(2) That requires the home to accept the casemanagement agency’s ents exclusively.[Eff and compftB 07 £W ] (Auth: 1-IRS§346—14, 346—334) (Imp: HRS §346—14, 346—334)

§17—1454—38 REPEALED. Eff 2/11/02, R FEB 072005

§17—1454—39 REPEALED. Eff 2/11/02, R FEB 072005

§17—1454-40 REPEALED. Eff 2/11/02, R FEB O72O1

§17—J.454-41 Personnel and staffing. (a) Theprimary caregiver shall:

(1) Reside in the community care foster familyhome;

(2) Be a NA, a LPN, or a RN;(3) Have at least one year of experience in a

home setting as a NA, a LPN, or a RN; and(4) Have a substitute caregiver who will assume

caregiving responsibilities in the absence ofthe primary caregiver

(b) The primary caregiver and substitutecaregiver shall meet the following requirements:

(1) The primary caregiver must be at leasttwenty-one years old, and the substitutecaregiver shall be at least eighteen yearsold;

(2) Have no physical or mental disabilities thatwould prevent their being able to meet the

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daily needs of clients on a twenty-fourbasis;

(3) Be able to communicate, read, and write inthe English language;

(4) Cooperate with the department to complete apsychosocial assessment of the caregivingfamily system in accordance with subsection17—1454—7(b) (2).

(5) Provide non—medical transportation throughpossession of a valid Hawaii driver’s licens.eand access to an insured vehicle, or an;alternative approved by the department.(A) When the caregiver does not have a valid

driver’s license, does not have accessto an insured vehicle, or both, awritten alternative transportation planshall be submitted to te department forapproval;

(B) The transportation plan may include butis not limited to the use of a handivan,taxi, or a substitute driver;

(C) When a substitute driver is used, thesubstitute driver shall:(i) Have a valid driver’s license;

(ii) Have a current tuberculosisclearance;

(iii) Provide a signed statementindicating no conviction recordthat may place the client at riskof harm; and

(iv) Use an insured vehicle;(6) Comply with all applicable federal, state,

and county laws, ordinances, rules,regulations, and regulatory requirements,including but not limited to statutes thatprohibit d4.scrimination against any person,

* on the grounds of race, color, nationalorigin, religion, creed, sex, age, maritalstatus, or handicap;

(7) Have a current tuberculosis clearance thatmeets department of health guidelines; and

(8) Have documentation of current training Inblood borne pathogen and infection control,cardiopulmonary resuscitation, and basicfirst aid.

(c) The primary caregiver shall attend twelvehours, and the substitute caregiver shall attend eighthours, of in-service training annually which shall be

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approved by the department as pertinent to themanagement and care df clients. The primary caregivershall maintain documentation of training received by

• all caregivers, in the caregiver file in the home.(d) The substitute caregiver who provides three

or more hours of services per day to a client shall, at.aminimum, beaNA.

(e) The primary caregiver shall identify allqualified substitute caregivers, approved .by thedepartment, who provide services for clients. Theprimary caregiver shall maintain a file on thesubstitute caregivers with evidence that the substitutecaregivers meet the requirements specified in thissection.

(f) The primary caregiver shall maintain a fileon all adult household members who are.not substitutecaregivers with evidence that they have current:

(1) Tuberculosis clearances that. meet departmentof health guidelines; and

(2) Background checks. . I

(9) The primary and substitute caregivers shallbe assessed by the department fo cothpetency in basiccaregiver skills and specific skill areas needed toperform tasks necessary to carrying out each client’sservice plan. The documentation of training and skill.competency of all caregivers shall ìç kept in theclient’s, case manager’s, and caregivér’s currentrecords with the current service plan.

(h) . The primary aregiver shall ensure that allsubstitute caregivers are approvàd by the departmentprior to providing services and shall provide a verbaland written report of all substitute caregiver changes,including additions, terminations and replacements, tothe department.

(i) The primary caregiver shall notify thedepartment of any dependent household members orchanges in household composition.

(j) When the primary caregiver will be absent orunable to perform regular duties, and clients arepresent, the primary caregiver shall:

Cl) Report the situation to the clients’ casemanagement agencies verbally ançl in writingprior to the planned absence or being unableto perform caregiving duties. Unplannedabsences or events that prevent the primarycaregiver from performing regular dutiesmustbe reported within twenty-four--hours ofoccurring;

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(2) Assure that a substitute caregiver isavailable and capable of managing all clientcare and any event occurring in the home; and

(3) Authorize all substitute caregivers to permitentrance by case management agency anddepartment staff, with or without priornotice, for the purpose of client monitoring,investigation, and guaiit assurance review.[Eff 2/11/02, am and comptEB 07 21105 3(Auth: HRS §S346—14, 346—334) (Imp: FIRS§S346—].4, 346—334)

§17-1454—42 Client eligibility requirements. Tobe admitted to the community care foster family home,the individual shall:

(1) Be certified by a physician as requiringnursing facility level of care. The medicaidagency medical consultant shall certify theindividual who is a participant in afederally funded medicaid program;.

(2) Voluntarily chooe to enter a community carefoster family home;

(3) Have a physical examination by a physicianwithin thirty days prior to admission orwithin seven days after admission;

(4) Have a tuberculosis clearance issued withintwelve months prior to admission.(A) An adult protective service client may

be admitted for emergency reasonswithout a current tuberculosisclearance, provided that the process toobtain a clearance is begun within threedays after being admitted to the home;

(B) All tuberculosis clearances shall complywith testing procedures established bythe department of health;

(5) Be plaQed and provided ongoing casemanagement services by a home and community-based case management agency; and

(6) Be a recipient of supplemental securityincome, if eligible f,quch benefit. [Eff2/11/02, am and camp UCD u7 2I5 ] (Auth:FIRS §S346—l4, 346—334) (Imp: FIRS §S346—14,346—334)

§17—1454—43 Client care and services. (a) The

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‘home shall care for not more than two adults at any onetime, who are unrelated to the foster family.

(b) One bed in each home shall be reserved formedicaid recipients.

(c) Care and services provided to the clientshall:

(1) Be appropriate to the age ‘and condition of•the client and provided in a homelikeenvironment;

(2) Be based on care directions from the client• to the maximum extent possible, with

• monitoring by the case management agency whenthe client, is not capable of providing caredirections;

(3) Be based on the caregiver following a serviceplan for addressing the client’s needs.. The

• RN case manager may delegate client care andservices as provided in chapter 16—89,subchapter 15, MAR;

(4) Includethe provision of personal care,homemaker, and respite setvices asappropriate;

(5) Include the caregiver observing the following.provisions of care:(A) Appropriate, safe techniques, and

infectioh control procedures; and($) Encouragement of client independence as

much as possible; . and(6) Include recreation and social activities,

which shall:(A) Be arranged and.provided, in accordance

with the service plan, in or outside thehome according to the,client’sinterests, needs, and capabilities; and

(B) Include access by the client to radio,television, and teleph2n.,, ,Jtf2/11/02, am and comp Ft13 ‘7 t”

(Auth: MRS §346—14, 346—334) (Imp:MRS §S346—14, 346—334)

§17—1454-44 Client transfer and discharge. (a)The transfer and discharge of the client may occurwhen:

(1) The home is unable to meet the needs of theclient;

(2) The primary caregiver and the client notifythe case management agency of intended

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transfers or discharges;(3). A minimum of three weeks advance notice is

given prior to any transfer or discharge to:(A) The home and the case manager, when ttiè

transfer or discharge is initiated bythe client or the client’s legalrepresentative; or

(B) The client and the clieht’s legalrepresentative, when the transfer ordischarge is initiated by the casemanagement agency or the home;

(4) Three weeks advance notice shall not berequired;(A) For emergency transfers or discharges;(B) When the transfer or discharge is

mutually agreed upon by the client orthe client’s legal representative, thehome, and the case manager; and

(C) When a transfer is required because ahome’s certificate ‘has been revoked.

(b) All transfers and discharges will becoordinated with the client, the client’s legalrepresentative, if applicable, the case managementagency, and the home.

(c) The home caregivers shall cooperate with thecase management agency and the department whenimmediate removal of the client’ is necessary.

(d) The immediate removal of the client shall beordered when the case management agency or thedepartment determines there is imminent danger to thelife, health, safety, or welfare of the client.

(e) When the client is relocated, the homecaregivers shall not obstruct the relocation processand shall cooperate with the appropriate casemanagement agencies in the relocation j3rocess. Suchcooperation shall include but not be limited to:

(1) Identifying and preparing for removal of themedications, insurance documents, clothing,safeguarded personal funds, valuables and allother belongings of the client; and

(2) Providing accessto the client’s file duringrelocation and return of the file to the casemanagement agency upon relocation.

(f) A home that will voluntarily close mustnotify the department in writing ninety days prior tot,toluntary closure. {Eff 2/11/Q2, am and compCU ii’? 21Xi5 ] (Auth; I-IRS §346—l4, 346—334) (Imp:

HRS §S346—l4, 346—334)

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§17—1454—44.1

§17—1454-44.1 Grievance. The community carefoster family home shall haye policies and proceduresby and through which a client may present grievancesabout the operation or services of the home. Thepolicies shall include a provision that a client maychoose to present any grievanóe directly to thedepartment of human services. The home shall:

(1) Inform the client or the client’s legalrepresentative of the grievance policies andprocedures and the right to appeal in agrievance situation;

(2) Provide a written copy of the grievancepolicies and procedures to the client or theclient’s legal representative, which includes,the names and telephone numbers of theindividuals who shall be contacted in orderto report a grievance; and

(3) Obtain signed acknowledgements f rpm theclient or the client’s legal representativethat the grievance policies an4ieftreswere reviewed. [Eff and comp ](Auth: I-IRS §5346Tl4, 346—334) (Imp: MRS§S346—14, 346—334)

§17-1454—45 Fire safety. (a) Thehome shallconduct, document, and maintain a record, in the home,of unannounced fire drills at different times of theday, evening, and night. Fire drills shall beconducted at least monthly under varied conditions andshall include the testing of smoke detectors.

• (b) The home shall assure that:(1) The client who is bed bound or unable to make

independent decisions about individual safetyshall have a designated person available atall times capable of evacuating the client;and

(2) All caregivers have been trained to implementappropriate emergency procedures in the eventof a fire. [Eff 2/11/02, amand comp

FEB 07 2005 3 (Auth: HRS §S346—14, 346—334) (Imp: HRS §S346—l4, 346—334)

§17—1454—46 Medication and nutrition. (a) Alicensed practical nu±ii or a registired nurse shalladminister medications that are to be injected, unlessphysician orders permit a client to self-inject. The

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registered nurse may delegate the administration ofmedication as provided in chapter 16-89, subchapter 15,HAR.

(b) The caregivers shall obtain training,relevant information, and regular monitoring from theclient’s physician, a home health agency, as defined inchapter 11-97, HAR, or an RN for all medication thatthe client requires.

(c) Medication errors and drug side effects shallbe reported immediately to the client’s physician, andthe case management agencyshall be notified withintwenty—four hours of such occurrences, as requiredunder section 17-1454—48.1(b). The caregivers shalldocument these events and. the action taken in theclient’s progress notes.

(d) Use of physical or chemical restraints shallbe:

(1) By order of a physician;(2) Reflected in the c1ient’ service plan; and::(3) Based on an assessment that includes the

consideration of less restrictive restraintalternatives.

(e) The caregivers shall obtain specificinstructions and training regarding special feedingneeds of clients frOm a person who is registered,certified, or licensed to proviIe such instructions andtraining. [Eff 2/11/02, am and domp FEB 07 ,mc ](Auth: HRS §S346—14, 346—334) (Imp: HRS §c34’6—14,346—334)

§17—1454—47 Client account. (a) The home shallmaintain a written accounting of the client’s personalfunds received and expended on the client’s behalf bythe home.

(b) Personal funds and valuables of the clienthandled by the home for safekeeping shall not be:

(1) Commingled with those of the home, theprimary or substitute caregivers, otherhousehold members, or other clients; Or

(2) Used as the home funds or petty cash. [Eff2/11/02, an and comp FEB 07 2Th ] (Auth:HRS §346—l4, 346—334) (Imp: MRS §346—l4,346—334)

§17-1454—48 Physical environment. (a) The homeshall include:

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§17—1454—48

(1) Bathrooms with non—slip surfaces in the tubsand or showers, and toilets adjacent oreasily accessible to sleeping rooms;

(2) Grab bars in bath and toilet rooms used bythe client, as appropriate;

(3) A common living area, which is adequate forsocialization and the recreational needs ofthe client;

(4) Wheelchair accessibility to sleeping rooms,bathrooms, common areas and exits, asappropriate;

(5) An operating underwriters laboratory approvedsmoke detector and fire extinguisher inappropriate locations; and

(6) A means of unobstructed travel from theclient’s bedroom to the outside of thedwelling at street or ground level.

(b) Client bedrooms shall:(1) Have a bedside curtain or screen to ensure

privaáy when a room is shared by the clientand another person;

(2) Be limited to twodlients, both of.whomshall consent to the arrangement; and

(3) Be in close proximity to the primary orsubstitute caregiver for timely interventionfor nighttime needs or emergencies, or beequipped with a call bell, intercom, ormonitoring device approved by the casemanagement agency.

(c) Housekeeping requirements shall include thefollowing:

(1) The primary or substitute caregiver shallfollow appropriate preventative maintenance

• procedures for equipment and devices used inthe care of clients;

(2) The primary or substitute caregiver shallfollow infection control procedures andproper procedures for disinfecting equipmentand devices used in the care of the client;and

• (3) The home shall be maintained in a clean, wellventilated, adequately lighted, and safemanner.

Cd) When there are intended changes to the home,the department shall be notified prior to the changesoccurring.

(1) The certificate holder shall ensure that theminimum physical environment requirements as

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§17—1454—48.1

specified in this section are met; and(2) A new home assessment is required when

changes occur to the structure or address ofthe home.

(e) The home shall have policies regarding.smoking on the property that:

(1) Prohibit smoking in enclosed living andrecreational areas used by clients; and

(2) Identify designated areas that may be usedfor purposes äf smoking. [Eff 2/11/02, amand comp FEB 97 20135 ] (Auth: HRS §346—14, 346—334) (Imp: HRS §S346—14, 346—334)

§17—1454—48.1 Quality assurance. (a) The homeshall have documented internal emergency managementpolicies and procedures for emergency situations thatmay affect the client, such as but not limited to:

(I) Sudden illness or accident; p

(2) Death;(3) Violent acts or abuse;(4) Natural disasters;(5) Fire; and(6) Power and telephone outage.(b) Adverse events shall be reported.(1) A verbal report to the case management agency

responsible for the client shall be madewithin twenty-four hours of the occu±réhcé;and

(2) A written report shall be sent to the casemanagement agency within seventy-two hours,excluding weekends and holidays, followingthe verbal report required under paragraph(1)

(c) The home shall inform the case managementagency of any changes occurring in the client’sbehavior and functioning that may necessitate a changeand update of the client’s service plan. A verbalreport shall be made to the case management agencyserving the client within twenty-four hours of theoccurrence of any of the following:

(1) Changes in the client’s condition requiringemergency treatment;

(2) Hospitalization of theclient;(3) Environmental changes or disasters affecting

the delivery of services to client;, and(4) Death of the client.

If any of the preceding events also constitutes an

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§17—1454—48.1

adverse event, the requirements of subsection (b) shallbe met.

(d) The home shall cooperate at all times withthe case management agency serving a client it hasplaced. in the home. Such cooperation shall includeproviding the case management agency access to the homeand the client at any time requested by the casemanagement agency.

(e) The home shall be subject to investigation bythe department at any time. The investigation may beannounced or unannounced and may include, but is notlimited to, one or more of the following:

(1) Reviews of administrative, fiscal, personnel,and client records;

(2) Inspection of serVice sites;(3) Service site visits to interview clients and

• to observe personnel and sub-contractorsproviding services; and

(4) Interviews with community hare foster familSihome caregivers and other adults in the home,and service sub—contractors. [Eff and comp

FEB 07 2O ] (Auth: MRS §S346—14, 346—334) (Imp: HRS §S346—14, 346—334)

§17—1454—49 Insurance requirements. (a) Thehomeshall obtain, maintain, and keep in force through aninsurance company authorized to do business in theState, or that meets the requirements of secftion 431:8—301, HRS, if using an insurance company not authorizedto do business in the State of Hawaii, the followingliability insurance, as appropriate:

(1) General;(2) Automobile; and(3) Errors and omissions. I

(b) All policies shall contain .an ‘endorsementthat such insurance may not be cancelled except uponthirty—calendar-days fwyigflotice to the State. [Eff2/11/02, am and comp ] (Auth: HRS §S346—14, 346—334) (Imp: HRS §346—14, 346—334)

§17—1454-49.1 Fiscal requirements.’ (a) The homeshall have adequate resources to finance its servicesin accordance with the provisions of this chapter.

(b) The home shall maintain fiscal records,documents and other evidence that sufficiently andproperly reflect all funds received, and all direct and

•

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indirect expenditures of any nature related to thehprne’s operation.

(c) All fiscal related material shall bemaintained by the home in accordance with generallyaccepted accounting principles, in form conducive tosound and efficient fiscal management and audit. [Effand comp FEB Ii? aiuj I (Auth: HRS §S346-14, 346—334)(Imp: HRS §S346—14, 346—334)

§17—1454—50 Client rigjs. (a) Written policiesand procedures regarding the rights of the clientduring the client’s stay in the home shall beestablished and a copy shall be provided to theclient, or the client’s legal representative, and madeavailable to the public when requested.

(b) These policies and procedures relating to’ thehome shall provide that each client in the home shall:

(1) Be fully informed, prior to or at the time ofadmission, of these rights and of all rulesgoverning the client’s conduct in the home.There shall be documentation signed by theclient or the client’s legal representativethat this procedure has been carried out;

(2) Have the right to reside in the home of theclient’s choice;

(3) Be fully informed, prior to pr at the time ofadmission, and during the client’s stay, ofservices available in or through the home ahdrelated charges;

(4) Be given a minimum of three weeks advancenotice of transfers or discharges, except inemergencies;

(5) Be encouraged and assisted to exercise theclient’s rights, including the client’sgrievance rights, and to recommend changes inpolicies and services to the primarycaregiver or outside representatives of theclient’s choice, free from restraint,interference, coercion, discrimination, orretaliation.(A) The. client shall be assisted in

contacting individuals or agencies ofthe client’s choiqe by the casemanagement agency; and

(B) The client may present grievances tothe department;

(6) Be fully informed of the conditions under

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which the home may manage the client’spersonal financial affairs;

(7) Not be humiliated, harassed, or threatened,and be free from physical and chemicalrestraints. Physical and chemical restraintsmaybe used as specified in section 17—1454—46(d); I

(8) Have the client’s personal an4 medicalrecords kept confidential;

(9) Be treated with understanding, respect, andfull consideration of the client’s dignityand individuality, including privacy intreatment and in care of the client’spersonal needs;

(10) Not be required to perform services for thehone unless agreed to by the client anddocumented;

(11) Have the right to associate and äornmunicateprivately with persons of the client’schoice, and to send and reâeive personal mailand items unopened;

(12) Have the right to meet with and participatein activities of social, religious, andcommunity groups at the client’s discretion;

(13) Retain ad use personal clothing andpossessions as space permits, unless to do sowould infringe upon the rights of otherclients;

(14) If married, be assured of privacy for visitsby the spouse and, if both are clients in thehome, be permitted to share aroon, withwritten consent of both clients;

(15) Have daily visiting hours and •provisions forprivacy established;

(16) Shall not have dietary restrictions used aspunishment; and

(17) Have a right to be free from abuse. [Eff2/11/02, am and comp FEB 07 2005 J (Auth:MRS §5346—14, 346—334) (Imp: MRS §5346—14,346—334)

§17—1454-51 REPEALED. Eff 2/11/02, R FEB07 2OI

§17—1454-52 Records. (a) Each home shallmaintain an administrative notebook including but not

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limited to:(1) Emergency procedures and an evacuation map;(2) Appropriate program polióies and procedures;

and(3) A list of applicable cOmmunity resources.(b) The home shall maintain separate notebooks

for each client in a manner that ensures legibility,order, and timely signing and dating of each entry inblack ink. Each client notebook shall bea permanentrecord and shall be kept in detail to:

(1) Permit effective professional review by the• case management agency, and the department;

and• (2) Provide information for necessary follow—up

care for the client.(c) The content of each client notebook shalJ. be..

consistent with standards established by the departmentand shall contain:

(1) Client’s vital information;(2) Client’s current individual service plan, and

when appropriate, a transportation planapproved by the department; .

(3) Current copies of the client’s physician’sorders;

(4) Client’s emergency management procedures;(5) Medication schedule checklist;(6) Daily documentation of the provision of

services through personal care qr skillednursing daily check list, RN and socialworker monitoring flow sheets, clientobservation sheets, and significant eventsthat may impact the life, health, safety, orwelfare of, or the provision of services tothe client, including but not limited toadverse events;

(7) Expenditure records; and(8) Personal inventory.(d) All client records and reports are

confidential, as provided in section 17—1454-13.1, andshall not be released without the written consent ofthe client or the client’s legal representative, or thecase management agency, as applicable. The casemanagement agency shall be informed of any request forthe release of information concerning clients and shallretain a copy of the client’s written consent torelease information.

(e) • When a client leaves a home, all records andreports kept by the home shall be given to the case

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§17—1454—52

n agç t agency. jEff 2/11/02, am and campb ] (Auth: HRS §346—14, 346—334) (Imp:

HRS §@346—14, 346—334)

§17—1454—53 to 17—1454—56 (Reserved)

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