Haw. Code R. § 11-800-42 - Client eligibility requirements

(a) To be admitted to the community care foster family home, the individual shall:

(1) Be certified by a physician as requiring nursing facility level of care. The medicaid agency medical consultant shall certify the individual who is a participant in a federally funded medicaid program;

(2) Voluntarily choose to enter a community care foster family home;

(3) Have a physical examination by a physician within thirty days prior to admission or within seven days after admission;

(4) Have a tuberculosis clearance issued within twelve months prior to admission,

(A) An adult protective service client may be admitted for emergency reasons without a current tuberculosis clearance, provided that the process to obtain a clearance is begun within three days after being admitted to the home;

(B) All tuberculosis clearances shall comply with testing procedures established by the department of health;

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

(6) Be a recipient of supplemental security income, if eligible for such benefit.

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

(1) The community care foster family home is certified for three beds;

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

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

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

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

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

Notes

Haw. Code R. § 11-800-42

[Eff 11/13/2018] (Auth: HRS §§ 321-481, 321-483, 321-485, 346-14) (Imp: HRS §§ 321-481, 321-483, 321-485, 346-14)