Haw. Code R. § 11-800-7 - Application

(a) Any person, agency, or organization that wants to be licensed as a home and community-based case management agency shall submit the following to the department:

(1) A signed application form provided by the department;

(2) A written statement of services to be provided;

(3) Information relating to the applicant's organization and administration;

(4) A signed financial statement that describes the policies and procedures governing internal controls of financial matters and includes information on revenues and expenses for the previous fiscal year related to services provided;

(5) Information on the number of staff members and the staff members' duties, educational backgrounds, and work experiences; and

(6) Background check documents, as provided in section 11-800-8.

(b) Any person, agency, or organization that wants to be certified as a community care foster family home 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 home that is to be a community care foster family home and is a NA a LPN, or a RN with at least one year of experience in a home setting;

(C) Background check documents, as provided in section 11-800-8; and

(2) Have a family system in the home that has the capacity to meet the certification requirements and to provide services as a community care foster family home. This determination shall be made through:

(A) A psychosocial assessment by the department, including but not limited to physical and mental disabilities, problem solving skills, coping strategies, and anger management that would prevent or limit the individuals from meeting the daily needs of clients on a twenty-four hour basis; and

(B) A standardized tool that relates to the care and needs of clients shall be utilized for the psychosocial assessment;

The assessment shall be updated when changes occur in the caregiver's household or the client's situation that may impact the life, health, safety, or welfare of, or the provision of services to, the client.

(c) The date of application shall be the date the department receives all required forms and information necessary for the department to make a disposition, including but not limited to:

(1) Background check information required under section 11-800-8; and

(2) Department of human services' decision regarding a request for exemption made pursuant to section 11-800-8(e).

Notes

Haw. Code R. § 11-800-7

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