Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 88.1 - SERVICES FOR PERSONS WITH DEVELOPMENTAL OR INTELLECTUAL DISABILITIES › Subchapter 1 - GENERAL PROVISIONS › Section 11-88.1-2 - Definitions

Current through June, 2024
"As used in this chapter:
"Adaptive behavior" is the collection of conceptual,
					 social, and practical skills that have been learned by people in order to
					 function in their everyday lives.
"Activities of daily living" (ADL) means activities related
					 to personal care including, but not limited to, bathing, dressing, toileting,
					 transferring and eating.
"Adult day health services (ADH)" means services offered to
					 a participant in a non-institutional community-based setting encompassing
					 health and social services needed for optimal functioning of the
					 participant.
"Adverse event" means any incident or event that may have
					 quality of care implications for participants, including but not limited
					 to:
(1) Changes in the participant's condition requiring
					 medical treatment;
(2) Hospitalization of the participant;
(3) Death of the participant;
(4) All bodily injuries sustained by the participant for
					 which medical treatment (i.e., treatment rendered by a physician, nurse
					 practitioner, ambulance or emergency medical personnel, or emergency room
					 medical staff) that may or may not require necessary follow-up regardless of
					 cause or severity;
(5) Injuries of unknown cause;
(6) All reports of abuse and neglect made to the Department
					 of Human Services Adult Protective and Community Services Branch (APCS) or the
					 Department of Human Services Child Welfare Services Branch (CWS);
(7) All medication errors and unexpected reactions to drugs
					 or treatment;
(8) Situations where participant's whereabouts are unknown;
					 or situations where participant's behavior requires a plan of action or
					 intervention.
"Applicant" means a person whose written application has
					 been submitted to the division but who has not received final action on their
					 application.
"Application" means the documentation needed to determine
					 eligibility for services from the division. An application must be complete to
					 be considered.
"Assessment" means the process of gathering a broad range
					 of information through indirect and direct means such as interviewing, record
					 reviews, and direct observations. Assessment information assists in identifying
					 what is important to the person, how any issue of health or safety may be
					 addressed, and what needs to happen to support the person in the person's
					 desired life.
"Assistive technology" means a device such as an item,
					 piece of equipment, or product system, whether acquired commercially, modified,
					 or customized, that is used to increase, maintain or improve the functional
					 capabilities of a participant or a service that directly assists the
					 participant in the selection, acquisition or use of an assistive device.
					 Assistive technology does not include devices and services available under the
					 State Plan and EPSDT.
"Case management services" means services defined in HRS
					 §
										333F-1.
"Centers for Medicare & Medicaid Services (CMS)" means
					 the United States Department of Health and Human Services, Center for Medicare
					 & Medicaid services.
"Chore services" means services needed to maintain the home
					 in a clean, sanitary and safe environment.
"Clinical Interdisciplinary Team (CIT)" means the
					 established committee that uses available clinical evidence-based and current
					 prevailing practices in the field of intellectual and other disabilities to
					 assist in the determination of eligibility and to provide consultation to the
					 case managers.
"Conservator" means a person who is appointed by a court to
					 manage the estate of a protected person pursuant to section
					 560:5-409,
					 HRS. The term includes a limited conservator.
"Consumer directed services" means services where the
					 provider is directly employed by the participant or designated representative
					 and meets the developmental disabilities division's criteria to deliver
					 non-Medicaid services and Medicaid waiver services.
"Cost share" means the amount identified by the department
					 of human services as an individual's excess income available for meeting a
					 portion of the individual's own Medicaid health care cost.
"Department" means department of health, State of
					 Hawaii.
"Department of Health (DOH)" means department of health,
					 State of Hawaii.
"Department of Human Services (DHS)" means the department
					 of human services, State of Hawaii, which administers Title XIX, section
					 1915(c) of the Social Security Act (Hawaii Medicaid program).
"Developmental disabilities" means a severe chronic
					 disability of a person which:
(1) Is attributable to a mental or physical impairment or
					 combination of mental and physical impairments;
(2) Is manifested before the person attains age twenty-two
					 (22);
(3) Is likely to continue indefinitely;
(4) Results in substantial functional limitations in three
					 (3) or more of the following areas of major life activity:
self-care, receptive and expressive language, learning,
					 mobility, self-direction, capacity for independent living, and economic
					 sufficiency; and
(5) Reflects the person's need for a combination and
					 sequence of special care, interdisciplinary care, or generic care, treatment or
					 other services which are of lifelong or extended duration and are individually
					 planned and coordinated.
"Developmental Disabilities Division (DDD) " means
					 developmental disabilities division, department of health, State of
					 Hawaii.
"Director" means director of the department of health,
					 State of Hawaii.
"Division" means the developmental disabilities division,
					 department of health, State of Hawaii.
"Division chief" means the chief of the developmental
					 disabilities division, department of health, State of Hawaii.
"Early and Periodic Screening, Diagnostic, and Treatment
					 (EPSDT)" means Medicaid's comprehensive and preventive child health program for
					 individuals under the age of twenty-one (21) years.
"Emergency outreach" means services that are immediate and
					 short-term, on-site or telephonic, support for situations in which a
					 participant's presence in home or program is at risk due to the participant's
					 display of challenging behavior that occurs with intensity, duration and
					 frequency so as to endanger the participant's safety or the safety of others or
					 results in the destruction of property.
"Emergency respite services" means emergency short-term
					 out-of-home placement for a participant with potential for danger to self or
					 others, challenging behavior, or the participant's significant support system
					 is compromised such as the death of a primary caregiver.
"Emergency shelter services" means emergency short-term
					 out-of-home placement of a participant in need of intensive intervention in
					 order to avoid institutionalization or more restrictive placement and for
					 return to the current or a new living situation once stable.
"Employment services" means pre-vocational, or on-going
					 individual employment support or group employment support to assist a
					 participant to prepare for, obtain, and sustain paid employment at or above the
					 State's minimum wage or to engage in self-employment.
"Environmental accessibility adaptations (EAA)" means those
					 physical adaptations to a participant's home that are necessary for the health,
					 welfare and safety of the participant and that enable the participant to
					 function with greater independence in the home. Such adaptations include the
					 installation of ramps and grab-bars, widening of doorways, modification of
					 bathroom facilities or the installation of specialized electric and plumbing
					 systems that are necessary to accommodate the medical equipment and supplies
					 that are necessary for the welfare of the participant.
"Guardian" means a court appointed legal guardian of the
					 person pursuant to sections
					 560:5-204
					 and
					 560:5-304,
					 Hawaii Revised Statutes.
"Home and community-based services (HCBS) waiver program"
					 means services provided under the Title XIX, section 1915(c) waiver of the
					 Social Security Act. The HCBS program permits a state to furnish an array of
					 home and community-based services that assist Medicaid beneficiaries to live in
					 the community and avoid institutionalization.
"Individualized service plan (ISP)" means the written plan
					 required by section
					 333F-6
					 that is developed by the individual, with the input of family, friends, and
					 other persons identified by the individual as being important to the planning
					 process. The plan shall be a written description of what is important to the
					 individual, how any issue of health or safety shall be addressed, and what
					 needs to happen to support the individual in the individual's desired
					 life.
"Instrumental activities of daily living" (IADL) means
					 activities such as light housework, laundry, meal preparation, transportation,
					 grocery shopping, using the telephone, managing one's medication and money
					 management.
"Intellectual disability (ID)" means significantly
					 sub-average general intellectual functioning resulting in or associated with
					 concurrent moderate, severe, or profound impairments in adaptive behavior and
					 manifested during the developmental period.
"Intermediate care facility for individuals with
					 intellectual disabilities (ICF/ID)" means an ICF/ID that provides intermediate
					 care facility/mental retardation (ICF/MR) services as defined in
					 42 CFR
					 440.150. (Note: ICF/MR is the abbreviation
					 currently used in all Federal requirements; however, CMS prefers to use the
					 accepted term "individuals with intellectual disability" (ID) instead of
					 "mental retardation").
"Intermediate Care Facility for Persons with Intellectual
					 Disabilities level of care (ICF/ID LOC)" is a level of care determination for
					 an individual applying for Medicaid waiver services. An individual that meets
					 ICF/ID LOC shall have a diagnosis of either developmental or intellectual
					 disability, adaptive functioning with at least moderate deficiency or below,
					 and will benefit from waiver services.
"Medicaid waiver" or "waiver services" or "waiver" or "home
					 and community-based services" program means the Title XIX, section 1915(c)
					 waiver program approved by the Centers for Medicare & Medicaid Services
					 (CMS) for which institutional requirements are waived for an individual with a
					 developmental or intellectual disability, who requires services and support
					 similar to those provided in an institution, to remain in the community.
"Monitor" means to conduct a systematic, coordinated,
					 objective, qualitative review of services provided by any person, agency or
					 organization.
"Natural Support" means unpaid support that is available to
					 the participant within the family, and community.
"Non-medical transportation" means services offered to
					 enable a waiver participant to gain access to waiver and other community
					 services, activities and resources. These services are offered in addition to
					 medical transportation required by federal Medicaid regulations and
					 transportation services under the State Plan.
"Participant" means a person who meets the eligibility
					 criteria and voluntarily elects to receive services from the division.
"Person" means any individual, and the individual's
					 guardians or legal representatives.
"Personal assistance/habilitation (PAB) services" means a
					 range of assistance or training in activities of daily living (ADL) and
					 instrumental activities of daily living (IADL).
"Personal emergency response system (PERS) " means an
					 emergency response system in which an electronic device that enables a waiver
					 participant to secure help in an emergency is connected to a response
					 center.
"Person-centered planning" means a process, directed by the
					 individual or the family with long term care needs, intended to identify the
					 strengths, capacities, preferences, needs, and desired outcomes of the
					 individual.
"Provider" means an agency or individual who provides
					 Medicaid waiver services and meets the developmental disabilities division's
					 criteria to deliver the services to participants.
"Purchase of service (POS) provider" means an agency or
					 individual who meets the division's criteria to deliver non-Medicaid waiver
					 services.
"Representative" means any person who can advise and
					 advocate for a person with a developmental or intellectual disability and who
					 shall serve at the request and pleasure of that person; provided that should
					 the person with a developmental or intellectual disability be a minor, is
					 legally incapacitated, or has not requested a representative, the parent or
					 guardian of the person may request a representative to assist on behalf of the
					 person with a developmental or intellectual disability.
"Respite" means services that are furnished on a short-term
					 basis because of the absence or need for relief of those individuals normally
					 providing care for the participant.
"Services" means appropriate assistance provided to a
					 person with a developmental or intellectual disability living in the community.
					 These services include case management, residential alternatives, respite
					 services, counseling, program for single-entry access, informational and
					 educational services to the public, provision of individually appropriate
					 services, and support which are not provided under other federal, state, or
					 county laws and regulations.
"Severe, chronic disability" means a documented consistent
					 pattern of disability over the lifetime of a person that is progressive or
					 expected to be lifelong or unchanged.
"Skilled nursing (SN)" means services within the scope of
					 chapter
					 457, HRS,
					 and other skilled nursing functions required by federal law and the State Plan.
					 Services are supervised by or provided by a registered professional nurse
					 licensed to practice in the State of Hawaii.
"Specialized medical equipment and supplies (SMES)" means
					 devices, controls or appliances which enable a participant to increase
					 abilities to perform activities of daily living or to perceive, control or
					 communicate with the environment in which the participant lives. Items
					 necessary for life support, ancillary supplies and equipment necessary to the
					 proper functioning of such items, and durable and nondurable medical equipment
					 not available under the Medicaid State Plan are included.
"State matching funds" means the portion of Medicaid costs
					 that the State pays to finance its Medicaid program. The state match is
					 determined by the federal medical assistance percentage (FMAP).
"State Plan" means Hawaii Medicaid State Plan.
"Support" means both government funded and nongovernment
					 funded services which assist a person with a developmental or intellectual
					 disability to live in the community.
"Title XIX" means the Medicaid program defined in the Title
					 XIX of the Social Security Act, 42 Code of Federal Regulations, Chapter
					 42, Public Health Service, department
					 of health and human services.
"Training and consultation" means services for an
					 individual who provides support, training, or supervision to a participant.
					 These services include instruction about treatment regimens and other services
					 included in the ISP, the use of equipment specified in the service plan, and
					 updates as necessary to safely maintain the participant at home.
"Utilization Review Committee (URC)" means the committee
					 that reviews services for the authorization of services above or below the
					 service limitations or conditions to ensure that participants' needs are
					 met.
"Vehicular modifications" means adaptations to an
					 automobile or van to accommodate the special needs of a participant to
					 integrate more fully into the community and to ensure the health, welfare and
					 safety of the participant. This does not include adaptations or improvements to
					 the automobile or van that are of general utility and are not of direct medical
					 or remedial benefit to the participant; purchase or lease of an automobile or
					 van; and regularly scheduled upkeep and maintenance of the automobile or
					 van.
"Ward" means a person for whom a guardian has been
					 appointed.
"Waitlist" means a list, maintained by the department, of
					 persons waiting for home and community-based services.