reglab/statecodes huggingface dataset:
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-52 - Licensing

Current through June, 2024
(a) It shall be unlawful for any group or
				  person to operate a freestanding birthing facility unless it is licensed by the
				  director.
(b) Any person, or group
				  of persons, desiring to operate a freestanding birthing facility shall apply to
				  the director for a license on forms provided by the department. The director
				  shall issue a license if the proposed facility meets the requirements under
				  this chapter.
(c) A license, unless
				  abandoned or revoked for just cause as determined by the director, shall be
				  renewed every year, on date of issue, or of such other interval of time as may
				  be decided by the director. Application for renewal of license shall be made by
				  the governing body of the freestanding birthing facility at least sixty days
				  prior to expiration date as determined from the license. If application for
				  renewal is not filed, the license shall be automatically cancelled as of the
				  expiration date determined from the license.
(d) A provisional license may be issued for a
				  specific period of time at the discretion of the director should additional
				  time for correction of deficiencies be deemed advisable. Not more than two
				  successive provisional licenses shall be issued to a particular
				  facility.
(e) In respect to a
				  particular facility, a specific rule may be waived for a period of one year, at
				  the discretion of the director.
(f)
				  Each license shall be issued to a physical facility and to a governing body;
				  change in either shall require that the department be notified and, at the
				  discretion of the director, may require that a new license be issued.
(g) The department shall be notified in
				  writing fifteen days prior to the appointment of a new administrator or a new
				  medical director. A change of administrators or medical directors, at the
				  discretion of the director may require that a new license be issued.
(h) The license issued by the director shall
				  be posted in a conspicuous place visible to the public on the premises of the
				  freestanding birthing facility.
(i)
				  Inspection visits may be made to the licensed freestanding birthing facility at
				  any reasonable time without prior notice by the authorized staff of the
				  department.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-53 - License revocation

Current through June, 2024
(a) After due
				  notice, and after suitable opportunity for hearing, conducted in accordance
				  with chapter
				  91, HRS, the director may suspend,
				  revoke, or refuse to issue or renew a license to any governing body because of
				  a failure to meet:
(1) Requirements of this
				  chapter; or
(2) The conditions
				  under which the license was issued.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-54 - Administration

Current through June, 2024
(a) The administrative personnel under the
				  direction of an administrator shall develop and carry out such administrative
				  procedures as are necessary to achieve the objectives and policies of the
				  governing body.
(b) The
				  administrator shall establish policies and develop procedures to ensure that
				  all employees are free of infectious diseases. These policies shall include an
				  annual physical examination specifically oriented to rule out infectious
				  disease conducted by a licensed physician.
(1) If the tuberculin skin test is
				  significant, a standard chest x-ray and appropriate medical follow up shall be
				  obtained. A yearly chest x-ray for three successive years thereafter shall be
				  required. Additional chest x-rays may be required at the discretion of the
				  director.
(2) If the tuberculin
				  skin test is negative, a second skin test shall be done after one week but not
				  later than three weeks after the first test. The results of the second test are
				  to be considered the baseline and are used to determine the appropriate follow
				  up. If the second test is negative it shall be repeated once yearly thereafter
				  until it becomes significant.
(3)
				  Any employee who develops evidence of an infectious disease shall be
				  immediately excluded from any duties relating to food handling and direct
				  patient contact and shall remain excluded until such time as a physician
				  certifies that it is safe for the individual to resume normal duties. Skin
				  lesions, respiratory tract symptoms and diarrhea shall be considered
				  presumptive evidence of infectious disease.
(4) There shall be adequate documentation
				  that all employees have been fully informed about, and understand, paragraphs
				  (1) to (4).
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-55 - Construction and physical environment requirements

Current through June, 2024
(a) The
				  facility shall be constructed and maintained in accordance with state, and
				  local zoning, building, fire safety and sanitation laws.
(b) The facility shall be accessible to, and
				  functional, for physically handicapped persons.
(c) There shall be adequate space for
				  preparation, sterilization, and storage of instruments and supplies.
(d) Adequate toilet, lavatory, and bathing
				  facilities shall be available for patients' and staff use.
(e) Each birthing room:
(1) Shall be of adequate size and appropriate
				  shape to provide for the equipment, staff, supplies and emergency procedures
				  required for the physical and emotional care of the mother, her support
				  persons, and the newborn during birth, labor, and the postpartum
				  period.
(2) Shall have a minimum of
				  one hundred twenty square feet with a minimum dimension of ten feet.
(3) Shall have doorways and hallways of
				  adequate width and configuration to accommodate maneuvering of ambulance
				  stretchers.
(4) Shall be located to
				  provide rapid unimpeded access to an exit of the building which shall
				  accommodate emergency transportation vehicles and equipment.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-56 - Fees for licensing

Current through June, 2024
Appropriate fees, if any, as determined by the director,
					 shall be charged by the department for obtaining a new license or obtaining a
					 license renewal. Prior notice of the amount of the fee shall be provided to the
					 licensee.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-57 - Governing body

Current through June, 2024
(a) The governing body shall be the supreme
				  authority of the facility, responsible for the management, control and
				  operation of the facility; including the appointment of an administrator,
				  medical director, and professional staff.
(b) The governing body shall specify which
				  obstetrical procedures may be done in the facility.
(c) The governing body shall be formally
				  organized in accordance with a written constitution and by-laws.
(d) The governing body shall meet regularly
				  at least once a year, and the minutes of these meetings shall be kept as a
				  permanent record in the facility.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-58 - Infection control

Current through June, 2024
(a) Definitive
				  procedures governing sterilization techniques shall be developed. The written
				  procedures shall include:
(1) The technique
				  to be used for particular instrument or group of instruments.
(2) The length of time to accomplish
				  sterilization.
(3) Temperature,
				  time and pressure control levels established for steam sterilization.
(4) Proper methods of preparation of items
				  for sterilization.
(5) Shelf
				  storage for sterile items established.
(6) Use of sterilizer indicators.
(7) Use of routine bacteriological sterilizer
				  culture controls as might be indicated.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-59 - Inservice education

Current through June, 2024
There shall be an appropriate inservice education program.
					 This shall include, but not be limited to annual training, fire prevention,
					 infection control, and accident prevention. There shall be adequate
					 documentation of these educational procedures.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-60 - Laundry service

Current through June, 2024
(a) Provision shall
				  be made for the handling, storage and transportation of soiled and clean
				  laundry and for satisfactory cleaning procedures.
(b) Infectious laundry shall be handled in
				  accordance with the provisions of section
				  325-7, HRS or any
				  method approved by the director.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-61 - Medical director

Current through June, 2024
(a) The medical
				  director shall develop appropriate written policies and procedures to provide
				  the necessary preventive, diagnostic and therapeutic services to patients in
				  order to achieve the objectives of the facility.
(b) The medical director shall cooperate with
				  the administrator to:
(1) Approve appropriate
				  staff and professional educational programs; and
(2) Recommend to the governing body the names
				  of physicians and midwives to be appointed to the professional staff.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-62 - Medical records

Current through June, 2024
(a) There shall be
				  available sufficient appropriately qualified staff and necessary supporting
				  personnel to facilitate the accurate processing, checking, indexing, filing and
				  prompt retrieval of records and record data.
(b) All patient records shall be confidential
				  and are the property of the facility which shall secure them against loss,
				  destruction, defacement, tampering, and use by legally unauthorized
				  persons.
(c) Patient records shall
				  contain the following:
(1) Prior to delivery,
				  the patient record shall contain the following:
(A) Sufficient history, physical examination,
				  x-ray, and laboratory data to support the decision to utilize the birthing
				  facility. The laboratory data must include an Rh factor determination, as well
				  as the result of a serological test for syphilis.
(B) Evidence of a search for any special
				  hazards which might confront the patient and evidence of preparation to handle
				  same should they develop.
(C) An
				  informed consent form signed by the patient or her guardian.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-63 - Nursing service

Current through June, 2024
(a) Each facility
				  shall have a nursing staff which shall be directed by the director of nursing.
				  The director of nursing shall be a qualified registered professional nurse who
				  shall be appointed by the administrator with the approval of the governing
				  body. The director of nursing shall develop such nursing service policies and
				  procedures, recruit such nursing personnel, and provide such supervision as is
				  necessary to achieve the objectives of the facility.
(b) Each facility shall have a nursing staff
				  sufficient in number and qualifications to meet the nursing needs of the
				  patients in the facility. There shall be at least one registered nurse present
				  and on duty at all times when a patient is in the facility.
(c) There shall be an organized written
				  departmental plan which includes objectives, administrative authority, staffing
				  patterns, job descriptions, and responsibilities for each category of nursing
				  personnel.
(d) There shall be
				  appropriate nursing policies and procedures delineating the scope of
				  services.
(e) Working personnel in
				  each birthing room shall include, in addition to a physician or a midwife, at
				  least one registered professional nurse who shall serve as a circulating
				  nurse.
(f) All nursing personnel
				  shall be trained in adult and neonatal resuscitation procedures.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-64 - Pathology

Current through June, 2024
(a) All abnormal tissues and fetuses shall be
				  appropriately preserved for examination by a pathologist at the freestanding
				  birthing facility.
(b) A report of
				  such examination shall be placed in the patient's record.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-65 - Patient care

Current through June, 2024
(a) All patients admitted to a facility shall
				  have been under prior care by a member of the professional staff.
(b) Patients and newborns shall remain under
				  observation in this facility for a reasonable period of time to ensure that no
				  immediate postpartum complications are present. In no case shall they remain
				  longer than twenty-four hours post delivery.
(c) Arrangements shall be made for all
				  mothers to be screened for blood type and Rh factor. Those determined to be Rh
				  negative shall have provision for appropriate follow up studies both prenatally
				  and at the time of delivery in order to determine the need for anti D immune
				  globulin (human) to prevent sensitization by the postpartum mother. There
				  should be evidence of a plan for appropriate use of Rh immune
				  globulins.
(d) Every physician or
				  midwife practicing midwifery shall, upon birth of a child, install or cause to
				  be installed in each eye of each newborn one per cent silver nitrate solution
				  contained in a wax ampule, or appropriate opthalmic preparations containing
				  tetracycline or erythromycin. These latter are the only antibiotics of approved
				  effectiveness in preventing development of opthalmia neonatorium. A maximum of
				  thirty minutes shall be allowed between the time of birth and the
				  administration of the approved prophylactic agent.
(e) At the time of discharge from the
				  facility each patient shall be provided with a document which includes, as a
				  minimum, the following information:
(1) The
				  exact procedures which were performed using accepted medical
				  terminology.
(2) The precise names,
				  both proprietary and generic of all medications administered to the patient in
				  the facility or given to the patient at the time of discharge from the
				  facility.
(3) Activities to be
				  encouraged, and activities to be avoided by the patients, as well as
				  instructions for care of the infant.
(4) Specific telephone numbers of the
				  attending midwife or physician, as well as the telephone number of at least one
				  suitable backup person.
(5) The
				  telephone number and location of the nearest hospital to be used by the patient
				  should emergency complications arise.
(6) Date and location of the first postpartum
				  checkup.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-66 - Pharmaceutical service

Current through June, 2024
(a) Each facility
				  shall have a list of standing orders and procedures which shall be signed by
				  the medical director.
(b) Only
				  medications on the standing order list of medications shall be administered in
				  the facility and only given within the dosage ranges so specified.
				  Documentation of all such medications given must be maintained on the patient's
				  medical record and such orders shall be signed by the physician or midwife
				  ordering the medication.
(c)
				  Medicines maintained in the facility shall be appropriately stored and
				  safeguarded against access by unauthorized persons. Appropriate records shall
				  be kept of the disposition of all medications.
(d) If the facility has a pharmacy, it shall:
(1) Be of sufficient size to permit orderly
				  storage and accurate identification of all medicines and have appropriate
				  physical facilities to properly carry out its functions.
(2) Comply with all applicable state rules
				  and federal regulations.
(3) Be
				  under the supervision of a pharmacist who shall do all dispensing of
				  medications.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-67 - Professional staff

Current through June, 2024
There shall be an organized professional staff consisting
					 of licensed midwives and suitably qualified physicians. The professional staff
					 shall be appointed by the governing body.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-68 - Special equipment and supplies

Current through June, 2024
There shall be appropriate equipment and supplies
					 maintained for the mother and the newborn which shall include, but not be
					 limited to:
(1) A bed suitable for
				  labor, birth and recovery.
(2)
				  Oxygen with flow meters and masks, or equivalent.
(3) Suction and bulb suction immediately
				  available.
(4) Resuscitation
				  equipment to include resuscitation bags, endotrachial tubes, and all sized
				  airways for the mother and newborn.
(5) Firm surfaces suitable for
				  resuscitation.
(6) Emergency
				  medications, intravenous fluids, and related supplies and equipment for both
				  mother and newborn.
(7) Fetal
				  monitoring equipment such as fetoscope or Doppler monitoring device.
(8) A means for monitoring and maintaining
				  the optimum body temperature of the newborn.
(9) A clock with a sweep second
				  hand.
(10) Sterile suturing
				  equipment and supplies.
(11)
				  Adjustable examination light.
(12)
				  Containers for soiled linen and waste materials which shall be closed or
				  covered.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-69 - Transfer agreement

Current through June, 2024
The facility shall establish transfer agreements which
					 will expedite the transfer of patients to hospitals when it is desirable to do
					 so. There shall be documented evidence that a local hospital has agreed to
					 admit, without delay, patients from the facility should the staff of the
					 facility feel this is advisable.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-70 - Penalty

Current through June, 2024
In addition to any other appropriate action to enforce
					 these rules, the director may initiate procedures for invoking penalties as
					 provided in chapter
					 321, HRS.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 93 - HOSPITALS FREESTANDING BIRTHING FACILITIES › Subchapter 2 - FREESTANDING BIRTHING FACILITIES › Section 11-93-100 - Severability

Current through June, 2024
If a provision of this chapter or the application thereof
					 to any person or circumstances is held invalid, the remainder of this chapter
					 or the application of the provision to other persons or circumstances shall not
					 be affected thereby.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 1 - GENERAL PROVISIONS › Section 11-94.2-1 - Purpose

Current through June, 2024
The purpose of this chapter is to establish minimum
					 requirements for the protection of the health, welfare, and safety of
					 residents, personnel, and the public in nursing facilities that provide care
					 and services for residents at the skilled nursing and intermediate care
					 facility level of care. This chapter shall not be construed to lower standards,
					 ordinances, or rules established by other divisions or subdivisions of State
					 government; in all instances the more stringent rules shall
					 apply.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 2 - LICENSING REQUIREMENTS › Section 11-94.2-6 - Licensing

Current through June, 2024
(a) No person or group of persons may operate
				  a nursing facility unless the facility is licensed by the department.
(b) All nursing facilities shall be licensed
				  pursuant to this chapter and meet all requirements for licensure under state
				  law prior to admitting any residents, except those operated by the federal
				  government or agency thereof.
(c)
				  The department may accept accreditation by the Joint Commission or other
				  nationally recognized accreditation or certification organizations including,
				  but not limited to, the U.S. Centers for Medicare and Medicaid Services, as
				  demonstrating a facility's compliance with all relicensing inspections required
				  by the department.
(d) The
				  department shall inspect each nursing facility at least annually, or at a time
				  interval as determined by the department for relicensing. The department,
				  without prior notice, may enter the premises at any time to secure compliance
				  with or to prevent a violation of this chapter.
(e) The department may exempt a facility from
				  a relicensing inspection when the facility is accredited or certified in
				  accordance with this section under the following conditions:
(1) The facility provides a certified copy of
				  the facility's official accreditation or certification report to the
				  department;
(2) The facility
				  continuously holds full accreditation or certification by the accreditation or
				  certification organization; and
(3)
				  The facility holds a current and valid state license.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 2 - LICENSING REQUIREMENTS › Section 11-94.2-7 - Application

Current through June, 2024
The applicant shall submit:
(1) An application on a form approved by the
				  department with the following supporting documentation or information:
(A) Name, address, and contact information of
				  the owner(s);
(B) Registration of
				  corporation, articles of incorporation, limited liability company with a list
				  of officers, directors, trustees, members, or advisory board members;
(C) Bylaws;
(D) Copy of documents recognizing the
				  applicant's ability to do business in the State;
(E) An annual budget including all
				  anticipated income and expenses demonstrating the facility's financial
				  capability to ensure the health, safety, and welfare of residents;
				  and
(F) Building plans indicating
				  accurate measurements to scale of the entire facility with certificate of
				  occupancy as appropriate;
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 2 - LICENSING REQUIREMENTS › Section 11-94.2-8 - Maximum time period for processing of a complete license application

Current through June, 2024
(a) The department shall grant or deny an
				  application and inform the applicant of its decision within ninety days of
				  receipt of a complete application.
(b) If the department does not grant a
				  license or deny an application within ninety days of receipt of the complete
				  application, the application for issuance of a license shall be deemed approved
				  on the ninetieth day. After the expiration of the ninety days, the department
				  shall issue the license within thirty days.
(c) Notwithstanding the requirements of
				  subsections (a) and (b), the maximum period of ninety days shall be extended
				  indefinitely in the event of a national disaster, state emergency, or union
				  strike that would prevent the applicant, the agency, or the department from
				  fulfilling application review in a timely manner.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 2 - LICENSING REQUIREMENTS › Section 11-94.2-9 - Denial of licensure

Current through June, 2024
An application for a license may be denied for any of the
					 reasons that include but are not limited to the following:
(1) Failure of the applicant to comply with
				  this chapter or chapter
				  321, HRS;
(2) Failure of the applicant to provide all
				  requirements specified in section 11-94.2-7;
(3) Failure of the applicant to possess and
				  provide evidence of financial capability to operate the facility pursuant to
				  this chapter;
(4) The fraudulent
				  representation or misrepresentation of facts by the applicant;
(5) Failure to comply with and provide
				  criminal history record check information pursuant to section
				  321-15.2, HRS;
				  and
(6) Determination by the
				  department that the applicant does not possess a reputable or responsible
				  character.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 2 - LICENSING REQUIREMENTS › Section 11-94.2-10 - Inspection

Current through June, 2024
(a) All inspections and complaint
				  investigations shall be unannounced and may be conducted outside of normal
				  business hours of the State.
(b)
				  The department may conduct inspections and investigations of an exempt facility
				  regarding complaints, adverse accreditation or certification findings, or
				  periodic validation surveys.
(c)
				  Following an inspection, a statement of deficiencies, if any, shall be
				  presented to the facility. The facility shall return a plan of correction to
				  the department within ten days of the receipt of the statement of deficiencies.
				  Receipt of the statement of deficiencies is presumed to be within five days
				  from the date of the notice. Facilities shall be allowed a reasonable time to
				  implement the plan of correction. A follow-up inspection may be made by the
				  department to assess the progress in the plan of correction. If there has not
				  been substantial progress in carrying out the plan of correction, the license
				  shall be revoked or shall not be renewed. A provisional license may be issued
				  should the department determine that good faith efforts are being made by the
				  facility to carry out the plan of correction and the facility requires
				  additional time to meet the requirements.
(d) The department shall charge appropriate
				  fees for the processing of an application, issuance of a new license, and a
				  license renewal. The department shall provide prior notice of the amount of the
				  fee to the licensee.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 2 - LICENSING REQUIREMENTS › Section 11-94.2-11 - Waiver

Current through June, 2024
(a) Every request for a waiver from an
				  otherwise applicable licensing requirement shall be set forth in writing and
				  submitted to the department for approval. The licensee shall submit the
				  information required in this subsection to enable the department to make a
				  decision on the request for a waiver.
(1) The
				  department shall not act upon or consider any incomplete requests for waivers.
				  A waiver request shall be deemed complete only when all required and requested
				  information, including a reason for the waiver and a proposal for an alternate
				  plan to ensure the health, safety, welfare, and civil rights of the
				  resident(s), including resident care and life safety safeguards, is received by
				  the department;
(2) Every request
				  shall be signed by the licensee and shall constitute an acknowledgment and
				  agreement that the licensee will comply with all terms and conditions of the
				  waiver and this chapter upon approval of the request;
(3) The department may require the submission
				  of additional information after the request has been submitted;
(4) A waiver shall not be
				  transferable;
(5) The failure of
				  the department to act on a completed request for a waiver within sixty days of
				  receipt of request shall be deemed an approval of the request, provided that
				  the licensee acts in accordance with the request process;
(6) Notwithstanding the requirements of
				  paragraph (5), the maximum period of time of sixty days shall be extended
				  indefinitely in the event of a national disaster, state emergency, or union
				  strike that would prevent the applicant, the agency, or the department from
				  fulfilling application review in a timely manner; and
(7) Waivers may be granted on a case-by-case
				  basis and shall not be construed as a precedent for any other circumstances or
				  situations.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 3 - ADMINISTRATION REQUIREMENTS › Section 11-94.2-16 - Governing body and management

Current through June, 2024
(a) Each facility
				  shall have an organized governing body, or designated persons functioning as
				  the governing body, that has overall responsibility for the conduct of all
				  activities. The governing body may include the administrator. The facility
				  shall maintain methods of administrative management that assure that the
				  requirements of this section are met.
(b) The facility shall ensure that:
(1) Staff sufficient in number and
				  qualifications shall be on duty twenty-four hours a day to carry out the
				  policies, responsibilities, assessed care needs of the residents and program of
				  the facility; and
(2) The numbers
				  and categories of personnel shall be determined by the number, acuity level,
				  and needs of residents.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 3 - ADMINISTRATION REQUIREMENTS › Section 11-94.2-17 - Administrator

Current through June, 2024
All freestanding and hospital-based nursing facilities
					 shall be administered by:
(1) A person
				  appointed by the governing body and responsible for the management of the
				  facility; and
(2) Licensed by the
				  State as a nursing home administrator; or
(3) In the absence of the administrator, an
				  employee who has been designated, in writing, to act on the administrator's
				  behalf for a determined period of time as approved by the department.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 3 - ADMINISTRATION REQUIREMENTS › Section 11-94.2-18 - Medical director

Current through June, 2024
The facility must designate a physician to serve as medical
					 director. The medical director is responsible for:
(1) Development, implementation, and
				  evaluation of resident care policies;
(2) Coordination of medical care in the
				  facility; and
(3) Consultation and
				  training to licensed staff as necessary.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 3 - ADMINISTRATION REQUIREMENTS › Section 11-94.2-19 - Ownership and financial capability

Current through June, 2024
(a) The facility
				  shall provide the department with current information about ownership of the
				  facility including:
(1) The name of each
				  person who has an ownership interest of ten per cent or more in the
				  facility;
(2) The name of each
				  person who is the owner (in whole or in part) of any mortgage, deed or trust,
				  note, or other obligation secured (in whole or in part) by the
				  facility;
(3) The officers and
				  directors of the corporation, if the facility is organized as a corporation, is
				  incorporated, or is a limited liability company, and any changes in the
				  officers and directors; and
(4) The
				  name of each partner if the facility is organized as a partnership.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 3 - ADMINISTRATION REQUIREMENTS › Section 11-94.2-20 - In-service education

Current through June, 2024
(a) There shall be
				  a staff in-service education program that includes the following:
(1) Orientation for all new employees that
				  shall include:
(A) Information to acquaint
				  them with the philosophy, organization, program, policies and procedures,
				  practices, and goals of the facility; and
(B) Competency evaluation to ensure that
				  staff are able to carry out their respective duties;
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 3 - ADMINISTRATION REQUIREMENTS › Section 11-94.2-21 - Arrangement for services

Current through June, 2024
When the facility does not employ a qualified person to
					 render a required or necessary service, it shall have a written agreement or
					 contract with a qualified outside person or provider to provide the needed
					 service.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 3 - ADMINISTRATION REQUIREMENTS › Section 11-94.2-22 - Medical record system

Current through June, 2024
(a) The facility
				  shall have available sufficient appropriately qualified staff and necessary
				  supporting personnel to facilitate the accurate processing, auditing and
				  analysis, indexing, filing, and prompt retrieval of records, record data, and
				  resident health information.
(b) If
				  the employee who supervises medical records is not a registered health
				  information administrator or registered health information technician, there
				  shall be regularly scheduled visits by a qualified consultant who shall provide
				  reports to the administrator.
(c)
				  The following information shall be obtained and entered in the resident's
				  record at the time of admission to the facility:
(1) Personal information such as name, date,
				  and time of admission, date and place of birth, citizenship status, marital
				  status, social security number, or an admission number that can be used to
				  identify the resident without use of name when the latter is
				  desirable;
(2) Name and address of
				  next of kin, legal guardian, surrogate, or representative holding a power of
				  attorney;
(3) Sex, height, weight,
				  race, and identifying marks;
(4)
				  Reason for admission or referral;
(5) Language spoken and understood;
(6) Information relevant to religious
				  affiliation, if any;
(7) Admission
				  diagnosis, summary of prior medical care with listing of physicians providing
				  care, recent physical examination, tuberculosis status, and physician's orders;
				  and
(8) Advanced directives, as
				  applicable.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 3 - ADMINISTRATION REQUIREMENTS › Section 11-94.2-23 - Quality assurance and performance improvement

Current through June, 2024
(a) The
				  facility shall develop, implement, and maintain an effective, comprehensive,
				  data-driven quality assurance and performance improvement program that focuses
				  on indicators of the outcomes of care and quality of life for the full range of
				  care and services provided by the facility.
(b) The administrator shall be responsible
				  and accountable for ensuring the program is defined, implemented, and
				  maintained, and addresses identified priorities, and is annually approved by
				  the governing body.
(c) The program
				  shall be described in a written plan containing the process that will guide the
				  facility's efforts in assuring care and services are maintained at acceptable
				  levels of performance and continuous improvement.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 4 - RESIDENT CARE REQUIREMENTS › Section 11-94.2-28 - Resident accounts

Current through June, 2024
(a) In the event
				  the resident or family member requests the facility to manage the resident's
				  personal funds, an itemized account shall be made available in writing to the
				  resident or the legal guardian or surrogate, and shall be maintained and kept
				  current for the resident, including:
(1)
				  Written receipts for all personal possessions and funds received by or
				  deposited with the facility; and
(2) Written receipts for all disbursements
				  made to, or on behalf of, the resident.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 4 - RESIDENT CARE REQUIREMENTS › Section 11-94.2-29 - Resident abuse, neglect, and misappropriation of resident property

Current through June, 2024
(a) The facility shall develop and implement
				  written policies and procedures that prohibit mistreatment, neglect, and abuse
				  of residents and misappropriation of resident property.
(b) All alleged violations involving
				  mistreatment, neglect, or abuse, including injuries of unknown source or
				  origin, and alleged misappropriation of resident property shall be reported
				  immediately to the administrator of the facility, and to other officials in
				  accordance with state law through established procedures.
(c) The resident involved, and the resident's
				  family, legal guardian, or surrogate shall be informed of the alleged violation
				  and the investigation that is being conducted.
(d) The facility shall maintain a record that
				  all alleged violations were thoroughly investigated and shall take all
				  reasonable steps to prevent further abuse while the investigation is in
				  progress.
(e) The results of all
				  investigations shall be reported to the administrator of the facility or the
				  designated representative and to other officials, including the department, in
				  accordance with state law within five working days of the incident.
(f) If the alleged violation is verified,
				  appropriate corrective action shall be taken to protect the resident's safety
				  as well as other residents in the facility.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 4 - RESIDENT CARE REQUIREMENTS › Section 11-94.2-30 - Resident care

Current through June, 2024
The facility shall have written policies and procedures
					 that address all aspects of resident care needs to assist the resident to
					 attain and maintain the highest practicable health and medical status,
					 including but not limited to:
(1)
				  Respiratory care including ventilator use;
(2) Dialysis;
(3) Skin care and prevention of skin
				  breakdown;
(4) Nutrition and
				  hydration;
(5) Fall
				  prevention;
(6) Use of
				  restraints;
(7) Communication;
				  and
(8) Care that addresses
				  appropriate growth and development when the facility provides care to infants,
				  children, and youth.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-36 - Admission, transfer, and discharge

Current through June, 2024
(a) There shall be
				  written policies and procedures available to staff, residents, and the public
				  that govern:
(1) All services provided by the
				  facility;
(2) The admission,
				  transfer, and discharge of residents; and.
(3) Notification to the resident, resident's
				  representative, and the state long term care ombudsman of transfer or discharge
				  initiated by the facility.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-37 - Social work services

Current through June, 2024
(a) The facility
				  shall provide medically related social work services to help residents attain
				  or maintain the residents' highest practicable physical, mental, and
				  psychosocial well-being.
(b) The
				  number of hours of social work services shall be determined by the resident
				  capacity, acuity level, and needs.
(c) Social work services provided to each
				  resident shall be documented in each resident's medical record and shall
				  include but not be limited to:
(1) A social
				  history and assessment of current social and emotional needs;
(2) A social work plan of care for each
				  resident recorded in the medical record and integrated into the comprehensive
				  assessment and overall care plan coordinated or integrated with other various
				  disciplines;
(3) A discharge plan,
				  as appropriate; and
(4) Evidence of
				  regular review of social work services and discharge plan in conjunction with
				  the overall plan of care.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-38 - Activities

Current through June, 2024
(a) The facility must provide for an ongoing
				  program of age-appropriate activities designed to meet the interests, physical,
				  mental, and psychosocial well-being of each resident.
(b) The activities program shall be directed
				  by an activity professional.
(c) A
				  schedule of activities shall be made available for review by the department as
				  requested.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-39 - Nursing services

Current through June, 2024
(a) Each facility
				  shall have nursing staff sufficient in number and qualifications to meet the
				  nursing needs of the residents. There shall be at least one registered nurse at
				  work full-time on the day shift, for eight consecutive hours, seven days a
				  week, and at least one licensed nurse at work on the evening and night shifts,
				  unless otherwise determined by the department.
(b) Nursing services shall include but are
				  not limited to the following:
(1) A
				  comprehensive nursing assessment of each resident and the development and
				  implementation of a plan of care within five days of admission. The nursing
				  plan of care shall be developed in conjunction with the physician's admission
				  physical examination and initial orders. A nursing plan of care shall be
				  integrated with an overall plan of care developed by an interdisciplinary team
				  no later than the twenty-first day after, or simultaneously, with the initial
				  interdisciplinary care plan conference;
(2) Written nursing observations and
				  summaries of the resident's status recorded, as appropriate, due to changes in
				  the resident's condition, but no less than quarterly; and
(3) Ongoing evaluation and monitoring of
				  direct care staff to ensure quality resident care is provided.
Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 94.2 - NURSING FACILITIES › Subchapter 5 - PROGRAM REQUIREMENTS › Section 11-94.2-40 - Dietary services

Current through June, 2024
(a) The food and
				  nutritional needs of the residents shall be met through a nourishing,
				  well-balanced diet in accordance with the recommended dietary allowances of the
				  Food and Nutrition Board of the National Research Council, and shall be
				  adjusted for age, sex, activity, and disability.
(1) At least three meals shall be served
				  daily at regular times with not more than a fourteen hour span between a
				  substantial evening meal and breakfast on the following day;
(2) Between meals nourishment that is
				  consistent with the resident's needs shall be offered routinely and shall
				  include a regular schedule of hydration to meet each resident's
				  needs;
(3) Appropriate substitution
				  of foods shall be promptly offered to all residents as necessary;
(4) Food shall be served in a form consistent
				  with the needs of the resident and the resident's ability to consume
				  it;
(5) Food shall be served with
				  appropriate utensils;
(6) Residents
				  needing special equipment, implements, or utensils to assist them when eating
				  shall have the items provided by the facility; and
(7) There shall be a sufficient number of
				  competent personnel to fulfill the food and nutrition needs of residents. Paid
				  feeding attendants shall be trained as per the facility's state-approved
				  training protocol.