Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-34 - Utilization control for NFs

Current through June, 2024
(a) This section
				  defines the utilization control process which shall be administered in
				  accordance with state and federal regulations to achieve optimal quality
				  control of the utilization of services provided under the state plan.
(b) The provisions for utilization control
				  are as follows:
(1) Providers of NF services
				  shall admit only those recipients whose health care needs may be met by the
				  facility;
(2) Each resident shall
				  receive the necessary nursing, medical and psychosocial services to attain and
				  maintain the highest possible mental and physical functional status, as defined
				  by the comprehensive resident assessment and plan of care;
(3) The NF shall operate and provide services
				  in compliance with all state, federal, and local laws, regulations, and codes
				  and with accepted professional standards and principles that apply to
				  professionals providing services in the NF;
(4) The services provided by or arranged by
				  the NF shall meet professional standards of quality and be provided by
				  qualified persons in accordance with each resident's written plan of care;
				  and
(5) The following requirements
				  regarding nurse aides shall be met:
(A) A
				  nursing facility shall not use any individual working in the facility as a
				  nurse aide for more than four months unless the individual:
(i) Has completed a nurse aide training and
				  competency evaluation program certified by the State; and
(ii) Is competent to provide such
				  services;
(B) A nursing
				  facility shall provide for individuals used as nurse aides a nurse aide
				  training competency and evaluation program certified by the State and such
				  preparation as may be necessary to complete such a program;
(C) A nursing facility shall not permit an
				  individual to serve as a nurse aide or provide services of a type for which the
				  individual has not demonstrated competency. A nursing facility shall not use
				  such an individual as a nurse aide unless the facility has inquired of the
				  state registry as to information in the registry concerning the
				  individual;
(D) A nursing facility
				  shall not use any individual as a nurse aide if there has been a period of
				  twenty-four consecutive months during which no nursing or nursing-related
				  services were performed by the individual for monetary compensation. Such
				  individual will need to complete a new training and competency evaluation
				  program;
(E) A nursing facility
				  shall provide regular performance reviews and regular inservice education to
				  assure that individuals used as nurse aides are competent to perform services
				  as nurse aides, including training for individuals providing nursing and
				  nursing-related services to residents with cognitive impairments;
(F) Any findings of abuse or neglect of
				  residents or misappropriations of residents' property by nurse aides shall be
				  reported to the state department of health; and
(G) The State shall:
(i) Establish and maintain a registry of all
				  individuals who have satisfactorily completed a nurse aide training and
				  competency evaluation program certified by the State;
(ii) The registry shall include specific
				  documented findings by the State of resident neglect or abuse or
				  misappropriation of resident property as well as any brief statement of the
				  individual disputing the findings; and
(iii) When inquiries to the registry are made
				  concerning an individual listed in the registry, any information disclosed
				  concerning such a finding shall also include disclosure of any such statement
				  in the registry relating to the finding or a clear and accurate summary of such
				  a statement.