As predicted, several changes were made to both state and federal laws since publication.

1. Hawaii Statutes

New Uniform Health Care Decisions Act (Modified) The 1999 Hawaii Session Laws Act 169, signed by the governor on July 1, 1999 and now codified in Chapter 327E of the Hawaii Revised Statutes established the Uniform Health Care Decisions Act (Modified). The new law repealed or changed several provisions of the Hawaii Revised Statutes. The UHCDA takes a comprehensive approach by placing the "living will," the durable power of attorney for health care, a "family consent" or surrogate law, and some provisions concerning organ donation together in one statute. The new "individual instruction" which takes the place of what was commonly called the "living will," applies to a wide range of health care decisions, not just end of life decisions. The residual decision making portions of the act--or surrogate provisions--are different than the family consent statute that have now been adopted in a majority of states, but still permit "interested persons" to make decisions for a person who no longer can make health care decisions and there is no applicable individual instruction, designated surrogate, court appointed guardian or agent designated in a power of attorney for health care. The UHCDA applies in all settings--hospitals, nursing homes, care homes, outpatient offices and in the community. A completely new Chapter 4 is available in its entirety here.

Grandparents Rights--A new law deleted in its entirety a requirement that either or both of the child's parents are deceased, or the child's parents are divorced or residing separate or apart before a grandparent may file a petition with the family court for an order of reasonable visitation rights.

Small Estates-- In order to expand the ability of the clerk of the court to act as guardian of small estates of incapacitated adults a new law was passed to increase the amount of the value of the estate to $10,000

B. Federal Statutes

Medicare.-- Effective in 1998 certain Medicare beneficiaries who have both Part A and Part B can choose to get their benefits through a variety of risk-based plans known as Part C of Medicare. To participate in this Part C, the beneficiaries must be entitled to Part A under Medicare and be enrolled in Part B (except for End Stage Renal Disease (ESRD) patients, who must be enrolled in Part C before they get ESRD; they cannot switch to Part C after they are diagnosed with ESRD). As is the case for risk plans, organizations that are seeking to contract as Medicare+Choice plans will have to meet specific organizational, financial, and other requirements.

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