Bill Text: HI HB1410 | 2018 | Regular Session | Amended
Bill Title: Relating To Emergency Medical Services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2018-03-15 - Received notice of discharge of conferees (Hse. Com. No. 385). [HB1410 Detail]
Download: Hawaii-2018-HB1410-Amended.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
1410 |
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TWENTY-NINTH LEGISLATURE, 2017 |
H.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO EMERGENCY MEDICAL SERVICES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
PART I
SECTION 1. The legislature finds that anti-tobacco campaigns have played a major role in the overall decline of cigarette smoking. A key tool of tobacco use control has been taxation policy, which has been shown to be particularly effective for youths, who are generally more price-sensitive, and thus are less likely to start or maintain cigarette smoking when it is expensive.
The health effects of smoking are well established and include increased risk of heart attack, stroke, and other medical events to which Hawaii's emergency medical services system routinely responds. A clear nexus thus exists between cigarette smoking and utilization of the emergency healthcare system. However, due to declining rates of smoking, the long-term sustainability of the cigarette tax as a revenue source for the emergency medical system special fund is not guaranteed.
The purpose of this part is to repeal the emergency medical services special fund, redirect the fund's revenue sources, which are the cigarette tax, motor vehicle registration fee, and investment pool returns, to the general fund, and appropriate an equal dollar amount to the department of health for purposes of overseeing the statewide comprehensive emergency medical system with no discernable disruptions.
In fiscal year 2015-2016, emergency medical services special fund revenues from cigarette sales were $8,800,000; revenues from vehicle registration fees were $6,538,865; and revenues from the investment pool account were $151,502.46. Total emergency medical system special fund revenues in fiscal year 2015-2016 were $15,490,367.46.
SECTION 2. Section 245-15, Hawaii Revised Statutes, is amended to read as follows:
"§245-15 Disposition of revenues. All moneys collected pursuant to this chapter shall be paid into the state treasury as state realizations to be kept and accounted for as provided by law; provided that, of the moneys collected under the tax imposed pursuant to:
(1) Section 245-3(a)(5), after September 30, 2006, and prior to October 1, 2007, 1.0 cent per cigarette shall be deposited to the credit of the Hawaii cancer research special fund, established pursuant to section 304A-2168, for research and operating expenses and for capital expenditures;
(2) Section 245-3(a)(6), after September 30, 2007, and prior to October 1, 2008:
(A) 1.5 cents per cigarette shall be deposited to the credit of the Hawaii cancer research special fund, established pursuant to section 304A-2168, for research and operating expenses and for capital expenditures;
(B) 0.25 cents per cigarette shall be deposited to the credit of the trauma system special fund established pursuant to section 321-22.5; and
(C) 0.25 cents per cigarette shall be deposited to the credit of the emergency medical services special fund established pursuant to section 321-234;
(3) Section 245-3(a)(7), after September 30, 2008, and prior to July 1, 2009:
(A) 2.0 cents per cigarette shall be deposited to the credit of the Hawaii cancer research special fund, established pursuant to section 304A-2168, for research and operating expenses and for capital expenditures;
(B) 0.5 cents per cigarette shall be deposited to the credit of the trauma system special fund established pursuant to section 321-22.5;
(C) 0.25 cents per cigarette shall be deposited to the credit of the community health centers special fund established pursuant to section 321-1.65; and
(D) 0.25 cents per cigarette shall be deposited to the credit of the emergency medical services special fund established pursuant to section 321-234;
(4) Section 245-3(a)(8), after June 30, 2009, and prior to July 1, 2013:
(A) 2.0 cents per cigarette shall be deposited to the credit of the Hawaii cancer research special fund, established pursuant to section 304A-2168, for research and operating expenses and for capital expenditures;
(B) 0.75 cents per cigarette shall be deposited to the credit of the trauma system special fund established pursuant to section 321-22.5;
(C) 0.75 cents per cigarette shall be deposited to the credit of the community health centers special fund established pursuant to section 321-1.65; and
(D) 0.5 cents per cigarette shall be deposited to the credit of the emergency medical services special fund established pursuant to section 321-234;
(5) Section 245-3(a)(11), after June 30, 2013, and prior to July 1, 2015:
(A) 2.0 cents per cigarette shall be deposited to the credit of the Hawaii cancer research special fund, established pursuant to section 304A-2168, for research and operating expenses and for capital expenditures;
(B) 1.5 cents per cigarette shall be deposited to the credit of the trauma system special fund established pursuant to section 321-22.5;
(C) 1.25 cents per cigarette shall be deposited to the credit of the community health centers special fund established pursuant to section 321-1.65; and
(D) 1.25 cents per cigarette shall be
deposited to the credit of the emergency medical services special fund
established pursuant to section 321-234; [and]
(6) Section 245-3(a)(11), after June 30, 2015, and [thereafter:]
prior to July 1, 2017:
(A) 2.0 cents per cigarette shall be deposited to the credit of the Hawaii cancer research special fund, established pursuant to section 304A-2168, for research and operating expenses and for capital expenditures;
(B) 1.125 cents per cigarette, but not more than $7,400,000 in a fiscal year, shall be deposited to the credit of the trauma system special fund established pursuant to section 321-22.5;
(C) 1.25 cents per cigarette, but not more than $8,800,000 in a fiscal year, shall be deposited to the credit of the community health centers special fund established pursuant to section 321-1.65; and
(D) 1.25 cents per cigarette, but not more
than $8,800,000 in a fiscal year, shall be deposited to the credit of the
emergency medical services special fund established pursuant to section 321-234[.];
and
(7) Section 245-3(a)(11), after June 30, 2017, and thereafter:
(A) 2.0 cents per cigarette shall be deposited to the credit of the Hawaii cancer research special fund, established pursuant to section 304A-2168, for research and operating expenses and for capital expenditures;
(B) 1.125 cents per cigarette, but not more than $7,400,000 in a fiscal year, shall be deposited to the credit of the trauma system special fund established pursuant to section 321-22.5; and
(C) 1.25 cents per cigarette, but not more than $8,800,000 in a fiscal year, shall be deposited to the credit of the community health centers special fund established pursuant to section 321-1.65.
The department shall provide an annual accounting of these dispositions to the legislature."
SECTION 3. Section 249-31, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:
"(b) From each annual motor vehicle
registration fee, the director shall deposit $40 into the state highway fund
and $5 into the [emergency medical services special fund.] general
fund."
SECTION 4. Section 321-234, Hawaii Revised Statutes, is repealed.
["§321-234 Emergency medical
services special fund. (a) There is established within the state
treasury a special fund to be known as the emergency medical services special
fund to be administered and expended by the department.
(b) The moneys in the special fund shall be
used by the department for operating a state comprehensive emergency medical
services system including enhanced and expanded services, and shall not be used
to supplant funding for emergency medical services authorized prior to [July 1,
2004].
(c) Fees remitted pursuant to section
249-31, cigarette tax revenues designated under section 245-15, interest and
investment earnings attributable to the moneys in the special fund, legislative
appropriations, and grants, donations, and contributions from private or public
sources for the purposes of the fund, shall be deposited into the special fund.
(d) The department shall submit an annual
report to the legislature no later than twenty days prior to the convening of
each regular session that outlines the receipts of, and expenditures from, the
special fund."]
SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $15,490,370 or so much thereof as may be necessary for fiscal year 2017-2018 and the same sum or so much thereof as may be necessary for fiscal year 2018-2019 for the statewide comprehensive emergency medical services system.
The sums appropriated shall be expended by the department of health for the purpose of this part.
PART II
SECTION 6. Section 237D-6.5, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:
"(b) Revenues collected under this chapter shall be distributed in the following priority, with the excess revenues to be deposited into the general fund:
(1) $1,500,000 shall be allocated to the Turtle Bay conservation easement special fund beginning July 1, 2015, for the reimbursement to the state general fund of debt service on reimbursable general obligation bonds, including ongoing expenses related to the issuance of the bonds, the proceeds of which were used to acquire the conservation easement and other real property interests in Turtle Bay, Oahu, for the protection, preservation, and enhancement of natural resources important to the State, until the bonds are fully amortized;
(2) $26,500,000 shall be allocated to the convention center enterprise special fund established under section 201B-8;
(3) $82,000,000 shall be allocated to the tourism special fund established under section 201B-11; provided that:
(A) Beginning on July 1, 2012, and ending on June 30, 2015, $2,000,000 shall be expended from the tourism special fund for development and implementation of initiatives to take advantage of expanded visa programs and increased travel opportunities for international visitors to Hawaii;
(B) Of the $82,000,000 allocated:
(i) $1,000,000 shall be allocated for the operation of a Hawaiian center and the museum of Hawaiian music and dance at the Hawaii convention center; and
(ii) 0.5 per cent of the $82,000,000 shall be transferred to a sub-account in the tourism special fund to provide funding for a safety and security budget, in accordance with the Hawaii tourism strategic plan 2005-2015; and
(C) Of the revenues remaining in the tourism special fund after revenues have been deposited as provided in this paragraph and except for any sum authorized by the legislature for expenditure from revenues subject to this paragraph, beginning July 1, 2007, funds shall be deposited into the tourism emergency special fund, established in section 201B-10, in a manner sufficient to maintain a fund balance of $5,000,000 in the tourism emergency special fund;
(4) $103,000,000 for fiscal year 2014-2015,
$103,000,000 for fiscal year 2015-2016, $103,000,000 for fiscal year 2016-2017,
and $93,000,000 for each fiscal year thereafter shall be allocated as follows:
Kauai county shall receive 14.5 per cent, Hawaii county shall receive 18.6 per
cent, city and county of Honolulu shall receive 44.1 per cent, and Maui county
shall receive 22.8 per cent; provided that [commencing]:
(A) Commencing with fiscal year 2017-2018, each county may expend a portion of the tax revenues allocated to it pursuant to this paragraph to purchase vehicles, equipment and supplies and to pay any other costs incurred to supplement existing ambulance service in the county; and
(B) Commencing with fiscal year 2018-2019, a sum that represents the difference between a county public employer's annual required contribution for the separate trust fund established under section 87A-42 and the amount of the county public employer's contributions into that trust fund shall be retained by the state director of finance and deposited to the credit of the county public employer's annual required contribution into that trust fund in each fiscal year, as provided in section 87A-42, if the respective county fails to remit the total amount of the county's required annual contributions, as required under section 87A-43; and
(5) $3,000,000 shall be allocated to the special land and development fund established under section 171-19; provided that the allocation shall be expended in accordance with the Hawaii tourism authority strategic plan for:
(A) The protection, preservation, maintenance, and enhancement of natural resources, including beaches, important to the visitor industry;
(B) Planning, construction, and repair of facilities; and
(C) Operation and maintenance costs of public lands, including beaches, connected with enhancing the visitor experience.
All transient accommodations taxes shall be paid into the state treasury each month within ten days after collection and shall be kept by the state director of finance in special accounts for distribution as provided in this subsection.
As used in this subsection, "fiscal year" means the twelve-month period beginning on July 1 of a calendar year and ending on June 30 of the following calendar year."
SECTION 7. (a) The department of health shall establish a two-year pilot program in the county of Hawaii and the city and county of Honolulu to allow those counties to independently regulate and operate ambulance service; provided that the department of health shall maintain its statewide systems for billing and collections, communications, and medical records. The pilot program shall commence on July 1, 2019 and shall be terminated on June 30, 2021.
(b) Under the pilot program, the authority to regulate ambulance service, including the certification of vehicles, equipment, and supplies, shall rest with the county of Hawaii and the city and county of Honolulu, respectively; provided that ambulance services provided under the pilot program shall meet or exceed the minimum standards established by the department of health.
(c) Any person who provides emergency medical service as an employee of any ambulance service under the pilot program shall be subject to chapter 453, Hawaii Revised Statutes.
(d) Ambulance service providers operating under the pilot program shall establish and maintain an alcohol and substance abuse policy for employees that is equivalent to, or exceeds the provisions of, the safety and health standards established by the United States Department of Transportation for holders of commercial driver's licenses.
(e) Ambulance service made available under the pilot program shall not be denied to any person on the basis of the person's ability to pay therefor or because of the lack of prepaid health care coverage or proof of either ability to pay or of coverage.
(f) The appropriations made for the pilot program shall not lapse on June 30, 2019; provided that all appropriations which are unexpended and unencumbered on June 30, 2020 shall lapse on that date.
(g) The use of latex gloves by personnel providing ambulance services under the pilot program is prohibited.
SECTION 8. The department of health, in cooperation with the county of Hawaii and the city and county of Honolulu, shall submit a report on the pilot program established pursuant to this part to the legislature no later than twenty days before the commencement of the regular session of 2019. The report shall include information on the operations and regulation of ambulance services under the pilot program, including information on costs for vehicles, equipment, supplies, and personnel and any regulations developed and contracts entered into by the participating counties. The report shall include findings and recommendations, as well as any proposed legislation, regarding county regulation and operation of ambulance services.
SECTION 9. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2017-2018 and the same sum or so much thereof as may be necessary for fiscal year 2018-2019 for the county ambulance service pilot program established by this part.
The sums appropriated shall be expended by the department of health for the purposes of this part.
PART III
SECTION 10. The legislature finds that a high percentage of calls for emergency medical services are from repeat callers who call multiple times per day for issues that do not require an emergency response. Most 911 calls originate from residences and many involve medical concerns that could be addressed by a functioning community paramedic system. The volume of calls for emergency medical services rises each year due to growth in population and tourism and often outpaces the availability of resources. Therefore, it is critical to establish community paramedic services to provide appropriate services to non-emergency callers who would otherwise be using valuable emergency medical services needed by other individuals.
For these reasons, the legislature adopted House Concurrent Resolution No. 90 during the regular session of 2016. This resolution requested that the chief of the department of health's emergency medical services and injury prevention system branch convene and chair a working group to develop a community paramedic program, including educational standards for certifications, to relieve emergency services personnel from the obligation to respond to non-emergency calls.
The working group, in its December 2016 report to the legislature, recommended that a community paramedic services pilot program be established at two to three of the six metropolitan and rural sites it identified. The working group found that community paramedicine could reduce the high volume of 911 calls for non-emergent medical conditions. It also found that community paramedicine could improve health in the State by addressing calls involving non-emergency services, post hospital discharge care, the homeless population, hospice care, behavioral health, and acute and chronic medical conditions such as infectious diseases, diabetes, hypertension, and asthma.
The purpose of this part is to implement the recommendations of the working group convened pursuant to House Concurrent Resolution No. 90, regular session of 2016, by establishing and appropriating funds for a three-year community paramedic services pilot program and requiring an evaluation of the program's effectiveness.
SECTION 11. (a) There is established a three-year community paramedic services pilot program, to be administered by the department of health. The pilot program shall commence on July 1, 2017, and shall terminate on June 30, 2020. The program shall be conducted at two to three pilot sites approved by the director of health. The program shall include the following components:
(1) Training and certification. Kapiolani community college shall:
(A) Develop a community paramedic curriculum in consultation with the department of health;
(B) Institute a community paramedic training program; and
(C) In partnership with the University of Hawaii community colleges, train community health workers based on common core competencies to work with community paramedics.
The department of health shall develop and implement a community paramedic certification procedure;
(2) Staffing. The department of health shall recruit and hire a community paramedicine administrator, an appropriate number of community paramedicine medical directors for each pilot site, and other personnel as needed;
(3) Equipment and supplies. The department of health shall procure non-transport vehicles and contract with emergency medical services providers to provide necessary supplies and medical equipment;
(4) Medical records. Community paramedics providing services under the pilot program shall initially use the existing Hawaii emergency medical services medical record system, but shall transition to a more suitable medical record system when funds become available and such a system is identified; and
(5) Billing. The department of health shall develop a fee schedule for community paramedic services in consultation with insurance carriers. Billing and collections for community paramedic services shall be conducted by the department of health, emergency medical services and injury prevention system branch. All moneys collected shall be deposited into the general fund of the State.
(b) In developing and implementing the community paramedic services pilot program, the department of health shall solicit the participation of and consult with members of the working group convened pursuant to House Concurrent Resolution No. 90, regular session of 2016, in addition to:
(1) Representatives of the health insurance industry, including insurers, health maintenance organizations, and mutual benefit societies;
(2) A representative of the Queen's Medical Center; and
(3) A representative of the Healthcare Association of Hawaii.
SECTION 12. The department of health, emergency medical services and injury prevention system branch, shall submit a written report on the results of the three-year community paramedic services pilot program, including any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2021. The report shall address but shall not be limited to:
(1) An evaluation of the selected pilot sites' effectiveness in terms of patient outcomes, 911 system impact, and costs within eighteen months of the start of services at the pilot sites; and
(2) A calculation of the program's return on investment, based on:
(A) The estimated cost savings from any reductions in usages of emergency ambulance services, emergency facilities, and associated personnel as a direct result of the provision of community paramedic services during the three-year pilot program; and
(B) The overall impact of the pilot program.
SECTION 13. No later than January 2, 2018, the department of health shall adopt interim rules, which shall be exempt from chapter 91 and chapter 201M, Hawaii Revised Statutes, to effectuate the purposes of this part; provided that the interim rules shall remain in effect until , or until the department adopts rules pursuant to chapter 91, whichever occurs sooner.
SECTION 14. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2017-2018 and the same sum or so much thereof as may be necessary for fiscal year 2018-2019 for the community paramedic services pilot program established pursuant to this part.
The sums appropriated shall be expended by the department of health for the purposes of this part.
SECTION 15. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 16. This Act shall take effect on July 1, 2090.
Report Title:
Emergency Medical Services; Ambulance Service; Counties; Community Paramedic Services
Description:
Repeals the Emergency Medical Services Special Fund and appropriates an equal amount of general funds to the Department of Health for emergency medical services. Establishes a pilot program and authorizes TAT expenditure for county regulation and operation of ambulance services. Establishes and appropriates funds for a community paramedic pilot program. (HD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
