Bill Text: HI SB1135 | 2010 | Regular Session | Introduced
Bill Title: Certificate of Need; Regional Councils
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2009-05-11 - Carried over to 2010 Regular Session. [SB1135 Detail]
Download: Hawaii-2010-SB1135-Introduced.html
Report Title:
Certificate of Need; Regional Councils
Description:
Makes conforming amendments to the health planning and resources development and health care cost control law, including the certificate of need process, regarding the creation of regional councils. Repeals the review panel, statewide health coordinating council, and subarea councils and replaces them with regional councils.
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THE SENATE |
S.B. NO. |
1135 |
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TWENTY-FIFTH LEGISLATURE, 2009 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to HEALTH PLANNING.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Section 323D-2, Hawaii Revised Statutes, is amended as follows:
1. By amending the definitions of "subarea" and "subarea council" to read:
"["Subarea"] "Regional"
means one of the geographic [subareas] regions designated by the
state agency pursuant to section 323D-21.
["Subarea] "Regional
council" means a [subarea health planning] regional council
established pursuant to section 323D‑21."
2. By repealing the definitions of "review panel" and "statewide council".
[""Review panel" means the
panel established pursuant to section 323D-42.
"Statewide council" means the
statewide health coordinating council established in section 323D-13."]
SECTION 2. Section 323D-12, Hawaii Revised Statutes, is amended to read as follows:
"§323D-12 Health planning and development functions; state agency. (a) The state agency shall:
(1) Have as a principal function the responsibility
for promoting accessibility for all the people of the State to quality health
care services at reasonable cost. The state agency shall conduct such studies
and investigations as may be necessary as to the causes of health care costs
including inflation[.] and reimbursements to health care providers.
The state agency may contract for services to implement this paragraph. The
certificate of need program mandated under part V shall serve this function.
The state agency shall promote the sharing of facilities or services by health
care providers whenever possible to achieve economies [and shall restrict
unusual or unusually costly services to individual facilities or providers
where appropriate];
(2) Serve as staff to and provide technical
assistance and advice to [the statewide council and] the [subarea]
regional councils in the preparation, review, and revision of the state
health services and facilities plan;
(3) Conduct the health planning activities of the
State in coordination with the [subarea] regional councils, implement
the state health services and facilities plan, and determine the statewide
health needs of the State after consulting with the [statewide council;]
regional councils; and
(4) Administer the state certificate of need program pursuant to part V.
(b) The state agency may:
(1) Prepare such reports and recommendations on
Hawaii's health care costs and public or private efforts to reduce or control
costs and health care quality as it deems necessary. The report may include[,]
but not be limited to[,] a review of health insurance plans, the
availability of various kinds of health insurance and malpractice insurance to
consumers, and strategies for increasing competition in the health insurance
field[.];
(2) Prepare and revise as necessary the state health
services and facilities plan[.];
(3) Prepare, review, and revise the annual
implementation plan[.];
(4) Assist the [statewide council] regional
councils in the performance of [its] their functions[.];
(5) Determine the need for new health services
proposed to be offered within the State[.];
(6) Assess existing health care services and
facilities to determine whether there are redundant, excessive, or
inappropriate services or facilities and make public findings of any that are
found to be so. The state agency shall weigh the costs of the health care
services or facilities against the benefits the services or facilities provide
and there shall be a negative presumption against marginal services[.];
(7) Provide technical assistance to persons, public
or private, in obtaining and filling out the necessary forms for the
development of projects and programs[.];
(8) Prepare reports, studies, and recommendations on
emerging health issues, such as medical ethics, health care rationing,
involuntary care, care for the indigent, including reimbursements to providers
and standards for research and development of biotechnology and genetic
engineering[.]; and
(9) Conduct such other activities as are necessary to meet the purposes of this chapter."
SECTION 3. Section 323D-13.5, Hawaii Revised Statutes, is amended to read as follows:
"[[]§323D-13.5[]]
Disqualification from position or membership. The chairpersons of the [statewide
council, the subarea health planning councils and the review panel,] regional
councils shall not be employed by or married to health care
providers."
SECTION 4. Section 323D-15, Hawaii Revised Statutes, is amended to read as follows:
"§323D-15 State health services and
facilities plan. There shall be a state health services and facilities
plan [which] prepared by the state agency that shall address the
health care needs of the State, including inpatient care, health care
facilities, including critical access hospitals, and special needs. The
plan shall depict the most economical and efficient system of care commensurate
with adequate quality of care, and shall include standards for utilization of
health care facilities and major medical equipment. The plan shall provide for
the reduction or elimination of underutilized, redundant, or inappropriate health
care facilities and health care services[.] and shall be submitted to
the legislature on June 30 and December 31 of each year."
SECTION 5. Section 323D-17, Hawaii Revised Statutes, is amended to read as follows:
"§323D-17 Public hearings required.
In the preparation of the state health services and facilities plan or
amendments to the state health services and facilities plan, the state agency
and the [statewide council] regional councils shall conduct a
public hearing on the proposed plan or the amendments and shall comply with the
provisions for notice of public hearings in chapters 91 and 92."
SECTION 6. Part III of chapter 323D, Hawaii Revised Statutes, is amended by amending its title to read:
"PART
III. [SUBAREA HEALTH PLANNING] REGIONAL COUNCILS"
SECTION 7. Section 323D-21, Hawaii Revised Statutes, is amended to read as follows:
"§323D-21 [Subarea health planning]
Regional councils, established. There are established, [subarea
health planning] regional councils for geographical [areas which]
regions that shall be designated by the state agency [in consultation
with the statewide council]. Each county shall have at least one [subarea
health planning] regional council. The [subarea health planning]
regional councils shall be placed within the state agency for
administrative purposes."
SECTION 8. Section 323D-22, Hawaii Revised Statutes, is amended by amending its title and subsection (a) to read as follows:
"§323D-22 [Subarea health planning]
Regional councils, functions, quorum and number of members necessary to
take valid action. (a) Each [subarea health planning] regional
council shall review, seek public input, and make recommendations relating to
health planning for the geographical [subarea] region it serves[.]
and shall review and comment upon actions by the state agency before these
actions are made final in the making of findings relating to applications for a
certificate of need. In addition, the [subarea health planning] regional
councils shall:
(1) Identify and recommend to the state agency [and
the council] the data needs and special concerns of the respective [subareas]
regions with respect to the preparation of the state plan[.];
(2) Provide specific recommendations to the state
agency [and the council] regarding the highest priorities for health
services and resources development[.];
(3) Review the state health services and facilities
plan as it relates to the respective [subareas] regions and make
recommendations to the state agency [and the council.];
(4) Advise the state agency in the administration of
the certificate of need program for their respective [subareas.] regions;
(5) Advise the state agency on the cost of
reimbursable expenses incurred in the performance of their functions for
inclusion in the state agency budget[.];
(6) Advise the state agency in the performance of its
specific functions[.]; and
(7) Perform other such functions as agreed upon by
the state agency and the respective [subarea] regional councils.
[(8) Each subarea health planning council
shall recommend for gubernatorial appointment at least one person from its
membership to be on the statewide council.]"
SECTION 9. Section 323D-23, Hawaii Revised Statutes, is amended to read as follows:
"§323D-23 [Subarea health
planning] Regional councils, composition, appointment. Members
of [subarea health planning] regional councils shall be appointed
by the governor, subject to section 26-34. Nominations for appointment shall
be solicited from health-related and other interested organizations, and
agencies, including health planning councils, providers of health care within
the appropriate [subarea,] region, and other interested persons.
The members of the [subarea health planning] regional councils
shall not be compensated for their services but shall be reimbursed for
reasonable expenses necessary to the performance of their function."
SECTION 10. Section 323D-43, Hawaii Revised Statutes, is amended to read as follows:
"§323D-43 Certificates of need. (a) No person, public or private, nonprofit or for profit, shall:
(1) Construct, expand, alter, convert, develop, initiate, or modify a health care facility or health care services in the State that requires a total capital expenditure in excess of the expenditure minimum; or
(2) Substantially modify or increase the scope or type of health service rendered; or
(3) Increase, decrease, or change the class of usage of the bed complement of a health care facility, or relocate beds from one physical facility or site to another,
unless a certificate of need therefor has first been issued by the state agency.
[(b) No certificate of need shall be issued
unless the state agency has determined that:
(1) There is a public need for the facility
or the service; and
(2) The cost of the facility or service
will not be unreasonable in the light of the benefits it will provide and its
impact on health care costs.
(c)] (b) The state agency may
adopt criteria for certificate of need review [which] that are
consistent with this section. [Such] These criteria may include
but are not limited to need, cost, quality, accessibility, availability, and
acceptability.
Each decision of the state agency to issue a
certificate of need [shall], except in an emergency situation that poses
a threat to public health, shall be consistent with the state health
services and facilities plan in effect under section 323D-15. Each certificate
of need issued shall be valid for a period of one year from the date of
issuance unless the period is extended for good cause by the state agency and
expenditures for the project shall not exceed the maximum amount of the
expenditures approved in the certificate of need."
SECTION 11. Section 323D-44, Hawaii Revised Statutes, is amended as follows:
1. By amending subsection (a) to read:
"(a) An applicant for a certificate of need shall file an application with the state agency. The state agency shall provide technical assistance to the applicant in the preparation and filing of the application.
Each application shall include a statement evaluating the facility's or service's probable impact on health care costs and providing additional data as required by rule. The statement shall include cost projections for at least the first and third years after its approval.
The state agency shall not accept an
application for review until the application is complete and includes all
necessary information required by the state agency. The state agency shall
determine if the application is complete within thirty days of receipt of the
application. If the state agency determines that the application is
incomplete, the state agency shall inform the applicant of the additional
information that is required to complete the application. When the state
agency determines that the application is complete, the period for agency
review described in subsection (b) shall begin, and the state agency shall
transmit the completed application to the appropriate [subarea] regional
councils, [the review panel, the statewide council,] appropriate
individuals, and appropriate public agencies. The state agency may require the
applicant to provide copies of the application to the state agency, the
appropriate [subarea] regional councils, [the review panel,
the statewide council,] appropriate individuals, and appropriate public
agencies. If, during the period for agency review, the state agency requires
the applicant to submit information respecting the subject of the review, the
period for agency review [shall], at the request of the applicant, shall
be extended fifteen days."
2. By amending subsection (d) to read:
"(d) Notwithstanding anything to the
contrary in subsections (a) and (b), the state agency may adopt rules in
conformity with chapter 91 providing that all completed applications pertaining
to similar types of services, facilities, or equipment affecting the same
health service [area] region shall be considered in relation to
each other but no less often than twice a year."
SECTION 12. Section 323D-44.6, Hawaii Revised Statutes, is amended to read as follows:
"[[]§323D-44.6[]]
Review of certain applications for certificate of need; waiver. The [subarea]
regional council, [the review panel, and the statewide council may,]
at [their] its discretion, may choose to waive [their
respective prerogatives] its prerogative of review of any
certificate of need application."
SECTION 13. Section 323D-44.7, Hawaii Revised Statutes, is amended to read as follows:
"[[]§323D-44.7[]]
Monitoring of approved certificates of need. The state agency [may]
shall monitor implementation of approved certificates of need granted by
the agency."
SECTION 14. Section 323D-45, Hawaii Revised Statutes, is amended to read as follows:
"§323D-45 [Subarea] Regional
council[, review panel, and statewide council] recommendations for
issuance or denial of certificates of need. (a) Except for an
administrative review as provided in section 323D-44.5, or in an emergency
situation or other unusual circumstances as provided in section 323D‑44(c),
the state agency shall refer every application for a certificate of need to the
appropriate [subarea] regional council or councils[, the
review panel, and the statewide council]. The [subarea] regional
council [and the review panel] shall consider all relevant data and
information submitted by the state agency, [subarea councils,] other [areawide]
regions or local bodies, and the applicant, and may request from them
additional data and information. The [review panel] regional council
shall consider each application at a public meeting and shall submit its
recommendations with findings to the [statewide council.] state
agency. The [statewide] regional council shall consider [the]
its recommendation [of the review panel] at a public meeting and
shall submit its recommendations to the state agency within such time as the
state agency prescribes. The [statewide council] state agency and
the [review panel] regional council may join together to hear or
consider simultaneously information related to an application for a certificate
of need.
(b) At a public meeting in which a [subarea]
regional council [or the review panel] considers an application
for a certificate of need[, any person shall]:
(1) Any
person shall have the right to be represented by counsel and to present
oral or written arguments and evidence relevant to the application; [any]
(2) Any
person directly affected by the application may conduct reasonable questioning
of persons who make factual allegations relevant to the application; [any]
and
(3) Any staff member of the state agency may conduct reasonable questioning of persons who make factual allegations relevant to the application; and
a record of the meeting shall be kept."
SECTION 15. Section 323D-47, Hawaii Revised Statutes, is amended to read as follows:
"§323D-47 Request for reconsideration.
The state agency may provide by rules adopted in conformity with chapter 91 for
a procedure by which any person [may], for good cause shown, may request
in writing a public hearing before a reconsideration committee for purposes of
reconsideration of the agency's decision. The reconsideration committee shall
consist of the administrator of the state agency and the [chairpersons of
the statewide council, the review panel, the plan development committee of the
statewide council, and the] appropriate [subarea health planning] regional
council. The administrator shall be the chairperson of the reconsideration
committee. A request for a public hearing shall be deemed by the
reconsideration committee to have shown good cause, if:
(1) It presents significant, relevant information not previously considered by the state agency;
(2) It demonstrates that there have been significant changes in factors or circumstances relied upon by the state agency in reaching its decision;
(3) It demonstrates that the state agency has materially failed to follow its adopted procedures in reaching its decision;
(4) It provides such other bases for a public hearing as the state agency determines constitutes good causes; or
(5) The decision of the administrator differs from
the recommendation of the [statewide] regional council.
To be effective a request for such a hearing shall be received within ten working days of the state agency decision. A decision of the reconsideration committee following a public hearing under this section shall be considered a decision of the state agency for purposes of section 323D-44."
SECTION 16. Section 323D-54, Hawaii Revised Statutes, is amended to read as follows:
"§323D-54 Exemptions from certificate of need requirements. Nothing in this part or rules with respect to the requirement for certificates of need applies to:
(1) Offices of physicians, dentists, or other practitioners of the healing arts in private practice as distinguished from organized ambulatory health care facilities, except in any case of purchase or acquisition of equipment attendant to the delivery of health care service and the instruction or supervision for any private office or clinic involving a total expenditure in excess of the expenditure minimum;
(2) Laboratories, as defined in section 321-11(12), except in any case of purchase or acquisition of equipment attendant to the delivery of health care service and the instruction or supervision for any laboratory involving a total expenditure in excess of the expenditure minimum;
(3) Dispensaries and first aid stations located within business or industrial establishments and maintained solely for the use of employees; provided such facilities do not regularly provide inpatient or resident beds for patients or employees on a daily twenty-four-hour basis;
(4) Dispensaries or infirmaries in correctional or educational facilities;
(5) Dwelling establishments, such as hotels, motels, and rooming or boarding houses that do not regularly provide health care facilities or health care services;
(6) Any home or institution conducted only for those who, pursuant to the teachings, faith, or belief of any group, depend for healing upon prayer or other spiritual means;
(7) Dental clinics;
(8) Nonpatient areas of care facilities such as parking garages and administrative offices;
(9) Bed changes that involve ten per cent or ten beds of existing licensed bed types, whichever is less, of a facility's total existing licensed beds within a two-year period;
(10) Projects that are wholly dedicated to meeting the State's obligations under court orders, including consent decrees, that have already determined that need for the projects exists;
(11) Replacement of existing equipment with its modern-day equivalent;
(12) Primary care clinics under the expenditure thresholds referenced in section 323D-2;
(13) Equipment and services related to that equipment[,]
that are primarily invented and used for research purposes as opposed to usual
and customary diagnostic and therapeutic care;
(14) Capital expenditures that are required:
(A) To eliminate or prevent imminent safety hazards as defined by federal, state, or county fire, building, or life safety codes or regulations;
(B) To comply with state licensure standards;
(C) To comply with accreditation standards, compliance with which is required to receive reimbursements under Title XVIII of the Social Security Act or payments under a state plan for medical assistance approved under Title XIX of such Act;
(15) Extended care adult residential care homes and assisted living facilities; or
(16) Other facilities or services that the agency
through the [statewide council] regional councils chooses to
exempt, by rules pursuant to section 323D‑62."
SECTION 17. Section 323D-13, Hawaii Revised Statutes, is repealed.
["§323D-13 Statewide health
coordinating council. (a) There is established a statewide health
coordinating council which shall be advisory to the state agency and the
membership of which as appointed by the governor shall not exceed twenty
members.
(b) The members of the statewide council
shall be appointed by the governor in accordance with section 26-34, provided
that a nonvoting, ex officio member who is the representative of the Veterans'
Administration shall be designated by the Veterans' Administration. The
membership of the statewide council shall be broadly representative of the age,
sex, ethnic, income, and other groups that make up the population of the State
and shall include representation from the subarea councils, business, labor,
and health care providers. A majority but not more than eleven of the members
shall be consumers of health care who are not also providers of health care.
(c) The statewide council shall select a
chairperson from among its members. The members of the statewide council shall
not be compensated but shall be reimbursed for necessary expenses incurred in
the performance of their duties.
(d) The number of members necessary to
constitute a quorum to do business shall consist of a majority of all members
who have accepted nomination to the council, and have been confirmed and
qualified as members of the council. When a quorum is in attendance, the
concurrence of a majority of the members in attendance shall make any action of
the council valid.
(e) No member of the statewide council
shall, in the exercise of any function of the statewide council described in
section 323D-14(3), vote on any matter before the statewide council respecting
any individual or entity with which the member has or, within the twelve months
preceding the vote, had any substantial ownership, employment, medical staff,
fiduciary, contractual, creditor, or consultative relationship. The statewide
council shall require each of its members who has or has had such a
relationship with an individual or entity involved in any matter before the
statewide council to make a written disclosure of the relationship before any
action is taken by the statewide council with respect to the matter in the
exercise of any function described in section 323D-14 and to make the
relationship public in any meeting in which the action is to be taken."]
SECTION 18. Section 323D-14, Hawaii Revised Statutes, is repealed.
["§323D-14 Functions; statewide
health coordinating council. The statewide council shall:
(1) Prepare and revise as necessary the
state health services and facilities plan;
(2) Advise the state agency on actions
under section 323D-12;
(3) Appoint the review panel pursuant to
section 323D-42; and
(4) Review and comment upon the following
actions by the state agency before such actions are made final:
(A) The making of findings as to
applications for certificate of need; and
(B) The making of findings as to the
appropriateness of those institutional and noninstitutional health services
offered in the State."]
SECTION 19. Section 323D-42, Hawaii Revised Statutes, is repealed.
["§323D-42 Review panel.
There is established a review panel for the purposes of reviewing applications
for certificates of need. The review panel shall be appointed by the statewide
council. The review panel shall include at least one member from each county
and a majority of the members shall be consumers. Membership on the statewide
council shall not preclude membership on the review panel established in this
section."]
SECTION 20. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 21. This Act shall take effect upon its approval.
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