Bill Text: HI SB2595 | 2022 | Regular Session | Amended
Bill Title: Relating To The Department Of Health.
Spectrum: Moderate Partisan Bill (Democrat 8-1)
Status: (Introduced - Dead) 2022-02-18 - Report adopted; Passed Second Reading, as amended (SD 1) and referred to WAM. [SB2595 Detail]
Download: Hawaii-2022-SB2595-Amended.html
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THE SENATE |
S.B. NO. |
2595 |
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THIRTY-FIRST LEGISLATURE, 2022 |
S.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO THE DEPARTMENT OF HEALTH.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that Act 212, Session Laws of Hawaii 2021, requires the transfer of the Oahu regional health care system facilities of the Hawaii health systems corporation, comprising Leahi hospital and Maluhia, to the department of health.
The legislature further finds that the complexity of this transfer is high because of logistical, clinical, labor relations, and financial issues. Due to the department of health's recent focus on the response to water contamination issues at Red Hill and the ongoing coronavirus disease 2019 pandemic, an extension of the date by which the transfer is to be complete is necessary to assure that the intent of Act 212, Session Laws of Hawaii 2021, is properly achieved.
Accordingly, the purpose of this Act is to:
(1) Extend the date by which the transfer is to be completed;
(2) Grant the transition working group certain exemptions to enable it to carry out its responsibilities more expeditiously;
(3) Set the proper manner by which the Oahu regional health care system should seek operational funding during the pendency of the transition process; and
(4) Appropriate moneys from the general fund to formulate and execute a comprehensive business and transition plan.
SECTION 2. Act 212, Session Laws of Hawaii 2021, is amended as follows:
1. By amending section 1 to read:
"SECTION 1. The legislature finds that the Hawaii health systems corporation comprises five semi-autonomous health care regions within the State, including east Hawaii, west Hawaii, Kauai, Oahu, and Maui. The Maui region no longer operates any health care facilities.
The legislature further finds that the Oahu region is unique and distinguishable from the other regions due to the logistical complexities of the Oahu regional health care system facilities and the limited but crucial nature of the services these facilities, Leahi hospital and Maluhia, currently provide. Because the Oahu facilities almost exclusively serve long-term care and medicaid patients, groups traditionally underserved by private facilities because of the high cost of their care, the Oahu region's long-term care operations are run more as a safety-net social service and, compared to the other regions, have less opportunity for additional revenue generation.
While the need for long-term care beds on Oahu has decreased in recent years, a study completed by the department of business, economic development, and tourism has projected that the State's population aged sixty-five and older will grow by one hundred forty-eight per cent over the next twenty five years. On Oahu, this translates to an estimated shortfall of eleven hundred long-term care beds in the next five to ten years alone. Thus, despite the costs of long-term care, it is vital that state facilities continue to operate to ensure that beds remain available for the State's aging population.
Similar to the Oahu region, the department of health operates the Hawaii state hospital, a facility that does not generate revenue but is nonetheless necessary to provide care and treatment for mentally ill patients in Hawaii. In recent years, the Hawaii state hospital has experienced a challenge in providing sufficient bed space for admitted patients. As of September 2019, two hundred twenty patients occupied beds at the Hawaii state hospital--well over the maximum capacity of two hundred two. To meet its needs, the Hawaii state hospital was also required to contract with Kahi Mohala, a privately-run facility, to care for an additional forty-six patients.
Beyond its responsibility for the Hawaii state hospital, the department of health has also been charged with addressing the significant gap in the behavioral health care system between acute psychiatric care facilities and low acuity residential treatment. Data collected in the State estimate that more than half of all individuals experiencing a mental health crisis, or fifty-four per cent, have needs that align better with services delivered within a subacute level of care facility rather than an emergency room.
The legislature also finds that Act 90, Session Laws of Hawaii 2019, established the involuntary hospitalization task force and Act 263, Session Laws of Hawaii 2019, established a working group to evaluate current behavioral health care and related systems, including existing resources, systems gaps, and identification of action steps that may be taken to improve the overall system of care. The findings from these initiatives highlight the need in Hawaii for a coordinated network of stabilization beds that will allow triage, clinical assessment, and recommendation for the next level of care for those struggling with substance use, mental health conditions, and homelessness.
The National Coalition for the Homeless has found that sixty-four per cent of homeless individuals are dependent on alcohol or other substances. In Hawaii, the Oahu homeless point in time count reported that 36.4 per cent of homeless single adults suffer from some type of mental illness. The intersection of homelessness and behavioral health conditions is a crisis in Hawaii, which contributes to Hawaii having the second highest rate of homelessness in the nation. Unfortunately, there is currently no coordinated system of stabilization from the streets that assesses for and links to the next level of clinical care.
The legislature additionally finds that the current options for those needing stabilization from challenges related to substance use, mental health conditions, and homelessness are overburdened and inadequate, and emergency facilities throughout the State have experienced substantial increases in psychiatric emergency admissions, resulting in overcrowding and unsafe environments for patients and medical staff.
The legislature also finds that comprehensive crisis response and stabilization services are crucial elements of the continuum of care. Reducing unnecessary transportation to emergency departments and appropriately placing individuals in more suitable levels of care will improve outcomes for patients, reduce inpatient hospital stays, and facilitate access to other behavioral health services.
Subacute residential stabilization services have been a missing component of a comprehensive behavioral health continuum of care, which would bridge the gap between acute hospitalization and lower-level residential and community resources. Many individuals who are transported to an emergency room or for emergency examination and hospitalization are not acute enough in their illness to warrant psychiatric hospitalization. On the other hand, their symptomology is too acute for them to be admitted to a group home, shelter, or other existing low acuity residential program or, if they are admitted, they are often unsuccessful in those environments. More often than not, these individuals fail because they have not had time to stabilize in an environment where they can be closely monitored. This lack of post-acute care contributes to the poor outcomes of both acute behavioral health inpatient and community-based services because many individuals are not appropriate for either level, but fall somewhere in the middle.
The legislature further finds that state facilities exist that have underutilized space that could accommodate these services with minimal effort and adjustments and reduce certain burdens and barriers. Therefore, assertive efforts should be undertaken to ensure the availability of these resources and to organize them in a way that is beneficial to the State.
Through discussions with the Oahu region, it has been determined that some of the Oahu region's health care facilities, particularly Leahi hospital, are currently underutilized and have the potential to be re-purposed for other important health care and social service needs.
The legislature also finds that, while statutorily tied to the Hawaii health systems corporation, the Oahu region operates mostly autonomously and its functions and target population are unique from those of the other regional health care systems. As such, there is little necessity for the Oahu regional health care system to remain a part of the Hawaii health systems corporation. With proper planning and implementation, the Oahu regional health care system could be strategically assimilated into the department of health, and its facilities could be used, in addition to long-term care, to help alleviate the need for subacute residential mental health stabilization and other subacute care services.
The purpose of this Act is to:
(1) Commence the transfer of the Oahu regional
health care system in its entirety from the Hawaii health systems corporation
to the department of health, to be completed no later than December 31, [2021;]
;
(2) Enable the Oahu regional health care system, department of health, Hawaii health systems corporation, and other state agencies to implement the processes and transactions required to effectuate the completion of the transition;
(3) Require the department of health to consult with the University of Hawaii regarding services provided at Leahi hospital and Maluhia, and allow University of Hawaii students to rotate through those facilities for training purposes;
(4) Authorize the department of health to pay rent to the University of Hawaii for the use of the Leahi hospital property at a rate and on terms to be negotiated between the department of health and the University of Hawaii;
(5) Clarify the rights, powers, and exemptions held by the Oahu regional health care system during the transition period and the rights, powers, and exemptions held by the inpatient services division of the department of health following completion of the transfer of the Oahu regional health care system;
(6) Establish a working group to develop, evaluate, and implement the transition plan;
(7) Appropriate moneys from the mental health and substance abuse special fund to formulate and execute a comprehensive business and transition plan; and
(8) Appropriate moneys from the funds received by the State of Hawaii from the American Rescue Plan Act of 2021, Public Law 117-2 (Section 9901) to transfer the Oahu regional health care system in its entirety from the Hawaii health systems corporation to the department of health."
2. By amending section 6 to read:
"SECTION 6. (a) The budget of the Oahu regional health care system shall be transferred from the Hawaii health systems corporation to the department of health; provided that:
(1) The Oahu regional health
care system's budget codes and all related allocated funds of the Oahu region shall
be reflected in the state budget and all other related tables; [and]
(2) The organizational
structure of the Oahu regional health care system shall remain unchanged, unless
modified and approved by the working group established pursuant to section 9 of
this Act, and as approved by the conditions established in this part or as required
by law[.]; and
(3) During the transition period, all requests for operational funds necessary for the Oahu regional health care system to maintain its operations at Leahi Hospital and Maluhia shall be made by the Oahu regional health care system and shall be submitted with budget requests made by the Hawaii health systems corporation; provided further that, when appropriated, funding for the Oahu regional health care system shall be designated under HTH 215, the program ID assigned to the Oahu regional health care system.
(b) The
transfer of positions and respective class specifications of the Oahu region
from the Hawaii health systems corporation's personnel system to the department
of health, as set forth in a transition document submitted by the working group
established pursuant to section 9 of this Act no later than twenty days prior to
the convening of the regular session of 2022, shall be completed no later than December
31, [2022,] ; provided
that:
(1) All employees of the
Oahu region who are employed as of December 31, [2022,] ,
shall be transferred to the department of health before the transition of the Oahu
regional health care system into the department of health is complete;
(2) All employees of the Oahu region who occupy civil service positions shall be transferred to the department of health by this Act and retain their civil service status, whether permanent or temporary, and shall maintain their respective functions as reflected in their current position descriptions during the transition period; provided that any changes determined necessary by the working group established pursuant to section 9 of this Act shall follow standard union consultation process prior to implementation;
(3) Employees shall be transferred without loss of salary; seniority, except as prescribed by applicable collective bargaining agreements; retention points; prior service credit; any vacation and sick leave credits previously earned; and other rights, benefits, and privileges, in accordance with state employment laws;
(4) The personnel structure of the Oahu regional health care system shall remain unchanged, unless modified and approved by the working group and as approved by the conditions established pursuant to this Act;
(5) Any employee who, prior to this Act, is exempt from civil service or collective bargaining and is transferred as a consequence of this Act shall be transferred without loss of salary and shall not suffer any loss of prior service credit, contractual rights, vacation or sick leave credits previously earned, or other employee benefits or privileges, and, except in the instance of discipline, shall be entitled to remain employed in the employee's current position for a period of no less than one year after the transition of the Oahu regional health care system into the department of health is complete;
(6) The wages, hours, and other conditions of employment shall be negotiated or consulted, as applicable, with the respective exclusive representative of the affected employees, in accordance with chapter 89, Hawaii Revised Statutes; and
(7) The rights, benefits, and privileges currently enjoyed by employees, including those rights, benefits, and privileges under chapters 76, 78, 87A, 88, and 89, Hawaii Revised Statutes, shall not be impaired or diminished as a result of these employees being transitioned to the department of health pursuant to this Act. The transition to the department of health shall not result in any break in service for the affected employees. The rights, benefits, and privileges currently enjoyed by employees shall be maintained under their existing collective bargaining or other agreements and any successor agreement."
3. By amending subsection (b) of section 7 to read:
"(b) Notwithstanding any law to the contrary, the terms
of the following members of the board of directors of the Hawaii health systems
corporation shall expire on December 31, [2022:] :
(1) The regional chief executive officer of the Oahu regional health care system; and
(2) The two board members residing on the island of Oahu appointed pursuant to section 323F-3(b)(7), Hawaii Revised Statutes."
4. By amending section 8 to read:
"SECTION
8. (a) During the transition planning period commencing
on July 1, 2021, to and including the completion of the transition of the Oahu regional
health care system into the department of health no later than December 31, [2022,]
, the Oahu regional system board
may:
(1) Develop and implement its own policies, procedures, and rules necessary or appropriate to plan, operate, manage, and control its facilities without regard to chapter 91, Hawaii Revised Statutes;
(2) Enter into and perform any contract, lease, cooperative agreement, partnership, or other transaction whatsoever that may be necessary or appropriate in the performance of its purposes and responsibilities, and on any terms the regional system board may deem appropriate with either:
(A) Any agency or instrumentality of the United States, or with any state, territory, possession, or subdivision thereof; or
(B) Any person, firm, association, partnership, or corporation, whether operated on a for-profit or not-for-profit basis; provided that the transaction furthers the public interest;
(3) Conduct activities and enter into business relationships the regional system board deems necessary or appropriate, including but not limited to:
(A) Creating nonprofit corporations, including but not limited to charitable fundraising foundations, to be controlled wholly by the regional system board or jointly with others;
(B) Establishing, subscribing to, and owning stock in business corporations individually or jointly with others; and
(C) Entering into partnerships and other joint venture arrangements, or participating in alliances, purchasing consortia, health insurance pools, or other cooperative agreements, with any public or private entity; provided that any corporation, venture, or relationship entered into under this subsection shall further the public interest;
(4) Execute, in accordance with all applicable bylaws, rules, and laws, all instruments necessary or appropriate in the exercise of any powers of the regional system board;
(5) Make and alter regional system board bylaws and rules for its organization and management without regard to chapter 91, Hawaii Revised Statutes;
(6) Enter into any contract or agreement whatsoever, not inconsistent with the laws of the State, execute all instruments, and do all things necessary or appropriate in the exercise of the powers granted under chapter 323F, Hawaii Revised Statutes, including securing the payment of bonds; provided that contracts or agreements executed by the regional system board shall only encumber the regional subaccounts of the regional system board;
(7) Own, purchase, lease, exchange, or otherwise acquire property, whether real, personal, or mixed, tangible or intangible, and any interest therein, in the name of the regional system board; provided that the regional system board shall be subject to the requirements of section 323F-3.5, Hawaii Revised Statutes;
(8) Contract for and accept any gifts, grants, and loans of funds or property, or any other aid in any form from the federal government, the State, any state agency, or any other source, or any combination thereof, in compliance, subject to chapter 323F, Hawaii Revised Statutes, with the terms and conditions thereof; provided that the regional system board shall be responsible for contracting for and accepting any gifts, grants, loans, property, or other aid if intended to exclusively benefit the Oahu region public health facilities and operations;
(9) Provide health and medical services to the public directly or by agreement or lease with any person, firm, or private or public corporation, partnership, or association through or in the health facilities of the regional system board or otherwise; provided that the regional system board shall be responsible for conducting the activities under this paragraph solely within the Oahu regional system;
(10) Approve medical staff bylaws, rules, and medical staff appointments and reappointments for all public health facilities of the regional system board, including but not limited to determining the conditions under which a health professional may be extended the privilege of practicing within a health facility, as determined by the regional system board, and adopting and implementing reasonable rules, without regard to chapter 91, Hawaii Revised Statutes, for the credentialing and peer review of all persons and health professionals within the facility; provided that the regional system board shall be the governing body responsible for all medical staff organization, peer review, and credentialing activities to the extent allowed by law;
(11) Enter into any agreement with the State, including but not limited to contracts for the provision of goods, services, and facilities for the support of the regional system board's programs, and contracting for the provision of services to or on behalf of the State;
(12) Develop internal policies and procedures for the procurement of goods and services, consistent with the goals of public accountability and public procurement practices, and subject to management and financial legislative audits; provided that the regional system board shall enjoy the exemptions under section 103‑53(e) and chapter 103D, Hawaii Revised Statutes;
(13) Authorize, establish, and abolish positions; and
(14) Employ or retain any attorney, by contract or otherwise, for the purpose of representing the regional system board in any litigation, rendering legal counsel, or drafting legal documents for the regional system board.
(b) During the transition period commencing on July
1, 2021, to and including the completion of the transition of the Oahu regional
health care system into the department of health no later than December 31, [2022,]
, the Oahu regional system board shall
continue to enjoy the same sovereign immunity available to the State.
(c) During the transition period commencing on July
1, 2021, to and including the completion of the transition of the Oahu regional
health care system into the department of health no later than December 31, [2022,]
, the Oahu regional system board shall
be exempt from chapters 36, 37, 38, 40, 41D, 103D, 103F, part I of chapter 92, and
section 102-2, Hawaii Revised Statutes."
5. By amending section 9 to read:
"SECTION 9. (a) There is established a working group of the Oahu regional health care system and department of health to develop, evaluate, and implement any additional steps necessary to complete the transition of the Oahu regional health care system into the department of health.
(b) The working group shall consist of the following members:
(1) The director of health or the director's designee, who shall serve as co-chair and who, along with the chair of the Oahu regional system board or the chair's designee, shall have final authority over transfer activities to be implemented by the working group;
(2) The chair of the Oahu regional system board or the chair's designee, who shall serve as co‑chair and who, along with the director of health or the director's designee, shall have final authority over transfer activities to be implemented by the working group;
(3) The chief executive officer of the Oahu regional health care system or the chief executive officer's designee;
(4) One or more department of health staff members as deemed necessary by the director of health or the director's designee; and
(5) One or more Oahu regional health care system staff members as deemed necessary by the chief executive officer of the Oahu regional health care system or the chief executive officer's designee.
(c) In addition, the working group shall include the following members who shall serve in a consultative capacity:
(1) One representative from the behavioral health administration of the department of health;
(2) One representative from the department of human resources development;
(3) One representative from the department of accounting and general services;
(4) One representative from the department of the attorney general;
(5) One representative from the department of budget and finance;
(6) One representative from the
office of planning;
(7) The chair of the Hawaii health systems corporation board or the chair's designee;
(8) One representative from the Hawaii health systems corporation human resources department;
(9) One representative from the Hawaii health systems corporation finance department;
(10) One representative from the state procurement office;
(11) One representative from the Hawaii Government Employees Association, who shall be invited to participate;
(12) One representative from the United Public Workers, who shall be invited to participate;
(13) Community representatives as recommended and invited by the co-chairs; and
(14) Others as recommended and invited by the co-chairs.
(d) In
carrying out its purpose, the working group shall develop a comprehensive business
plan and transfer framework to govern and manage the additional steps necessary
to complete the transfer of the Oahu region into the department of health. The comprehensive business plan and transfer framework
shall include but not be limited to the following:
(1) Preparation of a five-year pro forma operating plan and budget for the continuing operations of Leahi hospital and Maluhia;
(2) Preparation of a ten-year pro forma capital improvement plan and budget for the continuing operations of Leahi hospital and Maluhia;
(3) Identification
and preparation of proposed legislation to address any matters not covered by this
Act that may be necessary to complete the transfer of the Oahu regional health care
system into the department of health;
(4) Identification of all real property, appropriations, records, equipment, machines, files, supplies, contracts, books, papers, documents, maps, and other property made, used, acquired, or held by the Oahu regional health care system to effectuate the transfer of the same to the department of health;
(5) Identification of all debts and other liabilities that will remain with the Hawaii health systems corporation and the remaining debts and liabilities to be transferred to the department of health;
(6) Identification of all contractual arrangements and obligations of the Oahu regional health care system, including but not limited to those related to personal service contracts, vendor contracts, and capital improvement projects;
(7) Development and implementation of any and all policies and procedures necessary to ensure that the facilities within the Oahu regional health care system remain compliant with all federal, state, and local laws and regulations; and
(8) Development and implementation of procedures to extricate the Oahu regional health care system from system-wide services secured or provided by the Hawaii health systems corporation or enable the Oahu region to continue to utilize those services on a temporary or permanent basis through interagency agreement.
(e) Members of the working group shall serve without compensation but shall be reimbursed for reasonable expenses necessary for the performance of their duties, including travel expenses. No member of the working group shall be subject to chapter 84, Hawaii Revised Statutes, solely because of the member's participation in the working group.
(f) The working group shall submit a report to the legislature no later than twenty days prior to the convening of the regular session of 2022 that shall include the five-year pro forma operating and budget plan, ten-year pro forma capital improvement plan, proposed legislation to address any matters not covered by this Act that may be necessary to complete the transfer of the Oahu regional health care system into the department of health, and a timeline of major milestones necessary to effectuate the transfer of personnel, assets, liabilities, and contracts needed to complete the transfer pursuant to this Act. The report shall also document the completion of the transfer and dissolution of the Oahu regional health care system.
(h) The working group shall be exempt from chapter 92, Hawaii Revised Statutes."
6. By amending section 14 to read:
"SECTION
14. This Act shall take effect on July 1,
2021; provided that part II of this Act shall take effect on December 31, [2022.]
."
SECTION 3. 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 2022-2023 for the creation of a comprehensive business plan and transfer framework for the transfer of the Oahu regional health care system and its facilities, Leahi hospital and Maluhia, to the department of health.
The sum appropriated shall be expended by the department of health for the purposes of this Act.
SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 5. This Act shall take effect on January 1, 2050.
Report Title:
DOH; HHSC; Oahu Region; Leahi Hospital; Maluhia; Transition; Working Group; Appropriation
Description:
Extends the deadline by which the transfer of the Oahu regional health care system from the Hawaii Health Systems Corporation to the Department of Health shall take place. Sets the manner by which the Oahu Regional Health Care System should request operational funding during the transitional period. Exempts the working group from chapter 92, Hawaii Revised Statutes. Appropriates moneys. Effective 1/1/2050. (SD1)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
