Report Title:

Trauma System Special Fund; Surcharge

 

Description:

Establishes additional funding mechanisms for the trauma system special fund.  Makes appropriations.

 


HOUSE OF REPRESENTATIVES

H.B. NO.

1700

TWENTY-FOURTH LEGISLATURE, 2007

 

STATE OF HAWAII

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to the trauma system special fund.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


     SECTION 1.  The legislature finds that trauma care in Hawaii is in a state of crisis and recognizes that trauma care is a public health priority.

     Injury is the leading cause of death for persons between the ages of one to forty-four in the State of Hawaii, causing more deaths than are caused by cancer and heart disease combined.  This underscores the seriousness of traumatic injury as a public health problem in the State.

     When injuries are serious, specialized equipment and prompt access to physicians and other trained health care providers make a significant difference in a trauma patient's health outcome.  A weak trauma system decreases the State's readiness to respond not only to the normal flow of critically injured patients, but to unforeseen disasters and emergencies as well.

     As the American College of Surgeons noted in its October 2005 report, "Hawaii Trauma System Consultation," extreme isolation and limited physician re-supply capability renders Hawaii uniquely vulnerable to natural disasters that may occur in a mid-pacific environment.  A functional trauma system with the capacity to handle a surge in demand is a fundamental necessity in responding to both natural and man-made disasters.

     Typically, the cost of providing care to trauma patients is far higher than the total payments received from those patients.  Without additional resources, it is unlikely that Hawaiis trauma system will increase in capacity and is at risk of losing what specialized trauma care is currently available.

     A January 2006, report by the legislative reference bureau entitled, "On-Call Crisis in Trauma Care:  Government Responses," noted that the rationale for public support of uncompensated trauma services is the same as for critical police and fire services; a trauma system is a necessary public service that ought to be publicly supported.

     In light of these findings, the legislature enacted Acts 305 and 316, Session Laws of Hawaii 2006, to ensure and encourage the availability of trauma care in the State by creating a trauma system special fund and dedicating a portion of the revenues generated from cigarette and tobacco tax for the trauma system special fund.  However, under the terms of these Acts, cigarette and tobacco tax revenues will not be deposited into the trauma system special fund until September 30, 2007, at the earliest.

     The legislature acknowledges that there is a desperate need to expand the resources available for trauma care in Hawaii.  It is also evident that additional resources are needed immediately to ensure the health, welfare, and safety of the citizens of our State.  Accordingly, this Act provides a variety of mechanisms to provide needed resources for Hawaii's trauma system. 

Among other things, this Act:

     (1)  Establishes surcharges for violations of chapters 291 (traffic violations), 291E (use of intoxicants while operating a vehicle), 706 (crimes of violence), and 712, part IV (offenses related to drugs and intoxicating compounds);

     (2)  Establishes surcharges for violations of sections 291C-12 (accidents involving death or serious bodily injury), 291C-12.5 (accidents involving substantial bodily injury), 291C-6 (accidents involving bodily injury), and 291C-161 (Statewide Traffic Code);

     (3)  Clarifies that the trauma system special fund consists of, among other things, trauma system surcharges, and cigarette tax revenues;

     (4)  Provides that the methodology used in calculating costs incurred by hospitals providing care to trauma patients takes into account:

         (A)  Physician on-call coverage that is demonstrated to be essential for trauma services within the hospital;

         (B)  Equipment that is demonstrated to be essential for trauma services within the hospital;

         (C)  The creation of overflow or surge capacity to allow a trauma center to respond to mass casualties resulting from an act of terrorism or natural disaster; and

     (5)  Defines "trauma center"; and

     (6)  Appropriates an unspecified amount for fiscal years 2007-2008 and 2008-2009, for the trauma system special fund.

     The purpose of this Act is to establish additional funding mechanisms to enhance the availability of resources in the trauma system special fund to ensure the availability of care for trauma patients in the State.

     SECTION 2.  Chapter 291, Hawaii Revised Statutes, is amended by adding a new section to part I, to be appropriately designated and to read as follows:

     "§291-    Trauma system surcharge.  (a)  In addition to any other civil penalties ordered by the court, a person who is convicted of any offense under this part shall be ordered to pay a trauma system surcharge of $          ; provided that the

surcharge shall not be ordered when the court determines that the defendant is unable to pay the fee.

     (b)  The defendant shall pay the surcharge to the clerk of the court.  The surcharge shall be deposited with the director of finance who shall transmit the fee to the trauma system special fund pursuant to section 321-22.5."

     SECTION 3.  Chapter 291E, Hawaii Revised Statutes, is amended by adding a new section to part IV to be appropriately designated and to read as follows:

     "§291E-    Trauma system surcharge.  (a)  In addition to any other civil penalties ordered by the court, a person who is convicted of any offense under this part shall be ordered to pay a trauma system surcharge of $          ; provided that the surcharge shall not be ordered when the court determines that the defendant is unable to pay the fee.

     (b)  The defendant shall pay the surcharge to the clerk of the court.  The surcharge shall be deposited with the director of finance who shall transmit the fee to the trauma system special fund pursuant to section 321-22.5."

     SECTION 4.  Chapter 706, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§706-    Trauma system surcharge.  (a)  In addition to any other civil penalties ordered by the court, a person who has been convicted of either a crime of violence or any offense listed in part IV of chapter 712 shall be ordered to pay a trauma system surcharge of $          ; provided that the surcharge shall not be ordered when the court determines that the defendant is unable to pay the fee.

     (b)  The defendant shall pay the surcharge to the clerk of the court.  The surcharge shall be deposited with the director of finance who shall transmit the fee to the trauma system special fund pursuant to section 321-22.5.

     (c)  For purposes of this section, "crime of violence" means:

(1)  Murder in any degree;

(2)  Manslaughter;

(3)  Assault in the first degree;

(4)  Kidnapping;

(5)  Sexual assault in the first degree;

(6)  Sexual assault in the second degree;

(7)  Continuous sexual assault of a minor under the age of fourteen years old;

(8)  Robbery in the first degree;

(9)  Robbery in the second degree; and

(10) Burglary in the first degree."

     SECTION 5.  Section 291C-12, Hawaii Revised Statutes, is amended by amending subsection (d) to read as follows:

     "(d)  [For] In addition to any other penalties ordered by the court for any violation under this section[, a]:

(1)  A surcharge of $500 shall be imposed[, in addition to any other penalties,] and shall be deposited into the neurotrauma special fund[.] pursuant to section 321H‑4; and

(2)  A surcharge of $           shall be imposed and shall be deposited into the trauma system special fund pursuant to section 321-22.5;

provided that a surcharge shall not be imposed when the court determines that the defendant is unable to pay the fee."

     SECTION 6.  Section 291C-12.5, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:

     "(c)  [For] In addition to any other penalties ordered by the court for any violation under this section[, a]:

(1)  A surcharge of $250 shall be imposed[, in addition to any other penalties,] and shall be deposited into the neurotrauma special fund[.] pursuant to section 321H‑4; and

(2)  A surcharge of $           shall be imposed and shall be deposited into the trauma system special fund pursuant to section 321-22.5;

provided that a surcharge shall not be imposed when the court determines that the defendant is unable to pay the fee."

     SECTION 7.  Section 291C-12.6, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:

     "(c)  [For] In addition to any other penalties ordered by the court for any violation under this section[, a]:

(1)  A surcharge of $100 shall be imposed[, in addition to any other penalties,] and shall be deposited into the neurotrauma special fund[.] pursuant to section 321H‑4; and

(2)  A surcharge of $           shall be imposed and shall be deposited into the trauma system special fund pursuant to section 321-22.5;

provided that a surcharge shall not be ordered when the court determines that the defendant is unable to pay the fee."

     SECTION 8.  Section 291C-161, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows:

     "(e)  In addition to any other civil penalties ordered by the court, the court shall order every person who has violated this chapter to pay a trauma system surcharge of $          ; provided that the surcharge shall not be ordered when the court determines that the defendant is unable to pay the surcharge; and provided further that the defendant shall pay the surcharge to the clerk of the court.  The trauma system surcharge shall be deposited with the director of finance who shall transmit the fee to the trauma system special fund pursuant to section 321‑22.5.  The court may assess a sum not to exceed $50 for the cost of issuing a penal summons upon any person who fails to appear at the place within the time specified in the citation issued to the person for any traffic violation."

     SECTION 9.  Section 321-22.5, Hawaii Revised Statutes, is amended to read as follows:

     "[[]§321-22.5[]]  Trauma system special fund.  (a)  There is established within the state treasury a special fund to be known as the trauma system special fund to be administered and expended by the department of health.  The fund shall consist of:

(1)  Surcharges collected pursuant to sections 291-  , 291C-12, 291C-12.5, 291C-12.6, 291C-161, 291E-  , and 706-  ;

(2)  Cigarette tax revenues designated under section 245‑15;

(3)  Federal funds granted by Congress or executive order for the purpose of this chapter; provided that the acceptance and use of federal funds shall not commit state funds for services and shall not place an obligation upon the legislature to continue the purpose for which the federal funds are made available;

(4)  Funds appropriated by the legislature for this purpose, including grants-in-aid;

(5)  Grants, donations, and contributions from private or public sources for the purposes of the trauma system special fund; and

(6)  Interest on and other income from the fund, which shall be separately accounted for.

     Moneys in the trauma system special fund shall not lapse at the end of the fiscal year.  Expenditures from the trauma system special fund shall be exempt from chapters 103D and 103F.

     (b)  The moneys in the trauma system special fund shall be used by the department to support the continuing development and operation of a comprehensive state trauma system.  The trauma system special fund shall be used to subsidize the documented costs for the comprehensive state trauma system, including but not limited to the following:

(1)  Costs of under-compensated and uncompensated trauma care incurred by hospitals providing care to trauma patients; and

(2)  Costs incurred by hospitals providing care to trauma patients to maintain on-call physicians for trauma care. 

The money in the trauma system special fund shall not be used to supplant funding for trauma services authorized prior to July 1, 2006, and shall not be used for ambulance or medical air transport services.

     (c)  [Interest and investment earnings attributable to the moneys in the trauma system special fund, federal funding, legislative appropriations, and grants, donations, and contributions from private or public sources for the purposes of the trauma system special fund shall be deposited into the trauma system special fund.

     (d)]  Disbursements from the fund shall be made in accordance with a methodology established by the department to calculate costs incurred by a hospital providing care to trauma patients that are eligible to receive reimbursement under subsection (b).  The methodology shall take into account:

(1)  Physician on-call coverage that is demonstrated to be essential for trauma services within the hospital;

(2)  Equipment that is demonstrated to be essential for trauma services within the hospital;

(3)  The creation of overflow or surge capacity to allow a trauma center to respond to mass casualties resulting from an act of terrorism or natural disaster; and

(4)  All other hospital services and resources that are demonstrated to be essential for trauma services within the hospital.

     The department shall adopt rules pursuant to chapter 91 to effectuate the purposes of this section[, including the methodology for disbursements from the trauma system special fund].

     [(e)] (d)  To receive reimbursement, a hospital providing care to trauma patients shall apply to the trauma system special fund on a form and in a manner approved by the department; provided that recipients of reimbursements from the trauma system special fund shall be subject to the following conditions:

     (1)  The recipient of a reimbursement shall:

         (A)  Comply with applicable federal, state, and county laws;

         (B)  Comply with any other requirements the director may prescribe;

         (C)  Allow the director, the legislative bodies, and the state auditor access to records, reports, files, and other related documents, to the extent permissible under applicable state and federal law, so that the program, management, and fiscal practices of the recipient may be monitored and evaluated to ensure the proper and effective expenditure of public funds;

         (D)  Provide care to all injured patients regardless of their ability to pay; and

         (E)  Participate in data collection and peer review activities for the purpose of system evaluation and improvement of patient care; and

     (2)  Every reimbursement shall be monitored according to rules established by the director under chapter 91 to ensure compliance with this section.

     [(f)] (e)  Necessary administrative expenses to carry out this section shall not exceed five per cent of the total amount collected in any given year.

     [(g)] (f)  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 trauma system special fund.

     [(h)] (g)  For the purposes of this section:

     "Comprehensive state trauma system" means a coordinated integrated system providing a spectrum of medical care throughout the State designed to reduce death and disability by appropriate and timely diagnosis and specialized treatment of injuries, which includes hospitals with successive levels of advanced capabilities for trauma care in accordance with nationally accepted standards established by the American College of Surgeons Committee on Trauma.

     "Hospital providing care to trauma patients" means a hospital with emergency services that receives and treats injured patients.

     "Trauma care" means specialized medical care intended to reduce death and disability from injuries.

     "Trauma center" means a facility verified by the American College of Surgeons as being a level I, level II, level III, or level IV trauma center.  Level I represents the highest level attainable by a verified trauma center, and level IV represents the lowest level attainable by a verified trauma center."

     SECTION 10.  There is appropriated out of the general revenues of the State of Hawaii the sum of $          , or so much as may be necessary for fiscal year 2007-2008, and the sum of $          , or so much as may be necessary for fiscal year 2008-2009, to subsidize the documented costs for the comprehensive state trauma system, including the costs of under-compensated and uncompensated trauma care incurred by hospitals providing care to trauma patients and the costs incurred by hospitals providing care to trauma patients to maintain on-call physicians for trauma care.

     The sums appropriated shall be deposited into the trauma system special fund in accordance with section 321-22.5, Hawaii Revised Statutes.

     SECTION 11.  There is appropriated out of the trauma system special fund established in section 321-22.5, the sum of $          , or so much thereof as may be necessary for fiscal year 2007-2008, and the same sum, or so much thereof as may be necessary for fiscal year 2008-2009, to subsidize the documented costs for the comprehensive state trauma system, including the costs of under-compensated and uncompensated trauma care incurred by hospitals providing care to trauma patients and the costs incurred by hospitals providing care to trauma patients to maintain on-call physicians for trauma care.

     The sums appropriated shall be expended by the department of health for the purposes of this Act.

     SECTION 12.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 13.  This Act shall take effect upon its approval;


provided that sections 10 and 11 shall take effect on July 1, 2007.

 

INTRODUCED BY:

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