Rural Health

Establishes a statewide rural health plan; creates rural health
special fund; creates a position of rural transportation
coordinator under state department of transportation.

THE SENATE                              S.B. NO.           102
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  The legislature finds that adequate health care
 2 for the rural districts of the Big Island are sorely lacking.  In
 3 response to this urgent need, senate concurrent resolution no.
 4 31, 1998, requested the state department of health (DOH) to
 5 develop a rural health plan for the island of Hawaii, including
 6 the districts of Puna and Ka`u, to ensure the improvement of
 7 health facilities and to make available sufficient medical
 8 services.
 9      In its report to the legislature pursuant to the resolution,
10 the DOH found that the rural community perceptions are that
11 comprehensive medical care must come first before the economic
12 situation in Ka`u will improve, that elderly retirees have
13 limited access to specialists and may suffer long waits for
14 transportation to larger or specialized facilities, and that
15 there are too few medical facilities in places with inadequate
16 transportation and a dispersed population over a large geographic
17 area.
18      The legislature further finds that compared to the state
19 population, Puna has the worst overall socio-economic status in

Page 2                                                     
                                     S.B. NO.           102

 1 the State, including the second worst per capita income ($9,450),
 2 second highest percentage of population below two hundred per
 3 cent of the federal poverty level, second highest percentage of
 4 households receiving public financial aid, third highest
 5 percentage of households receiving food stamps, and fourth
 6 highest unemployment rate.  The legislature further finds that
 7 Puna has the fourth highest level of overall health risk in the
 8 State, including the second highest rate of births to mothers
 9 with pre-existing medical conditions, fourth highest percentage
10 of low birth weights, fifth highest rate of infant mortality, and
11 sixth highest percentage of teen births.
12      The legislature further finds that compared to the state
13 population, Ka`u has the third worst rate for socio-economic
14 status, including the fourth highest percentage of population
15 below two hundred per cent of the federal poverty level, forth
16 highest percentage of households receiving public financial aid,
17 fourth highest percentage of households receiving food stamps,
18 fifth worst per capita income, fifth highest unemployment rate,
19 and fifth highest percentage of adults without a high school
20 diploma.  The legislature further finds that Ka`u has the second
21 highest level of overall health risk in the State, including the
22 highest percentage of teen births, highest percentage of births
23 with low birth weight, third highest percentage of births with

Page 3                                                     
                                     S.B. NO.           102

 1 inadequate prenatal care, and seventh highest infant mortality
 2 rate.
 3      The legislature further finds that the health profiles of
 4 Ka`u and Puna could be immensely improved with adequate funding
 5 for health care needs and with decent public transportation.
 6      The purpose of this Act is to implement the recommendations
 7 of the DOH to improve the provision of adequate health care
 8 services and public transportation for rural communities.
 9      SECTION 2.  Chapter 321, Hawaii Revised Statutes, is amended
10 by adding a new section to part I to be appropriately designated
11 and to read as follows:
12      "321-    Statewide rural health plan; rural health special
13 fund.  (a)  The department of health shall develop a statewide
14 rural health plan in order to:
15      (1)  Obtain federal funds under the Medicare rural hospital
16           flexibility program to maintain access to hospitals in
17           rural communities by creating a network of shared
18           hospital services and resources within the State; and
19      (2)  Improve the efficiency and minimize the financial costs
20           of rural care by allowing flexibility in staffing and
21           in the number and type of beds maintained as a
22           requirement of federal funding subsidies.
23      (b)  The statewide rural health plan shall be developed and

Page 4                                                     
                                     S.B. NO.           102

 1 administered by the department of health in conformity with
 2 federal requirements for receiving grants pertaining to rural
 3 health.
 4      (c)  The department of health shall have a hospital
 5 certification category to certify rural facilities as critical
 6 access hospitals to serve the Medicare population.
 7      (d)  There is established the rural health special fund to
 8 be administered by the department of health, into which shall be
 9 deposited, if required by federal law or regulation, funds
10 relating to rural health.  Moneys in the fund shall be expended
11 exclusively for improvement of rural health needs and in
12 accordance with federal requirements."
13      SECTION 3.  There is created a position within the
14 department of transportation for a rural transportation
15 coordinator to assist in the identification, establishment,
16 funding, and coordination of affordable and convenient public
17 rural transportation services, particularly to allow residents to
18 access health care in the Ka`u district, island of Hawaii.  The
19 coordinator shall develop a plan, with the assistance of the
20 department of health, to establish a public rural transportation
21 system for the Ka`u district, particularly as those
22 transportation services affect access to health care services,
23 including primary providers, emergency facilities, and hospitals.

Page 5                                                     
                                     S.B. NO.           102

 1 The plan shall be incorporated into administrative rules of the
 2 department of health pursuant to authority under section
 3 321-1.5(5), Hawaii Revised Statutes.
 4      SECTION 4.  New statutory material is underscored.
 5      SECTION 5.  This Act shall take effect upon its approval.
 7                           INTRODUCED BY:  _______________________