Honolulu, Hawaii
                                                   , 1999

                                 RE: H.B. No. 743
                                     H.D. 2

Honorable Calvin K.Y. Say
Speaker, House of Representatives
Twentieth State Legislature
Regular Session of 1999
State of Hawaii


     Your Committee on Consumer Protection and Commerce, to which
was referred H.B. No. 743, H.D. 1, entitled: 


begs leave to report as follows:

     The purpose of this bill is to mandate health care plans,
policies, contracts, or agreements, including workers'
compensation and motor vehicle policies, to provide coverage and
reimbursement for the services of advanced practice registered
nurses (APRNs).

     Your Committee received testimony supporting this measure
from the Department of Health, a number of APRNs, Hawaii Nurses'
Association (HNA), the Hawaii Chapter of the American Psychiatric
Nurses Association (APNA), the Hawaii Medical Services
Association, and approximately 190 consumers of APRN services.
Kaiser Permanente submitted testimony commenting on this measure.
The Hawaii Insurers Council (HIC) testified in opposition to the
workers' compensation provisions, stating that under provisions
contained in the bill, APRNs are equated with medical doctors and
other health care providers which would allow them to diagnose
and prescribe treatment with no oversight by a licensed medical

     HNA testified that APRNs are recognized as providers under
federal Medicare and Medicaid programs, and that some categories
of APRNs are recognized under Hawaii's HealthQUEST program.

                                 STAND. COM. REP. NO. 719
                                 Page 2


     APNA testified that in a 1986 study, the U.S. Congress
Office of Technology Assessment (OTA) noted that APRNs can
provide safe care that meets generally recognized standards of
quality, emphasizes personal and preventive dimensions of care,
and provides services that would otherwise be unavailable in
inner cities, remote areas, and certain settings where demand or
ability to pay are insufficient to support physicians' practices.
APNA also testified that multiple studies have demonstrated the
cost effectiveness and acceptance of APRNs as primary health care
providers, with the OTA study reporting an APRN cost-per-care
episode as at least 20 percent less than traditional medical
provider cost with the same population.  APNA further stated that
data from various state boards of nursing clearly indicate that
there are extremely few incidences of disciplinary actions taken
against APRNs.

     Your Committee has incorporated amendments suggested by HIC,
which remove language defining APRNs as "health care providers,"
and, instead, include APRNs in the definition of "medical care",
or "medical services."

     As affirmed by the record of votes of the members of your
Committee on Consumer Protection and Commerce that is attached to
this report, your Committee is in accord with the intent and
purpose of H.B. No. 743, H.D. 1, as amended herein, and
recommends that it be referred to the Committee on Finance in the
form attached hereto as H.B. No. 743, H.D. 2.

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Consumer
                                   Protection and Commerce,

                                   RON MENOR, Chair