Report Title:

State Health Planning and Development

Description:

Amends the certificate of need program by, inter alia, repealing letter of intent requirement, increasing expenditure minimums; adding geriatricians as primary care clinic providers; and increasing penalties for violations.

HOUSE OF REPRESENTATIVES

H.B. NO.

919

TWENTY-SECOND LEGISLATURE, 2003

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

RELATING TO HEALTH.

 

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 definition of "construct", "expand", "alter", "convert", "develop", "initiate", or "modify" to read:

""Construct", "expand", "alter", "convert", "develop", "initiate", or "modify" includes the erection, building, reconstruction, modernization, improvement, purchase, acquisition, or establishment of a health care facility or health care service[;] or any portion of such a facility or service; the purchase or acquisition of equipment attendant to the delivery of health care service and the instruction or supervision therefore; the arrangement or commitment for financing the offering or development of a health care facility or health care service[;] or any portion of such a facility or service; any obligation for a capital expenditure by a health care facility; and studies, surveys, designs, plans, working drawings, specifications, procedures, and other actions necessary for any such undertaking, which will:

(1) Result in a total capital expenditure in excess of the expenditure minimum,

(2) Substantially modify, decrease, 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."

2. By amending the definition of "expenditure minimum" to read:

""Expenditure minimum" means [$4,000,000] $5,000,000 for capital expenditures, [$1,000,000] $1,500,000 for new or replacement medical equipment, and $400,000 for used medical equipment."

3. By amending the definition of "health" to read:

""Health" includes physical and [mental] behavioral health."

4. By amending the definition of "primary care clinic" to read:

""Primary care clinic" means a clinic for outpatient services providing all preventive and routine health care services, management of chronic diseases, consultation with specialists when necessary, and coordination of care across health care settings or multiple providers or both. Primary care clinic providers include:

(1) General or family practice physicians;

(2) General internal medicine physicians;

(3) Pediatricians;

(4) Obstetricians and gynecologists;

(5) Physician assistants; [and]

(6) Advanced practice registered nurses[.]; and

(7) Geriatricians."

SECTION 2. Section 323D–11, Hawaii Revised Statutes, is amended to read as follows:

"§323D-11 State health planning and development agency. There is established within the department of health for administrative purposes only, the state health planning and development agency. The state agency shall be headed by an administrator who shall be [appointed by the governor subject to section 26-34.] subject to chapter 76. The state agency shall administer [the] state health planning and [cost containment activities as required by law.] promote accessibility for all the people of the State to quality health services at reasonable cost."

SECTION 3. Section 323D–12, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(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)] (3) Assist the statewide council in the performance of its functions[.];

[(5)] (4) Determine the need for new health services proposed to be offered within the State[.];

[(6)] (5) 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)] (6) Provide technical assistance to persons, public or private, in obtaining and filling out the necessary forms for the development of projects and programs[.];

[(8)] (7) Prepare reports, studies, and recommendations on emerging health issues, such as medical ethics, health care rationing, involuntary care, care for the indigent, and standards for research and development of biotechnology and genetic engineering[.]; and

[(9)] (8) Conduct such other activities as are necessary to meet the purposes of this chapter."

SECTION 4. Section 323D–13, Hawaii Revised Statutes, is amended to read as follows:

"§323D-13 Statewide health coordinating council. (a) There is established a statewide health coordinating council [which] that 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] Department of Veterans Affairs shall be designated by the [Veterans' Administration.] Department of Veterans Affairs. 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] a subarea [councils, business, labor, and health care providers.] council. 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), shall 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 5. 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, shall not be employed by [or married to] health care providers."

SECTION 6. Section 323D-18, Hawaii Revised Statutes, is amended to read as follows:

"§323D-18 Information required of providers. Providers of health care doing business in the State shall submit such statistical and other reports of information related to health and health care as the state agency finds necessary to the performance of its functions. The information deemed necessary includes but is not limited to:

(1) Information regarding changes in the class of usage of the bed complement of a health care facility under section 323D-54(9);

(2) Implementation of services under section 323D-54;

[(3) Projects that are wholly dedicated to meeting the State's obligations under court orders, including consent decrees, under section 323D-54(10);

(4)] (3) Replacement of existing equipment with an updated equivalent under section [323D-54(11);] 323D-54(10);

[(5)] (4) Primary care clinics under the expenditure thresholds under section [323D-54(12);] 323D-54(11); and

[(6)] (5) Equipment and services related to that equipment, that are primarily intended for research purposes as opposed to usual and customary diagnostic and therapeutic care."

SECTION 7. Section 323D–21, Hawaii Revised Statutes, is amended to read as follows:

"§323D-21 Subarea health planning councils, established. There are established[,] subarea health planning councils for geographical areas [which] that shall be designated by the state agency in consultation with the statewide council. Each county shall have at least one subarea health planning council. [The subarea health planning councils shall be placed within the state agency for administrative purposes.]"

SECTION 8. Section 323D–22, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) Each subarea health planning council shall review, seek public input, and make recommendations relating to health planning for the geographical subarea it serves. In addition, the subarea health planning councils shall:

(1) Identify and recommend to the state agency and the council the data needs and special concerns of the respective subareas 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 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[.];

(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 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–45, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) At a public meeting in which a subarea council or the review panel considers an application for a certificate of need, 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 person directly affected by the application may conduct reasonable questioning of persons who make factual allegations relevant to the application; 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 10. Section 323D–50, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:

"(c) Any person who violates any provision of this chapter or rules adopted under this chapter[, with]:

(1) With respect to the agency's requests for reporting, may be subject to an administrative penalty not to exceed [$2,000] $20,000 for each seven-day period or fraction thereof that the violation continues[.]; and

(2) With respect to all other provisions, may be subject to an administrative penalty not to exceed $20,000 for each thirty-day period or fraction thereof that the violation continues.

The administrator of the state agency may impose the administrative penalty specified in this section by order; provided that no penalty shall be assessed unless the person charged shall have been given notice and an opportunity for a hearing pursuant to chapter 91. The administrative penalty contained in the notice of finding of violation shall become a final order unless, within twenty days of receipt of the notice, the person charged makes a written request for a hearing. For any judicial proceeding to recover the administrative penalty imposed, the administrator need only show that notice was given, a hearing was held or the time granted for requesting a hearing has expired without such a request, the administrative penalty was imposed, and that the penalty remains unpaid."

SECTION 11. 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)] (10) Replacement of existing equipment with its modern-day equivalent[;] that does not substantially change the scope of the service;

[(12)] (11) Primary care clinics under the expenditure thresholds referenced in section 323D–2;

[(13)] (12) 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)] (13) 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)] (14) Extended care adult residential care homes and assisted living facilities; or

[(16)] (15) Other facilities or services that the agency through the statewide council chooses to exempt, by rules pursuant to section 323D-62."

SECTION 12. Section 323D–52, Hawaii Revised Statutes, is repealed.

["§323D–52 Letters of intent. Persons proposing construction projects shall submit to the state agency letters of intent in such detail as may be necessary to inform the agency of the scope and nature of the projects at the earliest possible opportunity in the course of planning of such construction projects."]

SECTION 13. All officers and employees who may be affected by this Act shall be retained with their functions and shall maintain the same position status, whether civil service or exempt. The incumbent administrator is granted permanent civil service status without loss of salary, seniority, prior service credit, accrued vacation, sick leave or other employee benefits, and without the necessity of examination; and provided that the administrator possesses the minimum qualifications for the position. All officers and employees shall continue to perform their regular duties, subject to the state personnel laws and this Act without suffering any loss of salary, seniority, prior service credit, vacation, sick leave, or other employee benefit or privilege as a consequence of this Act.

SECTION 14. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 15. This Act shall take effect on June 1, 2003.

INTRODUCED BY:

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