Report Title:

Emergency and Budget Reserve Fund; Health and Human Services Appropriations

Description:

Appropriates funds from the Emergency and Budget Reserve Fund for various health and human services programs for FY 2004-2005. (SB3068 HD1)

THE SENATE

S.B. NO.

3068

TWENTY-SECOND LEGISLATURE, 2004

S.D. 2

STATE OF HAWAII

H.D. 1


 

A BILL FOR AN ACT

 

RELATING TO STATE FUNDS.

 

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

SECTION 1. The legislature finds that expenditures from the emergency and budget reserve fund established by section 328L-3, Hawaii Revised Statutes, are needed to meet the emergency economic situation currently facing the State. The legislature determines that the moneys are urgently needed to maintain levels of programs that are essential to the public health, safety, and welfare. The legislature further finds that the grants and subsidies under this Act are in the public interest and serve the public health, safety, and welfare.

PART I

SECTION 2. The legislature finds that the Hawaii poison hotline is part of a national poison prevention network that connects the public directly to specially trained pharmacists and nurses to help manage poison exposure and answer poison related questions twenty-four hours a day. Currently, the hotline receives twelve thousand calls a year. Through the hotline, the staff is able to provide early management of poisoning cases, precluding the need for an emergency services visit or response. Additionally, the hotline provides professional toxicology consultative services twenty-four hours a day at no charge to hospitals, other acute care health facilities, and health care providers.

The purpose of this part is to appropriate funds to the department of health for the Hawaii poison hotline.

SECTION 3. There is appropriated out of the emergency and budget reserve fund the sum of $200,000 or so much thereof as may be necessary for fiscal year 2004-2005 pursuant to chapter 103F, Hawaii Revised Statutes, to enable the department of health to operate a hospital-based poison center twenty-four hours a day.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART II

SECTION 4. The legislature finds that the Kauai community health center is one of Hawaii's newest community health centers, serving individuals in Kauai county who live below two hundred per cent of the federal poverty level. The legislature further finds that the center provides comprehensive medical services, including dental services, which help to alleviate the high rates of dental disease. Establishment of the center provided better access to much needed health and dental services by the poor and uninsured of Kauai county.

The purpose of this part is to ensure that the dental program at the Kauai community health center has sufficient resources to continue to serve the residents of Kauai county.

SECTION 5. There is appropriated out of the emergency and budget reserve fund the sum of $50,000 or so much thereof as may be necessary for fiscal year 2004-2005 as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, for dental services at Kauai community health center.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART III

SECTION 6. The legislature finds that Act 263, Session Laws of Hawaii 1996, authorized the transfer of the Hana medical center from the State to the Hana Community Health Center in July 1997, with a guarantee to continue providing needed financial support for the center's essential medical programs. The Hana community would not have accepted this transfer without the commitment to ensure the center's continued viability.

The legislature further finds that Hana is one of the most isolated areas in the State. During the rainy season from October to March, the frequent storms often wash out the roadways and disrupt electricity and telephone service. Hana town is fifty-seven miles from Wailuku, and the trip takes two hours along a single lane road with six hundred seventeen turns and fifty-six one-lane bridges. The district is made up of small, isolated settlements scattered over more than two hundred square miles. Many of the villages are located a minimum of forty-five minutes from the main town of Hana.

The Hana Community Health Center provides a hybrid of services. Unlike most clinics, the center must also coordinate activities with the ambulance services and provide assistance in stabilizing patients with life-threatening illnesses or traumatic injuries. These services are required twenty-four hours a day because the center is the only health care provider in the district. The coordination of emergency services and provision of life support care is absolutely essential to the three thousand residents of Hana and the five hundred thousand tourists who visit annually.

Hana also has some of the worst health and socioeconomic indicators in the State. Native Hawaiians account for sixty-five per cent of all the center's patients. Hana is federally designated as a medically underserved population, dental underserved population, and as a health professional shortage area. The center currently provides prevention-oriented health care, acute and chronic care, urgent care, limited laboratory testing, limited x-ray services, and prepackaged medications in lieu of a full pharmacy. A greatly reduced level of home health care is also provided, and seniors and those with mobility problems have benefited from this program.

In fiscal year 2001-2002, the center provided medical care to one thousand five hundred forty-nine patients, who made four thousand eight hundred nineteen visits, an increase of almost seven per cent from the previous fiscal year. Visitors accounted for twenty-five per cent of the patients, all of whom required urgent or emergency care. Almost nineteen per cent of the patients served did not have health insurance, and twenty per cent of the patients receiving care were insured through a medicaid or medicare health plan.

Dental care was initiated in October 1999 with the financial support of private foundations. The center provided dental services to two hundred twenty-seven patients, who made four hundred twenty-eight visits to the dentist between October 1999 and June 2000. Forty per cent of those dental patients were children and adolescents. One-third of patients served had no dental insurance, and twenty-one per cent of those receiving care were insured through a medicaid dental plan.

In March 2000, through a small federal grant, the center started "Mai E Ai", a lunch program for seniors age sixty years or older. Based on the traditional Hawaiian diet, a "local style" cooking, healthy meals prepared mostly from food available in the Hana district are served three days a week. Mai E Ai includes a physical fitness program before lunch and transportation to and from the program for kupuna in need. Home delivered meals are provided for those seniors unable to participate in the program due to physical limitations. Between March 20, 1999 and June 30, 2000, Mai E Ai served four hundred eighty congregate meals and one hundred ninety-eight home delivered meals to thirty-five kupuna.

When the center was operating as the Hana medical center as part of the State's community hospitals system, it required a subsidy of approximately $1,500,000 annually. Immediately upon transfer of the Hawaii health systems corporation in fiscal year 1997-1998, the legislature reduced its appropriation for the center's operations to $1,064,000. This was a thirty per cent reduction in funding in its first year of operation. In fiscal year 1998-1999, the legislature appropriated $800,000 for the operation of the center, $264,000 less than the amount appropriated the year before, or a second reduction of twenty-five per cent in the center's second year of operation. In the following year, the legislature appropriated $750,000 for operations, a further reduction of six per cent during the center's third year of operation. In fiscal year 2000-2001, the legislature maintained the appropriation at the $750,000 level. This amount is at least fifty per cent less than the cost of operations before the transfer to the center, or $617,300 less than what it cost the State to operate. The center operated at a $123,536 deficit in fiscal year 1998-1999 and a $53,463 deficit in fiscal year 1999-2000, which was covered by a $243,000 bank loan.

The center has demonstrated an ability to generate funds from a variety of funding sources for the initiation of new programs and services. However, State support will always be required to fund core medical services. This is a fact recognized by the state administration and the legislature prior to privatization.

The purpose of this part is to appropriate funds to the Hana Community Health Center to allow it to continue its current level of operations.

SECTION 7. There is appropriated out of the emergency and budget reserve fund the sum of $700,000 or so much thereof as may be necessary for fiscal year 2004-2005 as a subsidy, pursuant to chapter 42F, Hawaii Revised Statutes, to the Hana Community Health Center for operational expenses.

PART IV

SECTION 8. Molokai General Hospital is the only hospital on the island of Molokai and serves a population of approximately seven thousand residents. The hospital is a thirty-bed facility with fourteen acute care and sixteen long-term care beds. It provides twenty-four hour emergency care, urgent care, acute medical and pediatric inpatient care, low risk midwifery care, radiology services, ultrasound services, laboratory services, respiratory therapy, and physical therapy.

Although Molokai General Hospital is not a state hospital, it receives a monthly subsidy from the State, as a community hospital, and also receives aid from the county of Maui and federal grants and contracts. Molokai General Hospital receives most of its financial and management support as a subsidiary of Queen's Health Systems. However, because of the Queen's Health Systems' recent decrease in revenues, Molokai General Hospital's financial support has been severely affected. Thus, Molokai General Hospital must rely on increased financial support from the State, the county of Maui, and federal grants.

The purpose of this part is to provide financial support to Molokai General Hospital for its operating costs.

SECTION 9. There is appropriated out of the emergency and budget reserve fund the sum of $750,000 or so much thereof as may be necessary for fiscal year 2004-2005 as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, for the operating costs of Molokai General Hospital.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART V

SECTION 10. The legislature finds that donated dental services have been in operation since 1986 when the National Foundation for Dentistry for the Handicapped started the first donated dental services program in Colorado for individuals who are elderly, disabled, or medically compromised. This program links eligible individuals with volunteer dentists who provide needed dental care services. The National Foundation for Dentistry for the Handicapped is a charitable affiliate of the American Dental Association.

The legislature further finds that Hawaii is one of thirty-three states implementing a donated dental services program. The program began in January 2002 and is administered by the department of health, through the state council on developmental disabilities. Since the program started, thirty-seven individuals received completed dental care services with a total value of completed treatment of $81,550. The program involves fifty-eight volunteer dentists and twenty volunteer dental laboratories. However, without additional financial support, the donated dental services program in Hawaii is scheduled to end on March 31, 2004.

In an effort to address and support the dental care needs of people who are elderly, disabled, or medically compromised in Hawaii, the legislature appropriated $83,320 to the program for two previous fiscal years. There is a need to financially support the donated dental services program in order to implement the program for the next fiscal year 2004-2005. The purpose of this part is to appropriate funds to continue implementation of the donated dental services program in Hawaii.

SECTION 11. There is appropriated out of the emergency and budget reserve fund the sum of $30,765 or so much thereof as may be necessary for fiscal year 2004-2005 as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, for the donated dental services program in Hawaii.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART VI

SECTION 12. The legislature finds that community health centers and clinics provide much needed, high quality primary health care services to Hawaii's rural communities. These health centers are safety net providers of quality primary care services to all, on a sliding scale, regardless of insurance status or ability to pay. These facilities include the Kahuku Hospital on Oahu, the Molokai General Hospital, and the Hana Community Health Center on Maui among others. To cover the operational costs of providing quality care, community health centers generally rely on funding from a number of sources including federal and state funding, as well as from private grants.

The legislature further finds that the Waianae Coast Comprehensive Health Center is of particular concern. The forty thousand residents of Waianae, Oahu, due to their isolated location, rely heavily on the emergency medical services of the Waianae Coast Comprehensive Health Center, as the nearest emergency room is twenty miles away at St. Francis-West. The Waianae health center has only one ambulance and a twenty-four-hour emergency room. The lack of resources has considerable consequences for Waianae residents and visitors alike. The twenty-four-hour emergency room at the Waianae Coast Comprehensive Health Center may be closed unless continued legislative support is received.

The purpose of this part is to appropriate funds to cover operating costs of the twenty-four-hour emergency room at the Waianae Coast Comprehensive Health Center.

SECTION 13. There is appropriated out of the emergency and budget reserve fund sum of $750,000 or so much thereof as may be necessary for fiscal year 2004-2005 as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, for emergency services at the Waianae Coast Comprehensive Health Center.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART VII

SECTION 14. The legislature finds that Hawaii's community health centers provide family-oriented, high quality primary medical, dental, and behavioral health care services for people living in rural and urban medically underserved communities. These health centers exist in areas where economic, geographic, or cultural barriers limit access to primary health care for a substantial portion of the population, and they tailor services to the needs of the community. Such centers include: the Hana Community Health Center and Community Clinic of Maui; the Hamakua Health Center and Bay Clinic on the island of Hawaii; and the Kokua Kalihi Valley Comprehensive Family Services, Queen Emma Clinics, and the Kalihi-Palama, Waikiki, Waimanalo, and Waianae Coast Comprehensive Health Centers on Oahu. Residents, neighbor island visitors, and tourists statewide rely on community health centers to provide a wide array of medical services in rural communities.

The legislature further finds that the estimated number of Hawaii residents who do not have health insurance has doubled -- growing from 68,200 in 1996 to 135,900 in 2001. This increase generates a considerable economic impact on the State's hospitals, community health centers, and other participants in the health care industry and threatens their ability to effectively serve the whole community.

The legislature further finds that it is in the best interest of the State to ensure access to primary and preventive health care for its residents. Access to health care gives rise to a healthier population, who can then play a key role in the economic revitalization of our State. Moreover, providing access to care reduces state expenditures attributable to hospital and emergency room services for preventable injuries or illnesses.

SECTION 15. (a) The legislature finds that, while community health centers represent the best system of community-based primary care for uninsured people, financial support for community health centers is inadequate to meet increasing demands. More specifically, community health centers have experienced a forty-one per cent increase in uninsured visits since 1997.

(b) The legislature shall provide cost-effective primary medical, dental, and behavioral care for Hawaii residents who are uninsured, to ensure that the community health center system remains financially viable and stable in the face of a growing population of uninsured. The legislature shall budget for these services as long as this health crisis exists.

SECTION 16. There is appropriated out of the emergency and budget reserve fund the sum of $750,000 or so much thereof as may be necessary for fiscal year 2004-2005 as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, for Kauai Community Health Center.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART VIII

SECTION 17. There is appropriated out of the emergency and budget reserve fund of the State of Hawaii the sum of $200,000 or so much thereof as may be necessary for fiscal year 2004-2005 pursuant to chapter 103F, Hawaii Revised Statutes, for the chore services program.

The sum appropriated shall be expended by the department of human services for the purposes of this part.

PART IX

SECTION 18. There is appropriated out of the emergency and budget reserve fund the sum of $150,000 or so much thereof as may be necessary for fiscal year 2004-2005 pursuant to chapter 103F, Hawaii Revised Statutes, for costs related to homeless assistance.

The sum appropriated shall be expended by the housing and community development corporation of Hawaii for the purposes of this part.

PART X

SECTION 19. There is appropriated out of the emergency and budget reserve fund the sum of $750,000 or so much thereof as may be necessary for fiscal year 2004-2005 as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, to Kahuku hospital to fund the costs of emergency room operations, inpatient and outpatient care for the underinsured, medical malpractice insurance, and labor.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART XI

SECTION 20. There is appropriated out of the emergency and budget reserve fund the sum of $500,000 or so much thereof as may be necessary for fiscal year 2004-2005 as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, for Wahiawa General Hospital to provide indigent care services.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART XII

SECTION 21. There is appropriated out of the emergency and budget reserve fund the sum of $450,000 or so much thereof as may be necessary for fiscal year 2004-2005 pursuant to chapter 103F, Hawaii Revised Statutes, for the department of health to contract with primary health care centers for comprehensive oral health services to underserved children.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART XIII

Section 22. The legislature finds that, with the aging of Hawaii’s population and its changing social, economic, and health condition, the need for more long term care alternatives that are accessible, affordable, and comprehensive is persistent. The existing long term care infrastructure already does not adequately support current needs, and with the aging of the State's baby boomer population, the need to establish additional long term care resources is upon us.

The legislature believes that the State is already lagging behind in support systems that can accommodate the State's frail elders. Geographic, social, economic, and cultural barriers leave a large number of elder and disabled persons without adequate supports. It is imperative that the State develop and test new ways to bring care to the frailest citizens through direct care and support in innovative programs.

The legislature finds that, since 1986, the Program of All-Inclusive Care for the Elderly has been serving the frail elderly in the community by providing comprehensive health care and support services, which keep the elderly healthy and independent at home and avoid the need for costly nursing home care. The Program of All-Inclusive Care for the Elderly model was founded by the renowned On Lok organization in San Francisco, California as an effort to help families avoid placing their elderly in nursing homes. The model not only offered a comprehensive range of services such as adult day care, home care, medical care, nursing, rehabilitation therapies, nutrition, prescription drugs, and transportation, but it was able to demonstrate that these services can be provided at less cost than the traditional institutional care.

The Program of All-Inclusive Care for the Elderly uses a capitated payment system, which pools medicare, medicaid, and private pay funds. This payment system allows the Program of All-Inclusive Care for the Elderly to receive a flat, per-person monthly rate from these sources, without restrictions on services delivery and fee-for-service services limitation. This means that the Program of All-Inclusive Care for the Elderly's interdisciplinary team of health care professionals has the authority and flexibility to provide the services based on the individual person’s health and supportive care needs.

Recognizing the Program of All-Inclusive Care for the Elderly’s cost-effectiveness and its success in keeping the rate of hospitalization and nursing home placements to a minimum, the United States Congress authorized a national demonstration program in 1986 and, in 1997, authorized a "permanent provider" status for Program of All-Inclusive Care for the Elderly-based programs.

Faced with a rapidly growing elder population in Hawaii, an acute shortage of nursing home beds, and the rising cost of long term care, the legislature, in 1991, recognized the need for an alternative community based program that would be comprehensive, prevent institutionalization, and contain long term care cost. Out of this recognition of need, the legislature appropriated start-up funds to establish the Program of All-Inclusive Care for the Elderly in Hawaii through Maluhia hospital, which was formerly under the state department of health, but now under the jurisdiction of the Hawaii health systems corporation. Hawaii's program of all-inclusive care for the elderly provides a complete package of services that enhances the quality of life for the elderly participant and offers the potential to reduce and cap the costs of their medical needs.

The legislature further finds that the services provided by Hawaii's program of all-inclusive care for the elderly costs less than what medicare, medicaid, and private individuals currently pay for long-term institutional care. Since its establishment in the State, Hawaii's program of all-inclusive care for the elderly has served the elderly primarily in metropolitan Honolulu and recently began to serve all eligible seniors on Oahu.

Throughout the country, Program of All-Inclusive Care for the Elderly sites have been established in a predominantly urban community. However, the elderly in the rural communities in the United States are greatly underserved, and do not receive adequate health care and other services that could maintain their independence. The need for programs like the Program of All-Inclusive Care for the Elderly in rural America is great. Compared to their urban counterparts, the rural elderly:

(1) Report worse health status;

(2) Are generally older;

(3) Have more functional limitations;

(4) Are more likely to live alone at age seventy-five and older;

(5) Are more likely to be poor or near poor; and

(6) Are at greater risk of being placed in a nursing home.

The legislature finds that this is also true for the outlying areas of Honolulu, Oahu, as well as throughout the neighbor islands of the State. To establish Programs of All-Inclusive Care for the Elderly in rural areas, however, will require greater creativity, flexibility, and collaboration among providers, regulators, and policy makers. Because there are fewer health care providers and a smaller population of eligible seniors who live in sparsely populated areas and often alone, there are more challenges and obstacles that will face a rural Program of All-Inclusive Care for the Elderly than its urban counterpart.

The legislature also finds that there is a national effort to establish a more flexible Program of All-Inclusive Care for the Elderly model that can be molded for the diverse and unique characteristics of the rural communities. The National Program of All-Inclusive Care for the Elderly Association (Association) is composed of all Program of All-Inclusive Care for the Elderly-based programs and developing sites in the United States. The Association, in cooperation with the National Rural Health Association, has received a contract to provide technical assistance to rural providers in developing Program of All-Inclusive Care for the Elderly-based programs from the United States Department of Health and Human Services’ Health Resources and Services Administration.

In addition, the Association is introducing federal legislation that will give rural Program of All-Inclusive Care for the Elderly-based programs more flexibility from the current provider requirements and is requesting start-up funds for interested providers in these rural communities.

SECTION 23. The Hawaii health systems corporation shall study the feasibility of establishing rural program of all-inclusive care for the elderly-based programs for the outlying areas on Oahu and the neighbor islands. Building on the experience and expertise of the established program of all-inclusive care for the elderly-based program at Maluhia hospital, under the Hawaii health systems corporation, this study shall include:

(1) An assessment of the existing health care resources in the target rural areas;

(2) A market analysis to determine population size, need, and financial viability;

(3) Technical assistance from the National Program of All-Inclusive Care for the Elderly Association or its affiliates, or both, as made available to the Hawaii health systems corporation; and

(4) Processes by which to establish collaborative relationships with other health care providers and health care systems in rural communities.

The Hawaii health systems corporation shall submit a report of its findings and recommendations to the legislature not later than twenty days prior to the convening of the 2005 regular session.

SECTION 24. There is appropriated out of the emergency and budget reserve fund the sum of $50,000 or so much thereof as may be necessary for fiscal year 2004-2005 to study the feasibility of establishing Program of All-Inclusive Care for the Elderly-based programs in rural communities within the State.

The sum appropriated shall be expended by the Hawaii health systems corporation for the purposes of this Act.

PART XIV

SECTION 25. Children and adolescents are usually dependent on parents and caregivers for access to health care to maintain good health. Although most children and adolescents have access to a health care professional or service when they become sick or are injured, many of them, particularly those from poor families or in rural or isolated communities, are at risk for multiple health problems because they lack health insurance or access to a primary care provider.

Indigent children may experience two to three times the usual incidence of certain medical conditions, many of which are preventable. Even adolescents who have health insurance and a primary care provider do not readily seek medical care, and their parents or caregivers find it difficult to maintain their teenagers' regular visits to the doctor.

The most common health problems affecting children and adolescents today include injuries, chronic illnesses such as asthma, and mental health problems. In addition, adolescents and pre—adolescents are now engaging more frequently in risky behaviors and unhealthy lifestyles that may lead to more health problems as adults, including smoking, drinking alcohol, unsafe sex, and the abuse of illegal drugs, such as crystal methamphetamine, otherwise known as "ice."

Since all children and adolescents are required to attend school, school-based health services would encourage students, especially adolescents, to access care or information because these services would be readily available at little or no cost, and an adult would not have to "hold their hand." School-based student health services would also encourage students to seek mental health services, and alcohol and substance abuse counseling because they would be provided in a nonthreatening, "nonlabeling," and nonstigmatizing venue, as part of an array of services. As such, school-based student health services can play a strategic role in the delivery of school-based mental health assessments, day treatment, and mental health services required under the Felix v. Cayetano consent decree.

The legislature finds that school-based or school-linked health services enhanced and supported by services provided by community agencies are an important component of the comprehensive, multifaceted, integrated approach necessary to prevent and treat adolescent health problems. However, the legislature recognizes that an integrated approach requires more than outreach services that link youth to community resources, the coordination of school-based services, and the establishment of family resource centers and full-service schools. To meet the needs of all students, community input and investment are also required to identify and develop an array of school and community programs that reflect the needs and values of the community. Collaboration, communication, and cooperation between the school, parents, students, community agencies, and organizations are essential to successfully establish school-based student health services and ensure a seamless system of prevention, early intervention, treatment, and follow-up.

The purpose of this Part is to provide children and adolescents access to quality, affordable health care in an environment that is convenient, nonthreatening, and encouraging, by establishing a school-based student health services program.

SECTION 26. (a) The department of health, in collaboration with the department of education and department of human services, shall establish a school-based student health services program to complement the department of education's comprehensive school support services program. Within five years of the effective date of this Act, at least one student health services project shall be established in each school district, with no fewer than one student health services project in each of the departmental school complexes.

(b) In establishing the student health services program, the director of health, director of human services, and superintendent of education shall draft and sign a memorandum of agreement to establish and operate a school-based student health services program that complements the comprehensive school support services program. The school-based student health services program shall:

(1) Be student-centered;

(2) Fully integrate health-related services with other program components designed to:

(A) Facilitate development and learning; and

(B) Maximize and manage resources;

(3) Integrate school—centered resources;

(4) Integrate school and community resources; and

(5) Use to the fullest extent, available funding sources including:

(A) Medicaid, the medicaid early and periodic screening, diagnostic, and treatment program, and QUEST;

(B) Special education and the child and adolescent mental health division of the department of health;

(C) General funds; and

(D) Community resources, including agencies, foundations, grants, donations, and volunteers.

(c) The comprehensive student health services project may include the following components:

(1) Health education, including medically accurate, factually based sex education;

(2) Physical education and physical fitness;

(3) Health services;

(4) Nutrition services;

(5) Counseling, psychological, and social services;

(6) Substance and alcohol abuse counseling;

(7) Healthy school environment;

(8) Health promotion for staff;

(9) Parent and community involvement; and

(10) Mental health assessments and services.

The school-based student health services project shall not promote, provide referrals to, or provide abortions or abortion-related services on site.

(d) Prior to the establishment and operation of a student health services project, the superintendent of education and the school and community—based management council, in consultation with at least one hospital, community health center, or health care professional with a practice in the community, shall establish policies for the operation of the project, including:

(1) Procedures for obtaining the consent of a parent or guardian;

(2) Application of the program to persons needing financial assistance;

(3) Confidentiality of records;

(4) Financial responsibility;

(5) Limitation of liability; and

(6) Personnel.

SECTION 27. (a) The department of health, in collaboration with the department of education and the department of human services' office of youth services, shall convene a joint planning committee to plan and coordinate the provisions for school-based student health services that will complement the department of education's comprehensive school support services program.

(b) The director of health, director of human services, and superintendent of education shall designate members of their respective departments to sit on the joint planning committee to carry out the purposes of this Act. The planning committee may also include representatives of the following:

(1) The legislature;

(2) The board of education;

(3) Counselors;

(4) Students;

(5) Public employee labor unions;

(6) The Hawaii State Parent Teacher Student Association;

(7) Community health centers;

(8) The American Pediatric Society;

(9) Mental health providers;

    (10) Medical providers;

    (11) Dental services providers, including dental hygienists; and

    (12) Public health nurses.

SECTION 28. (a) The joint planning committee shall report its plan for the establishment and implementation of a school-based student health services program that complements the comprehensive school services program and other student support programs and services, to the legislature no later than twenty days prior to the convening of the regular session of 2005.

(b) The director of health, in collaboration with the director of human services and superintendent of education, shall report to the legislature on the experience of each comprehensive school-based student health services project no later than twenty days prior to the convening of the regular session of 2006. The report shall include:

(1) The policies of each comprehensive student health services project;

(2) The number of students served and the types of health services provided;

(3) The operating cost, including income collected through fees, monetary donations, private grants, and in—kind services;

(4) Quantifiable changes in high—risk behaviors among students receiving services;

(5) Benchmarks for physical and mental health and increases in positive outcomes for children and adolescents;

(6) The number of uninsured students served;

(7) The number of students who are referred for alcohol and substance abuse treatment or counseling;

(8) The number of students referred to their physicians or other specialists;

(9) Recommended changes to improve the program; and

(10) Any other information that the departments of health, human services, and education may determine to be necessary to assist the legislature in evaluating the efficacy and cost-effectiveness of the program.

SECTION 29. There is appropriated out of the emergency and budget reserve fund the sum of $750,000 or so much thereof as may be necessary for fiscal year 2004—2005 for comprehensive student health services.

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

PART XV

SECTION 30. The legislature finds that the cost to purchase medical malpractice and hospital liability coverage continues to rise and that stability in risk financing is needed for Hawaii health systems corporation, the department of health, and the John A. Burns school of medicine (JABSOM). The escalating costs of premiums, the lack of insurers providing hospital and medical malpractice liability coverage in Hawaii, the decreasing limits of coverage available, and coverage restrictions, make it important to establish a captive insurance company to insure and control exposure to these liability risks.

SECTION 31. The purpose of this Part is to authorize the Hawaii health systems corporation to organize a domestic captive insurance company to be created by the Hawaii health systems corporation, which when established, may provide malpractice coverage to the department of health, the John A. Burns School of Medicine, and other governmental entities or quasi-governmental entities of the State of Hawaii involved in the provision of health care. To organize the captive insurer, Hawaii health systems corporation shall prepare a formalized business plan and application to be submitted to the insurance division for review and approval, and a formalized financial plan to be submitted to the director of finance for review and approval.

SECTION 32. Notwithstanding the provisions of section 43l:19-10l as it defines "Affiliated company," medical malpractice insurance coverage may be provided by the captive to other governmental entities of the State of Hawaii, quasi- governmental entities of the State of Hawaii, other healthcare entities financially associated with the State of Hawaii and the physicians providers who are employees or on the medical staff of such entities.

SECTION 33. There is appropriated out of the emergency and budget reserve fund the sum of $11,000,000 or so much thereof as may be necessary for fiscal year 2004—2005 for uncompensated care and costs relating to the start-up of the captive insurance company.

The sum appropriated shall be expended by the Hawaii health systems corporation for the purposes of this Act.

PART XVI

SECTION 34. This Act shall take effect on July 1, 2004.