Honolulu, Hawaii


RE: S.B. No. 1076

S.D. 1




Honorable Ronald D. Kouchi

President of the Senate

Twenty-Ninth State Legislature

Regular Session of 2017

State of Hawaii




Your Committees on Commerce, Consumer Protection, and Health and Judiciary and Labor, to which was referred S.B. No. 1076 entitled:




beg leave to report as follows:


The purpose and intent of this measure is to:


(1) Require all healthcare facilities, when transferring a patient to another healthcare facility via air ambulance for receiving continuing or higher level care, to first request transport services from an air ambulance that is contracted with the patient's health carrier;


(2) Require notification if a non-contracted air ambulance service is utilized;


(3) Establish exceptions to ensure patient safety; and


(4) Establish a procedure for dispute resolution.


Your Committees received testimony in support of this measure from Kaiser Permanente and two individuals. Your Committees received testimony in opposition to this measure from the Department of Health, Kona Community Hospital, and Hawaii Life Flight Corporation. Your Committees received comments on this measure from the Hawaii Medical Association, Hawaii Pacific Health, Healthcare Association of Hawaii, Hawaii College of Emergency Physicians, The Queen's Health Systems, Castle Medical Center, and Hawaii Medical Service Association.


Your Committees find that healthcare needs sometimes require that a patient be transferred to another healthcare facility in order to receive continuing care or a higher level of care, and that because of Hawaii's unique geography, transfer to another facility in Hawaii often requires air ambulance services. Your Committees find that these air ambulance transfers require specialized equipment and technology and can be very costly.


Your Committees further find that when a patient is transported using an air ambulance service that does not contract with the covered patient's health insurance carrier, the health carrier determines an appropriate payment for the air ambulance provider, and the patient is expected to cover the difference between what the provider charged and what the health carrier pays. This process places the patient between the health carrier and the non-contracted air ambulance service when the non-contracted air ambulance service bills the patient for the difference. Your Committees find that this balance billing practice causes a significant financial burden on patients.


Your Committees recognize the complexity involved with the issue of balance billing, and appreciate the demonstrated collaboration on this issue by stakeholders in the community.


Your Committees have considered the testimony submitted and amended this measure by:


(1) Inserting the new chapter related to transfers utilizing air ambulance services providers into Title 24, Hawaii Revised Statutes, related to insurance, instead of creating a new part within chapter 321, Hawaii Revised Statutes;


(2) Deleting the definition of "notification";


(3) Deleting the requirement that notice provided to the health carrier by the transferring facility of use of a non-contracted air ambulance service be prior to commencing the transfer;


(4) Deleting provisions related to the dispute resolution process; and


(5) Making technical, nonsubstantive amendments for the purposes of clarity and consistency.


As affirmed by the records of votes of the members of your Committees on Commerce, Consumer Protection, and Health and Judiciary and Labor that are attached to this report, your Committees are in accord with the intent and purpose of S.B. No. 1076, as amended herein, and recommend that it pass Second Reading in the form attached hereto as S.B. No. 1076, S.D. 1, and be referred to your Committee on Ways and Means.


Respectfully submitted on behalf of the members of the Committees on Commerce, Consumer Protection, and Health and Judiciary and Labor,