Honolulu, Hawaii



RE:     H.B. No. 1453

        H.D. 1

        S.D. 1




Honorable Ronald D. Kouchi

President of the Senate

Thirtieth State Legislature

Regular Session of 2019

State of Hawaii




     Your Committee on Commerce, Consumer Protection, and Health, to which was referred H.B. No. 1453, H.D. 1, entitled:




begs leave to report as follows:


     The purpose and intent of this measure is to allow the Department of Health to:


     (1)  Establish fees to be collected from individuals who are transported by ambulance to a medical facility or who receive emergency medical services by emergency medical services personnel without being transported to a medical facility; and


     (2)  Adopt rules permitting transportation by ambulance to medical facilities other than hospital emergency departments.


     Your Committee received testimony in support of this measure from the Department of Health, City and County of Honolulu Emergency Medical Services Department, Hawaii Medical Service Association, American Medical Response, and five individuals.


     Your Committee finds that currently, 911 emergency medical patients are only transported to facilities designated as hospitals, with one exception.  However, not all patients who receive emergency medical services need to go to the hospital.  Your Committee further finds that emergency medical services have only been reimbursable if the patient is ultimately transported to a medical facility.  Data shows that there has been a consistent increase each year in the proportion of patients treated but not transported.  These patients essentially receive care free of charge at a time when the cost of quality health care continues to increase.


     Your Committee further finds that the paradigm of emergency medical services charging fees only when the end product is transport to an emergency room incentivizes inappropriate use of transport assets and emergency departments.  Many patients that utilize emergency medical services do not require hospitalization, and allowing emergency medical services to work with patients and community partners to develop and employ more customized care plans will provide more appropriate patient care while reducing the burden on emergency medical services and hospital resources.


     Your Committee has amended this measure by:


     (1)  Requiring private insurance coverage of ambulance services and statewide community paramedicine services rendered by emergency medical technicians or paramedics;


     (2)  Requiring the State's Medicaid program to provide coverage for ambulance services and the option of providing coverage for statewide community paramedicine services rendered by emergency medical technicians or paramedics;


     (3)  Clarifying that individuals receiving treatment from emergency medical services personnel can be charged fees when the services are provided as part of a community paramedicine program;


     (4)  Specifying that the emergency medical services fees collected pursuant to this measure be deposited to the credit of the emergency medical services special fund; and


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


     As affirmed by the record of votes of the members of your Committee on Commerce, Consumer Protection, and Health that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 1453, H.D. 1, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 1453, H.D. 1, S.D. 1, and be referred to your Committee on Ways and Means.


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