Honolulu, Hawaii


RE: H.B. No. 658

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. 658, H.D. 1, entitled:




begs leave to report as follows:


The purpose and intent of this measure is to include advanced practice registered nurses within certain rules adopted by the Department of Health.


Your Committee received testimony in support of this measure from the American Nurses Association in Hawaii, Hawaii Association of Professional Nurses, Hawaii Health and Harm Reduction Center, and fourteen individuals. Your Committee received comments on this measure from the Department of Health, Hawaii State Center for Nursing, and one individual.


Your Committee finds that advanced practice registered nurses (APRNs) have played an important role in addressing the health care access gap in Hawaii. APRNs have strict certification and licensing requirements and are permitted to work as independent providers, open their own practices, and be leaders in large organizations to help meet the growing needs of Hawaii residents. Your Committee notes that in some circumstances, private and publicly funded programs are required to have oversight by a medical director. However, despite their high level of training and the critical role APRNs play in Hawaii's health care system, APRNs are not included in Department of Health rules that would allow them to serve as medical directors and other medical leadership positions.


While your Committee is in support of exploring the feasibility of APRNs serving as medical directors and in other medical leadership roles, your Committee has concerns with this measure as currently drafted, as it is structurally awkward, lacks a purpose section to provide intent, and creates potential unintended consequences, such as non-compliance with federal requirements. Your Committee finds that consultation among stakeholders and further research are necessary to determine when APRNs should be eligible to serve in medical leadership positions and to produce a tailored measure allowing APRNs to serve as medical directors and similar medical leadership positions while identifying any exceptions, federal regulations, or other circumstances in which that eligibility may be inappropriate.


Accordingly, your Committee has amended this measure by deleting its contents and inserting language to:


(1) Include a purpose section;


(2) Establish the advanced practice registered nurse medical leadership working group (working group) to be convened by the Department of Health and chaired by the Director of Health;


(3) Specify that the working group is to research and make recommendations regarding APRNs' eligibility for medical leadership positions and identify any circumstances where that eligibility may be inappropriate;


(4) Require the working group to report its findings and any proposed legislation to the Legislature prior to the 2020 Regular Session; and


(5) Change its effective date to upon approval.


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. 658, H.D. 1, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 658, H.D. 1, S.D. 1, and be placed on the calendar for Third Reading.


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