HOUSE OF REPRESENTATIVES

H.B. NO.

2525

THIRTIETH LEGISLATURE, 2020

H.D. 1

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to homelessness.

 

 

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

 


     SECTION 1.  The legislature finds that the State has one of the highest rates of homelessness per capita in the nation.  Additionally, the legislature finds that The Queen's Medical Center provides the majority of medical care to the State's homeless population.  According to the Laulima Data Alliance, from January 2016 to September 2018, The Queen's Medical Center experienced approximately sixty per cent of all homeless visits on Oahu and forty-three per cent of all homeless visits in the State.

     Recognizing the high needs of the State's most medically fragile homeless populations, the legislature established the emergency department homelessness assessment pilot program and the medical respite pilot program through Act 209, Session Laws of Hawaii 2018.  Through contracts with the department of human services, The Queen's Medical Center was able to provide medical respite services and intense care navigation services to patients experiencing homelessness or patients at risk of experiencing homelessness.

     Through the emergency department homelessness assessment pilot program, the Queen's Care Coalition was able to identify homeless patients with high utilization of emergency department services and deliver short-term, post-discharge navigation services to special populations to reduce reliance on acute care by connecting patients to community services.  The Queen's Care Coalition provided one hundred thirty-one homeless adults with navigation services during the contract period of September 1, 2018, to June 30, 2019.  Of the homeless adults served:

     (1)  Ninety-four per cent were connected with community resources;

     (2)  Sixty-five per cent were document ready for housing; and

     (3)  Ninety-two per cent of the individuals that were connected to permanent housing were able to maintain their permanent housing after three months.

The emergency department homelessness assessment pilot program, as executed by the Queen's Care Coalition, was able to reduce:

     (1)  The number of unnecessary emergency department visits by thirty-nine per cent;

     (2)  The number of hospitalized days by seventeen per cent; and

     (3)  The amount of ambulance utilization by fifty-three per cent.

     The legislature further finds that Queen's Care Coalition had significant cost saving to three major Med-QUEST managed care plans.  Analysis on total cost of care pre- and post-Queen's Care Coalition has found an average of thirty-nine per cent reduction in total cost of care.

     The National Health Care for the Homeless Council recognizes medical respite as a needed service and response to the circumstances that people experiencing homelessness face.  These individuals suffer profound disparities in health and mortality compared to the general population.  After an acute care stay, recovery is extremely difficult on the streets, while shelters generally are not equipped to support people who are sick or injured.

     The need for medical respite care for individuals experiencing homelessness is a critical part of the continuum of care for this population.  Through a partnership with the Institute for Human Services, The Queen's Medical Center is able to provide medical respite to homeless patients who have been discharged and may need additional time to heal in a more appropriate level of care setting.

     The legislature also finds that the emergency department homelessness assessment pilot program has demonstrated positive results in delivering care coordination services, by a multidisciplinary team, to mitigate the number of unnecessary emergency department visits by patients experiencing homelessness or patients at risk of experiencing homelessness and merits continuation.  Additionally, the legislature finds that the medical respite pilot program has demonstrated positive results in delivering medical respite services for eligible individuals experiencing homelessness by providing services such as meals; case management; and medical, nursing, and psychiatric care and merits continuation.

     Furthermore, the legislature finds that the department of human services supports the continuation of both programs and is in the process of transitioning the programs from the department's homeless program office to the department's Med-QUEST division.

     Finally, the legislature notes that given that the pilot programs' funding ends on June 30, 2020, additional supports are necessary to ensure no lapse in resources for the emergency department homelessness assessment pilot program and medical respite pilot program, as they are transitioned to the Med-QUEST division.

     The purpose of this Act is to:

     (1)  Extend the emergency department homelessness assessment pilot program and medical respite pilot program to December 31, 2021; and

     (2)  Appropriate funds for the pilot programs.

     SECTION 2.  Act 209, Session Laws of Hawaii 2018, section 7, as amended by Act 128, Session Laws of Hawaii 2019, section 1, is amended as follows:

     1.  By amending subsection (c) to read:

     "(c)  The department of human services shall work with the participating hospital under the emergency department homelessness assessment pilot program to collect and analyze data to be included in a report that contains a summary and explanation of the data regarding the efficacy of emergency department intervention by the multidisciplinary team in mitigating the number of unnecessary emergency department visits by patients experiencing homelessness or patients at risk of experiencing homelessness.  The report shall contain findings and recommendations, including any proposed legislation, for continuation, modification, or termination of the pilot program.  The department of human services shall submit the report to the legislature no later than twenty days prior to the convening of the regular [session] sessions of 2020[.] and 2021."

     2.  By amending subsection (e) to read:

     "(e)  The emergency department homelessness assessment pilot program shall cease to exist on [June 30, 2020.] December 31, 2021."

     SECTION 3.  Act 209, Session Laws of Hawaii 2018, section 9, as amended by Act 128, Session Laws of Hawaii 2019, section 1, is amended as follows:

     1.  By amending subsection (c) to read:

     "(c)  The department of human services shall submit a report to the legislature of its findings and recommendations, including any proposed legislation, regarding the pilot program no later than twenty days prior to the convening of the regular [session] sessions of 2020[.] and 2021."

     2.  By amending subsection (e) to read:

     "(e)  The medical respite pilot program shall cease to exist on [June 30, 2020.] December 31, 2021."

     SECTION 4.  There is appropriated out of the general revenues of the State of Hawaii the sum of $500,000 or so much thereof as may be necessary for fiscal year 2020-2021 for the department of human services to continue the emergency department homelessness assessment pilot program; provided that:

     (1)  The department of human services shall reimburse the participating hospital for expenses directly related to the emergency department homelessness assessment pilot program;

     (2)  No funds shall be disbursed to a participating hospital unless matched on a dollar-for-dollar basis by the participating hospital; and

     (3)  All funds designated as matching funds by the participating hospital shall be funds expended by the participating hospital for the pilot program.

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

     SECTION 5.  There is appropriated out of the general revenues of the State of Hawaii the sum of $500,000 or so much thereof as may be necessary for fiscal year 2020-2021 for the department of human services to continue the medical respite pilot program; provided that:

     (1)  The department of human services shall reimburse a participating hospital for expenses directly related to the medical respite pilot program;

     (2)  No funds shall be disbursed to a participating hospital unless matched on a dollar-for-dollar basis by the participating hospital; and

     (3)  All funds designated as matching funds by the participating hospital shall be funds expended by the participating hospital for the pilot program.

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

     SECTION 6.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 7.  This Act shall take effect on December 31, 2059; provided that sections 4 and 5 shall take effect on July 1, 2020.


 


 

Report Title:

DHS; Emergency Department Homelessness Assessment Pilot Program; Medical Respite Pilot Program; Appropriation

 

Description:

Extends the emergency department homelessness assessment pilot program and medical respite pilot program to December 31, 2021.  Appropriates funds.  Effective December 31, 2059.  (HD1)

 

 

 

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