STAND. COM. REP. NO. 979

                                   Honolulu, Hawaii
                                                     , 1999

                                   RE:  H.B. No. 743
                                        H.D. 3
                                        S.D. 1




Honorable Norman Mizuguchi
President of the Senate
Twentieth State Legislature
Regular Session of 1999
State of Hawaii

Sir:

     Your Committee on Commerce and Consumer Protection, to which
was referred H.B. No. 743, H.D. 3, entitled: 

     "A BILL FOR AN ACT RELATING TO ADVANCED PRACTICE REGISTERED
     NURSES,"

begs leave to report as follows:

     The purpose of this measure is to require that services
provided by advanced practice registered nurses be reimbursable
under health care plans, and as workers' compensation and
personal injury protection benefits.

     The Department of Health, the Hawaii Nurses' Association,
Hawaii Nurse-Midwives, the Hawaii Medical Service Association,
Kaiser Permanente, and an individual presented testimony in
support of this measure.  The Hawaii Government Employees
Association and four individuals, though not present at the
hearing, submitted written testimony in support of the measure.
State Farm Insurance Companies and the Hawaii Insurers Council,
presented testimony in opposition to the measure. 

     Your Committee finds that numerous studies, including a 1989
study conducted by the United States Office of Technology
Assessment, have documented the provision of safe, quality, and
cost-effective primary care services by advanced practice
registered nurses (APRNs).  


 
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     Your Committee further finds that sixteen states include
APRNs as providers under health plans.  In Hawaii, APRNs are
recognized as providers under the federal Medicare and Medicaid
programs, and some categories of APRNs are recognized as
providers under the State's QUEST program.  Passage of this
measure would ensure that consumers wishing to utilize the
services of APRNs would be able to have the cost of these
services covered under their health care plans, or as workers'
compensation or personal injury protection benefits.  

     Your Committee has amended this measure by replacing its
contents with the contents of S.B. No. 215.  As amended, this
measure:

     (1)  Adds a new section to chapter 431:10A, Hawaii Revised
          Statutes (HRS), instead of amending section 431:10A-
          116, HRS, to include services provided by APRNs as
          reimbursable services under health insurance plans; 

     (2)  Requires that mutual benefit societies provide
          "coverage and equitable reimbursement for services of
          advanced practice registered nurses as recognized in
          section 457-8.5", rather than "reasonable reimbursement
          for health plan covered services provided by advanced
          practice registered nurses"; 

     (3)  Includes APRNs under the workers' compensation law by
          amending the definition of "health care provider",
          rather than the definitions of "medical care", "medical
          services", or "medical supplies" under section 386-1,
          HRS;

     (4)  Amends section 386-27, HRS, to include APRNs as
          qualified health care providers; and

     (5)  Amends chapter 432D, HRS, to include services provided
          by APRNs as covered services under health maintenance
          organization health care plans.

     As affirmed by the record of votes of the members of your
Committee on Commerce and Consumer Protection that is attached to
this report, your Committee is in accord with the intent and
purpose of H.B. No. 743, H.D. 3, as amended herein, and
recommends that it pass Second Reading in the form attached
hereto as H.B. No. 743, H.D. 3, S.D. 1, and be referred to the
Committee on Ways and Means.


 
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                                   STAND. COM. REP. NO. 979
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                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Commerce and
                                   Consumer Protection,



                                   ______________________________
                                   BRIAN KANNO, Co-Chair



                                   ______________________________
                                   BRIAN T. TANIGUCHI, Co-Chair

 
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