Allows a patient's "next of kin" access to the patient's records. Allows the disclosure of a mental health patient's medical records for insurance reimbursement claim purposes. Makes appropriations from the emergency and budget reserve fund for various programs, services, and projects essential to public health, safety, and welfare. (SD1)

A BILL FOR AN ACT

PART I

SECTION 1. The legislature finds that existing law does not allow a patient's spouse and relatives to access medical records without a power of attorney or similar instrument. This situation becomes more problematic when the patient is deceased. In addition, when the privacy provisions of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) take effect, health care providers will not be allowed to provide any person access to the medical records of a patient without legal authorization.

A deceased individual's spouse or relative may require access to the medical records for death certificate, insurance, and other purposes, but may not have authority to access the records under existing Hawaii law without an acceptable legal instrument. In many cases, spouses and relatives do not possess such an instrument that extends beyond the death of the individual. A state "next of kin" statute will resolve that problem.

The purpose of this part is to allow a patient's "next of kin" access to the patient's records.

SECTION 2. Section 622-57, Hawaii Revised Statutes, is amended to read as follows:

"§622-57 Availability of medical records. (a) If a patient of a health care provider as defined in section 671-1, requests copies of [his or her] the patient's medical records, the copies shall be made available to the patient unless in the opinion of the health care provider it would be detrimental to the health of the patient to obtain the records. If the health care provider is of the opinion that release of the records to the patient would be detrimental to the health of the patient, the health care provider shall advise the patient that copies of the records will be made available to the patient's attorney upon presentation of a proper authorization signed by the patient.

(b) If an attorney for a patient asks a health care provider for copies of the patient's medical records and presents a proper authorization from the patient for the release of the information, complete and accurate copies of the records shall be given to the attorney within a reasonable time not to exceed ten working days.

(c) If a patient's next of kin asks a health care provider for copies of the patient's medical records, complete and accurate copies of the records shall be given to the patient's next of kin requesting the records within a reasonable time not to exceed ten working days; provided that the patient or the patient's authorized representative is unable to authorize release of the records to the patient's next of kin; provided further that the patient's next of kin possesses superseding authority to request and receive the records.

A health care provider may refuse to release the patient's medical records to the patient's next of kin if the health care provider determines that it would not be in the best interest of the patient to do so. In making this decision, the health care provider shall consider any indicators, suspicion, or substantiation of abuse.

For purposes of this subsection:

"Patient's next of kin" means:

A patient's next of kin possesses "superseding authority" when all higher ranked kin are unable to request copies of the patient's medical records.

(d) Reasonable costs incurred by a health care provider in making copies of medical records shall be borne by the requesting person."

PART II

SECTION 3. The legislature finds that the continued provision of mental health services is vital to the community. It is essential that providers be able to efficiently submit and collect available insurance reimbursements for such services. Insurance reimbursement claims typically require information on the patient treated. Therefore, any statutory authorization for the release of patient medical records must be limited in scope and ensure the privacy of the patient.

Accordingly, the purpose of this part is to permit mental health service providers to release records for billing purposes under limited circumstances while preserving a patient's right to confidentiality.

SECTION 4. Section 334-5, Hawaii Revised Statutes, is amended to read as follows:

"§334-5 Confidentiality of records. All certificates, applications, records, and reports made for the purposes of this chapter and directly or indirectly identifying a person subject hereto shall be kept confidential and shall not be disclosed by any person except so far (1) as the person identified, or the person’s legal guardian, consents, or (2) as disclosure may be deemed necessary by the director of health or by the administrator of a private psychiatric or special treatment facility to carry out this chapter, or (3) as a court may direct upon its determination that disclosure is necessary for the conduct [[]of[]] proceedings before it and that failure to make the disclosure would be contrary to the public interest, or (4) as disclosure may be deemed necessary under the federal Protection and Advocacy for Mentally Ill Individuals Act of 1986, Public Law 99-319, to protect and advocate the rights of persons with mental illness who reside in facilities providing treatment or care[.], or (5) as disclosure is made to the person's health care insurer to obtain reimbursement for services rendered to the person; provided that disclosure shall be made only if the provider informs the person that a reimbursement claim will be made to the person's insurer, the person is afforded an opportunity to pay the reimbursement claim directly, and the person does not pay. For the purposes of this section, "facilities" shall include, but not be limited to, hospitals, nursing homes, community facilities for mentally ill individuals, boarding homes, and care homes.

Nothing in this section shall preclude disclosure, upon proper inquiry, of any information relating to a particular patient and not clearly adverse to the interests of the patient, to the patient, the patient’s family, legal guardian, or relatives, nor, except as provided above, affect the application of any other rule or statute of confidentiality. The use of the information disclosed shall be limited to the purpose for which the information was furnished."

PART III

SECTION 5. The purpose of this part is to make appropriations from the emergency and budget reserve fund. The legislature finds that State revenues will not cover expenditures for programs essential to the public health, safety, and welfare. As a direct result of the State budgetary shortfall, the State would need to eliminate and severely cut necessary programs, services, and projects provided by hospitals, health centers, and other agencies throughout the State, especially in rural areas. This reduction in health services would occur abruptly and immediately jeopardize the public health, safety, and welfare. Therefore, the legislature finds that an urgency exists to ensure that the following hospitals, agencies, services, and projects are funded to secure the public health, safety, and welfare.

SECTION 6. Molokai General Hospital is the only hospital on the island of Molokai, and serves a population of approximately seven thousand residents. The hospital is a thirty-bed facility with fourteen acute care and sixteen long-term care beds. It provides twenty-four hour emergency care, urgent care, acute medical and pediatric inpatient care, low risk midwifery care, radiology services, ultrasound services, laboratory services, respiratory therapy, and physical therapy.

Although Molokai General Hospital is not a state hospital, it receives a monthly subsidy from the State as a community hospital, and also receives aid from the county of Maui and federal grants and contracts. Molokai General Hospital receives most of its financial and management support from being a subsidiary of Queen's Health Systems. However, because of the Queen's Health Systems' recent decrease in revenues and their decision to downsize, Molokai General Hospital's financial support has been severely affected. Thus, Molokai General Hospital must rely on increased financial support from the State, the county of Maui, and federal grants.

The purpose of this section is to provide financial support to Molokai General Hospital for its operating costs.

There is appropriated out of the emergency and budget reserve fund the sum of $850,000, or so much thereof as may be necessary for fiscal year 2003-2004, and the same sum, or so much thereof as may be necessary for fiscal year 2004-2005, for the operating costs of Molokai General Hospital.

SECTION 7. The legislature finds that the health of Molokai residents is at risk, with nearly one in six residents diagnosed with diabetes. Lamalama Ka `Ili Community Health Services of Molokai General Hospital is an organization dedicated to the health and well-being of Molokai residents. Lamalama Ka `Ili offers intensive diabetes care management, including nutrition counseling, free blood sugar checks, and access to a diabetes specialist once a month. Additionally, Lamalama Ka `Ili offers a hospice program, which provides end of life care for Molokai residents and their families, cancer care management, including a cancer patient support group, and a myriad of other programs including those developed for the kupuna, the young, overweight, and other at-risk members of the community.

The purpose of this section is to provide financial support to Molokai General Hospital for Lamalama Ka `Ili Community Health Services to fund its programs and general operating costs.

There is appropriated out of the emergency and budget reserve fund the sum of $150,000, or so much thereof as may be necessary for fiscal year 2003-2004, and the same sum, or so much thereof as may be necessary for fiscal year 2004-2005, for Molokai General Hospital for Lamalama Ka `Ili Community Health Services programs and general operating costs.

SECTION 8. There is appropriated out of the emergency and budget reserve fund the sum of $850,000, or so much thereof as may be necessary for fiscal year 2003-2004, and the same sum, or so much thereof as may be necessary for fiscal year 2004-2005, for a grant-in-aid to Kahuku hospital to fund the costs of emergency room operations, inpatient and outpatient care for the underinsured, medical malpractice insurance, and labor.

SECTION 9. There is appropriated out of the emergency and budget reserve fund the sum of $1,236,260, or so much thereof as may be necessary for fiscal year 2003-2004, and the same sum, or so much thereof as may be necessary for fiscal year 2004-2005, for Waianae District Comprehensive Health and Hospital Board, Inc., to subsidize its operations and programs.

SECTION 10. There is appropriated out of the emergency and budget reserve fund the sum of $1,200,000, or so much thereof as may be necessary for fiscal year 2003-2004, for Wahiawa General Hospital to provide indigent care services.

SECTION 11. There is appropriated out of the emergency and budget reserve fund the sum of $120,000, or so much thereof as may be necessary for fiscal year 2003-2004, and the same sum, or so much thereof as may be necessary for fiscal year 2004-2005, for the operations of the bone marrow registry of the St. Francis Medical Center.

SECTION 12. There is appropriated out of the emergency and budget reserve fund the sum of $750,000, or so much thereof as may be necessary for fiscal year 2003-2004, for a grant-in-aid to Saint Francis Healthcare System, for the Maui Renal Dialysis Center.

SECTION 13. The legislature finds that a poison center's services are essential to the proper functioning of an emergency medical services system. The mission of a poison center is to prevent and reduce harm from poisoning through the provision of comprehensive poison information services. A properly functioning poison center assists in saving lives, preventing needless suffering, and helps reduce health care costs.

The Hawaii poison center currently responds to more than 12,000 calls annually to its free twenty-four hour statewide hotline. Many of the center's calls are acute in nature and the center's professionally trained nursing staff are able to provide early management of poisoning cases, obviating the necessity of an emergency services visit or response. Professional toxicology consultative services are available twenty-four hours a day at no charge to hospitals, other acute care health facilities, and health care providers. Additionally, the center provides on going, free statewide public information and education services that are preventive in nature, and professional education for health care providers.

The purpose of this section is to appropriate funds for the poison center to continue operating twenty-four hours a day.

There is appropriated out of the emergency and budget reserve fund the sum of $260,000, or so much thereof as may be necessary for fiscal year 2003-2004, and the same sum, or so much thereof as may be necessary for fiscal year 2004-2005, to enable the department of health to operate a hospital-based poison center twenty-four hours a day.

SECTION 14. There is appropriated out of the emergency and budget reserve fund the sum of $100,000, or so much thereof as may be necessary for fiscal year 2003-2004, and the same sum, or so much thereof as may be necessary for fiscal year 2004-2005, for a grant-in-aid to the Maui AIDS Foundation for the case management program.

SECTION 15. There is appropriated out of the emergency and budget reserve fund the sum of $800,000, or so much thereof as may be necessary for fiscal year 2003-2004, and the same sum, or so much thereof as may be necessary for fiscal year 2004-2005, for Hana Community Health Clinic to subsidize its operations and care services for uninsured patients.

SECTION 16. The legislature finds that the estimated number of Hawaii residents who do not have health insurance has doubled -- growing from 68,200 in 1996 to 135,900 in 2001. This makes lack of health insurance a serious concern for the State. This increase generates a considerable economic impact on the State's hospitals, community health centers, and other participants in the health care industry and threatens their ability to effectively serve the whole community.

According to the Kaiser Commission on Medicaid and the Uninsured:

The legislature further finds that it is in the best interests of the State to ensure access to primary and preventive health care for its residents. In addition to giving rise to a healthier population, providing access to care reduces state expenditures attributable to hospital and emergency room services for preventable injuries or illnesses.

The most effective means to encourage access to primary health care for residents who do not have health insurance is through Hawaii's system of community health centers that:

The legislature further finds that, while community health centers represent the best system of community-based primary care for uninsured people, financial support for community health centers is inadequate to meet increasing demands. More specifically, community health centers have experienced a forty-one per cent increase in uninsured visits since 1997.

The purpose of this section is to provide cost-effective care for Hawaii residents who are uninsured, while at the same time ensuring that the community health center system remains financially viable and stable in the face of a growing population of uninsured.

There is appropriated out of the emergency and budget reserve fund the sum of $1,650,000, or so much thereof as may be necessary for fiscal year 2003-2004, and the sum of $1,650,000, or so much thereof as may be necessary for fiscal year 2004-2005, to the department of health to provide resources to nonprofit, community-based health-care providers to care for the uninsured. This appropriation shall pay for providing direct care, which includes primary medical, dental, and mental health care, and may pay for the purchase of prescription drugs. The department of health may distribute moneys on a per-visit basis, taking into consideration need on all islands.

SECTION 17. There is appropriated out of the emergency and budget reserve fund the sum of $300,000, or so much thereof as may be necessary for fiscal year 2003-2004, and the same sum, or so much thereof as may be necessary for fiscal year 2004-2005, for the Sexual Assault Treatment Center master contract.

PART IV

SECTION 18. The director of finance is authorized to issue general obligation bonds in the sum of $3,750,000, or so much thereof as may be necessary, and the same sum, or so much thereof as may be necessary, is appropriated for fiscal year 2003-2004, and the sum of $12,000,000, or so much thereof as may be necessary, and the same sum, or so much thereof as may be necessary, is appropriated for fiscal year 2004-2005, to design, construct, landscape, and furnish the Kulamalu Long-Term Care Facility, a new long-term care facility consisting of one hundred two skilled nursing and/or intermediate care facility (SNF/ICF) beds, in Kula, Maui.

SECTION 19. The appropriations made for capital improvement projects authorized in this part shall not lapse at the end of the fiscal biennium for which the appropriation is made; provided that all appropriations which are unencumbered as of June 30, 2005, shall lapse as of that date.

PART V

SECTION 20. The sums appropriated in part III of this Act shall be expended by the department of health for their respective purposes. The sum appropriated in part IV of this Act shall be expended by the Hawaii health systems corporation for the purposes of that part.

PART VI

SECTION 21. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 22. This Act shall take effect upon its approval; provided that parts III, IV, and V shall take effect on July 1, 2003.