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. Repeals sunset of mental health parity law. (SD2)

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.

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, except for records subject to Title 42 Code of Federal Regulations Part 2, confidentiality of alcohol and drug abuse patient records; provided that disclosure shall be made only if the insurer 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 and declares that the grants and subsidies provided in this part are in the public interest and serve 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 $750,000, or so much thereof as may be necessary for fiscal year 2003-2004, as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, to 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, as a grant pursuant to chapter 42F, Hawaii Revised Statutes, to 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, as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, 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 $965,841, or so much thereof as may be necessary for fiscal year 2003-2004, as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, to the Waianae District Comprehensive Health and Hospital Board, Inc., to fund its operations and programs.

SECTION 10. There is appropriated out of the emergency and budget reserve fund the sum of $600,000, or so much thereof as may be necessary for fiscal year 2003-2004, as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, 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, as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, to the St. Francis Medical Center for the operations of the bone marrow registry.

SECTION 12. 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 twelve thousand 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 ongoing, 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, to enable the department of health to operate a hospital-based poison center twenty-four hours a day.

SECTION 13. 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, as a grant pursuant to chapter 42F, Hawaii Revised Statutes, to the Maui AIDS Foundation for the case management program.

SECTION 14. 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, as a subsidy pursuant to chapter 42F, Hawaii Revised Statutes, to the Hana Community Health Clinic for its operations and care services for uninsured patients.

SECTION 15. 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, 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 16. 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, for the Sexual Assault Treatment Center master contract.

SECTION 17. The legislature finds that "ice" is the greatest health and public safety threat to communities on the island of Hawaii. In August of 2001, the Hawaii Island Methamphetamine Summit was held, one of the first of four held throughout the country. United States Senator Daniel K. Inouye, Drug Enforcement Administration administrator Asa Hutchinson, National Crime Prevention Council vice president Jim Copple, and Dr. Wesley Clark, director of the Center for Substance Abuse Treatment in Washington, D.C. traveled to the island of Hawaii to address the devastating impact that "ice" has had on communities across the country.

The purpose of the summit was to focus attention and resources upon the problem of "ice" and the crisis and epidemic that it has become on the island of Hawaii. Child protective services reports that over one thousand five hundred children on the island of Hawaii have been placed under the jurisdiction of the courts, with over ninety per cent using "ice" or drugs.

The Hawaii county police department reported that "ice" arrests between 1997 and 2001 have increased four hundred thirty-one per cent. Ice seizures in Hawaii county increased from almost twenty-seven ounces in 1998 to two hundred nineteen ounces in 2001. The Big Island Substance Abuse Council, the largest substance abuse treatment provider in Hawaii county, reports that "ice" has become the drug of choice for Big Island residents by a two-to-one margin over any other drug. In 2001-2002, forty-five per cent of those seeking treatment admitted that "ice" was their first drug of choice, far outpacing cocaine (seven per cent), heroin (three per cent), marijuana (twenty per cent), and alcohol (twenty-five per cent). The U.S. Attorney's Office has also recognized that Hawaii county has been hard hit by "ice", reporting that Hawaii's greatest threat is "ice" and its devastating impact upon families, children, and the safety of the entire community.

In 2001, Hawaii county conducted a comprehensive survey and research into the problem of drugs and substance abuse by adolescents. The juvenile justice comprehensive strategic plan, conducted as a result of a federal grant from the Office of Juvenile Justice and Drug Prevention, through the Hawaii county office of the prosecuting attorney, revealed that adolescents from Hawaii county were at the highest risk for drug use and abuse in the State of Hawaii. Data from the department of health's report, "The 2000 Hawaii Student Alcohol and Drug Abuse Study (1987-2000)," shows that a greater percentage of students in Hawaii county, in grades six, eight, ten, and twelve have used drugs and engaged in risky behavior or committed more crimes than students throughout the rest of the State. This disturbing data was an impetus for Hawaii county to seek federal assistance through the office of Senator Daniel K. Inouye.

However, federal assistance alone will not solve the crisis and epidemic currently affecting children, families, and communities. The only hope to eliminate this threat is for every level of government to do its part and for each community to actively participate in the issues affecting them. Because of the unique challenges posed by a population of approximately one hundred forty thousand spread out over four thousand twenty-eight square miles, with entirely distinct communities with distinct characteristics, the legislature finds that it is important for each community to participate in its own healing and its own initiatives. Through community effort, neighborhoods must be saved from the devastation of drug use and abuse, or run the risk of losing our most precious resource, our children. The legislature further finds that Hawaii county, the county with the highest rate of substance abuse among youth, should have its own treatment facility, rather than forcing residents to send their children to Oahu or Maui for treatment.

The purpose of this section is to make an appropriation for the establishment of an adolescent substance abuse treatment facility to address the use of "ice".

There is appropriated out of the emergency and budget reserve fund of the State of Hawaii the sum of $300,000 or so much thereof as may be necessary for fiscal year 2003-2004 for the establishment of an adolescent treatment center to treat poly-drug abuse on the island of Hawaii.

SECTION 18. The legislature finds that "ice" is the greatest threat to a community's health and public safety. In 2001, Hawaii county conducted a comprehensive survey and researched the problem of drug and substance abuse by adolescents. The juvenile justice comprehensive strategic plan, conducted by a federal grant from the Office of Juvenile Justice and Drug Prevention, through the Hawaii county Office of the Prosecuting Attorney, revealed that adolescents from Hawaii county were at the highest risk for drug use and abuse among all adolescents in the State of Hawaii. The purpose of this section is to make an appropriation for more effective community based anti-drug programs to prevent the use of "ice".

There is appropriated out of the emergency and budget reserve fund of the State of Hawaii the sum of $200,000 or so much thereof as may be necessary for fiscal year 2003-2004 for community anti-drug efforts aimed at preventing crystal methamphetamine use on the island of Hawaii.

PART IV

SECTION 19. The sums appropriated in part III of this Act shall be expended by the department of health for their respective purposes.

PART V

SECTION 20. Act 121, Session Laws of Hawaii 1999, as amended by Act 243, section 8 paragraph 2, Session Laws of Hawaii 2000, is amended by amending section 6 to read as follows:

″SECTION 6. This Act shall take effect on July 1, 1999; provided that insurance, health, or service plan contracts subject to the terms of this Act and issued or renewed after December 31, 1999, shall be amended to be consistent with this Act[; and provided that this Act shall be repealed on June 30, 2003].″

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 part III shall take effect on July 1, 2003; and provided further that part V shall take effect on June 29, 2003.