Establishes a trauma system fund to ensure and encourage the availability of trauma care in the State. Establishes dedicated sources of revenue for the fund. (SD2)

A BILL FOR AN ACT

SECTION 1. The legislature finds that trauma care in Hawaii is in a state of crisis and recognizes that trauma care is a public health priority.

Injury is the leading cause of death for persons between the ages of one to forty-four in the State of Hawaii, causing more deaths than are caused by cancer and heart disease combined. This underscores the seriousness of traumatic injury as a public health problem in the State.

When injuries are serious, specialized equipment and prompt access to physicians and other trained health care providers make a significant difference in a trauma patient's health outcome. A weak trauma system decreases the State's readiness to respond not only to the normal flow of critically injured patients, but to unforeseen disasters and emergencies as well. As the American College of Surgeons noted in its October 2005 report "Hawaii Trauma System Consultation", extreme isolation and limited physician re-supply capability renders Hawaii uniquely vulnerable to natural disasters that may occur in a mid-Pacific environment. A functional trauma system with the capacity to handle a surge in demand is a fundamental necessity in responding to both natural and man-made disasters.

Typically, the cost of providing care to trauma patients is far higher than the total payments received from those patients. Without additional resources, it is unlikely that Hawaii′s system will develop greater capacity and it is at risk of losing what specialized trauma care is currently available.

A January 2006 report by the legislative reference bureau entitled, "On-Call Crisis in Trauma Care: Government Responses", noted that "the rationale for public support of uncompensated trauma services is the same as for critical police and fire services; a trauma system is a necessary public service that ought to be publicly supported."

The purpose of this Act is to establish a trauma system special fund to ensure the availability of care for trauma patients in the State and to establish dedicated sources of revenue to finance that care.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§321-   Trauma system special fund. (a) There is established within the state treasury a special fund to be known as the trauma system special fund to be administered and expended by the department of health. Moneys in the trauma system special fund shall not lapse at the end of the fiscal year. Expenditures from the trauma system special fund shall be exempt from chapters 103D and 103F.

(b) The moneys in the trauma system special fund shall be used by the department to support the continuing development and operation of a comprehensive state trauma system. The trauma system special fund shall be used to subsidize the documented costs for the comprehensive state trauma system including but not limited to the following:

(c) Fees remitted pursuant to section 249-31, interest and investment earnings attributable to the moneys in the trauma system special fund, federal funding, legislative appropriations, and grants, donations, and contributions from private or public sources for the purposes of the trauma system special fund shall be deposited into the trauma system special fund.

(d) The department shall adopt rules pursuant to chapter 91 to effectuate the purposes of this section, including the methodology for disbursements from the trauma system special fund.

(e) To receive reimbursement, a hospital providing care to trauma patients shall apply to the trauma system special fund on a form and in a manner approved by the department; provided that recipients of reimbursements from the trauma system special fund shall be subject to the following conditions:

(f) Necessary administrative expenses to carry out this section shall not exceed five per cent of the total amount collected in any given year.

(g) The department shall submit an annual report to the legislature no later than twenty days prior to the convening of each regular session that outlines the receipts of and expenditures from the trauma system special fund."

SECTION 3. Section 249-31, Hawaii Revised Statutes, is amended to read as follows:

"§249-31 State registration fee. (a) All vehicles and motor vehicles in the State as defined in section 249-1, including antique motor vehicles, except as otherwise provided in sections 249-4 and 249-6, shall be subject to a [$25] $      annual vehicle registration fee. The fee shall become due and payable on January 1, and shall be paid before April 1 in each year together with all other taxes and fees levied by this chapter; provided that should any county elect to renew motor vehicle registrations on a staggered basis as authorized by section 286-51, the state registration for that county shall likewise be staggered so that the state registration fee is due and payable at the same time and shall be collected together with the county fee. The state registration fee shall be deemed delinquent if not paid with the county registration fee. The respective counties shall collect this fee together with the vehicle registration tax collected for the county and shall transfer the moneys collected under this section to the State.

(b) From each annual motor vehicle registration fee, the director shall deposit $20 into the state highway fund [and], $5 into the emergency medical services special fund[.], and $      into the trauma system special fund."

SECTION 4. Section 36-27, Hawaii Revised Statutes, is amended to read as follows:

"§36-27 Transfers from special funds for central service expenses. Except as provided in this section, and notwithstanding any other law to the contrary, from time to time, the director of finance, for the purpose of defraying the prorated estimate of central service expenses of government in relation to all special funds, except the:

shall deduct five per cent of all receipts of all other special funds, which deduction shall be transferred to the general fund of the State and become general realizations of the State. All officers of the State and other persons having power to allocate or disburse any special funds shall cooperate with the director in effecting these transfers. To determine the proper revenue base upon which the central service assessment is to be calculated, the director shall adopt rules pursuant to chapter 91 for the purpose of suspending or limiting the application of the central service assessment of any fund. No later than twenty days prior to the convening of each regular session of the legislature, the director shall report all central service assessments made during the preceding fiscal year."

SECTION 5. Section 36-30, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) Each special fund, except the:

shall be responsible for its pro rata share of the administrative expenses incurred by the department responsible for the operations supported by the special fund concerned."

SECTION 6. There are established such positions as necessary to implement the provisions of this Act. These positions shall be appointed by the director of health without regard to chapter 76, Hawaii Revised Statutes. These positions shall be included in any benefit program generally applicable to the officers and employees of the State.

SECTION 7. There is appropriated out of the general revenues of the State of Hawaii the sum of $1, or so much thereof as may be necessary for fiscal year 2006-2007, to be deposited into the trauma system special fund.

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

SECTION 8. There is appropriated out of the trauma system special fund the sum of $1, or so much thereof as may be necessary for fiscal year 2006-2007, to be expended by the department of health for the purposes of this Act.

SECTION 9. The department of health shall submit an annual report on the expenditures of the trauma system special fund and the progress toward developing a fully integrated statewide trauma system to the legislature not later than twenty days prior to the convening of the regular session of 2007 and each year thereafter.

SECTION 10. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 11. This Act shall take effect on July 1, 2006, provided that section 3 shall take effect on October 1, 2006.