HB223 HD1

SECTION 1. This Act shall be known as the "Health Care Reinvestment Act".

SECTION 2. The legislature finds that according to the American Hospital Association, one third of the nation's hospitals already operate in the red. Hospitals are incurring high additional costs ensuring essential health care services such as emergency on-call coverage, emergency transport services, and services provided by struggling rural hospitals. Between 2000 and 2004, hospitals reduced essential health care services as they faced volume increases, higher costs, liability concerns, and low or no payment for trauma services.

While Hawaii has been a leader in providing health care insurance to permanent employees who work a minimum of twenty hours per week, pursuant to the Prepaid Health Care Act, there are many who are unable to obtain such coverage. Employers have been hit hard by the high cost of health care and, therefore, may employ more people at less than twenty hours per week to avoid having to pay health insurance coverage. This may save money for the employer in the short-term, but the long-term repercussions will have serious health and economic effects on us all.

It is imperative that health care coverage be provided to all, regardless of age, race, ethnicity, income, or health status who are ineligible for any state or federal health care program. Health care coverage provided to those in need will relieve a significant amount of strain on hospitals by facilitating:

(1) Reimbursements for health care services providers;

(2) Regular health maintenance through a primary care physician for acute or chronic health conditions; and

(3) A reduction in costly emergency room visits.

The purpose of this Act is to earmark general excise tax revenues generated by health care services to support:

(1) Hawaii's trauma system;

(2) First responder activities relating to disasters;

(3) Statewide aeromedical evacuation programs;

(4) Rural hospitals;

(5) A structural assessment of hospitals and long-term care facilities to determine their ability to withstand hurricanes, earthquakes, and other natural disasters; and

(6) Reduce the number of uninsured in Hawaii.

SECTION 3. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§321- Health care reinvestment fund; support for health care services. (a) There is established the health care reinvestment fund, to be administered by the department of health, and into which shall be deposited state general excise tax revenues generated by health care services, as defined under section 237-31, and collected each fiscal year under section 237-31; provided that of the taxes collected:

(1) Twenty-five per cent shall be deposited into the trauma system special fund established under section 321-22.5;

(2) Ten per cent shall be expended to provide medical malpractice insurance subsidies for subspecialists such as orthopedics, trauma surgery, general surgery, and obstetrics/gynecology;

(3) Ten per cent shall be used to support statewide aeromedical evacuation services authorized in section 321-228;

(4) Ten per cent shall be expended to support emergency facilities and provide grants to keep rural hospitals open, including resources for Kahuku hospital;

(5) Ten per cent shall be expended to support health care workforce development for medically underserved areas of the state; and

(6) The remaining taxes collected shall be used for legislative appropriations to the health insurance support special fund established under section 346- .

(b) The department shall submit a report to the legislature no fewer than twenty days prior to the convening of each regular session, beginning with the regular session of 2008, that includes:

(1) The status of the health care reinvestment fund;

(2) The amount of moneys taken in by and expended from the fund; and

(3) The purposes for which these amounts were expended.

(d) As used in this section "medically underserved area" means a geographic region designated by the Secretary of the United States Department of Health and Human Services under 42 U.S.C. § 254e as a primary medical care health professional shortage area."

SECTION 4. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§346‑ Health insurance support special fund; Hawaii health insurance support. (a) There is established within the department the health insurance support special fund, to be administered by the department, and into which shall be deposited legislative appropriations from the health care reinvestment fund.

(b) Moneys in the health insurance support special fund shall be expended by the department for the purposes of supporting:

(1) Reimbursements to health care providers and hospitals statewide for services rendered to medicaid patients;

(2) The department's keiki care program established pursuant to H.B. No. 1008, H.D. 1, 2007; and

(3) Subsidies for part-time worker insurance plans to provide for those who do not qualify to receive employer-funded health insurance under the Hawaii Prepaid Health Care Act.

(c) The department shall submit a report to the legislature, no fewer than twenty days prior to the convening of each regular session, beginning with the regular session of 2008, which shall include:

(1) The status of the health insurance support special fund;

(2) The amount of moneys taken in by and expended from the fund; and

(3) The purposes for which these amounts were expended.

(d) The director shall adopt rules in accordance with chapter 91 to carry out the purposes of this section.

(e) As used in this section "health care provider" means an individual or institution licensed, certified, or otherwise authorized or permitted by law to provide health care in the ordinary course of business or practice of a profession."

SECTION 5. 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:

(1) Special out-of-school time instructional program fund under section 302A-1310;

(2) School cafeteria special funds of the department of education;

(3) Special funds of the University of Hawaii;

(4) State educational facilities improvement special fund;

(5) Convention center enterprise special fund under section 201B-8;

(6) Special funds established by section 206E-6;

(7) Housing loan program revenue bond special fund;

(8) Housing project bond special fund;

(9) Aloha Tower fund created by section 206J-17;

(10) Funds of the employees' retirement system created by section 88-109;

(11) Unemployment compensation fund established under section 383-121;

(12) Hawaii hurricane relief fund established under chapter 431P;

(13) Hawaii health systems corporation special funds;

(14) Tourism special fund established under section 201B‑11;

(15) Universal service fund established under chapter 269;

(16) Integrated tax information management systems special fund under section 231-3.2;

(17) Emergency and budget reserve fund under section 328L‑3;

(18) Public schools special fees and charges fund under section 302A-1130(f);

(19) Sport fish special fund under section 187A-9.5;

(20) Neurotrauma special fund under section 321H-4;

(21) Deposit beverage container deposit special fund under section 342G-104;

(22) Glass advance disposal fee special fund established by section 342G-82;

(23) Center for nursing special fund under section [[]304A-2163[]];

(24) Passenger facility charge special fund established by section 261-5.5;

(25) Solicitation of funds for charitable purposes special fund established by section 467B-15;

(26) Land conservation fund established by section 173A-5;

(27) Court interpreting services revolving fund under section 607-1.5;

(28) Trauma system special fund under section 321-22.5;

(29) Hawaii cancer research special fund;

(30) Community health centers special fund; [~~and~~]

(31) Emergency medical services special fund[[];

(32) Health insurance support special fund established by section 346- ; and

(33) Health care reinvestment fund established by section 321- ;

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

"§36-30 Special fund reimbursements for departmental administrative expenses. (a) Each special fund, except the:

(1) Transportation use special fund established by section 261D-1;

(2) Special out-of-school time instructional program fund under section 302A-1310;

(3) School cafeteria special funds of the department of education;

(4) Special funds of the University of Hawaii;

(5) State educational facilities improvement special fund;

(6) Special funds established by section 206E-6;

(7) Aloha Tower fund created by section 206J-17;

(8) Funds of the employees' retirement system created by section 88-109;

(9) Unemployment compensation fund established under section 383-121;

(10) Hawaii hurricane relief fund established under chapter 431P;

(11) Convention center enterprise special fund established under section 201B-8;

(12) Hawaii health systems corporation special funds;

(13) Tourism special fund established under section 201B‑11;

(14) Universal service fund established under chapter 269;

(15) Integrated tax information management systems special fund under section 231-3.2;

(16) Emergency and budget reserve fund under section 328L‑3;

(17) Public schools special fees and charges fund under section 302A-1130(f);

(18) Sport fish special fund under section 187A-9.5;

(19) Neurotrauma special fund under section 321H-4;

(20) Center for nursing special fund under section [[]304A-2163[]];

(21) Passenger facility charge special fund established by section 261-5.5;

(22) Court interpreting services revolving fund under section 607-1.5;

(23) Trauma system special fund under section 321-22.5;

(24) Hawaii cancer research special fund;

(25) Community health centers special fund; [~~and~~]

(26) Emergency medical services special fund[[];

(27) Health insurance support special fund established by section 346- ; and

(28) Health care reinvestment fund established by section 321- ;

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 7. Section 237-31, Hawaii Revised Statutes, is amended to read as follows:

"§237‑31 Remittances[.]; disposition. All remittances of taxes imposed by this chapter shall be made by money, bank draft, check, cashier's check, money order, or certificate of deposit to the office of the department of taxation to which the return was transmitted. The department shall issue its receipts therefore to the taxpayer and shall pay the moneys into the state treasury as a state realization, to be kept and accounted for as provided by law; provided that:

(1) The sum from all general excise tax revenues realized by the State that represents the difference between $90,000,000 and the proceeds from the sale of any general obligation bonds authorized for that fiscal year for the purposes of the state educational facilities improvement special fund shall be deposited in the state treasury in each fiscal year to the credit of the state educational facilities improvement special fund for public school capital improvement program needs; [~~and~~]

(2) A sum, not to exceed $5,000,000, from all general excise tax revenues realized by the State shall be deposited in the state treasury in each fiscal year to the credit of the compound interest bond reserve fund[.]; and

(3) Of the taxes under this chapter collected from health care services each fiscal year with the exception of the county surcharge on state tax authorized by section 46-16.8, a maximum of $100,000,000 annually shall be deposited to the credit of the health care reinvestment fund, established by section 346- .

For purposes of this paragraph, "health care services" means the following medical services:

(A) Preventive care;

(B) Emergency care;

(D) Diagnostic laboratory services;

(E) Diagnostic and therapeutic radiological services; and

(F) Services purchased from:

(i) Dentists;

(ii) Chiropractors;

(iii) Optometrists;

(iv) Psychologists;

(v) Physical therapists;

(vi) Home nursing care;

(vii) Nursing and care homes; and

(viii) Counseling."

SECTION 8. Section 321-22.5, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:

"(c) Interest and investment earnings attributable to the moneys in the trauma system special fund, federal funding, legislative appropriations[,] and grants, moneys from the health care reinvestment fund, 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."

SECTION 9. There is appropriated out of the health care reinvestment fund the sum of $45,000,000 or so much there of as may be necessary for fiscal year 2007-2008 and the same sum or so much thereof as may be necessary for fiscal year 2008-2009 to be deposited into the health insurance support special fund.

SECTION 10. There is appropriated out of the health insurance support special fund the sum of $45,000,000 or so much thereof as may be necessary for fiscal year 2007-2008 and the same sum or so much thereof as may be necessary for fiscal year 2008-2009 to support:

(1) Hospitals in meeting their needs for securing emergency on-call services;

(2) Emergency transport services; and

(3) Rural hospitals in providing health care services.

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

SECTION 11. There is appropriated out of the health care reinvestment fund the sum of $55,000,000 or so much thereof as may be necessary for fiscal year 2007-2008 and the same sum or so much thereof as may be necessary for fiscal year 2008-2009 to:

(1) Subsidize payments of high-deductible health insurance premiums for employees who are ineligible for employer-provided health insurance pursuant to chapter 393, Hawaii Revised Statutes; and

(2) Assist individuals who do not qualify for any other state-funded health care insurance assistance program in acquiring adequate health care insurance coverage.

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

SECTION 12. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 13. This Act shall take effect on July 1, 2007.

HOUSE OF REPRESENTATIVES	H.B. NO.	223
TWENTY-FOURTH LEGISLATURE, 2007		H.D. 1
STATE OF HAWAII