Report Title:
Regional Councils; Certificate of Need
Description:
Establishes regional councils in place of subarea councils, the statewide council, and the certificate of need review panel to increase the decision-making power of regions in the certificate-of-need process. (HB3326 HD1)
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
3326 |
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TWENTY-FOURTH LEGISLATURE, 2008 |
H.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO HEALTH.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Chapter 323D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§323D- Acute care facility proposals; long-term care beds. The state agency shall require and establish criteria for the inclusion of an adequate number of long-term care beds in any certificate of need application submitted by an acute care facility, to ensure the facility contributes to the long-term care needs of the community it will serve."
SECTION 2. Section 321-225, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
"(a) There is established within the department of health for administrative purposes only the state emergency medical services advisory committee, which shall sit in an advisory capacity to the department of health on all matters relating to the state system. The advisory committee may advise the department of health upon request of the department or upon its own initiative with regard to the state system. The advisory committee shall:
(1) Monitor, review, and evaluate on an ongoing basis
the operations, administration, and efficacy of the state system, or any
components thereof, to determine conformity with and maximum implementation of
this part[.];
(2) Prepare and submit periodic assessments, reports,
and other documents relating to the state system to ensure the implementation
of this part, as deemed necessary or desirable in the discretion of the
advisory committee[.];
(3) Seek the input of the public in relation to the
state system to ensure adequate fulfillment of the emergency medical services
needs of the State consistent with this part[.];
(4) Participate in any planning or other policymaking
with regard to the state system, and seek the participation of the public,
including [subarea health planning] regional councils in its
consideration of plans and policies relating to the state system[.];
(5) Perform other functions, and have other duties
necessary to ensuring the fullest implementation and maintenance of the state
system[.]; and
(6) Advise the department of health in formulating a master plan for emergency medical services, including medicom, the "911" system, and other components necessary to meet the emergency medical needs of the people of the State which shall be submitted to the legislature."
SECTION 3. Chapter 323D, Hawaii Revised Statutes, is amended by amending its title of part III to read:
"PART
III. [SUBAREA HEALTH PLANNING] REGIONAL COUNCILS"
SECTION 4. Section 323D-2, Hawaii Revised Statutes, is amended as follows:
1. By amending the definitions of "state health services and facilities plan", "subarea", and "subarea council" to read:
""State health services and
facilities plan" means the comprehensive plan for the economical delivery
of health services in the [State] state prepared by the [statewide
council.] state agency.
["Subarea"] "Region"
means one of the geographic [subareas] regions designated by the
state agency pursuant to section 323D-21.
["Subarea council"] "Regional
council" means a [subarea health planning] regional
council established pursuant to section 323D-21."
2. By repealing the definitions of "review panel" and "statewide council".
[""Review panel" means the
panel established pursuant to section 323D-42.
"Statewide council" means the
statewide health coordinating council established in section 323D-13."]
SECTION 5. Section 323D-12, Hawaii Revised Statutes, is amended to read as follows:
"§323D-12 Health planning and development functions; state agency. (a) The state agency shall:
(1) Have as a principal function the responsibility
for promoting accessibility for all the people of the [State] state
to quality health care services at reasonable cost. The state agency shall
conduct such studies and investigations as may be necessary as to the causes of
health care costs including inflation[.] and reimbursements to health
care providers. The state agency may contract for services to implement
this paragraph. The certificate of need program mandated under part V shall
serve this function. The state agency shall promote the sharing of facilities
or services by health care providers whenever possible to achieve economies [and
shall restrict unusual or unusually costly services to individual facilities or
providers where appropriate;];
(2) [Serve as staff to and provide technical
assistance and advice to the statewide council and the subarea councils in the
preparation, review, and revision of] Prepare, review, and revise
the state health services and facilities plan;
(3) Conduct the health planning activities of the
State in coordination with the [subarea] regional councils,
implement the state health services and facilities plan, and determine the
statewide health needs of the [State] state after consulting with
the [statewide council;] regional councils; and
(4) Administer the state certificate of need program pursuant to part V.
(b) The state agency may:
(1) Prepare such reports and recommendations on Hawaii's health care costs and public or private efforts to reduce or control costs and
health care quality as it deems necessary. The report may include[,]
but not be limited to[,] a review of health insurance plans, the
availability of various kinds of health insurance and malpractice insurance to
consumers, and strategies for increasing competition in the health insurance
field[.];
(2) Prepare and revise as necessary the state health
services and facilities plan[.];
(3) Prepare, review, and revise the annual
implementation plan[.];
(4) Assist the [statewide council] regional
councils in the performance of [its] their functions[.];
(5) Determine the need for new health services
proposed to be offered within the [State.] state;
(6) Assess existing health care services and
facilities to determine whether there are redundant, excessive, or
inappropriate services or facilities and make public findings of any that are
found to be so. The state agency shall weigh the costs of the health care
services or facilities against the benefits the services or facilities provide
and there shall be a negative presumption against marginal services[.];
(7) Provide technical assistance to persons, public
or private, in obtaining and filling out the necessary forms for the
development of projects and programs[.];
(8) Prepare reports, studies, and recommendations on
emerging health issues, such as medical ethics, health care rationing,
involuntary care, care for the indigent, provider reimbursements, and
standards for research and development of biotechnology and genetic
engineering[.]; and
(9) Conduct such other activities as are necessary to meet the purposes of this chapter."
SECTION 6. Section 323D-13.5, Hawaii Revised Statutes, is amended to read as follows:
"[[]§323D-13.5[]]
Disqualification from position or membership. The chairpersons of the [statewide
council, the subarea health planning] regional councils [and the
review panel,] shall not be employed by or married to health care
providers."
SECTION 7. Section 323D-15, Hawaii Revised Statutes, is amended to read as follows:
"§323D-15 State health services and facilities
plan. [There shall be a] The state agency shall prepare a
state health services and facilities plan which shall address the health care
needs of the [State,] state, including inpatient care, health
care facilities, critical access hospitals, and special needs. The plan
shall depict the most economical and efficient system of care commensurate with
adequate quality of care, and shall include standards for [utilization] use
of health care facilities and major medical equipment. The plan shall provide
for the reduction or elimination of [underutilized,] underused,
redundant, or inappropriate health care facilities and health care services[.]
and shall be presented to the legislature by the state agency on a bi-annual
basis not less than twenty days prior to the beginning of the regular session, beginning
with the regular session of 2011."
SECTION 8. Section 323D-17, Hawaii Revised Statutes, is amended to read as follows:
"§323D-17 Public hearings required. In the
preparation of the state health services and facilities plan or amendments to
the state health services and facilities plan, the state agency and the [statewide
council] regional councils shall conduct [a] public hearing
on the proposed plan or the amendments and shall comply with the provisions for
notice of public hearings in chapters 91 and 92."
SECTION 9. Section 323D-21, Hawaii Revised Statutes, is amended to read as follows:
"§323D-21 [Subarea health planning]
Regional councils, established. There are established, [subarea
health planning] regional councils for geographical areas which
shall be designated by the state agency [in consultation with the statewide
council]. Each county shall have at least one [subarea health planning]
regional council. The [subarea health planning] regional
councils shall be placed within the state agency for administrative
purposes."
SECTION 10. Section 323D-22, Hawaii Revised Statutes, is amended to read as follows:
"§323D-22 [Subarea health
planning] Regional councils, functions, quorum and number of
members necessary to take valid action. (a) Each [subarea health
planning] regional council shall review, seek public input, and make
recommendations relating to health planning for the geographical [subarea]
region it serves. In addition, [the subarea health planning] regional
councils shall:
(1) Identify and recommend to the state agency [and
the council] the data needs and special concerns of the respective [subareas]
regions with respect to the preparation of the state plan[.];
(2) Provide specific recommendations to the state
agency [and the council] regarding the highest priorities for health
services and resources development[.];
(3) Review the state health services and facilities
plan as it relates to the respective [subareas] regions and make
recommendations to the state agency [and the council.];
(4) Advise the state agency in the administration of
the certificate of need program for their respective [subareas.] regions;
(5) Advise the state agency on the cost of
reimbursable expenses incurred in the performance of their functions for
inclusion in the state agency budget[.];
(6) Advise the state agency in the performance of its
specific functions[.]; and
(7) Perform other such functions as agreed upon by
the state agency and the respective [subarea] regional councils.
[(8) Each subarea health planning council shall
recommend for gubernatorial appointment at least one person from its membership
to be on the statewide council.]
(b) The number of members necessary to constitute a quorum to do business shall consist of a majority of all the members who have accepted nomination to the regional council, and have been confirmed and qualified as members of the regional council. When a quorum is in attendance, the concurrence of a majority of the members in attendance shall make any action of the regional council valid."
SECTION 11. Section 323D-23, Hawaii Revised Statutes, is amended to read as follows:
"§323D-23 [Subarea health planning]
Regional councils, composition, appointment. Members of [subarea
health planning] regional councils shall be appointed by the
governor, subject to section 26-34. Nominations for appointment shall be
solicited from health-related and other interested organizations, and agencies,
including health planning councils, providers of health care within the
appropriate [subarea,] region, and other interested persons. The
members of the [subarea health planning] regional councils shall
not be compensated for their services but shall be reimbursed for reasonable
expenses necessary to the performance of their function."
SECTION 12. Section 323D-43, Hawaii Revised Statutes, is amended to read as follows:
"§323D-43 Certificates of need. (a) No person, public or private, nonprofit or for profit, shall:
(1) Construct, expand, alter, convert, develop,
initiate, or modify a health care facility or health care services in the [State]
state that requires a total capital expenditure in excess of the expenditure
minimum; [or]
(2) Substantially modify or increase the scope or type of health service rendered; or
(3) Increase, decrease, or change the class of usage of the bed complement of a health care facility, or relocate beds from one physical facility or site to another,
unless a certificate of need therefor has first been issued by the state agency.
[(b) No certificate of need shall be issued
unless the state agency has determined that:
(1) There is a public need for the facility or the
service; and
(2) The cost of the facility or service will not
be unreasonable in the light of the benefits it will provide and its impact on
health care costs.
(c)] (b) The state agency may
adopt criteria for certificate of need review [which] that are
consistent with this section. Such criteria may include but are not limited to
need, cost, quality, accessibility, availability, and acceptability.
Each decision of the state agency to issue a certificate of need shall, except in an emergency situation that poses a threat to public health, be consistent with the state health services and facilities plan in effect under section 323D-15. Each certificate of need issued shall be valid for a period of one year from the date of issuance unless the period is extended for good cause by the state agency and expenditures for the project shall not exceed the maximum amount of the expenditures approved in the certificate of need."
SECTION 13. Section 323D-44, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
"(a) An applicant for a certificate of need shall file an application with the state agency. The state agency shall provide technical assistance to the applicant in the preparation and filing of the application.
Each application shall include a statement evaluating the facility's or service's probable impact on health care costs and providing additional data as required by rule. The statement shall include cost projections for at least the first and third years after its approval.
The state agency shall not accept an application for review
until the application is complete and includes all necessary information
required by the state agency. The state agency shall determine if the
application is complete within thirty days of receipt of the application. If
the state agency determines that the application is incomplete, the state
agency shall inform the applicant of the additional information that is
required to complete the application. When the state agency determines that
the application is complete, the period for agency review described in
subsection (b) shall begin, and the state agency shall transmit the completed
application to the appropriate [subarea] regional councils, [the
review panel, the statewide council,] appropriate individuals, and
appropriate public agencies. The state agency may require the applicant to
provide copies of the application to the state agency, the appropriate [subarea]
regional councils, [the review panel, the statewide council,]
appropriate individuals, and appropriate public agencies. If, during the
period for agency review, the state agency requires the applicant to submit
information respecting the subject of the review, the period for agency review
shall, at the request of the applicant, be extended fifteen days."
SECTION 14. Section 323D-44.6, Hawaii Revised Statutes, is amended to read as follows:
"[[]§323D-44.6[]]
Review of certain applications for certificate of need; waiver. The [subarea
council, the review panel, and the statewide council] regional councils
may, at their discretion, choose to waive their respective prerogatives of
review of any certificate of need application."
SECTION 15. Section 323D-44.7, Hawaii Revised Statutes, is amended to read as follows:
"[[]§323D-44.7[]]
Monitoring of approved certificates of need. The state agency [may]
shall monitor implementation of approved certificates of need granted by
the agency."
SECTION 16. Section 323D-45, Hawaii Revised Statutes, is amended to read as follows:
"§323D-45 [Subarea council,
review panel, and statewide council] Regional council
recommendations for issuance or denial of certificates of need. (a)
Except for an administrative review as provided in section 323D-44.5, or in an
emergency situation or other unusual circumstances as provided in section
323D-44(c), the state agency shall refer every application for a certificate of
need to the appropriate [subarea] regional council or [councils,
the review panel, and the statewide council.] councils. The [subarea]
regional council [and the review panel] shall consider all
relevant data and information submitted by the state agency, [subarea
councils,] other areawide or local bodies, and the applicant, and may
request from them additional data and information. The [review panel] regional
council or councils to which the application is referred shall consider
each application at a public meeting and shall submit its recommendations with
findings to the [statewide council. The statewide council shall consider
the recommendation of the review panel at a public meeting and shall submit its
recommendations to the state agency within such time as the state agency
prescribes. The statewide council and the review panel may join together to
hear or consider simultaneously information related to an application for a
certificate of need.] state agency within such time as the state agency
prescribes.
(b) At a public meeting in which a [subarea] regional
council [or the review panel] considers an application for a certificate
of need, any person shall have the right to be represented by counsel and to
present oral or written arguments and evidence relevant to the application; any
person directly affected by the application may conduct reasonable questioning
of persons who make factual allegations relevant to the application; any staff
member of the state agency may conduct reasonable questioning of persons who
make factual allegations relevant to the application; and a record of the
meeting shall be kept."
SECTION 17. Section 323D-47, Hawaii Revised Statutes, is amended to read as follows:
"§323D-47 Request for reconsideration.
The state agency may provide by rules adopted in conformity with chapter 91 for
a procedure by which any person may, for good cause shown, request in writing a
public hearing before a reconsideration committee for purposes of
reconsideration of the agency's decision. The reconsideration committee shall
consist of the administrator of the state agency and the [chairpersons of
the statewide council, the review panel, the plan development committee of the
statewide council, and the] appropriate [subarea health planning
council.] regional council or councils. The administrator shall be
the chairperson of the reconsideration committee. A request for a public hearing
shall be deemed by the reconsideration committee to have shown good cause, if:
(1) It presents significant, relevant information not previously considered by the state agency;
(2) It demonstrates that there have been significant changes in factors or circumstances relied upon by the state agency in reaching its decision;
(3) It demonstrates that the state agency has materially failed to follow its adopted procedures in reaching its decision;
(4) It provides such other bases for a public hearing as the state agency determines constitutes good causes; or
(5) The decision of the administrator differs from
the recommendation of the [statewide council.] appropriate regional
council or councils.
To be effective, a request for such a hearing shall be received within ten working days of the state agency decision. A decision of the reconsideration committee following a public hearing under this section shall be considered a decision of the state agency for purposes of section 323D-44."
SECTION 18. Section 323D-54, Hawaii Revised Statutes, is amended to read as follows:
"§323D-54 Exemptions from certificate of need requirements. Nothing in this part or rules with respect to the requirement for certificates of need applies to:
(1) Offices of physicians, dentists, or other practitioners of the healing arts in private practice as distinguished from organized ambulatory health care facilities, except in any case of purchase or acquisition of equipment attendant to the delivery of health care service and the instruction or supervision for any private office or clinic involving a total expenditure in excess of the expenditure minimum;
(2) Laboratories, as defined in section 321-11(12), except in any case of purchase or acquisition of equipment attendant to the delivery of health care service and the instruction or supervision for any laboratory involving a total expenditure in excess of the expenditure minimum;
(3) Dispensaries and [first aid] first-aid
stations located within business or industrial establishments and maintained
solely for the use of employees; provided such facilities do not regularly
provide inpatient or resident beds for patients or employees on a daily
twenty-four-hour basis;
(4) Dispensaries or infirmaries in correctional or educational facilities;
(5) Dwelling establishments, such as hotels, motels, and rooming or boarding houses that do not regularly provide health care facilities or health care services;
(6) Any home or institution conducted only for those who, pursuant to the teachings, faith, or belief of any group, depend for healing upon prayer or other spiritual means;
(7) Dental clinics;
(8) Nonpatient areas of care facilities such as parking garages and administrative offices;
(9) Bed changes that involve ten per cent or ten beds of existing licensed bed types, whichever is less, of a facility's total existing licensed beds within a two-year period;
(10) Projects that are wholly dedicated to meeting the State's obligations under court orders, including consent decrees, that have already determined that need for the projects exists;
(11) Replacement of existing equipment with its modern-day equivalent;
(12) Primary care clinics under the expenditure thresholds referenced in section 323D-2;
(13) Equipment and services related to that equipment, that are primarily invented and used for research purposes as opposed to usual and customary diagnostic and therapeutic care;
(14) Capital expenditures that are required:
(A) To eliminate or prevent imminent safety hazards as defined by federal, state, or county fire, building, or life safety codes or regulations;
(B) To comply with state licensure standards; and
(C) To comply with accreditation standards, compliance with which is required to receive reimbursements under Title XVIII of the Social Security Act or payments under a state plan for medical assistance approved under Title XIX of such Act;
(15) Extended care adult residential care homes and assisted living facilities; or
(16) Other facilities or services that the agency
[through the statewide council] chooses to exempt, by rules pursuant to
section 323D-62."
SECTION 19. Section 323D-62, Hawaii Revised Statutes, is amended to read as follows:
"§323D-62 Rules. The state agency and the [statewide
health coordinating council] regional councils may adopt necessary
rules for the purposes of this chapter in accordance with chapter 91."
SECTION 20. Section 323D-74, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
"(a) The agency, after consultation with the attorney
general, shall, if appropriate, hold a public hearing during the course of
review, which hearing may be held jointly with the [certificate of need
review panel or the statewide health coordinating council,] appropriate
regional council or councils and in which any person may file written
comments and exhibits or appear and make a statement. The agency or the
attorney general may subpoena additional information or witnesses, require and
administer oaths, require sworn statements, take depositions, and use related
discovery procedures for purposes of the hearing and at any time prior to
making a decision on the application."
SECTION 21. Section 323D-13, Hawaii Revised Statutes, is repealed.
["§323D-13 Statewide health coordinating
council. (a) There is established a statewide health coordinating
council which shall be advisory to the state agency and the membership of which
as appointed by the governor shall not exceed twenty members.
(b) The members of the statewide council
shall be appointed by the governor in accordance with section 26-34, provided
that a nonvoting, ex officio member who is the representative of the Veterans'
Administration shall be designated by the Veterans' Administration. The
membership of the statewide council shall be broadly representative of the age,
sex, ethnic, income, and other groups that make up the population of the State
and shall include representation from the subarea councils, business, labor,
and health care providers. A majority but not more than eleven of the members
shall be consumers of health care who are not also providers of health care.
(c) The statewide council shall select a
chairperson from among its members. The members of the statewide council shall
not be compensated but shall be reimbursed for necessary expenses incurred in
the performance of their duties.
(d) The number of members necessary to
constitute a quorum to do business shall consist of a majority of all members
who have accepted nomination to the council, and have been confirmed and
qualified as members of the council. When a quorum is in attendance, the
concurrence of a majority of the members in attendance shall make any action of
the council valid.
(e) No member of the statewide council
shall, in the exercise of any function of the statewide council described in
section 323D-14(3), vote on any matter before the statewide council respecting
any individual or entity with which the member has or, within the twelve months
preceding the vote, had any substantial ownership, employment, medical staff,
fiduciary, contractual, creditor, or consultative relationship. The statewide
council shall require each of its members who has or has had such a
relationship with an individual or entity involved in any matter before the
statewide council to make a written disclosure of the relationship before any
action is taken by the statewide council with respect to the matter in the
exercise of any function described in section 323D-14 and to make the
relationship public in any meeting in which the action is to be taken."]
SECTION 22. Section 323D-14, Hawaii Revised Statutes, is repealed.
["§323D-14 Functions; statewide
health coordinating council. The statewide council shall:
(1) Prepare and revise as necessary the state
health services and facilities plan;
(2) Advise the state agency on actions under
section 323D-12;
(3) Appoint the review panel pursuant to section
323D-42; and
(4) Review and comment upon the following actions
by the state agency before such actions are made final:
(A) The making of findings as to
applications for certificate of need; and
(B) The making
of findings as to the appropriateness of those institutional and
noninstitutional health services offered in the State."]
SECTION 23. Section 323D-42, Hawaii Revised Statutes, is repealed.
["§323D-42 Review panel. There is
established a review panel for the purposes of reviewing applications for
certificates of need. The review panel shall be appointed by the statewide
council. The review panel shall include at least one member from each county
and a majority of the members shall be consumers. Membership on the statewide
council shall not preclude membership on the review panel established in this
section."]
SECTION 24. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun, before its effective date.
SECTION 25. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 26. This Act shall take effect on January 1, 2050.