SB2418

SECTION 1. The purpose of this Act is effectuate the recommendations of the Maui Health Initiative Task Force established pursuant to Act 219, Session Laws of Hawaii 2007, to create procedural efficiency in the certificate of need application process by eliminating the statewide health planning council and the review panel, and by renaming the subarea health planning councils to regional health planning councils.

SECTION 2. Section 323D-2, Hawaii Revised Statutes, is amended by deleting the definitions of "statewide council" and "review panel":

["~~"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 3. 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 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. 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~~] regional health planning councils in the preparation, review, and revision of the state health services and facilities plan[;], and may, when deemed necessary by the state agency, retain a non-voting advisory panel of unbiased experts to provide additional expertise and assistance;

(3) Conduct the health planning activities of the State in coordination with the [~~subarea~~] regional health planning councils, implement the state health services and facilities plan, and determine the statewide health needs of the State after consulting with the [~~statewide council;~~] regional health planning 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 health planning councils in the performance of [~~its~~] their functions[.];

(5) Determine the need for new health services proposed to be offered within the 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, 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 4. 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 5. 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~~] regional health planning councils [~~and the review panel,~~] shall not be employed by or married to health care providers."

SECTION 6. 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 7. 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 health planning 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 8. Chapter 323D, part III, Hawaii Revised Statutes, is amended by amending the title to read:

"PART III. [~~SUBAREA~~] REGIONAL HEALTH PLANNING COUNCILS"

SECTION 9. Section 323D-21, Hawaii Revised Statutes, is amended to read as follows:

"§323D-21 [~~Subarea~~] Regional health planning councils, established. (a) There are established[~~, subarea~~] five regional health planning councils [~~for~~] to represent each 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 council.~~] region, as follows:

(1) The Oahu regional health planning council;

(2) The Kauai regional health planning council;

(3) The Maui regional health planning council;

(4) The east Hawaii regional health planning council, comprising the Puna district, north Hilo district, south Hilo district, Hamakua district, and Kau district; and

(5) The west Hawaii regional health planning council, comprising the north Kohala district, south Kohala district, north Kona district, and south Kona district;

and to be identified as regional health planning councils I, II, III, IV, and V, respectively.

(b) The [~~subarea~~] regional health planning 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~~] Regional health planning councils, functions, quorum and number of members necessary to take valid action. (a) Each [~~subarea~~] regional health planning council shall review, seek public input, and make recommendations relating to health planning for the geographical [~~subarea~~] region it serves. In addition, the [~~subarea~~] regional health planning 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 health planning 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 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."

SECTION 11. Section 323D-23, Hawaii Revised Statutes, is amended to read as follows:

"§323D-23 [~~Subarea~~] Regional health planning councils, composition, appointment. Members of [~~subarea~~] the regional health planning 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 regional health planning councils shall represent diverse levels of related expertise to ensure comprehensive and sagacious decision making. The members of the [~~subarea~~] regional health planning 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-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 13. Section 323D-44, Hawaii Revised Statutes, is amended to read as follows:

"§323D-44 Applications for certificates of need. (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 health planning 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 health planning 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~~] regional health planning council[~~, the review panel, and the statewide council~~] may, at [~~their~~] its discretion, choose to waive [~~their~~] its respective prerogatives of review of any certificate of need application."

SECTION 15. Section 323D-45, Hawaii Revised Statutes, is amended to read as follows:

"§323D-45 [~~Subarea~~] Regional health planning council[~~, review panel, and statewide 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 health planning council or councils[~~, the review panel, and the statewide council~~]. The [~~subarea~~] regional health planning council [~~and the review panel~~] shall consider all relevant data and information submitted by the state agency, [~~subarea~~] regional health planning councils, other [~~areawide or~~] local bodies, and the applicant, and may request from them additional data and information. The [~~review panel~~] regional health planning council 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.~~]

(b) At a public meeting in which a [~~subarea~~] regional health planning 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 16. 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~~] chairperson of the appropriate [~~subarea~~] regional health planning council. 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;~~] cause; or

(5) The decision of the administrator differs from the recommendation of the [~~statewide~~] regional health planning council.

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 17. Section 323D-62, Hawaii Revised Statutes, is amended to read as follows:

"§323D-62 Rules. The state agency and the [~~statewide~~] regional health [~~coordinating council~~] planning councils may adopt necessary rules for the purposes of this chapter in accordance with chapter 91."

SECTION 18. Section 323D-74, Hawaii Revised Statutes, is amended by amending its title and subsection (a) to read as follows:

"[[]§323D-74[]] Hearings. (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~~] state agency or the [~~statewide~~] appropriate regional health [~~coordinating~~] planning council, 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 19. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 20. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2418
TWENTY-FOURTH LEGISLATURE, 2008
STATE OF HAWAII