SB169.DOC

SECTION 1. The legislature finds that many of the residents of Hawaii are increasingly unable to obtain timely and appropriate health care because of physician and dentist shortages. These shortages primarily affect the rural areas of our State. In the area of medical services, shortages are especially acute in disciplines such as family practice, obstetrics, gynecology, and orthopedics.

The legislature further finds that the increasingly high cost of a physician's professional education requires physicians to seek out the higher incomes that allow them to repay their student loans. However, physician salaries in rural shortage areas are often lower than those in non-shortage areas.

Federal loan repayment and stipend programs for health care providers have historically been successful in encouraging health care providers to work in rural and underserved areas. Incentives such as stipends can be provided to physicians and dentists to offset the lower salaries offered in shortage areas.

The purpose of this Act is to establish the Hawaii health corps, a program that will provide stipends for physicians and dentists who agree to provide a minimum of three years of service in health professional shortage areas of the State. These stipends are intended to help physicians and dentists repay their medical or dental school loan debt and ease the high cost of living and malpractice insurance in Hawaii. The program also requires the physicians and dentists that are awarded stipends to serve as first responders during civil defense and other emergencies while enrolled in the program.

SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

HAWAII HEALTH CORPS

§ ‑1 Definitions. As used in this chapter, unless the context otherwise requires:

"Dentist" means a person licensed under chapter 448.

"Department" means the department of health.

"Director" means the director of health.

"Health professional shortage area" means areas of the State designated by the Health Resources and Services Administration of the United States Department of Health and Human Services as having shortages of primary medical care, dental care, or mental health care providers, including any rural area of the State and areas served by community health centers.

"Physician" means a person licensed under chapter 453.

"Program" means the Hawaii health corps program.

"Service obligation" means the duty to provide health care services in a health professional shortage area of the State and during periods declared to be an emergency by the governor, undertaken in exchange for a physician or dentist stipend from the program.

§ ‑2 Hawaii health corps; established. The Hawaii health corps program is established to encourage physicians and dentists to serve in areas of the State where there is a shortage of health care providers. Stipends shall be granted to an aggregate maximum of one hundred physicians and dentists at any one time. The program shall be administered by the department of health. In administering this program, the department shall:

(1) Adopt rules and develop guidelines to administer the program;

(2) Identify and designate health professional shortage areas and qualifying sites, including all community health centers and Hawaiian health centers;

(3) Establish criteria for the selection, and select physicians and dentists to participate in the stipend program;

(4) Define and determine compliance with the program enrollment requirement, licensure requirement, and service obligations;

(5) Collect and manage repayments from stipend recipients who do not meet the licensure requirement or service obligations under the program;

(6) Publicize the program, particularly to maximize participation by individuals who live in health professional shortage areas;

(7) Solicit and accept grants and donations from public and private sources for the program; and

(8) Establish criteria and procedures for calling program participants into service during a civil defense or other emergency.

§ ‑3 Hawaii health corps stipend. (a) The department shall award annual stipends of not more than $30,000 per year to each physician or dentist who agrees to:

(1) Provide health care services, for which the physician or dentist is validly licensed, for a minimum of three years to individuals residing in health care professional shortage areas as designated by the department;

(2) Provide during the stipend year not less than fifty per cent of their services in a health professional shortage area or not less than ten per cent of their services to uninsured patients;

(3) Repay the stipend in full if the physician or dentist that received the stipend is unable to complete the minimum three year service obligation requirement; and

(4) Provide first responder emergency services during civil defense and other emergencies proclaimed under section 127-10 or 128-7.

(b) No limitation shall be placed on expenditure of the stipend by the recipient. The department shall determine the manner and timing of stipend payments to ensure performance of the stipend service obligation. Not more than five years of stipends shall be paid to any one recipient.

§ ‑4 Hawaii health corps first responder service obligation. If a civil defense or other emergency, proclaimed under section 127-10 or 128-7, physicians and dentists participating in the Hawaii health corps program may be ordered into service by the governor as a critical action relief lineup to serve in areas of the State and in a capacity determined by the director.

§ ‑5 Preference and selection. (a) In selecting stipend recipients, the department shall give first priority preference to:

(1) Graduates of the University of Hawaii John A. Burns school of medicine;

(2) Graduates of a Hawaii-based residency program, or

(3) Graduates of a Hawaii affiliated medical or dental school.

(b) There shall be a second priority preference to fill shortages in specialty areas, including obstetrics, gynecology and orthopedics, in health professional shortage areas that have been designated by the department.

§ ‑6 Rules. The department shall adopt rules to implement the program. The rules shall be adopted pursuant to chapter 91, but shall be exempt from public notice and public hearing requirements.

§ ‑7 Hawaii health corps special fund. (a) There is established within the state treasury a special fund to be known as the Hawaii health corps special fund to be administered and expended by the department of health.

(b) The fund shall be used to provide stipends to qualifying Hawaii health corps physicians and dentists pursuant to this chapter.

(c) Moneys deposited into this fund shall include funds transferred from the community health centers special fund pursuant to section 321-1.65, the trauma system special fund pursuant to section 321-22.5, appropriations made by the legislature from general funds, private contributions, stipend repayments, and interest on and other income from the fund, which shall be separately accounted for.

(d) Legislative appropriations are not required for the transfer of moneys from the community health centers special fund or the trauma system special fund to the Hawaii health corps special fund."

SECTION 3. Section 321-1.65, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) The moneys in the special fund shall be used by the department of health for the operations of federally qualified health centers[.] and the Hawaii health corps program pursuant to chapter ."

SECTION 4. Section 321-22.5, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(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[.] and the Hawaii health corps program pursuant to chapter . 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:

(1) Costs of under-compensated and uncompensated trauma care incurred by hospitals providing care to trauma patients; and

(2) Costs incurred by hospitals providing care to trauma patients to maintain on-call physicians for trauma care.

The money in the trauma system special fund shall not be used to supplant funding for trauma services authorized prior to July 1, 2006, and shall not be used for ambulance or medical air transport services."

SECTION 5. (a) The department of health shall implement the Hawaii health corps program no later than June 30, 2010.

(b) For the purposes of efficiency in the implementation of this new program, the department shall award a minimum of thirty stipends of $30,000 per recipient in the first year of the program, an additional thirty stipends of $30,000 per recipient in the second year of the program, and an additional thirty stipends of $30,000 per recipient in the third year of the program. Thereafter, the department shall award annually a maximum of one hundred stipends in perpetuity.

(c) The director of health shall report to the legislature on the status of the Hawaii health corps program no later than twenty days prior to the convening of each regular session of the legislature beginning with the regular session of 2010.

SECTION 6. If any part of this Act is found to be in conflict with federal requirements that are a prescribed condition for the allocation of federal funds to the State, the conflicting part of this Act is inoperative solely to the extent of the conflict and with respect to the agencies directly affected, and this finding does not affect the operation of the remainder of this Act in its application to the agencies concerned. The rules under this Act shall meet federal requirements that are a necessary condition to the receipt of federal funds by the State.

SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 8. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	169
TWENTY-FIFTH LEGISLATURE, 2009
STATE OF HAWAII