SB420 SD2.DOC

SECTION 1. The legislature finds that the passage of the American Affordable Care Act of 2010 (ACA) places health care at the forefront of our national domestic policy agenda. The ACA aims to transform health care in America from a reactive, fragmented, payment-oriented delivery system to a proactive, comprehensive, quality-based consumer-centered way of living. The ACA enacts policies that affect health care and healthy lifestyles, including insurance market reforms, coverage choices, affordability of coverage, and individual and employer responsibilities, and investment in public health programs, community health centers, workforce development, quality, patient-centeredness, prevention, transparency, and accountability. These coverage expansions and improvements present both challenges and opportunities for states and communities to successfully implement the ACA.

The legislature recognizes the enactment of the ACA as an opportunity to transform Hawaii's health care system. The legislature finds that the State is a partner with the federal government in translating the provisions of the ACA into an improved health care system and that the system is made up of many interrelated parts. Perhaps the most significant part is the network of federally qualified health centers (community health centers).

Community health centers serve uninsured, low-income patient populations with demographic complexities and co-morbidities, medicaid members, and the homeless – those groups who are most likely to be helped by the ACA and medicaid expansion, in addition to privately insured individuals and families. Community health centers:

(1) Are nonprofit, community-based organizations whose purpose and expertise lie in providing quality person-centered health care to underserved populations and regions;

(2) Provide culturally and linguistically appropriate health care and a broad range of primary care and preventive services;

(3) Are located in medically underserved areas where people have limited access to other health care providers because of geographic and socio-economic barriers;

(4) Contribute greatly to the economies and livability of the communities they serve; and

(5) Are cost-effective providers whose care results in healthier patients and decreased use of emergency, specialty, and inpatient services.

Community health centers save the health care system $1,262 per patient per year due to timely, effective care and care management that reduces unnecessary emergency room, inpatient, and specialty utilization. This translated to savings of nearly $160,000,000 in 2009. Community health centers' patient-centered delivery system features comprehensive primary medical, behavioral health, and dental services; and care management and services that enhance access, compliance, and patient engagement; and focuses on quality outcomes supported by electronic health records that conform to meaningful use requirements. Community health centers are a smart investment that results in healthier communities while saving the State money.

The legislature acknowledges that, although the ACA expands the population that will be eligible for medicaid coverage and private insurance, those provisions do not take place until 2014, leaving uncertainty for many and an increased number of uninsured individuals as the economy continues to struggle. Furthermore, as seen in Massachusetts following implementation of that state's landmark health reform law, with the ACA implementation community health centers may see an increase in the number and proportion of the state's uninsured that are treated at their facilities.

For these reasons, it is imperative that the State provide support and resources that will synchronize the trajectory of community health center growth with implementation of the ACA provisions at the state level. Congress permanently authorized community health centers and the National Health Service Corps in the ACA because it recognized the community health center as the medical model and system that will transform health care. The ACA provides robust investment for operating costs, capital infrastructure, and workforce development programs in rural areas and community health centers over the next five years; however, much of this funding is competitive and in jeopardy of being restricted or eliminated.

The legislature finds that it is in the best interests of the State to ensure access to primary and preventive health care for its residents. In addition to facilitating a healthier population, improving access to health care reduces state expenditures attributable to hospital and emergency room services for preventable injuries or illnesses. The legislature recognizes the merit in supporting community health centers to expand their capacity to serve the uninsured, which make up approximately ten per cent of Hawaii's adult population, and to become the health care home for the newly insured under the ACA. The legislature further recognizes the need to develop infrastructure and facilities for community health centers to meet the demand for services.

SECTION 2. The legislature finds that the State's federally matched medicaid and Med-QUEST programs form an essential support for underserved individuals and for community health centers. Among the medicaid programs that need to be fully funded are dental benefits for adults and outreach and enrollment services.

Oral health is as important as any other physical or mental health need and dental diseases contribute to cardiac health and premature births. Unaddressed dental needs affect the ability of individuals to obtain and keep employment.

Med-QUEST programs offer insurance options for low-income uninsured citizens. Under the ACA, such programs will expand to accommodate additional uninsured adults. It is in the best interests of the State to ensure that community programs reach out to and assist individuals and families with children to enroll in Med-QUEST programs for which they are eligible.

The legislature further finds that there are millions of dollars available to community health center providers through the ACA to pay for electronic health records for meaningful use. Accordingly, the legislature supports the modest investment of state funds to serve as the ten per cent match needed to establish a state office for the purpose of assisting Hawaii in obtaining its fair share of these funds.

Accordingly, the purpose of this Act is to appropriate funds to provide quality, cost-effective health care for Hawaii residents who are uninsured, newly insured, or privately insured by supporting Hawaii's community health centers as they transform from the safety net to the backbone of the health care system by promoting person-centeredness, wellness, and healthy living.

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $8,000,000 or so much thereof as may be necessary for fiscal year 2011-2012 and the same sum or so much thereof as may be necessary for fiscal year 2012-2013 to pay for the provision of direct health care for the uninsured at federally qualified health centers throughout the State, which may include primary medical, dental, and behavioral health care; provided that the distribution of funds may be on a "per visit" basis, and may include an additional per member per month quality incentive payment, taking into consideration the need on all islands.

The sums appropriated shall be expended by the department of health to provide resources to federally qualified health centers throughout the State for the provision of direct health care for uninsured persons.

SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $5,070,000 or so much thereof as may be necessary for fiscal year 2011-2012 to be expended by the department of human services to restore basic adult dental benefits to medicaid enrollees. The department shall obtain the maximum federal matching funds available for this expenditure.

SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $100,000 or so much thereof as may be necessary for fiscal year 2011-2012 to be expended by the department of human services to comply with federal regulations requiring at least one outstationed eligibility worker to be placed at every federally qualified health center site. The department shall obtain the maximum federal matching funds available for this expenditure.

SECTION 6. There is appropriated out of the general revenues of the State of Hawaii the sum of $600,000 or so much thereof as may be necessary for fiscal year 2011-2012 to be expended by the department of human services to provide outreach to families with children eligible for medicaid and Children's Health Insurance Program enrollment. The department shall obtain the maximum federal matching funds available for this expenditure.

SECTION 7. There is appropriated out of the general revenues of the State of Hawaii the sum of $80,000 or so much thereof as may be necessary for fiscal year 2011-2012 to be expended by the department of human services to provide outreach to families eligible for medicaid enrollment. The department shall obtain the maximum federal matching funds available for this expenditure.

SECTION 8. There is appropriated out of the general revenues of the State of Hawaii the sum of $550,000 or so much thereof as may be necessary for fiscal year 2011-2012 to be expended by the department of human services for the immigrant health initiative.

SECTION 9. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2011-2012 to be expended by the department of human services to establish an office to promote meaningful use and certify the eligibility of providers to obtain federal funds. The department shall obtain the maximum federal matching funds available for this expenditure.

SECTION 10. The following sums, or so much thereof as shall be sufficient to finance the projects listed in this section, are hereby appropriated out of the general revenues of the State of Hawaii for fiscal year 2011-2012.

1. Lanai Community Health Center, Lanai

Design, construction, and acquisition of land for the construction of a new facility.

Total funding $5,600,000

2. Waianae Coast Comprehensive Health Center, Oahu

Design and construction of a new satellite site and renovations to existing facilities.

Total funding $1,650,000

3. Hana Community Health Center, Maui

Design and construction of a nutrition center, business dining center, and kupuna group home adult day care facility.

Total funding $2,250,000

4. Kauai Community Health Center, Kauai

Design and construction of a multi use facility in Kapaa.

Total funding $9,700,000

5. Molokai Community Health Center, Molokai

Renovations to existing facilities and buildings.

Total funding $1,000,000

6. Kalihi Palama Health Center, Oahu

Acquisition, renovations, and equipment for a new facility.

Total funding $15,900,000

7. Pahoa Family Health Center, Hawaii

Renovations to existing exam rooms.

Total funding $800,000

SECTION 11. The sums appropriated for the respective capital projects set forth in section 10 shall be expended by the department of health for the purposes of this Act.

SECTION 12. This Act shall take effect on July 1, 2011.

THE SENATE	S.B. NO.	420
TWENTY-SIXTH LEGISLATURE, 2011		S.D. 2
STATE OF HAWAII