SB1036 HD1.DOC

SECTION 1. The legislature finds that the federal Patient Protection and Affordable Care Act of 2010 encourages states to develop innovative approaches to the delivery of integrated health services. The legislature further finds that Hawaii has a bold history as an innovator in ensuring that its residents have access to health care. The Hawaii Prepaid Health Care Act and the State's medicaid program have provided access to comprehensive managed care for low-income families. The State can create more effective alternative solutions for affordable health care by better integrating public health systems to balance public health care needs with associated costs to the State.

The overall fiscal costs and burden of substance use disorders with co-occurring mental health disorders on Hawaii's public health care system are unsustainable. Studies indicate that a small percentage of patients in the United States consume a disproportionate share of health care resources. Known as "super users", this one per cent of the population consumes twenty-one per cent of the nearly $1,300,000,000,000 spent each year on health care nationwide, according to a 2013 report from the Agency for Healthcare Research and Quality. In Hawaii, it has been reported that about five per cent of the medicaid population accounts for about forty-nine per cent of the State's annual health care costs. Considering the 2015 MedQUEST budget, this means about sixteen thousand people on MedQUEST cost over $1,000,000,000.

Super users' most common conditions involve multiple illnesses, one of which is often substance abuse. Similarly, patients who frequent emergency departments tend to suffer chronic illnesses or have multiple psychosocial risk factors, such as substance abuse, mental illness, or homelessness. The commonality among most super users is that they lack a social network to help them coordinate their aftercare. For example, many super users do not have a regular physician, so whenever medical care is necessary, they turn to the community hospital, which is often the most expensive and least efficient type of care for their needs.

The legislature finds that while the costly cycle of substance abuse is currently a financial burden on the State's health care system, it is also a treatable disease worthy of more attention and resources. Recent discoveries in the science of addiction have led to significant advances in drug abuse treatment that help people successfully manage their addiction and resume productive lives. While the social welfare factors that contribute to addiction present a complex problem, research indicates that treatment for substance use disorders can be effective and reduce costs to the health care and criminal justice systems. Research shows that about seventy per cent of addiction and mental health costs can be averted by effectively providing relevant treatment before the onset of more serious chronic conditions. Treating all of super users' complex issues in an integrated way is a sound social investment because it effectively reduces duplication and overutilization. Recent studies have proven that every $1 spent on treatment saves $4 in health costs.

Therefore, the purpose of this Act is to:

(1) Establish a working group within the department of health to address publicly-funded coverage of substance abuse treatment services; and

(2) Appropriate moneys for the department of health to convene the working group.

SECTION 2. (a) The department of health shall convene a working group to address the availability and accessibility of publicly-funded substance abuse treatment services for highly represented populations that use publicly-funded services.

(b) The working group shall:

(1) Review and recommend policy changes to publicly-funded services for substance use disorders including, but not limited to, the federal model of recovery-oriented system of care as outlined by the Substance Abuse and Mental Health Services Administration;

(2) Explore approaches for integrating healthcare with addiction treatment including, but not limited to, education and training for primary care providers dealing with patients with a substance use or co-occurring disorder;

(3) Ensure publicly-funded substance abuse treatment services are available and accessible to subpopulations, such as offenders, pregnant and parenting women, and co-occurring populations with legal involvement; and

(4) Determine the level of resources needed to improve outcomes for substance abuse treatment services.

(1) The director of health or the director's designee, who shall serve as the chairperson of the working group;

(2) One member of the house of representatives, to be appointed by the speaker of the house of representatives;

(3) One member of the senate, to be appointed by the president of the senate;

(4) The director of human services or the director's designee;

(5) The director of public safety or the director's designee;

(6) The chair of the Hawaii paroling authority or the chair's designee;

(7) One member representing the Hawaii Substance Abuse Coalition, to be invited by the chairperson of the working group;

(8) One member representing the Hawaii Psychiatric Medical Association, to be invited by the chairperson of the working group;

(9) One member representing a Hawaii inpatient or emergency room hospital, to be invited by the chairperson of the working group;

(10) One member representing Hawaii Primary Care Association, to be invited by the chairperson of the working group; and

(11) Any other member as assigned by the working group not to exceed a total of fifteen members.

(d) The members of the working group shall serve without pay but shall be reimbursed for their actual and necessary expenses, including travel expenses, incurred in carrying out their duties.

(e) The department of health shall submit to the legislature a report concerning the publicly-funded coverage of substance abuse treatment services no later than twenty days prior to the convening of the regular session of 2016.

SECTION 3. 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 2015-2016 for the department of health to convene a working group pursuant to section 2 of this Act.

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

SECTION 4. This Act shall take effect on July 1, 2112, and shall be repealed on June 30, 2016.

THE SENATE	S.B. NO.	1036
TWENTY-EIGHTH LEGISLATURE, 2015		S.D. 2
STATE OF HAWAII		H.D. 1