SB1036 SD2.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, however, by better integrating public health systems in order to balance public health care needs with the 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 the 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 task force within the department of health to address health care payment reform and reduce health care costs by implementing an effective substance abuse treatment system; and

(2) Appropriate moneys for the department of health to convene the task force.

SECTION 2. (a) The department of health shall convene a task force to address health care and payment reform steps to implement an effective addiction treatment system as a component of health care to improve outcomes and reduce overall health care costs.

(b) The task force shall:

(1) Provide multi-disciplinary teams to review and recommend policy changes in state and insurer systems for substance use disorders;

(2) Utilize the federal model of recovery-oriented system of care as outlined by the Substance Abuse and Mental Health Services Administration;

(3) Continue to integrate primary health care with addiction treatment by providing education and training to primary care providers on screening, brief interventions for mild or moderate substance use disorder conditions, and referrals to specialized substance use disorder treatment for moderate to chronic conditions;

(4) Develop a treatment program for mild to moderate conditions for substance use disorders and co-occurring disorders;

(5) Support transitional care management for emergency rooms to deal with patients with chronic substance use disorder or co-occurring disorders;

(6) Ensure Quest members and uninsured patients have adequate access to all modalities of substance abuse treatment, including residential, day treatment, and outpatient treatment that meets minimum levels of utilization according to medical necessity;

(7) Develop offender re-entry programs that target offenders with chronic substance use disorders or co-occurring disorders so that needed services can be accessed immediately;

(8) Design payment reform models for reimbursement that adequately address the complex care needed for super users or other chronic conditions of substance use disorders or co-occurring disorders and that promote collaboration and consider risk adjustments; and

(9) Determine the additional amount of funding needed to improve outcomes and reduce overall health care spending by providing funding for all modalities, including residential, day treatment, intensive outpatient, outpatient, and aftercare, for substance use disorders, co-occurring disorders, criminality, dual services, case management, peer mentoring, and recovery-oriented services.

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

(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) One member representing the Hawaii Substance Abuse Coalition, to be invited by the chairperson of the task force;

(7) One member representing the Hawaii Medical Association, to be invited by the chairperson of the task force;

(8) One member representing the University of Hawaii John A. Burns school of medicine's psychiatric department;

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

(10) Any other member as assigned by the task force.

(d) The members of the task force 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:

(1) Preliminary report concerning the progress made by the task force in improving substance use disorder and co-occurring disorder treatment no later than twenty days prior to the convening of the regular session of 2016; and

(2) Final report of findings and recommendations, including any proposed legislation, no later than twenty days prior to the convening of the regular session of 2017.

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 and the same sum or so much thereof as may be necessary for fiscal year 2016-2017 for the department of health to convene a task force pursuant to section 2 of this Act.

The sums 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, 2050, and shall be repealed on June 30, 2017.

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