SB2779.DOC

SECTION 1. The legislature finds that the city and county of Honolulu emergency medical services ran almost ninety thousand calls in 2015. Of these calls, many are from repeat callers who call multiple times per day for issues that do not need emergency services, but rather general assistance. As the call volume rises each year and the number of ambulance stations remains the same, it is critical to establish community paramedic services to provide the appropriate services for these repeat callers who would otherwise be using resources that could best serve individuals who need emergency medical services.

The purpose of this Act is to establish and appropriate funds for community paramedic services to expand the provision of emergency medical services and assist in providing more timely medical services to the community, improving overall quality of life and health.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"PART . COMMUNITY PARAMEDIC SERVICES

§321-A Definitions. As used in this part, unless the context clearly requires otherwise:

"Department" means the department of health.

"Eligible recipient" means:

(1) An individual who has received hospital emergency services three or more times in a period of four consecutive months in the past twelve months; or

(2) An individual who has been identified by the individual's primary care physician as an individual for whom community paramedic services pursuant to section 321-B would likely prevent admission to or would allow discharge from a nursing facility or would likely prevent readmission to a hospital or nursing facility.

"Emergency medical technician-community paramedic" or "community paramedic" means a person who is certified as an emergency medical technician and who meets the requirements for additional certification as a community paramedic pursuant to part II of chapter 453.

§321-B Community paramedic services; scope of practice; patient care plan. (a) A community paramedic shall practice in accordance with protocols and supervisory standards established by the department pursuant to this part.

(b) The department shall determine the scope of the practice of community paramedic services, which shall include but not be limited to health assessment, chronic disease monitoring and education, medication compliance, immunizations and vaccinations, laboratory specimen collection, hospital discharge follow-up care, and minor medical procedures approved by the department.

(c) A community paramedic may provide community paramedic services to eligible recipients as directed by a patient care plan if the plan has been developed by the patient's primary care physician, an advanced practice registered nurse, or a physician assistant, in conjunction with relevant local health care providers. The patient care plan shall ensure that the services provided by the community paramedic are consistent with the services offered by the patient's health care home, if one exists, that the patient receives the necessary services, and that there is no duplication of services to the patient.

(d) Services provided by a community paramedic to an eligible recipient who is also receiving care coordination services shall be in consultation with the providers of the recipient's care coordination services.

(e) A community paramedic shall be subject to all certification, disciplinary, complaint, and other regulatory requirements that apply to an emergency medical technician under part II of chapter 453.

§321-C Community paramedic services covered; medical assistance program. (a) The director of health shall determine the community paramedic services to include under medical assistance coverage. In determining the community paramedic services to include under medical assistance coverage, the director of health shall consider the potential of hospital admittance and emergency room utilization reductions as well as increased access to quality care in rural communities.

(b) The director of health shall evaluate the effect of medical assistance coverage of community paramedic services on the cost and quality of care and the coordination of these services with health care home services. The director shall require medical assistance enrolled providers that employ or contract with community paramedics to provide to the director, in the form and manner specified by the director, the utilization, cost, and quality data necessary to conduct this evaluation.

(c) Payment for services provided by a community paramedic under this part shall be a part of a care plan ordered by a primary care physician in consultation with the medical director of an ambulance service and must be billed by an eligible provider enrolled in medical assistance that employs or contracts with the community paramedic. The care plan shall ensure that the services provided by a community paramedic are coordinated with other community health providers and local public health agencies and that community paramedic services do no duplicate services already provided to the eligible recipient, including home health and waiver services.

(d) The director of health, in consultation with representatives of emergency medical service providers, physicians, public health nurses, and local public health agencies, shall determine payment rates for community paramedic services performed by community paramedics.

(e) Payment for services provided by a community paramedic shall be:

(1) Ordered by an ambulance medical director;

(2) Part of a patient care plan that has been developed in coordination with the eligible recipient's primary care physician and relevant local health care providers; and

(3) Billed by an eligible medical assistance enrolled provider that employs or contracts with the community paramedic."

SECTION 3. Chapter 453, Hawaii Revised Statutes, is amended by adding two new sections to part II to be appropriately designated and to read as follows:

"§453- Community paramedic services personnel. The practice of any community paramedic services, as determined by the department of health pursuant to part of chapter 321, by any individual shall be subject to certification under this part.

§453- Certification of community paramedic personnel. (a) To be eligible for certification by the Hawaii medical board as a community paramedic, as defined in section 321-A, an individual shall:

(1) Be currently certified as an emergency medical technician;

(2) Have two years of full-time service, or the part-time equivalent, as an emergency medical technician;

(3) Have successfully completed a community paramedic training program that has been approved by the Hawaii medical board or accredited by a board-approved national accreditation organization; provided that the training program shall include clinical experience that is provided under the supervision of an emergency medical services medical director, advanced practice registered nurse, physician assistant, or public health nurse operating under the direct authority of a local unit of government;

(4) Have completed a board-approved application form; and

(5) Meet all other requirements set by the Hawaii medical board.

(b) The Hawaii medical board shall provide standard application forms for the certification of community paramedics and shall provide for the periodic renewal of such certification. The Hawaii medical board shall assess a fee for such application, certification, and renewal. The Hawaii medical board shall provide for the revocation, suspension, or limitation of certification in the event an individual once certified under this section fails to maintain or meet requirements for continued certification, or for good cause shown."

SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $410,000 or so much thereof as may be necessary for fiscal year 2016-2017 to provide community paramedic services pursuant to this Act, including expenses related to personnel, equipment, and training.

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

SECTION 5. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

SECTION 6. New statutory material is underscored.

SECTION 7. This Act shall take effect on July 1, 2016.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2779
TWENTY-EIGHTH LEGISLATURE, 2016
STATE OF HAWAII