HB1761

SECTION 1. According to the United States Department of Housing and Urban Development's 2017 Annual Homeless Assessment Report, Hawaii ranked first among all states for the number of individuals experiencing homelessness per capita. There are an estimated fifty-one individuals experiencing homelessness for every ten thousand people in Hawaii.

The physical toll that homelessness takes on individuals is painfully apparent. The emotional and spiritual burdens of homelessness are less obvious but no less troublesome. In terms of the hierarchy of needs model developed by humanist psychologist Abraham Maslow, because individuals experiencing homelessness are focused on finding shelter to satisfy their physiological and safety needs, such individuals are not able to address their need for belonging, esteem, and achievement. As a result, homelessness is a barrier to individuals' achievement of their full potential.

In addition to the harm that homelessness inflicts on individuals, there are hidden costs of homelessness that are borne by the community. The over-utilization of emergency department services for non-emergency conditions by individuals experiencing homelessness puts upward pressure on medical costs for everyone. When hospital bills go unpaid, institutions are usually able to shoulder the costs in the short-term. For example, Queen's Medical Center reported that it absorbed about $40,000,000 over the past four years in unpaid expenses for emergency department and hospital services rendered to patients experiencing homelessness. Eventually, however, hospitals are forced to recover costs by passing the unpaid costs on to customers who are able to pay.

Based on publicly available statistics, the outlook at emergency departments is worsening. Hawaii Health Information Corporation estimated that Hawaii's hospitals statewide had around fifteen thousand nine hundred emergency department visits by patients experiencing homelessness in 2015. By the end of fiscal year 2016, Queen's Medical Center's emergency department alone logged almost eleven thousand visits by individuals experiencing homelessness. Further, between September 1, 2016, and November 30, 2016, at the Queen's Medical Center, thirty-nine individuals experiencing homelessness accounted for approximately seven hundred thirty-four emergency department visits. The situation is so critical that emergency department personnel worry that the surge of unnecessary over-utilization of an emergency department could bankrupt a hospital.

The legislature finds that it is in the public's interest to explore methods to mitigate the increasing cost of medical care due to the unnecessary use of emergency department visits by patients experiencing homelessness.

Additionally, the legislature finds that identifying patients experiencing and at risk for homelessness in emergency departments and conducting individualized assessments of those patients may increase the likelihood that those patients will receive referrals to services that address their particular situations. The legislature further finds that providing these patients with referrals to appropriate social services and other necessary services, such as preventative medical care and mental health treatment, may decrease the number of unnecessary, repeated emergency department visits by patients experiencing homelessness.

The purpose of this Act is to establish a pilot program to place social workers and social worker designees in emergency departments to identify individuals experiencing or at risk for homelessness and provide individualized assessments and referrals for wrap-around social services with a goal of reducing costs associated with chronic use of emergency departments.

SECTION 2. Definitions. For purposes of this Act:

"Emergency department" means a department in a hospital designated to provide critical care to stabilize and support a patient's condition due to sudden illness or injury.

"Governing body" means the policy making authority, whether an individual or a group, that exercises general direction over the affairs of a facility and establishes policies concerning its operation and the welfare of the individuals it serves.

"Homeless" means the same as in section 346-361, Hawaii Revised Statutes.

"Hospital" means any institution with an organized medical staff which admits patients for inpatient care, diagnosis, observation, and treatment.

"License" means a license issued by the relevant department regulating the profession at issue that certifies that an individual practicing the profession is in compliance with all existing state and federal laws and rules.

"Medical staff" means physicians and other individuals licensed by the State, who are permitted by law and who have been authorized by the governing body to provide patient care services within a facility.

"Physician" means a doctor of medicine or osteopathy licensed by the Hawaii medical board pursuant to chapter 453, Hawaii Revised Statutes.

"Social worker" means the same as in section 467E-1, Hawaii Revised Statutes.

"Social worker designee" means a staff person other than a social worker but with similar professional qualifications, such as nursing, psychology, psychiatry, counseling, or human development, and two years of social work supervised experience in a health care setting working directly with individuals and who is supervised by means of consultation with a social worker.

SECTION 3. (a) There is established within the department of health for administrative purposes a pilot program to be known as the emergency department homelessness assessment pilot program. The department of health, in consultation with Hawaii interagency council on homelessness and any other appropriate agency, shall serve as the administrator of the pilot program.

(b) A participating hospital in the pilot program shall place social workers or social worker designees in its emergency departments. The social workers or social worker designees shall identify patients experiencing homelessness or patients at risk of experiencing homelessness, assess the patients' current circumstances, and refer those patients to appropriate and available social services with a goal of reducing costs associated with chronic use of emergency departments.

The social workers and social worker designees who provide services as part of this pilot program shall not be employees of the State. The social workers and social worker designees shall be either employees of the participating hospital or individuals who are otherwise permitted by law and the governing body of a hospital to provide social services in the hospital.

(c) Each participating hospital shall submit qualitative and quantitative data as determined by the department of health to the department of health to demonstrate whether there is any correlation between interventions by social workers or social worker designees and the repeated use of emergency departments by patients experiencing homelessness.

(d) The department of health shall submit a report to the legislature no later than twenty days prior to the convening of the regular session of 2019. The report shall contain a summary and explanation of the data submitted by participating hospitals regarding the efficacy of emergency department intervention by social workers and social worker designees in mitigating the number of unnecessary emergency department visits by patients experiencing homelessness or patients at risk of experiencing homelessness. The report shall also contain findings and recommendations, including any proposed legislation, for continuation, modification, or termination of the pilot program.

(e) The emergency department homelessness assessment pilot program shall cease to exist on June 30, 2019.

SECTION 4. 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 2018-2019 to the department of health for implementation of the emergency department homelessness assessment pilot program, including all program costs and hiring of necessary staff.

The department of health shall reimburse participating hospitals for expenses directly related to the emergency department homelessness assessment pilot program; provided that no funds shall be disbursed to participating hospitals unless matched on a dollar-for-dollar basis by the participating hospital. All funds designated as matching funds by the participating hospital shall be funds expended by the participating hospital for the pilot program.

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

SECTION 5. This Act shall take effect upon its approval; provided that section 4 shall take effect on July 1, 2018.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	1761
TWENTY-NINTH LEGISLATURE, 2018
STATE OF HAWAII