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HOUSE OF REPRESENTATIVES |
H.B. NO. |
1761 |
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TWENTY-NINTH LEGISLATURE, 2018 |
H.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO HOMELESSNESS.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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.
SECTION 2.
Definitions. For purposes of this
Act:
"Advanced practice registered
nurse" means a person licensed as an advanced practice registered
nurse under chapter 457, Hawaii
Revised Statutes.
"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.
"Patient navigator" means an individual
who assists patients through the continuum of healthcare as it pertains to
their specific disease, ensuring that any and all barriers to that care are
resolved.
"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
multidisciplinary teams in its emergency departments. The multidisciplinary teams 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 individuals on a multidisciplinary team
who provide services as part of this pilot program shall not be employees of
the State. The individuals on a
multidisciplinary team 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 a
multidisciplinary team 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 a multidisciplinary team 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 on July 1, 3000.
Report Title:
Emergency
Department Homelessness Assessment Pilot Program
Description:
Establishes the Emergency Department Homelessness Assessment Pilot Program to identify a possible correlation between multidisciplinary team interventions and the use of hospital emergency departments by individuals experiencing homelessness and makes an appropriation. (HB1761 HD1)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.