SB2298 HD2

SECTION 1. The legislature finds that demand for healthcare providers in Hawaii is growing because of an increase in population size, particularly among the aged population; an improvement in access to care due to broader insurance coverage; and a higher prevalence of chronic diseases. At the same time, there is a primary care provider shortage in Hawaii that will be exacerbated by the projected retirements of current physicians and advanced practice registered nurses. If nothing is done to address the gap between healthcare supply and demand, patients will suffer from longer wait times to see providers and poorer health outcomes. Even more so, the evolution of healthcare delivery means academic institutions across Hawaii face challenges in ensuring an adequate number of future healthcare professionals who are well-distributed by location and by specialty and who are prepared to deliver primary, specialty, and behavioral health care in rural, urban, and suburban settings across Hawaii. Thus, the legislature acknowledges that in order to meet these growing healthcare demands, the State must work with academic institutions and healthcare professionals to ensure that there is an adequate and well-prepared healthcare workforce.

The legislature further finds that Hawaii high school students and residents are interested in pursuing careers in the healthcare service industry. However, in-state educational institutions are constrained by the lack of clinical education and field work sites in Hawaii and the limited supply of qualified primary and specialty care preceptors. The legislature recognizes that current efforts are underway to address these clinical site limitations, including travel support from health professional schools in Hawaii for students and residents who are incurring high costs for training away from their home island. With out-of-state training having such a high cost, the State must consider expanding in-state healthcare provider education capacity.

The legislature also finds that the development of new clinical preceptors and training sites is increasingly difficult. The cohort of preceptors consists largely of volunteers who share the kuleana of educating the future healthcare workforce. Yet, providers who offer such volunteer-based education assume this responsibility above and beyond their regular patient-care responsibilities, subjecting themselves to preceptor fatigue, especially in busy clinical settings. Developing sufficient clinical training opportunities and field placements in areas of high demand requires a sufficient number of appropriately trained preceptors, but the limited availability of preceptors restricts in-state healthcare academic institutions from expanding healthcare provider training. Some states, including Maryland, Georgia, and Colorado, have identified preceptor tax exemptions as a means to increase the supply of health professional preceptors and trainees.

The purpose of this Act is to create a tax credit that encourages preceptors to offer professional instruction, training, and supervision to students and residents seeking careers as healthcare providers throughout Hawaii, with the intention of building capacity for clinical education at in-state academic programs that are nationally accredited for the training of medical, nursing, dental hygiene, social work, psychology, physical therapist assistant, or pharmacy professionals.

SECTION 2. Chapter 235, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§235- Healthcare preceptor tax credit. (a) There shall be allowed to each taxpayer subject to the tax imposed by this chapter, a healthcare preceptor tax credit for supervising volunteer-based supervised clinical training rotations which shall be deductible from the taxpayer's net income tax liability, if any, imposed by this chapter for the taxable year in which the credit is properly claimed.

(b) The amount of the credit determined under this section for the taxable year shall be equal to $1,000 for each volunteer-based supervised clinical training rotation supervised by the taxpayer; provided that the aggregate amount of tax credit awarded to any taxpayer pursuant to this section shall not exceed $5,000 for any income tax year regardless of the number of volunteer-based supervised clinical training rotations supervised by the taxpayer.

(1) Shall prepare any forms that may be necessary to claim a tax credit under this section; and

(2) May require the taxpayer to furnish the certificate issued under subsection (d) and any other reasonable information necessary to ascertain the validity of the claim for the tax credit made under this section.

(d) The preceptor credit assurance committee, established pursuant to section 321- , shall:

(1) Maintain records of the names, addresses, and license number of the qualified taxpayers claiming the credits under this section; and

(2) Verify the number of volunteer-based supervised clinical training rotations each taxpayer supervised by verifying:

(A) That each taxpayer meets the requirements to serve as a preceptor;

(B) The number of hours the taxpayer spent supervising an eligible primary care student or trainee in each volunteer-based supervised clinical training rotation;

(D) Whether the taxpayer was uncompensated.

Upon each determination, the preceptor credit assurance committee shall issue a certificate to the taxpayer verifying the number of volunteer-based supervised clinical training rotations supervised by the taxpayer.

(e) If in any taxable year the annual amount of certified credits reaches $2,000,000 in the aggregate, the preceptor credit assurance committee shall immediately discontinue certifying credits and notify the department of taxation. In no instance shall the preceptor credit assurance committee certify a total amount of credits exceeding $2,000,000 per taxable year. To comply with this restriction, the preceptor credit assurance committee shall certify credits on a first come, first served basis.

(f) A tax credit under this section that exceeds the taxpayer's net income tax liability may be used as a credit against the taxpayer's net income tax liability in subsequent years until exhausted. All claims for tax credits under this section, including any amended claims, shall be filed on or before the end of the twelfth month following the close of the taxable year for which the credits may be claimed. Failure to comply with this subsection shall constitute a waiver of the right to claim the credit.

(g) For the purpose of this section:

"Academic program" means an academic degree granting or graduate medical education program that holds either its principal accreditation or a physical location in Hawaii that provides education to students of whom more than fifty per cent are residents of Hawaii.

"Advanced practice registered nurse student" means an individual participating in a degree-granting academic program that is nationally accredited by the Commission on Collegiate Nursing Education for the education of primary care advanced practice registered nurses and recognized by the board of nursing pursuant to chapter 457.

"Dental hygienist student" means an individual participating in an academic program that is nationally accredited for the training of dental hygienists or expanded dental hygienists pursuant to chapter 447.

"Eligible professional degree or training certificate" means a degree or certificate that fulfills a requirement to be a dental hygienist pursuant to chapter 447, a physician or osteopathic physician pursuant to chapter 453, an advanced practice registered nurse pursuant to chapter 457, a physical therapist assistant pursuant to chapter 461J, a pharmacist pursuant to chapter 461, a psychologist pursuant to chapter 465, or a social worker pursuant to chapter 467E.

"Eligible student or trainee" means an advanced practice registered nurse student, dental hygienist student, medical student, pharmacy student, psychology student, social work student, or physical therapist assistant student.

"Medical student" means an individual participating in an academic program nationally accredited by the Liaison Committee on Medical Education or American Osteopathic Association Commission on Osteopathic College Accreditation leading to the doctor of medicine or doctor of osteopathic medicine degree. For the purposes of this section the term medical student includes graduates from Liaison Committee on Medical Education and American Osteopathic Association Commission on Osteopathic College Accreditation programs who have continued their training, in the role of resident or fellow, to obtain the additional qualifications needed for both medical licensure pursuant to chapter 453 and specialty certification.

"Nationally accredited" means holding an institutional accreditation by name for such primary care education pursuant to chapter 447, 453, 457, 461, 461J, or 467E.

"Pharmacy student" means an individual participating in an academic program that is nationally accredited for the training of individuals to become registered pharmacists pursuant to chapter 461.

"Preceptor" means a dentist or dental surgeon licensed pursuant to chapter 448, a physician or osteopathic physician licensed pursuant to chapter 453, an advanced practice registered nurse licensed pursuant to chapter 457, a pharmacist licensed pursuant to chapter 461, a physical therapist licensed pursuant to chapter 461J, a psychologist licensed pursuant to chapter 465, or a social worker pursuant to chapter 467E who may be either licensed or unlicensed.

"Psychology student" means an individual participating in an academic program that is nationally accredited for the training of individuals to become psychologists pursuant to chapter 465.

"Physical therapist assistant student" means an individual participating in an academic program that is nationally accredited for the training of individuals to become registered physical therapist assistants pursuant to chapter 461J.

"Social worker student" means an individual participating in an academic program in this State that is nationally accredited for the training of social work professionals pursuant to chapter 467E.

"Volunteer-based supervised clinical training rotation" means an uncompensated period of supervised clinical training on behalf of an eligible student or trainee that totals at least eighty hours of supervisory time annually, in which a preceptor provides personalized instruction, training, and supervision that is offered to an eligible student or trainee to enable the eligible student or trainee to obtain an eligible professional degree or training certificate."

SECTION 3. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§321- Preceptor credit assurance committee. (a) There is established the preceptor credit assurance committee within the department of health, to be convened by the university of Hawaii Hawaii/Pacific basin area health education center and center for nursing. The preceptor credit assurance committee shall:

(1) Develop and implement a plan for allocating and distributing healthcare preceptor tax credits under section 235- including:

(A) A process to ensure that requests for credit are reviewed and verifications are processed by the thirtieth of January of each calendar year; and

(B) A documentation process for the deans, directors, or their designees to qualify a preceptor for the tax credit. This shall include:

(i) Preceptor name, address, place of practice, and Hawaii provider license number;

(ii) Dates and hours of volunteer-based supervised clinical rotation per eligible student;

(iii) Attestation that the volunteer-based supervised clinical rotation per eligible student or trainee is uncompensated; and

(iv) Other information as identified as necessary by the committee;

(2) Complete duties as described in section 235- ; and

(3) Be composed of representatives of academic programs with eligible students or trainees.

(b) There shall be no civil liability for any member of the preceptor credit assurance committee for any act done in furtherance of the purpose for which the preceptor credit assurance committee was established.

(c) The committee may hold a meeting closed to the public pursuant to section 92-4 for the purpose of considering information affecting the privacy of an individual, provided that information in which an individual has a significant privacy interest as provided in subsection 92F-14(b) shall be considered to be information affecting the privacy of an individual.

(d) As used in this section:

"Academic program" shall have the same meaning as in section 235- .

"Eligible student or trainee" shall have the same meaning as in section 235- .

"Preceptor" shall have the same meaning as in section 235- .

"Volunteer-based supervised clinical rotation" shall have the same meaning as in section 235- ."

SECTION 4. The department of health shall evaluate the efficacy of the healthcare preceptor tax credit established by this Act and submit a report to the legislature no later than June 30, 2024, which shall include the department's findings and a recommendation of whether the tax credit should be retained or repealed.

SECTION 5. New statutory material is underscored.

SECTION 6. This Act shall take effect on July 1, 3000; provided that section 2 shall apply to taxable years beginning after December 31, 2018.

THE SENATE	S.B. NO.	2298
TWENTY-NINTH LEGISLATURE, 2018		S.D. 2
STATE OF HAWAII		H.D. 2