SB2374 SD1

SECTION 1. The legislature finds that a high percentage of calls for emergency medical services are from repeat callers who call multiple times per day for issues that do not require an emergency response. Additionally, most 911 calls originate from residences and are often for medical concerns that could be addressed by a functioning community paramedic system. 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 appropriate services to non-emergency callers who would otherwise be using valuable emergency medical services needed by other individuals.

Focused on identifying solutions, the department of health emergency medical services and injury prevention system branch convened a working group and compiled a report prior to the 2017 legislative session in response to House Concurrent Resolution No. 90, Regular Session of 2016. The working group, in its December 2016 report to the legislature, recommended that a community paramedic pilot program be established at two to three of the six metropolitan and rural sites it identified. The working group found that community paramedicine could reduce the high volume of 911 calls for non-emergency medical conditions. It also found that community paramedicine could improve health in the State by addressing the following: callers needing alternate destinations other than emergency departments; post-hospital discharge care; the homeless population; hospice care; behavioral health; and acute and chronic medical conditions such as infectious diseases, diabetes, hypertension, and asthma.

The purpose of this Act is to implement the recommendations of the working group convened pursuant to House Concurrent Resolution No. 90, Regular Session of 2016, by establishing and appropriating funds for a three-year community paramedic services pilot program and requiring an evaluation of the pilot program's effectiveness.

SECTION 2. There is established a three-year community paramedic services pilot program, to be administered by the department of health. The pilot program shall commence on January 1, 2019, and shall terminate on December 31, 2021. The program shall be conducted at two pilot sites approved by the director of health, with at least one site on a neighbor island. The program shall include the following components:

(1) Training and certification. Kapiolani community college shall:

(A) Develop a community paramedic curriculum in consultation with the department of health;

(B) Institute a community paramedic training program; and

(C) In partnership with the University of Hawaii community colleges, train community health workers based on common core competencies to work with community paramedics;

(2) Staffing. The department of health shall recruit and hire a community paramedicine administrator, an appropriate number of community paramedicine medical directors for each pilot site, and other personnel as needed;

(3) Equipment and supplies. The department of health shall procure non-transport vehicles and contract with emergency medical services providers to provide necessary supplies and medical equipment;

(4) Medical records. Community paramedics providing services under the pilot program shall initially use the existing Hawaii emergency medical services medical record system but shall transition to a more suitable medical record system when funds become available and such a system is identified; and

(5) Billing. The department of health shall develop a fee schedule for community paramedic services in consultation with insurance carriers. Billing and collections for community paramedic services shall be conducted by the department of health emergency medical services and injury prevention system branch. All moneys collected shall be deposited into the general fund of the State.

SECTION 3. The department of health emergency medical services and injury prevention system branch shall submit a report on the status of the implementation of the community paramedic services pilot program, including any additional resources and legislation required, to the legislature no later than twenty days prior to the convening of the regular session of 2019.

SECTION 4. The department of health emergency medical services and injury prevention system branch shall submit a report on the results of the three-year community paramedic services pilot program, including any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular sessions of 2020, 2021, and 2022. The report shall address but not be limited to the following:

(1) An evaluation of the effectiveness of the pilot program at the selected sites in terms of patient outcomes, 911 system impact, and costs within eighteen months of the start of services at the pilot sites;

(2) A calculation of the program's return on investment based on:

(A) The estimated cost savings from any reduction in usage of emergency ambulance services, emergency facilities, and associated personnel as a direct result of the provision of community paramedic services during the three-year pilot program; and

(B) The overall impact of the pilot program;

(3) Workforce issues, including but not limited to recruitment, access to training, certification, and retention efforts; and

(4) Sustainability and expansion efforts, including funding, staffing needs, and fee schedule.

SECTION 5. No later than June 30, 2019, the department of health shall adopt interim rules, which shall be exempt from chapters 91 and 201M, Hawaii Revised Statutes, to effectuate the purposes of this Act; provided that the interim rules shall remain in effect until , , or until the department adopts rules pursuant to chapter 91, Hawaii Revised Statutes, whichever occurs sooner.

SECTION 6. 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 program development, site operation, administration, and evaluation for the community paramedic services pilot program established pursuant to this Act.

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

SECTION 7. 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 Kapiolani community college for implementation of and training for the community paramedic services pilot program established pursuant to this Act.

The sum appropriated shall be expended by the University of Hawaii for the purposes of this Act.

SECTION 8. This Act shall take effect on July 1, 2050; provided that sections 6 and 7 shall take effect on July 1, 2050; provided further that this Act shall be repealed on December 31, 2021.

THE SENATE	S.B. NO.	2374
TWENTY-NINTH LEGISLATURE, 2018		S.D. 1
STATE OF HAWAII