Bill Text: HI HB1281 | 2021 | Regular Session | Amended
Bill Title: Relating To Emergency Medical Services.
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Passed) 2021-07-07 - Act 208, on 07/06/2021 (Gov. Msg. No. 1336). [HB1281 Detail]
Download: Hawaii-2021-HB1281-Amended.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
1281 |
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THIRTY-FIRST LEGISLATURE, 2021 |
H.D. 1 |
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STATE OF HAWAII |
S.D. 1 |
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A BILL FOR AN ACT
RELATING TO EMERGENCY MEDICAL SERVICES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
PART I
SECTION 1. Chapter 46, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:
"Part . COUNTY
EMERGENCY MEDICAL SERVICES SYSTEM
§46- Definitions. As used in this part, unless the context clearly requires otherwise:
"Advanced life
support" shall have the same meaning as defined in section 321-222.
"Basic
life support" means initiating noninvasive emergency patient care designed
to optimize the patient's chances of surviving the emergency situation. The care rendered consists of all first aid
procedures needed, but does not include invasive procedures that constitute the
practice of medicine; provided that state-approved basic life support personnel
may use fully automatic external defibrillators, initiate intravenous lines,
and perform manual external defibrillation under the direction and personal
supervision of a mobile intensive care technician.
"Community
paramedicine program" means an enhanced and expanded service in the county
emergency medical services system that allows state-licensed health care
professionals, and community health workers, to assist with public health,
primary care, and prevention services, including services through telehealth.
"County" means any county having a population of five hundred thousand or more.
"County system" means the county emergency medical services system.
"Emergency aeromedical services" shall have the same meaning as defined in section 321-222.
"Emergency medical services for children" shall have the same meaning as defined in section 321-222.
"Emergency medical services personnel" shall have the same meaning as defined in section 321-222.
§46- County emergency medical services system; establishment. Each county shall establish, administer, and maintain a county emergency medical services system to serve the emergency health needs of the people in the county. The county, in the implementation of this part, shall plan, coordinate, and provide assistance to all entities and agencies, public and private, involved in the county system. All emergency medical services or ambulance services conducted by or under the authority of the county shall be consistent with this part.
§46-
County,
functions; duties. In
addition to other functions and duties assigned under this part, the county
shall:
(1) Establish emergency medical services throughout the county that may
include emergency aeromedical services, which shall meet the requirements of
this part and include the purchase, maintenance, and servicing of all
vehicles, equipment, and supplies, a National Emergency Medical Services
Information System compliant pre-hospital electronic patient care record
system, and compatible data uploads to the cardiac arrest registry to enhance
survival, the state trauma system, and the department of health pre-hospital
electronic patient record registries; and
(2) Establish, administer, and maintain a medical communication system for
the county.
§46- Emergency medical services; fees. (a) The county may establish reasonable fees to be collected from individuals who are:
(1) Transported by emergency ground ambulance services to a health care facility within the county designated by the county for the care of the individual;
(2) Provided health care by emergency medical services personnel within the county but not transported by ground ambulance to a health care facility; or
(3) Provided care by the community paramedicine program.
(b)
No ambulance services, or any other emergency medical services available
from or under the authority of this chapter shall be denied to any person on
the basis of the ability of the person to pay or because of the lack of prepaid
health care coverage or proof of the ability to pay or coverage.
(c) The county may adopt rules pursuant to chapter 91 necessary to effectuate the purposes of this section.
§46- Community paramedicine program; established. (a) The county may establish and administer the community paramedicine program.
(b) The county may:
(1) Develop community paramedicine guidelines consistent with those adopted by the department of health;
(2) Explore and develop partnerships with public and private health care entities, insurers, and community organizations to facilitate the community paramedicine program; and
(3) Employ telehealth
within the community paramedicine program to enhance access and improve the
patient experience.
(c) The county shall adopt rules pursuant to chapter 91 to effectuate the purposes of this section.
§46- Emergency medical services; levels of service; contracts. The county shall determine the levels of emergency medical services that shall be implemented throughout the county; provided that the county shall provide no fewer than twenty-one ground ambulance units. The county may contract to provide emergency medical services, including emergency aeromedical services, or any necessary component of the county emergency services system.
§46- Grants. The county system may seek and accept any funds or property and other desirable support and assistance from any source whatsoever, whether gift, grant, services, or any combination thereof, subject to applicable laws.
§46- Immunity and limitation on liability for emergency aeromedical services. The county shall not be liable for any claim of injury or death based on a failure to establish or continue emergency aeromedical services in any part of the county.
§46- Rules. The county may adopt rules necessary for the implementation of this part, subject to chapter 91."
SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to part XVIII to be appropriately designated and to read as follows:
"§321- Retention of relevant documentation. Notwithstanding
any provision of this part or any other state or county law or ordinance to the
contrary, the department shall maintain data repositories, charts, patient
information, data submission, and epidemiology information for all emergency
medical services statewide."
SECTION 3.
Chapter 321, part XVIII, Hawaii Revised Statutes, is amended by amending
its title to read as follows:
"PART XVIII. STATE [COMPREHENSIVE] EMERGENCY
MEDICAL SERVICES SYSTEM."
SECTION 4. Section 321-221, Hawaii Revised Statutes, is amended to read as follows:
"§321-221 Findings and purpose. The legislature finds that the establishment
of a state [comprehensive] emergency medical services system [to
include but not be limited to], including emergency medical services
for children, is a matter of compelling state interest and necessary to
protect and preserve [the] public health [of the people of the
State]. A system designed to reduce
medical emergency deaths, injuries, and permanent long-term disability through
the implementation of a fully integrated, cohesive network of components, the legislature
further finds, will best serve [the] public health needs [of
the people]. Accordingly, the
purpose of this part is to establish and maintain a state [comprehensive]
emergency medical services system [throughout the] in communities
that can be most effectively served by the State, and to fix the
responsibility for the administration of this state system, which shall
provide for the arrangement of personnel, facilities, and equipment for the
effective and coordinated delivery of health care services under emergency
conditions, whether occurring as the result of a patient's condition [or
of], from natural disasters, or from other
causes. The system shall provide for
personnel, personnel training, communications, emergency transportation,
facilities, coordination with emergency medical and critical care services,
coordination and use of available public safety agencies, promotion of consumer
participation, accessibility to care, mandatory standard medical recordkeeping,
consumer information and education, independent review and evaluation, disaster
linkage, mutual aid agreements, and other components necessary to meet the
purposes of this part."
SECTION 5. Section 321-222, Hawaii Revised Statutes, is amended as follows:
1. By adding two new definitions to be appropriately inserted and to read:
""Service area" means the State, excluding any county having a population of five hundred thousand or more.
"Statewide"
means all counties in the State."
2. By
amending the definition of "emergency medical services for children"
to read:
""Emergency medical services for
children" means [comprehensive] emergency medical services,
including preventive, pre-hospital, hospital, rehabilitative, and other
post-hospital care for children.""
3. By
amending the definition of "state system" to read:
""State system" means the
state [comprehensive] pre-hospital medical services system."
SECTION 6. Section 321-223, Hawaii Revised Statutes, is amended to read as follows:
"[[]§321-223[]] State [comprehensive] emergency medical services system, establishment. The department [of health] shall
establish, administer, and maintain the state [comprehensive] emergency
medical services system to serve the emergency health needs of the people [of]
in the [State.] service area. [The department, in the implementation of
this part shall plan, coordinate, and provide assistance to all entities and
agencies, public and private, involved in the state system.] All emergency medical services or ambulance
services [conducted] contracted by or under the authority of the
department [of health] or any county within the service area
shall be consistent with this part."
SECTION 7. Section 321-224, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
"(a) In addition to other functions
and duties assigned under this part, the
department shall:
(1) Regulate ambulances and ambulance services[;] statewide;
(2) Establish emergency medical services throughout the [State,] service
area, including emergency aeromedical services, which shall meet the
requirements of this part, subject to section 321-228;
(3) Review and approve the curricula and syllabi of training courses offered
to emergency medical services personnel statewide who provide basic, intermediate,
and advanced life support, consult and coordinate with the University of
Hawaii, or any other accredited community college, college, or university, or
any professional organization that provides emergency medical services
training, regarding the training for basic, intermediate, and advanced life
support personnel, as provided in section 321-229;
(4) Collect and evaluate data for the continued evaluation of the [state]
statewide emergency medical services system, subject to section 321‑230;
(5) Coordinate, on a statewide basis, emergency medical resources and
the allocation of [the state system's] emergency services and
facilities in the event of mass casualties, natural disasters, national
emergencies, and other emergencies, ensuring linkage to local, state, and national
disaster plans, and participation in exercises to test these plans;
(6) Establish, administer, and maintain a communication system for the [state
system;] service area;
(7) Assist each county in the service area in the development of a "911"
emergency telephone system;
(8) Secure technical assistance and other assistance and consultation
necessary for the implementation of this part, subject to section 321-230;
(9) Implement public information and education programs to inform the public
of the [state] statewide system and its use, and disseminate
other emergency medical information, including appropriate methods of medical
self-help and first-aid, and the availability of first-aid training programs [in
the State;] statewide;
(10) Establish standards
and provide training for dispatchers in the state system, and maintain a
program of quality assurance for dispatch equipment and operations[;]. Dispatchers statewide shall obtain and
maintain emergency medical dispatch certification by July 1, 2026;
(11) Establish a program that will enable emergency service personnel statewide
to provide early defibrillation;
(12) Establish within the department the emergency medical service system for
children[;] statewide;
(13) Consult with the advisory committee on matters relating to the implementation of this part; and
(14) Establish and maintain statewide standards for emergency medical
services course instructor qualifications and statewide requirements for
emergency medical services training facilities."
SECTION 8. Section 321-224.2, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
"(a) The department shall establish reasonable fees to be collected from individuals who are:
(1) Transported by emergency ground ambulance services to a health care facility within the service area designated by the department for the care of the individual; or
(2) Provided health care by emergency medical services personnel within the service area but not transported by ground ambulance to a health care facility."
SECTION 9. Section 321-224.4, Hawaii Revised Statutes, is amended as follows:
1. By amending subsection (a) to read:
"(a) The department [of health] shall
establish and administer the community paramedicine program[.] within
the service area."
2. By amending subsection (c) to read:
"(c) For purposes of this part,
"community paramedicine program" means an enhanced and expanded
service in the state [comprehensive] emergency medical services system
that allows state-licensed health care professionals, and community health
workers, to assist with public health, primary care, and prevention services,
including services through telehealth."
SECTION 10. Section 321-226, Hawaii Revised Statutes, is amended to read as follows:
"§321-226 Emergency medical services and systems,
standards. The department [of
health] shall establish statewide standards for emergency medical
services and for emergency medical service systems consistent with [the
state system] this part and applicable federal guidelines for [such]
those services, including a requirement that ambulance service providers
licensed by the State establish and maintain an alcohol and substance abuse
policy for employees that the department [of health] deems is equivalent
to, or exceeds the provisions of, the safety and health standards established
by the federal Department of Transportation for holders of commercial driver's
licenses. In the event the standards are
determined or regulated by any other law, or by applicable federal guidelines,
standards required to be set by this section shall be at least equivalent to or
exceed the other state and federal standards."
SECTION 11. Section 321-227, Hawaii Revised Statutes, is amended to read as follows:
"§321-227 Regulation of ambulances. The department of health shall adopt, amend,
and repeal rules under chapter 91 for the regulation of ambulances within the
State, including but not limited to the certification of vehicles, equipment,
supplies, and communications systems[.]; provided that any county
operating a county emergency medical services system pursuant to part
of chapter 46 shall be responsible for the
purchase, maintenance, and servicing of all vehicles, equipment, supplies, and
communication systems. The department
may contract to certify air and ground ambulance units statewide. The department may charge a reasonable fee for
annual certification and safety inspections of air and ground ambulances. Any person who provides emergency medical
service as an employee of any emergency ambulance service statewide
shall be subject to chapter 453."
SECTION 12. Section 321-228, Hawaii Revised Statutes, is amended to read as follows:
"§321-228 Emergency medical services; counties. The department shall determine, in consultation
with the advisory committee under section 321-225, the levels of emergency
medical services that shall be implemented in each county[.] within
the service area. The department may
contract to provide emergency medical services, including emergency aeromedical
services, or any necessary component of [a county] the emergency
services system of a county within the service area in conformance with
the state system. [In the event] If
any county within the service area shall apply to the department to
operate emergency medical ambulance services within the respective county, the
department may contract with the county for the provision of those
services. The department shall operate
emergency medical ambulance services or contract with a private agency in those
counties [which] within the service area that do not apply to it
under this section. Any county or
private agency contracting to provide emergency medical ambulance services
under this section shall be required by the department to implement those
services in a manner and at a level consistent with the levels determined under
this section."
SECTION 13. Section 321-229, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:
"(a) The University of Hawaii shall provide
training courses in basic, intermediate, and advanced life support for
emergency medical services personnel[.] statewide. The curricula and syllabi of these courses
shall be approved in advance by the department [of health]. The curricula and syllabi of courses for
ambulance personnel shall be consistent with the scope and level of the
practice of emergency medical services associated with emergency ambulance
personnel certification defined by the Hawaii medical board under part II of
chapter 453.
(b)
The University of Hawaii, or other accredited community college,
college, or university, or any professional organization that is approved by
the department [of health] to provide emergency medical services
training, shall consult with the department [of health] and any
county operating a county emergency medical services system pursuant to part
of chapter 46 to determine the number and type of emergency medical
services courses necessary to support the staffing requirements for emergency
medical services. The basic life support
and advanced life support training programs shall be relevant to and consistent
with the training course required for certification under chapter 453."
SECTION 14. Section 321-230, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:
"(a) The department may contract for technical
assistance and consultation, including [but not limited to]
categorization, data collection, and evaluation appropriate to the needs of the
[state] statewide emergency medical services system. The collection and analysis of statewide
emergency medical services data, including pediatrics, trauma, cardiac,
medical, and behavioral medical emergencies, shall be for the purpose of
improving the quality of services provided.
The department may implement and
maintain a trauma registry for the collection of information concerning the
treatment of critical trauma patients at state designated trauma centers, and
carry out a system for the management of that information. The system may provide for the recording of
information concerning treatment received before and after a trauma patient's
admission to a hospital or medical center.
All state designated trauma centers shall submit to the department [of
health] periodic reports of each patient treated for trauma in the state
system in [such] the manner as the department shall specify.
For the purposes of this subsection, "categorization" means systematic identification of the readiness and capabilities of hospitals and their staffs to adequately, expeditiously, and efficiently receive and treat emergency patients.
(b) The department shall establish, administer,
and maintain an aeromedical emergency medical services system designed to
collect and analyze data to measure the efficiency and effectiveness of each
phase of [an] the statewide emergency aeromedical program.
The
department shall monitor aeromedical emergency ambulance service flights
statewide to include date of service, patient demographics, transport
diagnosis, and medical outcomes. The
department shall work with each health care facility as the intermediary to
arrange emergency transport of bariatric patients by the U.S. Coast Guard, and
maintain a registry of all emergency transports provided by the U.S. Coast
Guard. All statewide aeromedical
providers shall submit their data to the department as specified and requested
by the department.
The statewide aeromedical emergency medical services system shall serve the emergency health needs of the people of the State by identifying:
(1) The system's strengths and weaknesses;
(2) The allocation of resources; and
(3) The development of rotary-wing emergency aeromedical services standards;
provided that emergency helicopter use, including
triage protocols, shall be based on national aeromedical triage and transport
guidelines established by the Association of Air Medical Services, the American
College of Surgeons [and], the National Association of Emergency
Medical Service Physicians[.], or other department-approved national
aeromedical accreditation agency.
The department, in the implementation of this subsection, shall plan,
coordinate, and provide assistance to all entities and agencies, public and
private, involved in the statewide system."
SECTION 15. Section 321-232, Hawaii Revised Statutes, is amended as follows:
1.
By amending subsection (a) to read:
"(a) The department [of health] shall
establish reasonable fees for services rendered to the public within the
service area by the department [of health], any county[,] within
the service area, or private agency under this part; provided that all [such]
revenues [which shall be] collected by the department [of health]
and the respective counties pursuant to this section shall be deposited
into the state general fund, except [such] amounts necessary to provide
for collection services for bad debt accounts.
Fees required to be set by this section shall be established in
accordance with chapter 91."
2.
By amending subsection (c) to read:
"(c) In the event of nonpayment of any fees
required to be assessed by this section, the department [of health]
shall determine whether the recipient of [such] services is financially
able to pay [such] the fees and make every reasonable effort to
collect [such] the fees.
In the event the department finds the person is without sufficient
resources to pay for the services, no further action to collect the fees shall
be taken. If the services are paid by a
county or any other entity, and collection of [such] the fee is
delegated by contractual agreement to the county or other agency [which]
that provides the services, the county or other agency shall forward
records relating to unpaid fees for action by the department [of health]
under this subsection. No county or
other entity shall make a final determination of the ability of a person to pay
under this subsection. Any determination
of ability to pay for purposes of this subsection shall be in accordance with
rules [which] that the department [of health] shall adopt,
subject to chapter 91, governing [such] the
determinations."
SECTION 16. Section 321-234, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:
"(b) The moneys in the special fund shall be used
by the department for operating a state [comprehensive] emergency
medical services system including enhanced and expanded services, and shall not
be used to supplant funding for emergency medical services authorized prior to
[[]July 1, 2004[]]."
SECTION 17. Section 321-236, Hawaii Revised Statutes, is amended to read as follows:
"[[]§321-236[]]
Emergency medical services; use of latex gloves prohibited. The use of latex gloves by personnel
providing ambulance services or emergency medical services statewide pursuant
to this part and part of chapter 46 shall
be prohibited."
PART II
SECTION 18. (a) The transition of all rights, powers, functions, and duties of the department of health under part XVIII of chapter 321, Hawaii Revised Statutes, that are exercised within the island of Oahu are hereby transferred to the city and county of Honolulu and such transition shall commence with the transfer of all billing for emergency services on July 1, 2022. The transition of the rights, powers, functions, and duties of the department of health pursuant to part I, to the city and county of Honolulu shall be completed no later than July 1, 2024.
(b) Funding for the transition and maintenance of the rights, powers, functions, and duties of the department of health pursuant to part I, to the city and county of Honolulu shall be allocated as follows:
(1) For the first year of the transition, the city and county of Honolulu shall receive for fiscal year 2021-2022, $46,171,411 in general funds, and $3,500,000 from the emergency medical services special fund for the operation of an emergency medical service system in the city and county of Honolulu. Any additional costs shall be borne by the city and county of Honolulu. The department shall continue to provide all emergency service medical billing and collections for the city and county of Honolulu with all moneys received deposited in the State's general fund;
(2) For the second year of the transition, the city and county of Honolulu shall retain the amounts it receives from billing for its services of $28,362,414, receive fifty per cent of the amounts previously allocated from the general fund that do not include the amounts obtained through billing of $8,904,499, and receive $3,500,000 from the emergency medical services special fund for the operation of an emergency medical services system in the city and county of Honolulu. Any additional costs shall be borne by the county;
(3) For the third year of the transition, the city and county of Honolulu shall retain the amounts it receives from billing for its services of $28,362,414, receive twenty-five percent of the amounts previously allocated from the general fund that do not include the amounts obtained through billing of $4,452,249, and $3,500,000 from the emergency medical services special fund for the operation of an emergency medical services system in the city and county of Honolulu. Any additional costs shall be borne by the county; and
(4) For the fourth year of the transition and every year thereafter, the city and county of Honolulu shall continue to retain the amounts it receives from billing for its services and $3,500,000 from the emergency medical services special fund as the State's share pursuant to section 5 of article VIII of the Constitution of the State of Hawaii, and receive no additional funds from the State's general fund for the operation of an emergency medical services system in the city and county of Honolulu. Any additional costs shall be borne by the city and county of Honolulu.
SECTION 19. All rules, policies, procedures, guidelines, and other material adopted or developed by the department of health to implement provisions of the Hawaii Revised Statutes that are reenacted or made applicable to the city and county of Honolulu by this Act shall remain in full force and effect until amended or repealed by the city and county of Honolulu pursuant to chapter 91, Hawaii Revised Statutes. In the interim, every reference to the department of health or director of health in those rules, policies, procedures, guidelines, and other material as made applicable by this Act, is amended to refer to the city and county of Honolulu or the mayor of the city and county of Honolulu.
SECTION 20. All deeds, leases, contracts, loans, agreements, permits, or other documents executed or entered into by or on behalf of the department of health, pursuant to the provisions of the Hawaii Revised Statutes, that are reenacted or made applicable to the city and county of Honolulu by this Act shall remain in full force and effect. Effective July 1, 2021, every reference to the department of health or the director of health in those deeds, leases, contracts, loans, agreements, permits, or other documents shall be construed as a reference to the city and county of Honolulu or the mayor of the city and county of Honolulu.
SECTION 21. All personal computers and radios used, acquired, or held by the department of health relating to the functions transferred to the city and county of Honolulu shall be transferred with the functions to which they relate; provided that the department of health shall retain data repositories, charts, patient information, data submission, and epidemiology information for all emergency medical services within the State.
SECTION 22.
There is appropriated out of the general revenues of the State of Hawaii
the sum of $46,171,411 or so much
thereof as may be necessary for fiscal year 2021-2022, and $8,904,499 or
so much thereof as may be necessary for
fiscal year 2022-2023 for emergency medical services in the city and county of
Honolulu.
The sums
appropriated shall be expended by the city and county of Honolulu for the
purposes of this Act.
SECTION 23.
There is appropriated out of the emergency medical services special fund
established pursuant to section 321-234, Hawaii Revised Statutes, the sum of $3,500,000
or so much thereof as may be necessary for fiscal year 2021-2022 and the same
sum or so much thereof as may be necessary for fiscal year 2022-2023 for
emergency medical services in the city and county of Honolulu.
The sums
appropriated shall be expended by the city and county of Honolulu for the
purposes of this Act.
SECTION 24. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.
SECTION 25. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 26. This Act shall take effect upon its approval; provided that part I shall take effect on July 1, 2022, and part II shall take effect on July 1, 2021.
Report Title:
Emergency Medical Services; Transfer of Duties; DOH; City and County of Honolulu; Appropriation
Description:
Establishes a four-year transfer of certain duties, functions, and powers relating to emergency medical services for the city and county of Honolulu from the department of health to the city and county of Honolulu. Begins transition with the training and billing for emergency services on 7/1/2021. Appropriates general funds to the city and county of Honolulu for emergency medical services for fiscal years 2021-2022 and 2022-2023. Appropriates half of the moneys in the emergency medical services special fund to the general for fiscal years 2021-2022 and 2022-2023. Phases out state funding for emergency medical services in the city and county of Honolulu by 7/1/2024. (SD1)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
