Hawaii-2022-HB1550-Amended

SECTION 1. The legislature finds that many Hawaii residents are unable to obtain timely and appropriate health care due to shortages of health care providers in the State. These shortages threaten individual health and cumulatively adversely affect the State's health care costs. The John A. Burns school of medicine at the University of Hawaii at Manoa has engaged in strategies to increase the number of physicians in Hawaii by enrolling more students; rotating medical students to the neighbor islands for preclinical, up to twelve-week, rotations; developing longitudinal third-year rotation sites where a small number of students are in the same location for five months; developing a small number of sites for four-week fourth year clinical rotations; developing residency or fellowship rotations; and administering the Hawaii state loan repayment program that places recipients in medically underserved communities, especially the neighbor islands, among other endeavors.

The legislature also finds that current physician workforce data indicates that Hawaii has a shortage of about seven hundred fifty physicians when compared to general United States physician-patient ratios of a similar demographic population. Primary care, internal medicine, and some specialty physician shortages represent Hawaii's greatest area of need. Without these physicians, the people of Hawaii do not have access to the health care they need. At the John A. Burns school of medicine, eighty per cent of graduates who complete their medical school and residency training, also known as their graduate medical education, in the State remain in Hawaii to practice.

In Hawaii, graduate medical education costs are largely borne by the University of Hawaii and its affiliated health systems. Although some federal dollars have been used by the health systems to cover a portion of graduate medical education costs, the State can invest and expand medical school and residency training using newly available funds from the American Rescue Plan Act of 2021, Public Law 117-2.

The legislature finds that the Hawaii medical education council is tasked with overseeing the State's graduate medical education programs and the programs' ability to meet Hawaii's health care workforce requirements. The Hawaii medical education council must also ensure adequate funding of health care training programs, in particular graduate medical education. According to the Hawaii medical education council's 2022 report to the legislature, graduate medical education programs, especially those in primary care, geriatrics, psychiatry (adults and children), and addiction, serve a high proportion of the most vulnerable populations. Yet there has been a reduction in overall graduate medical education positions in the State, from two hundred forty-one positions in 2009 to two hundred thirty positions in 2021. The legislature further finds that nationally, Hawaii is in the bottom quintile for graduate medical education positions per population. Decreased federal and state funding have also had a significant impact on the number of available training positions.

The legislature recognizes that ongoing funding of graduate medical education is vital to address the physician shortage in the State. The legislature also recognizes the beneficial public outcomes that can be achieved by expanding capacity for training medical students on the neighbor islands, with the goal of having these students ultimately remain in Hawaii to practice.

Finally, the legislature finds that reestablishing the Hawaii medical education special fund, to be utilized as a means of funding graduate medical education and training, is a key component that will support the expansion of graduate medical education positions.

The purpose of this Act is to reestablish the Hawaii medical education special fund to enable the John A. Burns school of medicine, in consultation with the Hawaii medical education council, to provide funding for graduate medical education and training in the State, with an emphasis on supporting residency training on the neighbor islands and in medically underserved populations throughout the State.

SECTION 2. Chapter 304A, Hawaii Revised Statutes, is amended by adding a new section to subpart C of part V to be appropriately designated and to read as follows:

"§304A- Hawaii medical education special fund. (a) There is established within the state treasury the Hawaii medical education special fund to be administered by the John A. Burns school of medicine and into which shall be deposited all moneys received by the council, including:

(1) Moneys from the Centers for Medicare and Medicaid Services or other federal agencies;

(2) Appropriations made by the legislature to the special fund;

(3) Grants provided by governmental agencies or any other source;

(4) Moneys directed to the special fund from contracts;

(5) Donations and contributions made by private individuals or organizations for deposit into the special fund;

(6) Interest accrued on all amounts in the special fund; and

(7) Any other moneys made available to the special fund from other sources.

(b) Moneys from the Hawaii medical education special fund shall be expended by the John A. Burns school of medicine and shall be used for graduate medical education and training programs established under this chapter."

SECTION 3. New statutory material is underscored.

SECTION 4. This Act shall take effect on July 1, 2050.

HOUSE OF REPRESENTATIVES	H.B. NO.	1550
THIRTY-FIRST LEGISLATURE, 2022		H.D. 1
STATE OF HAWAII		S.D. 2