Bill Text: HI SB2219 | 2014 | Regular Session | Introduced

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Bill Title: Child Health; Early Intervention; Appropriation ($)

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Introduced - Dead) 2014-01-27 - Re-Referred to HMS/HTH/EDU, WAM. [SB2219 Detail]

Download: Hawaii-2014-SB2219-Introduced.html

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THE SENATE	S.B. NO.	2219
TWENTY-SEVENTH LEGISLATURE, 2014
STATE OF HAWAII

A BILL FOR AN ACT

 

 

relating to child health.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

PART I

     SECTION 1.  The legislature finds that Hawaii has served as a pioneer, incubator, and leader in population-based child health promotion, identification, and intervention programs.  These initiatives, designed and field tested in Hawaii, serve as the foundation for health care delivery systems across the country for children with special health care needs and their families, as well as those who are at risk.  In addition, these initiatives have garnered international attention and implementation.  Leaders from around the world have sought out Hawaii's pioneers for guidance.  The primary reason for Hawaii's status as a pioneer stems from the vision, leadership, and collaborative spirit of our kupuna, Dr. Setsu Furuno, Dr. Calvin Sia, Josie Woll, Ivalee Sinclair, Loretta "Deliana" Fuddy, and Ruth Ota, who exemplified on a daily basis family-centered care and upheld the principles of family-centered care in their quest to identify and serve Hawaii's most vulnerable children in a culturally appropriate, comprehensive, and community-based manner.

     The purpose of this Act is to honor the legacy of Hawaii's health pioneers by appropriating funds to restore services previously cut due to the global and national economic crisis that started in 2008, and to provide funding to enhance existing services by availing new technologies and service delivery models.

PART II

     SECTION 2.  The department of health provides early intervention services to infants and toddlers who have developmental delays or are biologically at risk for delay.  Early access to services combined with parent training have proven to reduce and eliminate delay and better prepare those families of children with complex needs who may require lifelong care and supports.  Although the early intervention program has had steady, life changing outcomes for many children and families for decades, it has not been immune to the impact of the fiscal crisis that has occurred within the last decade.  This economic strain has resulted in the loss of staff, changes in program eligibility, and lack of financing of critical program infrastructure.  Historically, at least since 1999, the program's budget need has exceeded its funding, resulting in the department seeking internally to cover shortfalls or delaying payments to providers.  For a program that is so valuable and key to the deployment of child health services, appropriate funding needs to be ensured all the way from the budgeting to the financing aspects.

     The early intervention section data system is antiquated, does not have the capability to interface electronically with the medical home or other referral sources, and does not have the support capabilities to generate federal, state, and ad hoc reports without human intervention and data manipulation.  Early intervention is one of the core programs within the pediatric medical neighborhood and must do its part to ensure that the population health gains envisioned by the Patient Protection and Affordable Care Act are fully realized.

     SECTION 3.  There is appropriated out of the general revenues of the State of Hawaii the sum of $1,230,000 or so much thereof as may be necessary for fiscal year 2014-2015 to cover the anticipated shortfall for the second half of the early intervention program's biennial budget for direct early intervention services.

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

     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 2014-2015 to develop the specifications and pricing, as well as an implementation plan, for a web-based early intervention data system.

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

PART III

     SECTION 5.  The compounded changes in eligibility for early intervention services started in 2009, and most recently in 2013 has increased the number of children in the gap group.  Children in the gap group are children who have identified concerns related to development, but may not have a demonstrated level of impairment significant enough to warrant mandated disability services through the Individuals with Disabilities Improvement Education Act of 2004.  The children who fall into this gap group face a limited and increasingly shrinking number of early intervention resources in the community.  The elimination of junior kindergarten and the implementation of a delayed start for kindergarten have also significantly extended the length of time in which these toddlers may access free and appropriate educational services that foster health growth and development.  The Patient Protection and Afforable Care Act mandates preventive screening and well child visits annually for children ages two and older at no cost to families.  However, as it relates to toddlers and young children, a significant amount of development occurs within a twelve month period, and any delays not addressed during the early childhood window have exponential, negative repercussions in the future.

     Children in the gap group are easily identifiable as they are children who were referred for evaluation and denied eligibility through early intervention or special education.  In addition, as these children age and the discrepancy between their development and that of their typical peers becomes more and more apparent, resources in the community such as preschool and child care programs are challenged with providing specialized services to best meet the needs of these children.  It is estimated that over two thousand of Hawaii's children fall into this gap group.  Funding was previously made available to provide technical assistance, consultation, training, and screening services to these community resources to support children with developmental and behavioral concerns and to maintain their ability to access services in the least restrictive and natural environment.  The funding for these resources also fell victim to the funding crisis of the last decade.  Re-establishing these services, with family-to-family liaison support, coordination with the medical home, and addressing social-emotional and behavioral challenges in child care settings will contribute to decreasing the need for more intensive costly services later in life.  This safety net concept for a developmental follow along program has most recently been field tested through limited federal funding as part of Hi‘ilei Hawai‘i.

     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 2014-2015 for operating expenses and staffing necessary to provide mental health and behavioral consultation and technical assistance to preschools and child care providers, and maintain and evaluate the developmental follow along program, Hi‘ilei Hawai‘i, which identifies, tracks, screens, and monitors children in the gap group for developmental delays.

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

     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 2014-2015 for family-to-family liaison services and medical home integration within Hi‘ilei Hawai‘i.

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

PART IV

     SECTION 8.  As critical as it is to screen children for developmental delays and autism, it is just as paramount to provide multiple points of screening for vision, hearing, and childhood obesity.  The Centers for Disease Control and Prevention reports that 12.5 per cent of American children and adolescents ages six to nineteen years old have suffered permanent damage to their hearing from excessive exposure to noise.  The Vision Council of America estimates that a quarter of school-age children suffer from vision problems that could have been addressed or eliminated if appropriate screening and follow-up had been in place.  Locally, program data from the former department of health school based hearing and vision screening program showed that 5.8 per cent of the children did not pass the hearing screen, of those children seventy-nine per cent had confirmed deficits upon follow-up evaluation, and 2.5 per cent of the children did not pass a major component of the examination.  This data was the last data set from the department of health program prior to its discontinuation in 1996 due to budget reductions.  Local research also indicates that almost one-third of the children ages four to six years old entering Hawaii public schools are either overweight or at risk for becoming overweight.

     Vision and hearing screening are historically part of the cornerstone to the pediatric well child exam, and screening of children for obesity, physical activity, and nutritional counseling have also been incorporated into the periodicity schedule.  However, as children age beyond the toddler years, participation in these exams decrease.  Children and families who live in remote areas may not have readily available providers.  In addition, it is not unusual to find that the length of time required to travel to obtain screening and preventive services in and of itself is prohibitive.

     Contemporary factors such as the use of video gaming, portable audio and electronic devices, as well as the growing obesity epidemic, call for an increase in access to screening for all children.

     The department of health was mandated by section 321-101, Hawaii Revised Statutes, to conduct a systematic hearing and vision program for school children.  This mandate has been unfunded and unimplemented since 1996.

     SECTION 9.  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 2014-2015 to provide school-based vision, hearing, and obesity screening.

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

PART V

     SECTION 10.  In 1997, the legislature established the authority for the department of health to conduct multidisciplinary and multiagency reviews of child deaths in order to reduce the incidence of preventable child deaths by identifying systemic problems and making recommendations for policy and systemic changes to prevent future child deaths.  Since its inception, Hawaii has quite actively convened a state child death review council of over twenty partner agencies and six population-based local teams.

     SECTION 11.  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 2014-2015 for operating expenses, including travel, child dealth review meeting costs, and costs to re-establish a child death review coordinator position.

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

PART VI

     SECTION 12.  This Act shall take effect on July 1, 2014.

 

INTRODUCED BY:	_____________________________

 

 

Report Title:

Child Health; Early Intervention; Appropriation

 

Description:

Creates an appropriation for early intervention services and a web-based early intervention data system.  Creates an appropriation for services for children with developmental concerns who do not qualify for services through the Individuals with Disabilities Improvement Education Act including family liaison services and medical home integration with Hi‘ilei Hawai‘i.  Creates an appropriation for school-based vision, hearing, and obesity screening.  Creates an appropriation for expenses needed to fund multiagency reviews of child deaths and re-establish a child death review coordinator position.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.