House Standing Committee on Consumer Protection & Commerce

Good afternoon everyone. We are convening the Committee on Consumer Protection and Commerce. It is Tuesday, February 11, 2025 at 2:00pm in Conference Room 329. Just some housekeeping measures first. We will in order to allow as many people to testify as possible, there will be a two minute time limit per testifier. For those on Zoom.

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Such behavior may be grounds for removal from the hearing without the ability to rejoin. All right, I'll be handing it over to my Vice Chair for testimony.

Thank you, Chair. So first on the agenda we have House Bill 496, House Draft 1 relating to mamaki tea And first up we have Department of Agriculture in support. Next we have oh, Department of Ag Measurement and Standards branch on zoom.

Go ahead. Hello, Chair, Vice Chair. Someone was supposed to be there from the Department to stand on a written testimony. I just thank the Committee for looking at our testimony and I'm here and available to answer any questions on zoom.

Thank you. Next we have Hue Farm Bureau in support.

Good afternoon, Vice Chair, Chair, Members of the Committee, Brian Miyamoto here on behalf of the Hawaii Farm Bureau. You have our written testimony in support. We want to protect this culturally important crop. This week we have hearings and bills on coffee labeling and magnut labeling. We're trying to fix those labeling laws.

Why don't we start out right with Maki and get it right now instead of trying to fix it down the road. So again, we're in strong support protecting this important cultural crop that actually we see more and more being grown and we want to grow this mamaki industry while protecting the Hawaii brand.

Thank you for the opportunity to testify.

Thank you. That's all I have registered to testify in person or on zoom. Is there anyone else who wishes to testify on this measure? Seeing none. Members any questions?

Chair, Department of Agriculture. Are you here on zoom? You requested in your testimony an additional inspector. How many vacancies do you have in the inspection division right now? Are you guys full up?

We don't have a labeling package inspection section anymore since the reference. And we have two vacancies for device inspection inspectors, but they're not specific to mamaki tea labeling or macadamia nuts. They're inspectors that would help us to do that.

But with all of these bills coming up, we've asked on the mamaki tea as well as the coffee and macadamia nuts to be able to reopen our label inspection branch, our package inspection branch that was eliminated in the RIF back in 2009, 2010 area.

Okay, so if we gave you an additional inspector for this, we would have to stand up that entire branch again.

We would be reopening that entire section in Oahu, which we've been trying to rebuild. We have one package and labeling inspector who also is a device inspector in Hilo.

Are you using as a vehicle for this to do that though? That seems beyond the scope of this bill. I'm just a little hesitant to give this additional inspector if it's going to be too far out of the scope of mamaki tea labeling.

Well, this can be combined with the other bills that we've asked for personnel for full time inspectors with the coffee and also the macadamia nut if it goes through. But right now we have no inspectors in Oahu to be able to perform that function.

Okay, so if we put in the. The requested position, is there a place for that person or are you saying you're going to necessarily need to stand up that division again for them?

No, we have a place for them here.

Okay. Okay. Thank you.

Thank you. Any other questions? Seeing none. Moving on to the next Bill. House Bill 978. House draft one relating to electric utilities. First up we have DCCA, Division of Consumer Advocacy. Thank you. Next we have the Public Utilities Commission with comments. Next we have Hoy Gas with comments. Not present.

Is there anyone else here wishing to testify in this measure? Seeing none. Members, any questions? Seeing none. Let's move on to the next measure. Next up we have House Bill 1316. House draft 1 relating to the Department of Land and Natural Resources. And we have DLNR, State Parks in support. Standing in support.

And that's all I have registered to testify in person or on Zoom on this measure. Anybody else here wishing to testify? Seeing none Members, any questions? Chair Matayoshi for DLNR.

It's not too clear where the registration fees go, I think. Did you mean for them to go into the special fund?

The registration fees would go into the special fund.

Okay. Do other park registration fees go into the special fund as well from other sources?

Those parks that we do charge fees? Yes.

Okay. Okay. Thank you. We'll make that change. Thank you.

Thank you.

Thank you. It's for DLNR. Hi. Welcome back. Thank you. It seems like this is, will the, I guess will the registration, registration fees cover all the costs of managing all of this these registration. I mean it feels like a lot of oversight because this applies statewide. Right? You have to do this.

Thank you. Representative Iwamoto.

Pk, tomc, DLNR, State Parks. This is not totally my area of expertise. I have some information on it. We do have other reservation systems in place. This specifically would be an establishing a statewide system for three specific parks.

Okay.

Hopefully. Thank you.

Thank you.

Any other questions Members? Seeing none. Let's move on to our next measure. Next up we have House Bill 914, House draft one relating to water carriers. First up we have DCCA Division of Consumer Advocacy in with comments. Public Utilities Commission with comments.

Aloha. Good afternoon. Chair Matayoshi, Vice Chair Chun and Members of the House Committee on Civil Protection and Commerce. My name is Andrew Okabe. I'm from the Public Utilities Commission. As a utility analyst. I'm here on behalf of the Public Utilities Commission. I stand the Public Utilities Commission written testimony providing comments on HB914 HD1. Thank you.

I'm available for any questions.

Thank you.

You guys have been doing a great job of it so far. But if you are gonna send in your testimony like he just did, please come to the mic so that everyone online can hear you too. Thank you.

Department of Agriculture in support.

Aloha, Chair, Vice Chair, Members of the Committee, Cedric Gates here on behalf of the Department of Agriculture. The Department stands on its written testimony in support here for any questions. Mahalo. Thank you.

You have Department of Transportation in support.

Hello Chair, Vice Chair, Members. Ed Sniffin with Hawaii DOT stand in support. Thanks.

That's all I have. Who registered to testify in person on zoom. Is there anyone else who wishes to testify on this measure? Yeah.

Good afternoon, Chair, Vice Chair, and Members of the Committee. My name is Chris Nakagawa on behalf of Young Brothers. We stand on our written testimony and strong support. Thank you.

Oh, go ahead.

Aloha. My name is Melissa Pavlicek. I'm here today on behalf of the Hawaii Harbors Users Group. We submitted our testimony as written only. But I just Wanted to underscore that. Our industry supports this measure. Thank you.

Thank you. Anybody else wishing to testify in this measure? Seeing none. Members, any questions? Chairman Matayoshi.

Is the consumer advocate here? I don't think they. I heard them. Yeah. Okay. I'll. I'll just kind of throw this question out. Generally to all of the testifiers who are here for this measure. There was testimony that stated that the automatic increase should not be pegged to the GDP price index.

I'm wondering if anyone has a proposal of alternative index, if any. This should be pegged to or I will make one up.

Hi, Andrew with PUC again there are various GDPIs you could use. We do note that we do use BCEI for decoupling purposes, but-

What does that acronym stand for?

Blue Chips Economic Indices, I believe. But that is a forward looking indices. If you are looking to complement the current language as proposed in the measure. You know, you would look at an indices that would look at like a past year and that's what BEA is portioned for.

You could look at the Congressional Budget Office report as well, I believe. But there are a few other out there rather than just BEA.

What would you have used for this one?

I don't have a comment as to which one is the most appropriate. If the Committee wants us to use BEA, then we will more than gladly use that. It is indice that does look in the past to determine what the inflation metric was for that time period.

Okay, I'm kind of inclined to blank that right now and then just for all the testifiers to submit testimony for Next Committee. What index they'd like to use or what index they would suggest to use. Okay, thank you, Chair. Young Brothers. Anyone else have a question on this one after.

Okay, well, I do have a question for Young Brothers as well. Thank you. Are you, are you. Do you, do you need to comply with the Jones Act and purchase new ships from American shipbuilders and, or something like that?

Yes, the answer is yes.

And does that affect your cost?

Yes.

And so we can compare your rates and what affects your rates and your expenses to other jurisdictions that. Are they going to have to comply with the same Jones Act? Is it going to affect their costs in the same way it affects your costs?

If I can understand your question. Other competitors.

Not competitors, but other jurisdictions where other shippers. I mean, because you're shipping in between islands or island. Just islands.

That's correct.

So they're both considered US Ports. So are there other carriers who are shipping between US Ports that must also comply with the Jones act, who must also pay more for American ships.

Generally speaking, the answer is yes. I can't speak for the other carriers, but yes, that's correct. Your understanding is correct. Chair, if I may, on the question you had before on the GDPI, just a bit of history. In 2021, there was a working group that was formed, and this is under Senator Lorraine Inouye that actually initiated this.

And so there's a number of stakeholders that actually participated in this in 2021, including the counties, DCA, the PUC, as well as the Legislature. I think the chair of the Transportation committees were there, the speaker and also the President's office was also involved in this.

And the consensus and the recommendations which is set forth in the report came up with the GDPPI as the index. So this is a little bit of history on that as to why in this Bill. It's we're just following the recommendations as set forth in the working group's report.

If the working group was in 2021, why is the Bill only coming up now or has it come up in prior sessions?

It hasn't been come up in prior sessions, but yeah, it's, I mean, in terms of, our understanding is that the Commission and maybe Andrew can answer that more. But I think we just wanted to clarify the language to make sure that the Commission has the authority to establish this water inflationary carrier index adjustment factor using GDPPI.

So that's the reason why we actually introduced this Bill for the purposes of just making sure that the language is clear that they have the jurisdiction and authority to establish this adjustment mechanism following GDPPI.

Okay. I still might blank it out or I might leave it in, but I'm definitely sending a Committee report note to the next chair to consider alternatives in your testimony for the next Committee, should they hear it. I suggest telling me telling them exactly what you just told me. Great. About the working group. Thanks. Thanks. Thank you.

For a second, though, Rep. Iwamoto, do you have any further questions? Okay. I am a little disturbed by the testimony from other testifiers that Young Brothers has come in for quite large increases recently and as soon as the increase was granted, have been coming in for larger and larger increases.

I am sympathetic that prices are going up, inflation is going up. At some point, I think that regular price increase is probably warranted up to a certain degree. But why? Can you kind of give the Committee an explanation as to why your requests have suddenly been spiking?

Yeah, it's a good question and I think this is one of the proposed solutions. This is this Bill itself in turning in actually establishing these rate mechanisms in place. We totally understand your issue or concern. We have the same issues and concerns in terms of.

But this is one of the solutions is so that to give more transparency and predictability to not just only us, but also to our customers. So by establishing mechanisms it breaks it up more. So it's basically much more phased in. It's not a silver bullet though.

It's not going to cure our rate increases because as you know, or as mentioned in the Bill, it's really to address inflationary costs which we haven't been able to recover for. And the one is, yeah, it's the system itself in terms of the regulations in place where we're not able to adjust rates.

And it's been since 2020, since the last rate increase. And so that's. It takes a lot of time and money and you know, just in terms of finding an application to actually file a rate case, it takes a whole lot of time and money.

And so that's the reason why a lot of times it comes in like these once every three or four years and we're trying to break that cycle. So by establishing these mechanisms it actually breaks it up better.

Is the length of time a symptom of PUC or is it that folks don't request one every year or like.

Other utilities like for us and for water carriers it's different from the electric utilities. But I think right now there's a six month process that we have to go through by statute. So it's in the laws under hrs 271G.

So that's really the process we have to undertake that it takes at least a six month process to actually change rates. That's. Go ahead. Sorry.

Oh no, I'm sorry, no.

So that's why, you know, we felt that this would be one step to help that to address your concern is to actually establish these mechanisms. And that was what exactly what the working group came up with is they the same concerns are raising is what they were looking at.

And so one of the solutions was this recommendation is in order for us to be sustainable and to actually to basically be able to continue to transport goods between the islands. We have to have the ability to actually at least the very minimum recovery inflationary costs, which is really in our opinion.

I think the working group's opinion was that it's a standardized index. It's not. It's something that's beyond our control. That's something that is very objective. It's based upon an index that's well known throughout the nation. And so we felt that.

And I can't speak for, I mean, at least from the working group's perspective, I think that was the consensus that this mechanism would be at least a potential solution to address some of the concerns that you're raising. Hope I answered that correctly.

This build, though, requires the PUC to. So have you proposed this mechanism to the PUC in the past?

Yes, we did, and it was dismissed. We filed an application last year, but it was dismissed for the same reasons where there was a lot of questions as to whether or not we could establish a mechanism outside of a rate case, as well as, you know, how we could do it.

So that's the reason why we actually filed this measure so that we can actually provide more clarity and authorization to the Commission. So it gives them the flexibility to actually establish these kinds of mechanisms.

So within a rate case, could you establish an automatic mechanism? Or you're saying that in a rate case you could only establish. We could.

We're currently, as you may be aware, we're currently in it. We've had a rate case for 2025, and so we have a request in there right now. So we're hoping that the Commission and the consumer advocate, we're all aligned that this is the mechanism that potentially could alleviate some of the rate shocks that you're talking about.

So you don't need this Bill then, if it's already in for 2025.

I think. I mean, based upon what we read in the orders, there's a lot of vagueness and there's still. There's a lot of confusion whether or not the Commission has the authority to actually establish a mechanism as part of, either in or outside of rate case.

And so that's why we felt that this Bill was necessary also, too, just to. Like you said, there's a working group report and we wanted to follow the recommendations.

So, okay, you're in the PUC on a red case to request this. Yes. This Bill, though, requires them to establish automatic adjustment mechanisms. Would you be okay with then leaving it to the PUC and having this change from a shall to may establish.

That's something we will need to talk to them about in terms of whether it's. We understand their workload is high. And so. And this is not just for us. Right. I think there's another carrier that's also applicable to this law, which is the Lanai Ferry system. So we understand that there's another carrier involved.

So, yeah, we just feel like it's very urgent for us, because in order for us to be sustainable, we need to have a mechanism in place to be able to recover at least inflationary costs.

Okay. What was your net profitability last year?

I don't know the exact numbers, but from the regulated side, we've been losing money every year. Yeah.

So you've been losing money for the past how many years you'd say?

I'd say at least three to five years. At least on the regulator side.

Okay.

At least there's one year. I think we made money, but I think there was most of the time when I'm. We're not even even actually having to earn a rate of return. We haven't been, it's all been negative on the regulated side.

Okay.

Okay. Thank you.

Yeah. Any questions?

Any other questions?

Thank you.

Thank you. Okay, Members, we're going to move on to the next measure. House Bill 1161, House draft one relating to transportation. First up we have DCCA insurance division with comments.

Good afternoon, Chair, Vice Chair, members of the committee, Jerry Bump. Testifying on behalf of the insurance division. Will stand on a written testimony providing comments.

Thank you. Department of Transportation, in support.

Chair, Vice Chair, members, Ed Sniffin, Hawaii DOT. tsand in support.

Thank you. Hawaii State Energy Office in support.

Chair, Vice Chair, Members of the Committee, HSEO. We stand on our testimony in support. And are here for questions. Thank you.

Thank you. Next we have Tax Foundation of Hawaii with comments on Zoom.

Good afternoon, Chair and members of the committee. This is Jade McMillen on behalf of the Tax foundation of Hawaii. We've submitted some comments on the measure. And will stand on our written comment. Thank you.

Thank you. Next we have Hawaii Food Industry Association with comments on Zoom. Nope. Okay, so all I have registered to testify online or in person. Is there anyone else wishing to testify in this measure? Seeing none. Members, any questions? Rep. Iwamoto

Thank you. I have a question for Transportation Director. Are the counties allowed to shift to a mileage based road usage charge on their own? Do they require the state to authorize them?

I believe the state is required. They require the state to authorize them to have this, this base charge. Yes.

My second question is why? Why do we need to allocate them any money to do that? What is, I couldn't understand the cost part of just saying, go ahead, charge them that way.

Yeah, I think the cost is, is for us, for the DOT. We're assisting the counties in adjusting the collection processes for all of this. Right now the gas tax is very elegant for all of us. I kick back and wait till Doltax cuts me a check.

But when we move to this road user charge platform for the state in July of this year, we got to start taking care of the data collection, the enforcement, and the funding collection for all those pieces.

The DIT from the city and County of Honolulu are picking up a lot of the bulk of the work in order to do that. So we have our consultant working with the counties to ensure that everybody's tied back into the same system. So all of our residents pay the same way seamlessly.

Okay, so I'm imagining, I am a car owner. So we would pay our car vehicle registration to the state and then we indicate what our odometer reading is for that year.

Yeah. So the way it would work right now is based on the safety inspections. That's where we would collect the data on what you owe, based on the delta of what you ran from last year. Then everything would be collected at your registration.

So when you pay your registration, you pay it to the City and County of Honolulu and they disperse the payments to the state.

So, but if it's. Okay, so, but if it's going to, if the county is setting their own amount and the money's going to the county, then why do you, where do you come in?

Yeah. So the way it all works is to ensure that we minimize the potential for overlaps of the different types of operations that are necessary. City and County of Honolulu takes the bulk of the collections for all of us, for all of the counties and the state at the registration fee.

So there's a state registration fee and weight tax. There's a city registration fee and weight tax. They'll collect both of them, then they'll disperse the payments to the state based on the requirements. It would be the same thing with road user charge.

So after we take the data at safety inspections, that data will be transmitted to the city, who will bill out at registration how much you owe. They'll collect for both the state's road user charge and the county's road user charge and disperse to the state.

Okay, thank you.

Thank you.

Chair? Ed, I understand the concept of the road usage charge, I think. I'm thinking about plug in hybrids. Do plug in hybrids fall under this too or not?

Plug any, anything that's under the definition of electric vehicle in the Federal Government is under this. So plug in hybrids are under that definition, I believe, and I can check for you.

Okay. So they'll get hit with this road usage charge, which I think that's fair, honestly. But they'll also be paying the gas tax occasionally.

Yes, exactly.

Okay. Thank you.

Thank you.

Great. Any other questions Members? Seeing none. Let's move on to the next measure. Next up we have House Bill 1301, House draft one relating to transportation. And first up, we have Public Utilities Commission with comments.

Good afternoon. PUC stands on its written testimony with comments.

All right, next we have Hawaii Association for justice in opposition.

Hello, Chair, Vice Chair, Members of the Committee. Evan Oy on behalf of the Hawaii Association For Justice. You have a written testimony, so we will stand on that. But just wanted to highlight a few of our main points. Our primary concern is the repeal of 279J, which includes the insurance statute which regulates transportation network companies.

And our other concern is primarily the, you know, the removal of joint several liability for transportation network companies which operate in the state. So those are two primary concerns. And we'll be here for any questions. Thank you, Chair and Vice Chair.

Great. Thank you. Next we have LIFT in opposition on zoom.

Yeah. Good afternoon. Chairman Matayoshi and Vice Chair Chun and Committee Members. Mahalo for the opportunity to provide testimony. Lift submits this letter in opposition to HB 1301, a Bill that would unnecessarily impose duties and liabilities on TNCs that will threaten the industry as a whole in the state.

TNCs are technology companies and designated TNCs as common carriers would completely eliminate the uniform statewide framework that governs the ride shared industry in Hawaii and has been working well for communities across the states. Courts have acknowledged that TNCs should not be treated like taxis or other common carriers.

Since day one, we've built safety into every part of the Lyft experience before, during and after the ride, which is unparalleled in the transportation industry. We've implemented strict policies and compliance with the TNC regulations to screen everybody who drives on the platform.

By requiring initial and annual background checks, conducting continuous criminal monitoring and driving record checks, and providing community safety education.

Created in partnership with the nation's largest antisexual violence organization, we've developed in right features that allow riders to share their location with family and friends, connect directly with with Lyft support, and quickly and easily access emergency assistance from the Lyft app. After the ride.

Our safety team is available 24/7 so riders can always reach a live person if they have concerns and so we can take action to help them help keep our community safe. These enhanced safety measures did not exist before the for hire transportation industry and even today remain unique to the ride sharing industry.

An increase in operational costs may be felt the hardest by people in Hawaii. Who rely on access to rideshare to get to work, access medical care, and obtain healthy food, and much more. At a time when people are already facing inflation and rising economic pressure, this Bill, if passed, would only add to that uncertainty.

So rideshare provides thousands of people in Hawaii with important earning opportunities and transportation options. People across Hawaii are driving with rideshare for supplemental income and helping vulnerable communities access essential services. Imposing the additional requirements for TNCs as proposing this Bill will resign.

Increased cost to the consumer and unnecessary as the current TNC rules and liability standards provide ample protection. For these reasons, we Bill and welcome the opportunity to discuss the issue further with the sponsor and other representatives of this Committee. Thank you for the opportunity and I stand by for questions.

Thank you. Next, we have Arab in opposition on zoom.

Good afternoon, Chair, Vice Chair, Members of the Committee. My name is Zahid Arab, and on behalf of Uber Technologies, I'm here today to respectfully oppose 1301. The push to classify TNCs like Uber as common carriers doesn't make sense and could create more harm than good.

Uber has been serving Hawaii for more than a decade, providing affordable and reliable transportation. And the regulatory framework we already have, like HB 1681 signed into a law a few years ago, has been working well for everyone. There's really no reason to disrupt a system that's functioning effectively.

Classifying TNCs as common carriers would impose unnecessary legal burdens and financial strain on both drivers and passengers. TNCs aren't like taxis or buses. We're technology platforms that connect drivers with riders, and we don't own or operate vehicles. Holding TNCs to the same liability standards as traditional carriers is not just unfair, it's unwarranted.

If passed, this Bill could hurt Hawaii's most vulnerable communities. Higher insurance costs and additional liabilities resulting from it will likely drive up fares, making it harder for riders, especially those on fixed incomes or in underserved areas, to afford the service they depend on.

This could also lead to fewer earning opportunities for drivers that rely on the platform to support their families. In addition, we already meet high insurance requirements in uninsured and underinsured motors coverage while passengers are in the car, which is far more than that of taxis or personal vehicles.

The existing framework is sufficient and protects both riders and drivers. In closing, instead of complicating things with unnecessary changes changes, we should stick to what's working. The law implemented in Honolulu in 2016 is a proven model, and it's one that balances the needs of drivers, passengers, and the community. Thank you.

Thank you. That's all I have registered to testify online or in person. There's anyone else wishing to testify on this measure? Seeing none. Members, any questions? Seeing none. Let's move on to the next measure. Next up, we have House Bill 624, House Draft 1 relating to school psychologists. First up, we have Department of Education in support. Nope. Next we have the Hawaii Association of School Psychologists.

Aloha. My name is Leslie Baunach. I'm the current Legislative Chair for the Hawaii Association of School Psychologists. In addition to standing on our testimony, I would like to respectfully respond to HPA's request to be part of our group. Unfortunately, they've been very adversarial towards us and we feel that their involvement would be counterproductive for what Rep. Woodson's intent of this committee actually is to sit down.

In addition, we were not involved in the clinical psychologist licensure. There also seems to be confusion around us being under the Board of Psychology. I would like to remind everyone that we were added in title at the doctoral level about 5-6 years ago.

So school psychologists in title are already under the Board of Psychology, but only at the doctoral level, whereas most school psychologists are actually a specialist level. We are not masters or doctorate. We're kind of in between. I just wanted to add those clarifying points and note that I am here if there are any questions or concerns. Thank you so much.

All right, thank you. Next we have the Board of Psychology in support.

Good afternoon, Chair, Vice Chair, Members of the Committee. My name is Christopher Fernandez, Executive Officer for the Board of Psychology. I'm here to stand on the board's testimony, supporting, and offering comments. Thank you.

Right. Thank you. That's all I have registered to testify in person or on zoom. Is there anyone else wishing to testify on this measure? Hello.

Hello, Chair, Vice Chair, Members of the Committee. Nui Sebast here with HCA will send out written testimony in support of this measure. Mahalo.

All right, thank you. Anybody else wishing to testify in this measure? Seeing none. Members, any questions? Seeing none. Let's move on to the next measure. Yeah. Next up, we have House Bill 815, House draft 1 relating to health insurance. First up, we have Department of Budget and Finance in opposition.

Good afternoon, Chair Matayoshi, Vice Chair Chun, and Members of the Committee. B&F stands on its testimony in opposition. Thank you.

Thank you. Next, we have United Public Workers in support.

Hello, Chair, Vice Chair, Members of the Committee. Kamakana Kaimuloa, Government Affairs Manager for United Public Workers. You have our written testimony and strong support. Appreciate the Chair's introduction of this Bill once again. And this Bill actually highlights one of the biggest challenges that public workers are actually facing right now, and that's the cost of health care benefits.

Happy to answer any questions you may have.

Thank you. Next we have HGEA in support.

Hello, Chair, Vice Chair, Members. Nui Sebastian with HGEA. We'll stand on our written testimony. A strong supporter of this measure. Great.

Thank you. That's all I have registered to testify in person or on zoom. Is there anybody else wishing to testify on this measure? Seeing none. Members, any questions? Seeing none. Let's move on to the next measure. Next up, we have House Bill 463, House Draft 1 relating to eviction records.

First up, we have Public First Law center in opposition. On Zoom.

Aloha. Chair, Vice Chair, Members of the Committee, this is Ben Creps for the Public First Law Center. You've got our written testimony in opposition, but basically we support the intent of this Bill and I apologize that I don't have video capability today, but we support the intent.

But we oppose the provisions that require automatic sealing of court records without a case by case determination by a judge. So those provisions run head on into the public's First Amendment right of access to the courts. The Constitution's promise of openness is critical to the integrity of our judicial system.

We, while the judiciary in the written testimony does not comment on the merits or legality of this Bill, please take a look at the Last paragraph of its written testimony, which I think is consistent with our constitutional concerns. In our written testimony, however, we offer a technological solution.

So instead of sealing cases, we suggest disassociating them from the tenant's name. So in our written testimony, you can see a screenshot and it's an example of what happens when you put in a person's name who's got a sealed record. So the sealed case still comes up.

It says case title redacted, but you can still, you know, from the circumstances, you can glean what it is. So with our, excuse me, with our suggestion of disassociating, that's a technological solution instead of sealing. That way, a search of a tenant's name would not bring up the eviction case.

So you still get to the same end result, but you don't have the constitutional concerns that we've noted in our written testimony. And also in our written testimony, we recommend that this Committee focus the Bill on discriminatory practices that are based on the status of an individual, not on sealed eviction records.

And we go we explain that a little further in our written testimony as well. I appreciate you listening to my testimony and I'll stand by for any questions.

Right. Thank you. Next we have Hoyt Appleseed Center for Law and Economic justice in support.

Hello Chair Matayoshi, and Vice Chair Chun, and Members of the Committee. My name is Susan Le and I'm representing Hawaii Appleseed Center for Law and Economic Justice in strong support of this measure. We stand on our written testimony in strong support.

But just wanted to highlight our concerns about the fact that there is no provision in this Bill about if tenants are looking to do a motion to reconsider or appeal.

And our concern is that currently how tenant screening third party sites work is that you can type in your name and even if it was sealed later on, their records are still archived, sold in bulk, it exists in the Ethernet and it's hard to remove.

And without state specific regulations and removing those and like requiring, let's say like every 30 days, those sites have to like, make sure they're up to date and in compliance. These records will follow the tenant regardless of if the ruling was overturned.

So we're just asking that the Committee consider keeping the record sealed or how the last testimony was disassociated from the name within the 10 days of the. Within the 10 day window of asking for a reconsider, a motion to reconsider, and if it is approved to be reconsidered, waiting until the case is no longer pending.

And fully ruled to release those records. Thank you.

Thank you. Next we have Hawaii Realtors with comments. Next, Hoy Workers center in support. No. Then Dina Scheck in support. Nope. That's all I have registered to testify in person or on Zoom.

Oh, sorry, I must not have got it. It's Daja Ostrowski. I think you might have had my Boss's name. Dina Scheck. I'm so sorry. So I'm an attorney with the Medical Legal Partnership. Dina Scheck is our legal Director. So I think if it's our testimony. I'm so sorry. Vice Chair. Thank you, Chair, Members of the Committee.

We're here to provide strong support and I was going to stand on our testimony, but I think I want to respond to some of the things I've seen. We are direct legal service providers.

So I'm an attorney that works specifically with tenants who are in eviction proceedings and doing these kind of things or have problems with their landlords. In particular. We work with a lot of the folks that you never see data on.

So these are the folks who are having an active issue with their landlord and they're coming to us early because we're trying to prevent that court action. No one really wants to see an eviction happen.

And I think one of the things we have a constant concern about, which we highlighted in our testimony, is that folks a lot of times will not take a case that has merit with their landlord because they're so concerned about having a record what that will look like for their future housing search.

So we even have folks who may have really meritous claims that they want to talk about. You'd be surprised how many times there's like arguments about the ledger particular, particularly if people are getting any kind of tenant based assistance or something like that.

Or even we've had a rash of things where folks want to be evicted for things like leaving their slippers outside, the colors of curtains, feral chickens. You don't hear any of these stories because there's not an opportunity to tell them. And that's why we want to have an opportunity to tell folks.

If you prevail against your landlord, it's not something that your future landlord is going to see immediately just by looking at ecort kokua. I'm completely cognizant of some of the issues of what it looks like now when someone can just use a third party search engine that looks through things.

But I'd ask that you don't stop this Bill now just because it seems complicated and complex, because these are also things we're worrying about, we're working through even in a criminal justice context. I know, I'm aware of folks get their records expunged.

The records are not automatically sealed and that information is still available and out there in the online system even after they've done an expungement. So this is just for us to try one simple mechanism. And we're specifically talking about folks who prevail against their landlords.

So this doesn't do anything about folks who still want to decide if someone's a good tenant. They're still absolutely able to do that. And I think we need to think as a system and ask you folks, where do these tenants who have records and don't have a single landlord in our state rent to them go?

They sit in our shelter system and they have nowhere else to go. I think there's other ways that landlords who are operating a business can protect themselves by having security deposits and things like that. Our law allows you to evict someone within five days. If they do not pay, they can take that immediately to court.

The court costs $214 to file a fee. That's even still keeping someone's security deposit for non payment of rent. So I think that those ideas of having a tenant that you have to evict and it being a problem are overblown based on the experience that I see.

In fact, we see the opposite where tenants have no ability to challenge the ledger with their landlord because they are given a five day notice to vacate. You're behind on rent based on my ledger. So thank you so much for the opportunity.

Thank you. Is anyone else wishing to testify in this measure?

Good afternoon, Chair. Vice Chair Committee Members. Mihoko Ito. I just wanted to note that I'm here on behalf of the Hawaii Association of Realtors and we stand on our comments. Thank you.

Thank you. Anybody else seeing? None. Members, any questions?

Going for the judiciary, but I don't think they're here, are they?

No, I didn't see them.

Okay. Well, I guess the who's the first testifier. Who's the organization again? Public first. Public first. You still there? I am. I notice you are stationed here in Hawaii, so I'm assuming you're familiar with our system.

I had never heard of this Association before and some of the other attorneys I spoke to had also never heard of it. Is this a, not even a common practice? Is this a practice in the State of Hawaii?

Well, so it is somewhat of a new concept. It's definitely not something that is currently being implemented by the judiciary. And frankly, I'm not sure if the judiciary is fully aware of it. You know, one thing is when they're operating, they're operating on, like, the back end, right.

They're looking at their system from, like, you know, whatever privileges the judiciary has, not necessarily from the, the public's perspective. But in my testimony, we've presented a screenshot, and that shows the Association. Right. So you put in the person's name, you do a search.

Even if a record's been sealed or if a case, an entire case has been sealed, it still comes up. It's just the case names redacted. So when we say disassociate, that is not like something that's going on right now. We're proposing, like, a techno technological kind of solution to it.

Where this, is this in any other state right now?

I, I honestly do not know. But, you know, I, I, and I don't know what the, the capabilities of Jeffs are.

So is your proposal to mostly just make sure the plaintiff doesn't show up if they are victorious in a summary possession matter?

Defendant, you know, because one of the things is. So first, you're running up against the First Amendment. There's a right of access to the courts. So we're trying to propose something where this can move forward but not be delayed from uncertainty from litigation.

But second, if you seal the entire case, you're also going to be obscuring potentially abusive practices by landlords. So you do want these available to some extent. And that's. We think we've offered an idea that's worth exploring, and frankly, that's something that the judiciary would need to weigh in on.

Yeah, no, I'm sorry. I thought this would apply to plaintiffs, too, if they were suing for lease violations. This is just summary possession, though.

It would be how you folks, you know, set it up. But what we're trying to draw the distinction is there's a distinction between simply just disassociating something so it's effectively not available online.

It's an interesting idea. I just. Without the judiciary here to weigh in on the technological feasibility of it, I'm not sure I feel comfortable.

For sure, it is something totally understood, and maybe it's something that could go on the Committee report for the next Committee.

Okay, but you haven't talked to the judiciary or anyone else about the feasibility of this thing you're proposing?

No. And to be clear, this isn't our Bill, but no, we haven't had any conversations like that?

Okay, thank you.

Thank you. Members, any other questions? Seeing none. Let's move on to the next measure. Next up, we have House Bill 467, House Draft 1 relating to foreclosures. First up, we have Elizabeth Ray on zoom. She was the only person registered to testify on this measure.

Is there anyone else wishing to testify on this measure either in person or on in zoom? Seeing none. I guess there's no questions asked of anybody. So let's move on to the next measure. Next up, we have House Bill 1325, House draft one relating to housing. First up, we have HHFDC in support. Democratic part of Hawaii in support.

Chair, Vice Chair, members of the committee. My name is Jun Shin on behalf of the Democratic Party of Hawaii. You have our written testimony, so I'll just keep it short.

The party supports policies that keep the people of Hawaii housed and we support the expansion of protections that this bill lays out because we think it's very important to provide adequate notice and resources to many of the tenants in affordable housing who English isn't their first language.

They're kupuna and, you know, they're people who are working very hard every day to just barely survive. And so we believe that the tenants shouldn't have to self organize and self advocate as been happening in a couple of these projects that have been like either developed during the process that we're developing. And so we're in support of this measure. Thank you for the opportunity to testify.

Thank you. Next we have Hawaii Appleseed, in support.

Hello, Chair Matayoshi, Vice Chair Chen, and committee members. A Hawaii Appleseed stands in strong support on our written testimony that you guys have. And I just wanted to highlight again that this bill is for the stabilization of tenants, for the right to return.

And studies have shown that sudden displacement and destabilization in general of housing results in really adverse impacts into health, education, financial stability and future economic opportunities. So the impacts are severe and want that to be recognized within our testimony. Thank you.

Thank you. Next we have Medical-Legal Partnership for Children in Hawaii in support.

Deja Ostrowski here for the Medical-Legal Partnership. I just wanted to note in our testimony of support, we have some amendments that we kind of brought in last minute. And that's because after the first hearing, we actually had folks in the development industry approach us and say this is something that we do all over.

This is something that when we do projects in other states, they require. And they actually sent us some ideas of some language to have better enforcement to make sure that tenants are protected. So I don't want that to stop the bill, but I do think that there's some.

Just to point out that even as a Hawaii resident, I want to have what Georgia has and what they have always required for a long time. So thank you.

Thank you. Next we have Hawaii Workers Center in support. India Cote in support, Elizabeth Ray in support. Doneileen Willets in support on Zoom.

Hi. Yes, I support. Should I share a little detail of my testimony or.

Sure, if you would like.

Okay. So I am currently a part of the first phase of Kuhio Homes. And the reason my family and I are actually refusing to move is not only because of the lack of communication, but our priority wasn't put first.

And the places that were offered were either run down, unavailable or just too far from our schools and clinics. And I'm not technically full time. I'm actually just a part time worker. But it's really difficult for a single parent, you know, to go through the motions of all of this.

It is mentally draining as we fight against time in hopes to figure out a better solution to all the chaos.

Okay. That conclude your testimony?

Yes.

Okay, thank you. Next we have Dina Shek as an individual in person. Oh.

Good morning. Good afternoon. Representative Matayoshi and committee members. Thank you for holding this hearing. I'm scrapping my testimony to just say this. This bill is about accountability and enforcement. We're so pleased that HHFDC is supporting this because it is what normally happens and should happen.

But as you can tell from what residents have been sharing, it's not happening. And so I have seen tenants show up at community meetings for years, often without required language access, share their concerns, questions and needs, to no avail. I have seen them follow up in writing with these concerns to no avail.

They have attended HPHA Board Meetings, the Hawaii Public Housing Authority Board Meetings, to share their concerns and demands, to no avail. Tenants recently asked for a meeting with the Governor to address these concerns.

He declined to meet with them and he pointed them back to the developer's website, where the right to return consists of a Google form to stay in touch. And I have linked that to my written testimony. If you would like to see the Google form.

Tenants have been doing weekly sign wavings on School Street every Thursday, which at least has garnered some excellent media coverage, which I've also linked in my testimony. But the main contract holders, HHFDC, HPHA in particular, have not been holding the developers accountable.

So although we appreciate their support today. And that is what this bill seeks to do. Add accountability and codify what the tenants have been asking for all along. A clear right to return, a clear process, clear communication and accountability so that they will be treated with respect throughout the relocation and return process.

So hopefully we can, as Deja Ostrowski had mentioned, strengthen some of the language to add tighter enforcement, including possibly quarterly updates that are linked to funding other measures to ensure that there are consequences to ignoring the law.

But please, thank you for listening to the tenants and it's exciting to please ask for your support of House Bill 1325. Thank you very much.

Thank you. That's all. I have registered to testify. Is there anyone else here wishing to testify on this measure in person or in zoom? Please, go ahead.

I'm sorry, excuse me. Hi, good afternoon. My name is Linda. I'm part of the community in KPT. My home is not affected by what's about to happen, but I am part of the community and I stand with my community full force.

Because what we're seeing is I feel like we've been looking down upon because maybe they look at us, we're from the housing or uneducated or whatever it may be. But we would like you guys to take into consideration to please, to help our community. Yeah. And to pass this law. Yeah.

That we hope that mainland redevelopment people won't be able to continue to come to our island and take redevelopment because it's a profit thing, what they're trying to make. So we just hope that you're standing with us as we are standing with our community in KPT. And there's a lot of us here.

Some of them don't want to come up to speak because they're shy, but we are standing as a community regardless of, you know, what's about to happen. One of our goals is to speak with Michaels and HPA.

We've been sending letters, calling, but nothing has been coming back for us to meet with them so that we can sit down and fix this measure, to work together. We're not against Michaels.

We don't hate Michaels, but we would like them to give us the respect and the promises that they spoke about when they made the redevelopment, that families will be able to return to their homes and that we'll be able to afford the rent to live on the property for the new redevelopment.

Thank you so much for your time this afternoon.

Thank you. Yeah, go ahead.

Good afternoon. You know, when I came last month, and I know time is of the essence, forgive me, but that's what tutus do, yeah. So last month when I came I heard people saying they stand on their testimony. What that mean? What they say is good enough? Can they add to it?

Or when Pow, pow, all is said, all is written, what that means? Stand on your testimony. No need talk no more. Pow, pow.

Usually when they say stand on their testimony, it's that they've submitted written testimony and they just. That's good enough. Could you please also state your name before you.

Oh, I'm so sorry. My name is June. I'm a longtime resident of KPT, which we know stands for Kuhio Park Terrace. And like Linda said, I'm not against redevelopment. I'm against the way they're going about doing it. You know, I heard this wahine say, and I think she's from the island of Maui.

She said something that captivated my heart until this very hour. She said, it's not so much what you do, but it's with the heart that you do it with. And I believe that if these people truly loved us, because, like I said over and over, we only can go around the mulberry bush.

We know we can drive upstate, downstate, but we got to live one with another. And I got to see my people every week at the same old shopping center with a broken heart. These people, when they plow, go back mainland, go wherever they like go.

But for us, who the promises are made to be broken by those who are making it. Where can we go? We cannot go no place but here to you guys, because in a sense, you're like our parents. You're the steward of the land. You take care of us. You listen to us.

And that's why we're here today asking you. We're so thankful that this is the second time we're coming. And if there's another third time, we pray that it won't be three. Stretch you out. We pray that it's three times and you're good to go around the bend again.

So just coming to ask you guys, please, kuku with your heart like that wahine said, it's with the heart that you do it. And that's why I'm standing with my people. So mahalo.

Thank you very much for coming.

You know, when I first came here, I never know nothing. Yeah. And Susanna said for the first time. Okay, introduce yourself. I literally never know. I literally stood up, faced the people and said, I'm so and so, and thank you.

And I bowed to the people, and I turned around and they were all laughing because they knew it was an honest thing that I don't know, I learning. I even had to ask our sister over there, what does PCP stand for? I'm learning. Teach me and at the same time love us. We are your island people. Thank you.

Thank you. Is there anybody else wishing to testify in this measure? Oh, please.

Good afternoon. My name is Rona Mangayayam. I'm the Youth Services Director of Kukua Kalihi Valley. Way back in 2022 when the plan for the KPT redevelopment was presented, we brought, me and my team brought, some of our youth in our program who lives at KPT to go and see what the plan is all about.

While we on our way to that venue, one of our youth asked me, Auntie Rona, if they will move us out in Kalihi, from Kalihi, will you accept us back in your program? That's a question that keeps ringing to me until now.

A few weeks ago we met some of our parents because some of their children we will have an opportunity to bring them for a peer to peer mental health workshop in Oregon. And one of the parents lives at KPT. They are on the phase two. And she said I really don't understand what is happening.

I don't know where we are going. I really don't know. And in our youth program the questions we ask is that how would you continue to be healthy? Because we want them to grow as young healers and young leaders in our island. What keeps you awake at night?

And one of the students in our program at Dole Middle School shared her thought and I will read, "One thing I know of the KPT redevelopment, it will affect our accessibility to school, work, and other resources. We mostly rely on the bus for transportation and here we live in close range to bus stops. Our current location is in walking distance to my school, my dad's work, and the PAC Resources Center which has been very helpful to my mom.

My parents are worried about having to start over, not having transportation to my dad's job, and my mom not knowing where to go and get help and resources if we are moved to a new place.

They also like that we have our own yard as well as our own washing machine which we may not have at the next place we get moved to. We also don't like the idea of moving away from our neighbors.

We have come to love them and we're afraid we may not have the same bond with neighbors if or when we move. I don't really like how they're doing this knowing some people have been here most of their lives creating memories for generations to us, this is home."

The right to return to a place is not just going to a building. It's going back to their roots, to the stories that they build with their ancestors, to a home that they've come to love and where they will continue to strive and thrive as people of this island.

If there's a law to protect them, give them assurance that they have the right to return to that home and place and neighbors, then that would ease those pain and hardship of transition if they have to be relocated because of redevelopments. So I ask you to please think of this youth in children as you consider this law. Thank you.

Thank you. Anybody else?

Aloha committee, Jesse Lipman, been working for the last three years with the residents, with the management, the housing authority and the redevelopment. I'm going to speak just as individuals so I can come from my heart and just ask what are we doing here?

Why are we moving out the most stable long term residents of the community, the lowest income with the least capacity to navigate change to build a high rise tower that wasn't in the plans that were presented to the community for 40 to 80% AMI which would average about 80,000 a year, far more than the current tenants get.

With no priority for Kalihi residents, with no involvement of the Office of Workforce Development for jobs or job skills or training for the community to spend $224 million of our tax monies for a New Jersey private company whose leadership is under federal indictment for fraud and racketeering. That's what we're doing here.

And these are the people that are getting moved out to go where? The park, burnt down unit in Waianae? That's where we're getting sent. So I'm just want to speak on behalf of the community. The communities come together. They want to be involved. They want accountability. They're asking for somebody to step up. I support this.

This is a step. But whether it's the state, the city and county, the housing authority, the developer, somebody needs to have accountability and leadership so the community can build itself up. We want to do that. Thank you.

Thank you. Anybody else wishing to testify on this measure? Seeing none. Questions? Members? Seeing none. Let's move on to the next measure. Next up we have House Bill 553 House draft one relating to insurance. First we have DCCA insurance division with comments.

Good afternoon Chair, Vice Chair, Members of the Committee. I'm Justin Chu with the DCCA and we stand on our written testimony offering comments.

Thank you. Next we have DHS with comments.

Aloha, Chair, Vice Chair. Members of the Committee. Judy Mohr Peterson, Med Quest Administrator, behalf of the Department of Human Services. We stand on a written testimony with. With comments. We appreciate the intent. We are also requesting an amendment. Thank you.

Great. Thank you. Next, we have the Attorney General's Office on Zoom.

Okay.

I am here in person. Good afternoon, Chair and Members of the Committee, Deputy Attorney Andrew. Deputy Attorney General Andrew Kim. We've provided written comments regarding the requirements of 2351 and possible defrayment. Thank you. I'll be here for questions.

Okay, thank you. Next, we have University of Hawaii system in support. No Kaiser Permanente with comments on Zoom.

Sorry, I apologize. Good afternoon, Chair, Vice Chair. John Kim Ritzer on behalf of Kaiser Permanente, Kaiser stands on his testimony offering comments and available for any questions. Thank you.

Next, we have Alzheimer's Association of Hawaii on Zoom.

Hello. Chair Matayoshi, Vice Chair Chun. Koby Chalk with the Alzheimer's Association in strong support of this measure, we just wanted to highlight that there are new therapies available for treating Alzheimer's that will actually delay the progression of the disease, but it requires early detection and then it requires biomarker testing to verify the diagnosis.

And there's several biomarker tests used in this, including others to rule out other forms of dementia, such as Lewy Body dementia, or vascular dementia that could be caused by a stroke. And we stand in strong support of this and are here for questions. Thank you.

Great. Thank you. Next we have American Lung Association on Zoom.

Aloha. Chair, Vice Chair, Members of the Committee, I'm Pedro Hara, Executive Director of the American Lung Association. We stand in strong support. You have our written testimony.

I just want to point out that it's incredibly important to be able to pass this as is the industry will ask for it to be a medical necessity or to limit it to instances of cancer. It's incredibly important to point out that this is a test.

And sometimes tests don't need to be a medical necessity in order to be able to find things that are important. A lot of the cancers, a lot of the diseases that we find are because doctors have the ability to be able to order tests to determine what is wrong with their patients.

And we need to allow doctors to be able to make that decision rather than allowing people in offices to make those decisions for them. So we really support this measure and ask you to pass it as is. We'll be here for questions. Thank you.

All right, thank you. Next we have HMSA with comments.

Good afternoon. Chair Matayoshi, Vice Chair Chun, Members of the Committee, Walden Au with HMSA. We just want to stand on our comments available for questions. Thank you.

Thank you. Next we have Hawaii Association of Health Plans with comments.

Good afternoon Chair Matayoshi, Vice Chair Chun, Members of the Committee. Rachel Wilkinson on behalf of the Hawaii Association of Health Plans and we stand in our written testimony offering comments. Thank you.

Thank you. Next we have American Cancer Society Cancer Action Network in support.

Thank you. Chair, Vice Chair, and Committee Members. Cynthia Au on behalf of the American Cancer Society Cancer Action Network or ACS CAN. Thank you for the opportunity to testify in strong support of the Bill. We ask that the Committee passes critical legislation as is to improve patient access to care.

Timely access to comprehensive biomarker testing will enable more patients to access the most effective treatments for their disease and can potentially help achieve the triple aim of of healthcare better health outcomes, improve quality life, and reduce costs. Progress is improving outcomes.

Cancer outcomes increasingly involves the use of precision medicine which involves information about a person's own genes or proteins to more accurately diagnose treat diseases like cancer. Biomarker testing for screening purposes is not covered under this Bill. I'd like to draw your attention to the written testimony of submitted by Natalie Hyman and Susan and Peter Hirano.

Both these stories highlight the inadequate coverage of biomarker testing by insurers in Hawaii. Natalie and Susan both received biomarker testing that was ordered by their oncologists to guide treatment of their cancers, but they received big bills because insurers did not want to cover the testing.

A peer reviewed study found that 64% of Hawaii's policies reviewed were more restrictive than the National Comprehensive Cancer Network guidelines for biomarker testing for advanced breast, non small cell lung cancer, melanoma, and prostate cancer. Ensuring equitable access to biomarker testing by improving coverage for access to testing across insurance types is key to reducing health disparities.

In order to make Hawaii patients have access, they need this game changing testing. The the Legislature should ensure that necessity is determined by doctors and not the latest by the doctors and the latest evidence, but not insurance companies. 20 other states have enacted this Bill. Thank you. I'm available for questions.

Great. Thank you. Next we have Natalie Hyman on Zoom.

Hello, my name is Natalie Hyman. I'm a patient advocate living with stage 4 metastatic breast cancer and I'm in strong support of this Bill. I did submit my written testimony, so I've learned from my previous Committee that I will not read it. But I hope you all will read my written testimony which explains why I'm here.

But just to highlight a couple of issues, the reason we need this Bill, as is and not amended is that our health insurance companies in Hawaii are currently denying medically necessary biomarker testing.

I personally have had that experience twice where my oncologist ordered what would be considered standard of care, medically necessary biomarker testing to determine what cancer drug will work on my cancer, and my insurance plans denied it. The first test was $5,800 and the second test was $9,650, both of which I appealed.

And I'm still fighting over with my insurance plans. Now, you know, the current definition in Hawaii statutory law of medical necessity says the insurance plan's medical Director has to agree with the Doctor that it's medically necessary. So we're putting our feet in the hands of the people who benefit, you know, financially from denying care.

So the bottom line is if you allow this medical necessity nonsense to get in this Bill, you are letting them get away with inconsistent decisions. They're not following the recommendations of the treating physicians. They're not following professional standards of care or current clinical practice guidelines for cancer and perhaps other diseases.

So patients should be able to get biomarker testing when it's ordered by their Doctor and there's sufficient evidence that it will help guide their treatment. But that's not what's happening today.

And so we cannot allow the insurance companies to dictate and use the vague and ambiguous current definition of medical necessity to now muddy the waters for biomarker testing. There's a reason the Bill was written this way. It's to force them to cover things that they don't want to cover. Thank you so much for your time.

Thank you. That's all I have. Who registered to testify in person or on Zoom? Is there anyone wishing to testify in this measure?

Good afternoon, Chair, Vice Chair, Members of the Committee. I'm Shane Morita. I'm a surgical oncologist. I've been in Hawaii for 16 and a half years. My father died of cancer 20 years ago.

I can tell you that there's been a major paradigm shift in cancer care and using precision medicine and to better tailor therapy with molecular biomarker testing is extremely important. So I strongly support this. Appreciate the opportunity. Thank you.

Thank you very much. Anybody else wishing to testify on this measure? Seeing none. Members, any questions? No. I have a question for HMSA really quick. So I just want to clarify one thing. So currently without this Bill, HMSA and mostly all insurers do cover some type of biomarker testing, is that correct under medical necessity?

Yeah. And I apologize I can't speak to Ms. Hines case, but we'd be happy to look into it if she would be able to provide us with the information to kind of go back and kind of close the loop on that. But under medical necessity.

Oh, yeah. Okay. Yeah no my question is this because, you know, some of the issues have been brought up about the essential health benefits. And so, you know, one of the essential health benefits is laboratory services, where usually diagnostic testing is covered, so. Right. I just want to clarify that biomarker testing is already offered.

That's, that's my understanding. That's how we reply it as well, to the auditor study.

Thank you.

Okay.

All right. Thank you. Any other questions? Members seeing none.

Okay. The next measure on the agenda is House Bill 557, House draft one relating to telehealth. And first up we have DCCA insurance division with comments.

Good afternoon, Chair, Vice Chair, Members of the Committee. DCCA stands on its written testimony providing comments.

Right. Thank you. Next we have Department of Health with comments.

Chair, Vice Chair, Members of the Committee, Lauren Kim, Department of Health Planning and Policy Officer. We're offering comments as well as simple but yet significant amendments intended to basically swap out the current House draft with our amendments.

Due to uncertainties about where federal health policy is going, we think it is prudent to extend the sunset date for the audio only reimbursement in Act 107 SLH 2023 to next year and see where we are then. One of the concerns is are they going to put restrictions on telehealth or audio only for reproductive health, for example?

So locking this in stone now in statute may, may be premature and we really need to see how federal health policy is going to shake out. Thank you for the opportunity to testify.

Thank you. Next we have Department of Human Services, the comments.

Hello, Chair, Vice Chair, Members of the Committee, Judy Mohr Peterson, Med Quest Administrator. On behalf of the Department of Human Services, we stand on a written testimony offering comments. We understand this is a complex issue and we are available to discuss and working through any of the issues.

Thank you.

Thank you. Next we have Hawaii State Health Planning and Development Agency in support.

Good afternoon. Chair Matayoshi, Vice Chair Chun, and Committee Shipta is in support of this Bill. We also think there's some nuanced issues there. I very much was impressed by the Department of Health's recent admonition about the fact that the new Administration could be cancelling some of these services.

We think audio only has been very helpful, particularly in behavioral health circumstances more than in other areas. And certainly in that area it needs to be considered because there are so many circumstances in which it's really difficult to get the video communication which we'd like to have.

So we stand with our testimony and think that that concern expressed by the Department of Health was very, very important. Thank you.

Thank you very much. Next we have AARP Hawaii in support.

Good afternoon. I'm Audrey Suga Nakagawa, the Advocacy Director for AARP and we stand on our position in strong support. I too would like to advocate for the Kupuna about the value of audio only technology of being able to access health care in that regard.

Not everyone is digital savvy and there's sometimes difficulties with connectivity and the affordability of interactive type of devices. So again, having the audio only as an option is very, very important to our kupuna. Thank you.

Thank you. Next we have American Cancer Society Cancer Action Network in support.

Thank you Chair, Vice Chairs, and Committee Members. The American, I'm Cynthia Au on behalf of the American Cancer Society Cancer Action Network. The American Cancer Society Cancer Action Network supports the intent of the Bill for further discussion. Cancer patients are already facing tremendous challenges and physician and specialist shortage in oncology has only added to their struggles.

This is not just inconvenient, it can also be physically and emotionally exhausting. For those already struggling with life threatening illness, access to healthcare providers is critical to ensure that patients receive the best possible care and support.

With Telephonic Telehealth, patients in rural and underserved areas can easily connect with specialists and receive timely recommendations or answers to their questions. The Legislature can help to ensure that all patients have access to the care they need regardless of their location or ability to travel.

So thank you again for the ability to support the intent of the Bill.

Thank you. Next we have Healthcare Association of Hawaii with comments.

Good afternoon Chair, Vice Chair, Members of the Committee. Fulton Raithel for the Healthcare Association of Hawaii. We stand on our written testimony asking for amendments. Thank you.

Great. Thank you. Next we have HMSA in opposition.

Thank you Chair, Vice Chair, Members of the Committee. While we did submit testimony opposition, we do wholeheartedly support the intent of perpetuating Act 107 from 2023. Our main concern now is that as currently written, some of the loosened guardrails for initiation and maintaining of the audio only telehealth through audio visual telehealth was removed.

Also, we would like to point out that we do feel that the 80% reimbursement rate that was agreed upon in 2023 would be appropriate given that the stakeholders came to the table two years ago. For those reasons we request amendments and we would like to see this access for behavioral health through audio only telehealth continue. Thank you.

Thank you. Next we have Aloha Care and support on Zoom.

Good afternoon Chair Matayoshi, Vice Chair Chun, and Members of the Committee. Thank you for the opportunity to testify on HB557 HD1. My name is Sarielyn Curtis providing testimony on behalf of Aloha Care. We have testified in support and submitted written testimony.

We would like to underscore our support on this measure on the principle of access to care, particularly for the Medicaid population. We serve over 70,000 Medicaid and Medicare duly eligible Members across all islands. This includes kupuna residents in rural and remote areas as well as those in underserved urban areas.

We support this measure as one way to improve access to care, especially given our state's provider shortages. We'd also like to underscore our support of reimbursement parity for telehealth. We understand a telehealth visit is not the same as an in person visit, but we're prioritizing access to care.

We concur with CMS, the Centers for Medicare and Medicaid Services in their final rule that practitioners should always use their clinical judgment in deciding to furnish services via telehealth whether the use of interactive audio only technology is sufficient to ensure that appropriate care is being delivered, including scheduling in person care as needed.

Mahalo for allowing me to testify in support of HB557 HD1 on behalf of Aloha Care.

Thank you very much. Next we have Hawaii Primary Care Association in support.

Hi Erik Abe for the Hawaii Primary Care Association. You have our rather lengthy testimony on this. I just wanted to provide a little bit of background behind this Bill during the interim in light of the the sunset of Act 107 at the end of the calendar year.

This year, the Hawaii Primary Care Association did have discussions with Representative Chun, who had agreed to introduce the version that the original version of this Bill.

The intention of that draft was to flesh out all of the main elements of Act 107 in light of the significant changes that were made to federal law as of December 9th of 2024. A lot of that is discussed in the testimony. It was subsequently amended by the Committee on Health.

However, as noted in our testimony, the draft as it presently sits is problematic. It basically would deny certain benefits that arguably have accrued since January 1st of 2025.

Based on my cursory review of the testimony that was submitted today, you know, it seems as though Department of Health, the University of Hawaii, the Health Care Association of Hawaii, and Queens, they all realized that the safest thing that the Legislature could do on this issue would be to extend Act 107, as they pointed in their testimony, for one year.

The only trouble with that is arguably because the definition has been changed as of January 1, the Insurance Commissioner has yet to make a determination on how the state is going to actually implement that change. If they should determine that, they're going to need to come up with rules or whatnot.

Just the rulemaking alone is going to take months. And so perhaps if that is what this Committee is inclined to do, you may want to consider extending it from one year to maybe two years. And that way, to a certain extent, Act 107 was for two years.

And so it will basically give these new changes a chance to actually see how it plays out. With that, I'll be happy to answer any questions.

All right, thank you. That's all. I have registered to testify online or in person. Is there anyone wishing to testify on this measure? Go ahead.

Aloha. I'm Melissa Pavlicek. I'm here today on behalf of the Hawaii Mental Health Coalition. Apologies if our testimony didn't come in. I have with me today one of our representatives from the Hawaii Counselors Association.

Hi, good afternoon. My name is Gina Luciano. I'm the President of the Hawaii Counselors Association, making up a part of the coalition.

We also represent the Hawaii Psychological Association, the National Association of Social Workers, and the Hawaii Marriage and Family Therapists. And we strongly support this Bill. Our highest priority is to ensure that behavioral health services can continue to be delivered by telehealth. And as you've heard from others.

And Gina will share with you briefly today why this is so important. We would prefer to see no sunset on those service, the reimbursement for those services. In addition, we do support audio only to establish the initial relationship and to maintain the relationship with the patient, as well as to support 100% reimbursement.

But for purposes of our testimony today, I really want to underscore. We support, moving forward, a Bill that will allow us to continue to provide behavioral health services by Telehealth.

Thank you. And briefly, as a former provider and worker of contracts that service people in rural communities throughout the state, not just Oahu, Maui, Big Island. The need for access for audio only telehealth. Is paramount in making sure that these reach broader communities. Thank you.

Thank you. Is there anybody else wishing to testify in this measure?

Yes, I would like to.

Okay, sure. Go ahead.

Hi. Good afternoon. Chair, Vice Chair, and Committee Members. I'm Dr. Jonathan Opayam on the Big island. And I'll be brief. What I'd like to say is there's a need for this telecommunications aspect to continue. There are times when I have appointments to see my PCP.

And for whatever reason, my medical Trans either doesn't show up or doesn't come. And I have no way to keep the appointment in order to get my medication that I need every month. So I just wanted to interject that into the testimony. My Doctor and I. My PCP are standing on what we've submitted.

But I wanted to Bring this to the Committee's attention. Thank you for your time.

Thank you very much. Is there anybody else wishing to testify? Seeing none. Members, any questions? I have a quick question for Department of Health. Yes, Vice Chair, good afternoon. So I just want to clarify your testimony so with the reference to Act 107.

So that's the original Act 107 and not the original version of this Bill or the HD one, is that correct?

Yes. So it's the session law as it is authorizing current audio only services and reimbursements today.

And you don't think there's an issue with referencing the federal code 42? I think it's.

I'm not familiar with the code that Mr. Abe referenced. I'd have to take a look at that and consult with my AG. But again, we're just recommending the safest move in a, in a, in a time where things are unpredictable would be the safest place just to extend the sunset date, however many years you wish.

Okay. All right. Thank you. Thank you. Members, any other questions? Seeing none. Let's move on to the next measure. Next we have House Bill 712 House draft one relating to health. First up we have Department of Health with comments.

Hello again, Lauren Kim. DOH 340B is a very, very important program. My department relies on it to provide critical service to the most, some of the most vulnerable populations, in particular in our harm reduction services branch. It is also an important program for our colleagues in the private sector who rely on this.

This contributes to their ability to take all commerce regardless of insurance or ability to pay. We are in the process of clarifying the enforcement mechanism for this.

We are in an active discussion both with private sector stakeholders, the Department of the Attorney General, and ask that this measure be passed out of Committee so that those conversations can continue. I'm available for questions. Thank you.

Thank you. Next we have Shipta in support. Okay. Standing on testimony and support. Next we have DCCA Office of Consumer Protection with comments.

Aloha, aweenallah, and good afternoon. We are the other part of the other agency involved in those conversations that Mr. Lauren Kim just mentioned.

Our concerns with the enforcement missing mechanism as drafted really I think prompted and pushed some of those to the forefront and we will continue to work with them to try and figure out how a Bill that seems to be aimed at protecting federally qualified health centers and service providers who are entities fits into a statute that protects consumers who are natural persons and not businesses.

Available for questions if needed. Thank you.

Thank you. Next we have Hawaii Primary Care Association in support.

Yes, Erik Abe for the Hawaii Primary Care Association. We're in strong support of this Bill. We offer Committee report language and draft language for your consideration. It's a friendly amendment.

Thank you. Next, we have Healthcare Association of Hawaii in support.

Hilton Raethel for the Healthcare Association of Hawaii testifying in strong support of this Bill. Congress set up the 340B legislation to provide a funding mechanism to support hospitals and federally qualified health centers. It has been in place for many, many years.

However, recent actions by drug, drug manufacturers have inhibited the use of this program here in the State of Hawaii. There is, at least on the hospital side, a $30 million a year impact of lost revenue.

As you've heard from other testifiers, we are working actively with the Department of the Attorney General, with the Department of Health and other agencies on the enforcement mechanism and we are very, very working actively to resolve that during this, this particular session. So thank you very much for allowing us to testify and we are available for questions.

Thank you.

Thank you. Next, we have Pharmaceutical Research and Manufacturers of America in opposition.

Good afternoon, Chair, Vice Chair, Committee Members. My name is William Gu appearing on behalf of Pharma, which is the trade Association for many of the larger drug companies in the United States. Pharma stands on its written testimony in opposition to the Bill. I would like to add one comment.

Contrary to what the Bill may imply, the accessibility of 340b discounted drugs to covered entities is not really an issue.

However, due to the recent proliferation of the number of contract pharmacies that are actually being utilized by these covered entities, some of which are not even located in Hawaii, and a lack of transparency as to who the recipients are of these discounted drugs through these contracted pharmacies.

Some of Pharma's Members are questioning whether or not these patients are actually qualified to receive 340b discounted drugs, which is really the intent of the program. And this Bill essentially affects their ability to do so. Thank you for the opportunity to testify here, answer any questions.

Great, thank you. Next, we have the Queen's Health System in support.

Aloha, Vice Chair, Chair, Members of the Committee. JC Mikinlak, on behalf of the Queen's Health System, will largely stand on our written testimony. This Bill helps really implement and preserve the intent of the 340B program, the federal program.

I would just also note that as a colleague that was just up here talking, stated, we have an annual requirement that we actually have to report to HRSA on the use of this particular program that includes an incredible amount of data in terms of who's actually getting these benefits and so forth.

So there is oversight and all of our hospitals have reporting and auditing requirements built into our policy so that we're, you know, following the law to, to the t. So. Thanks very much.

Thank you. Next we have the Hawaii Health and Harm Reduction Center and support on Zoom.

Aloha Chair, Vice Chair, and Members. Nicole Slevins with Hawaii Health and Harm Reduction Center. Mr. Kim's point is well taken and we're fully supportive of that. We do not serve people who have means or who are gaming the system. We are serving largely the under sheltered, unsheltered homeless in Honolulu.

We also provide medical case management services to people living with HIV. We serve Members of the transgender community. The 340b rebate program enables us to provide additional support to people living with limited or no economic means. Mahalo for the opportunity to testify.

Thank you. Next we have the Waianae Coast Comprehensive Health center in support on Zoom.

Aloha Chair, Vice Chair, Members of the Committee. We stand upon our origin, our origin, testimony, and strong support of this measure. Thank you very much.

Thank you. Next we have Biotechnology Innovation Organization in opposition on zoom.

Good afternoon, Mr. Chair and Members. Brian Warren with Bio National Biotech Association. 340B entities have access to steeply discounted drugs which they can dispense to patients and receive reimbursement by commercial payers at the full price. And they keep the difference as revenue. The 340B program has wonderful intent. However, it's experienced exponential growth in recent years.

Yet the growth has been primarily in areas that deviate from the 340B program's original intent. Safety net clinics such as FQHCs are a very worthy source of these discounted medications, yet they only make up a very small minority of the 340B program.

Instead, hospitals and for profit pharmacies have found out how to game the system by expanding into wealthy neighborhoods. However, adding more contract pharmacies hasn't increased patient access. All this has done is allow hospitals and pharmacies gaming the system to expand more.

And a 2022 analysis with 340b claims that as few as 1.4% of patients overall at contract pharmacies even saw a portion of the discount. The proponents might say that 340b does not cost taxpayers money, but that's not true.

When 340b medications are dispensed, patients, excuse me, the employer health plans or state Medicaid no longer gets that rebate because those medications have already been discounted. So under federal law, state Medicaid does not get that rebate. So this costs Hawaii, the State of Hawaii, money. Similarly, it's not true that manufacturers are cutting any 340b medicines.

We have been. Some Members of ours have been asking contract entities that use contract pharmacies to upload claims into clearinghouses so that those claims can be verified for accuracy and so that duplicate discounts and diversion of medicines, which are both prohibited under federal law, can be closely tracked. That's what this Bill is seeking to prohibit.

And that's why we opposed this Bill today. Thank you. I'm happy to answer any questions.

Great. Thank you. Next, we have Kelsey Kaku in support on Zoom.

Good afternoon, Chair, Vice Chair and Members of the Committee. I stand on my written testimony and support. I was born and raised on the Big island and I'm currently serving as an ambulatory care pharmacist for our community. And the intent of the 340B program is to ensure eligible patients have access to medications.

The cost savings from this program are used to expand services in our community and contract pharmacies serve on behalf of the covered entity to further extend that access and outreach. So this Bill is essential for us to ensure this access is available for our patients and our community.

Thank you so much for the opportunity to provide testimony today.

Great.

Thank you. That's all. I have registered to testify on this measure. Is anyone wishing to testify? Yeah, go ahead.

Good afternoon, Chair and Committee. I'm Mike Robinson, Hawaii Pacific Health. I believe we submitted our testimony in writing. We'll stand in our written. And we are in strong support of this Bill. Hawaii is made up of a system of nonprofit health care delivery systems.

So I just want to say that a lot of the anecdote you're hearing is the mainland experience in terms of arbitrage and accusation of that that does not occur here in the State of Hawaii. So I just want to make that point to counter on what we've heard today. Thank you.

Thank you. Anyone else here wishing to testify in person or on Zoom? Seeing none. Members, any questions?

Chair Mario Hilton. Was the point of 340B to pass on some or all of the discount to the patients or patients, or was it meant to be programmed to allow and encourage hospitals or other pharmacies to expand into more rural areas?

It was intended to provide a funding stream for hospitals and FQHCs to better support the community for those who are underinsured or uninsured. So it was not intended specifically at a patient level, but more at a community benefit level. So that was the intent of the legislation.

Okay, so there's no requirement to pass on your savings to the patient from the discounted drug costs?

No, no, it was never, never intended to. Sorry, my policy person is not here. No, our understanding it was not intended for to have a benefit to the individual patient. It's about access to facilities that serve patients and provide.

And as was mentioned by one of the other testifiers, all of our hospitals in the state are not for profit. They're here to serve the community. And this revenue stream is a funding stream that helps them provide cover services for and make up that difference.

It may be, you know, for services to uninsured and under underinsured individuals in the community. So it allows, you know, it's a funding stream for setting up resources, for providing staff, for providing services that are not necessarily covered by either government or non government insurance.

Thank you.

Thank you. Any other questions, Members Seeing none. Let's move on to our last measure, House Bill 250, House draft one relating to health. First up we have Department of Health in support.

Lauren Kim, DOH Department will stand on its testimony and support. Thank you.

Great, thank you. We have Shipta in support.

Aloha again, Chair Matayoshi, Vice Chair Chun, and Members. Shipta is obviously in support of this Bill. We've worked on it. We prior authorization is a difficult problem for all of us in healthcare. As you all know.

There are a number of bills out there, I think seven of them this year, four that would speed up the process, provide the right specialty for the right problem that's being adjudicated and all those things we support. This Bill, however, goes beyond. There are also two bills that promote mandatory reporting to Shipta.

So we have all the data, we know what the facts are and we understand how prior authorization is working in our state. Of course we support that. This Bill goes beyond that, looking for a solution to the problem that will take us a year or two to actually work on.

But the issue here would be to look at the science that's out there. And it's there. The science is there in terms of guidelines, appropriate use criteria, standards for all medical conditions that we that are being adjudicated under prior authorization.

If we as a state could agree on the standards that we apply to these, all these factors among the insurers, the doctors, the hospitals and the consumers, we could then automate this process and it would be done.

The decision would be made before you leave your Doctor's office or before you're as you're being admitted to the hospital rather than later with all the problems attached to it. Is it too complicated? No, I don't really think it is. The science is there.

When I was at the American College of Cardiology, you know, for heart failure, we have 20 different or 30 different versions of how heart failure is adjudicated.

We've done all this science that's peer reviewed by many, many different parties, including government entities, so that we understand how we can be very, very specific about looking into the complication of the science today to understand what is necessary care, what is appropriate care. So we create this Hawaii Health Care appropriateness and necessity body.

It's a work group and I don't think my correct testimony was uploaded today. It looks like to me at least the package I brought from my office was my old testimony instead of HD1.

But in the new testimony we wanted to say that of the 15 people on this group, we think the most efficient way, after talking to Members of the Committee to appoint that is to have out of the 155 are insurers appointed by the Hawaii Association of Health Plans. Five are providers.

They're appointed by the Hawaii Healthcare Association of Hawaii from hospitals, the Hawaii Medical Association for Doctors, the Primary Care Association for the FQHCs and primary care folks. And the five consumers would be EUTF, the state health Coordinating Council.

So in other words, it's an easier way to get there with the right kind of people to put this together. At the end of this, it's not mandatory, but we want to see if people will follow it and will make it happen because it would benefit all of us.

And we believe once again Hawaii can do this first and the rest of the nation might just follow along because it's a real solution to the problem. So we're here for questions if you need. Thank you very much. Mahalo.

Great, thank you. Next we have Hawaii Association of Professional Nurses on zoom. Not present. Next we have Hawaii Medical Association in support on Zoom.

Aloha. Good afternoon Chair Matayoshi and CPC Committee. Dr. Elizabeth Ignacio. Hawaii Medical Association HMA stands on our written test money available for questions. Chair.

Right, thank you. Oh, I also have from HU Medical Association Dr. Gerald Garcia on Zoom.

Aloha everyone. Thank you for the opportunity. So from the Hawaii Medical Association along with Dr. Ignacio and Dr. Jerry Garcia, we do support HB 250 HD1 with amendments and I'm also available for questions. Thank you.

Great, thank you. Next we have HMSA in opposition.

Aloha Chair, Vice Chair, Members of the Committee. Don Karisu on behalf of HMSA, first off, we just want to thank the Committee for really taking the time to understand this very complex and nuanced issue and want to just say that we respectfully oppose this version HB 250, as we believe that some of the requirements that were inserted are quite unrealistic and actually will end up stressing the system further and creating more administrative burden for the providers whom we are trying to help lessen the burden for.

We also believe that any additional statutory requirements could also further force health plans to go back to the insurance Commissioner to negotiate premium rate increases. And so we just want to state that again, we're opposed to this version of the Bill, but we are not opposed to improving the prior authorization process and really working collaboratively with stakeholders.

Just want to say that HMSA provided comments and I just want to highlight some because it's quite like I said, nuanced and complex. I just want to note for the Committee that there are actually CMS requirements that are being required of health plans starting in 2026, meaning health plans are already working towards implementation.

And these new requirements will continue to help to address the concerns raised about prior authorization frustrations. So under these new CMS requirements, PA timelines will be shortened, further helping to reduce the burden associated with PA processes. Transparency around medical necessity criteria and PA reporting will be strengthened and the adoption of electronic PA processes will be required.

And so we believe that it would be premature to add any new statutory requirements given that these new CMS requirements are pending and health plans are actively working towards implementation. Also to note just internally, we want to thank HMA, their doctors and their leadership and also of course, Dr.

Lewin for his leadership in continuing to think about this because we understand that there are challenges and we have been really committed to making forward progress internally as a health plan. It's noted in our testimony, so I'm not going to read it to you.

I would just ask that note for the Committee that there is an administrative version of this Bill in the Senate that is quite clean. It does speak to reporting.

And just wanted to say that if the Committee chooses to move this version of the Bill forward, we have noted some amendments, including moving this, the reporting requirements instead of under Shipta, to the insurance Commissioner who's the appropriate authority overseeing insurance and consumer protection in Hawaii. And also just asking for some language changes.

I'll be around for any questions. Thank you so much.

Great. Thank you. Next we have Hawaii Association of Health Plans with comments.

Thank you. Chair, Vice Chair, Members of the Committee, Rachel Wilkinson, on behalf of The Hawaii Association of Health Plans, and we stand in our written testimony providing comments. Thank you.

Thank you. Next, we have Mohalla Health LLC in support on Zoom.

Hello, I'm Esther Smith, and I am here to speak about the not so nuanced impacts that are going on with patients across our state due to the inappropriate burden of prior authorizations. 90% of prior authorizations are ultimately approved, according to our insurance company Executive friends.

And if that is true, then 90% of prior authorizations only cost us money, cost the system money, and cost the patient delay in care. So in this day and age, 90% of a process being entirely useless and costly is not appropriate and is something that could be addressed in a less nuanced way.

Further, prior authorizations are preventing hundreds of people from being seen by their primary care providers today. So when we talk about changing prior authorizations for the sake of the physicians, it really does obfuscate from the fact that we have a tremendous provider shortage in this state.

And so every 15 minutes I'm spending doing prior authorizations is 15 minutes of my not seeing a patient. And every patient I don't see results in some of them going to the emergency room. And the emergency rooms are overflowing because, again, we have a provider shortage.

And so I think it is appropriate to make some moves to actually reform care now and continue to study, because there are some obvious impacts.

I've brought my patient along with me today to just talk about how devastating prior authorizations are and how we really cannot delay getting going on making simple changes that will reduce the burden on providers. And maybe we keep some of the older doctors in business longer because prior authorizations are the largest cause of burnout.

Prior authorizations hurt patients. They should be limited to far, far more than they are now. And all of this electronic reporting, somebody needs to be in charge of making sure the quality of those tools is adequate. But I'm glad we get to leave on Jonathan because he'll.

He'll tell you about how awful our struggle has been just to get him appropriate equipment for the last three years. Thank you.

Thank you. Next we have Jonathan Opayam on Zoom.

Yes. Aloha, everyone. And again, Chair. Vice Chair, thank you for your time. As Dr. Smith alluded, the journey has been long and arduous. In excess of over two years now, trying to get an electric wheelchair for various reasons, denial comes back time after time after time.

I don't want to belabor the point because it's so dire, and I don't want to take up your time because I'm sure there are other things that you need to discuss and other people may want to have something to say, but I want to leave you with this. I'm running out of time. My legs are going ambulatory.

Movements are way more difficult now. I was diagnosed with MS in 98 and have been struggling with it ever since. The next time you bump your funny bone on your elbow, I hope this thought comes to mind. I don't have one on my right arm.

A year ago I fell and knocked the tip of that bone up into my tricep and it never healed properly. So as I said, I'm running out of time. Prior authorizations, yes, they do work, but they delay, delay, delay doesn't help the process.

Whatever you can do, whatever we can do together to mitigate this process and get people the equipment that they need for a life changing experience. There's no question we have to do this again. I implore you to look into this and understand that for some of us this is dire. We are running out of time.

Again from the Big island much Aloha. Thank you for your time and truly again, thank you. Aloha.

Thank you so much for your testimony. That's all I have registered to testify on this measure. Is there anyone else wishing to testify? Seeing none Members, any questions? Oh, go ahead. Lisa Marten.

I have a question for Dr. Lewin. How HMSA had suggested that the more appropriate place to report the statistics to would be the insurance Commissioner. Do you agree with that?

I think that there are three bills that have acted to come to ship to this time. We think we have the time and perspective to do that. There are some really pressing issues regarding housing and insurance and so forth on the insurance Commissioner.

So we think that we really have the time to pull this together and to work with all the parties to make it happen. And it really has to be all of us together to do this or it won't work. As we stated, this isn't a mandatory thing in statute.

This is saying we're going to come together and collaborate and see if we can't agree on what the standards are and then allow that to be automated. So we think it's doable and we know it's sensitive for everybody. This is tough for the insurance companies as well as it is for doctors and hospitals.

But we think this problem can be solved and Hawaii is the place to do it. We're ready to go. Thank you.

Thank you very much. I have a question also, if it's okay. Vice Chair for the Hawaii Academy of Family Physicians. Is that, is that you? No, that's or HMA. Do we have anyone here?

Dr. Ignacio.

Ignacio yes. Hi, Dr. Ignacio I'm here. Bye.

Yeah. So in your testimony, you were concerned there was some language that was put in by the health Chair in the last Committee about the turnaround time, and that included a requirement for the healthcare facility to respond to questions within a certain time frame or else have to submit a new prior authorization.

And your testimony suggested that that might be counterproductive. And you suggested a turnaround time of two weeks was it?

Two weeks to respond with additional information that's requested?

Yes. Yes, representative. So you think that would be appropriate?

Well, according to our colleagues and our Public Policy Committee, and we confer to a lot of our colleagues about what happens with prior auth and there's great heterogeneity and some inconsistency with how the payers handle the need for additional information.

But in General, they usually the provider is given at least two weeks to respond because it can take up to a week to know that it's been denied or even having a question of medical necessity.

So if we need to respond with additional information, acquire more information from the patient or from others, the specialties or whatever, we would like to have the normal amount of time that we've had in the past to respond with additional information to the payer.

So two weeks is usually the standard that a lot of my colleagues get to respond once there's a question of medical necessity.

Thank you very much. Thank you.

Thank you. Members, are there any other questions? Seeing none. We're going to take a short recess. Recession.

Reconvening Members, we have a number of items on the agenda. First up, we have HB496 HD1 relating to Mamaki Tea. Chair's recommendation is to add one FTE per the Department of AG's testimony for one inspector and to add an appropriation, blank appropriation for that. Members, any comments? Vice Chair for the vote.

Members voting on House Bill 496, House Draft 1. Chair's recommendation is to pass with amendments. Chair and Vice Chair vote Aye. Representative Ilagan. Aye. Representative Ichiyama. Aye. Representative Iwamoto. Aye. Representative Kong. Aye. Representative Lowen. Aye. Representative Marten. Aye. Representative Tam. Aye. Representative Pierick. Aye. Chair, your recommendation is adopted.

Thank you Members and thank you for bearing with the longer hearing that we had today. Next up, we have HB978 HD1 relating to electric utilities charge. Recommendation is to pass as is. Members, any comments? If not Vice Chair for the vote.

Members voting on House Bill 978 House Draft 1. Chair's recommendation is to pass unamended knowing the presence of all Members. Are there any Members who wish to vote? No. Any reservations saying none. Chair, your recommendation is adopted.

Thank you, Members. Next up, HB 1316 HD1 relating to the Department of Natural Department of Land and Natural Resources. We need to make a couple technical amendments in here and I'd like to amend it so that the registration fees go to the State Park Special Fund under Chapter 184. Members, any comments? Vice Chair for the vote.

Members voting on House Bill 1316 House Draft 1. Chairs recommendations to pass with amendments noting the presence of all Members. Are there any Members who wish to vote? No. Any other nos? Any reservations? Seeing none. Chair, your recommendation is adopted.

Moving on to HP914 HD1 relating to water carriers. Chair's recommendation is to blank the index and include in the Committee report that the next Committee should should consider any alternative indexes to peg this to. I want to change shall to may for the PUC's consideration in page one, line six and anywhere else that's applicable to.

I also want to note in the Committee report that this is already under consideration by the PUC and this Bill may not be needed. Members, any comments. If not Vice Chair for the vote.

Members voting on House Bill 914 House Draft 1. Chair's recommendation is to pass with amendments noting the presence of all Members. Are there any Members who wish to vote? No. Any reservations seeing none. Chair, your recommendation is adopted.

Thank you, Members. Next up, HB 1161 HD1 relating to transportation. I'd like to adopt the amendments of the Insurance Commissioner and DOT. I also want to add that DOT needs to add plug in hybrids to this program, but I am going to give them until July 12026 per the DOT's request to implement that.

So we'll give them about a year more. Members any comments? Not Vice Chair for the vote.

Members voting on House Bill 1161 House Draft 1 Chairs recommendation is to pass with amendments noting the presence of all Members. Are there any Members who wish to vote? No. Any other nos? Any reservations? Seeing none Chair, your recommendation is adopted.

Next up HP1301HD1 relating to transportation. We will be deferring this measure. Chair notes that under HRS 431 Article 10c section 703 this already requires TNCs to provide insurance coverage for drivers while they are engaged and work with them. Moving on to HB624 HD1 relating to school psychologists. Chair's recommendation is to pass this as is. Members any comments?

Vice Chair for the vote.

Members voting on House Bill 624 House draft one Chair's recommendation to pass unamended noting the presence of all Members. Are the any Members who wish to vote? No. Any reservations? Seeing none Chair, your recommendation is adopted.