Senate Standing Committee on Health and Human Services

Calling the HHS calendar for 101 hearing for of SB 1163. Excuse me. 1633. For SB 1633. While we await the the AEN Chair's notes on the... we're going to roll that calendar to the end of this calendar, which would be 130. No, 120 is... So we will. We'll roll the DM to 1:30 today. Okay. With that, we are in recess. And what's my next one?

Calling the 110 calendar of the Joint Session of Health Human Services and Labor. LBT is Labor? Okay. Sorry. Labor and Technology. Trying to figure out what the T stood for. This meeting is being streamed live on YouTube. In the unlikely event that we have to abruptly end this hearing due to technical difficulties, the Committee will reconvene to discuss any outstanding business on Wednesday, February 12, 2025 at 1pm in Room 225. For those on Zoom, your audio will be muted and video disabled until shortly before it's your turn to testify.

Each testify will have one minute to testify. If there's a technical glitch during your time to testify, we may have to move on to next person due to time constraints. I will be reading a list of individuals who submitted written testimony for each measure. We apologize if the closed captioning does not accurately transcribe the names.

If you are interested in reviewing the written testimony, please go to the Legislature's website. You will find the link on the status page for the measure. We appreciate your understanding and remind you that the Committee does have your testimony, that I reviewed them. So I encourage you to use your time to either add additional comments or...

Or stand on your written testimony. First up, SB 447, relating to Department of Health pilot program. We have Department of Health in support. Okay, thank you very much. Next, we have Department of Human Resources Development providing comments. Yes.

Hi, Chairs. Good afternoon. I'm Brenna Hashimoto, Director of the Department of Human Resources Development. We're providing comments on this measure. However, I just wanted to point out a couple of things. First of all, DHRD currently has three different forms of delegation available to departments if they would like to take on recruitment functions.

However, each of the delegations that we do offer, we do require that they comply with all of our civil service rules, policies, procedures, statutes, collective bargaining agreements, and all of that. And we do have concerns about some of the provisions in this delegation that do not comply with civil service.

Okay, thank you very much. Next we have Randy Perreira, Hawaii Government Employees Association, providing comments. Next we have Dawn Poiani in opposition, and then Ellen Awai in support. Anybody else wishing testifying on SB 447? Seeing none. Members, any questions? Okay. Senator Moriwaki, please proceed.

So the Department of Health did do a pilot. Is that what I understand from your testimony? Oh, that's Department of Health.

Come on up.

Hi, Director. So you did have a pilot that did all of these things that you say in the bill or what was in the stated in the bill?

Aloha. Kenny Fink with the Department of Health. Thank you for the question. We did a pilot with one aspect of what is in the bill, and that was the process by which for the classifications that are unique to the Department and those for which we're able to have delegated, all we did was instead of reviewing minimum qualifications at the time of application, we reviewed it for all the applicants.

And delaying that time to generate a list. We took all applicants and sent them to the program to review. And then when they selected an individual, we just reviewed the minimum qualifications for that one individual. So that was fully compliant with the outcome that the person was qualified before an offer was made. And that streamlined the process significantly. We avoided well over 100 applicants whose minimum qualifications would otherwise have been reviewed, allowing our recruitment staff to focus on other recruitment efforts.

So what the HRD Director is saying is that some of the proposals in this bill are not in compliance, but you're saying that what you have done is sufficient, or you're adding all of these other requirements that you see that HRD may have some concerns about?

The pilot includes other strategies as well that we have not yet tested, some of which additional authority would be required. I think every system is perfectly designed to achieve its results, and a government job today, unfortunately, is not as attractive or competitive. So I fully respect the merit principle.

But when we have more jobs than applicants, selecting one position is not taking an opportunity away from anyone else if they're qualified. So we're seeking the opportunity. We feel there's a need to innovate and happy to be laboratory to see what would work within certain guardrails, to see if it's scalable, provided that it does not impact, again, other people's opportunities or conflict with the intent of the merit principal.

So you are okay with restricting or taking out those things that HRD finds that may not be going with the merit principle or opening it up for all comers I guess?

We'd welcome the conversation to have a better understanding of what is required by the law versus policy. And, again, see if there's an opportunity to try different things and seek efficiency within the process. Like other departments, we have a 30% vacancy rate.

Unlike other departments, in a recent OWR survey, 43% of those who responded said they were looking for a job in the next 12 months. I have a sense of urgency to be able to continue to do the core functions of our Department. If people start leaving, there will be a downward spiral.

And I'm doing my best to keep the folks that we have and try and fill the vacancies as soon as we can. I fear that there's the risk of another pandemic, and if I start losing staff, our ability to respond, to protect the public will be challenged. Difficult. So I just want to clearly communicate I'm acting out of a sense of urgency.

So we understand that, and we'd like to support that. But I think in terms of looking at what is consistent application across the board, and maybe you have unique classes that could be addressed in that way. I'm just wondering, have you talked with HRD to see how you can streamline whatever you need to have done so that your urgent classes can be open and you can get, recruit and get people?

I appreciate that Deputy Director has been available, and I've engaged with him on conversations. I do believe we should be seeking efficiencies in reviewing how our processes go in that where he had offered their Wikiwiki Program as an option for delegation. And you know, to me that doesn't reduce steps, you know, so I wasn't clear about that. But I, you know, I'm trying to keep an open mind and see where we can work together.

I asked for a service, certain service level, that if there was a commitment to be able to verify minimum qualifications and even in less than a time we're able to do that now. So if there's a commitment to meet a certain service level, that would be okay. And if they're not able to, I'd welcome the flexibility for us to try.

I guess that what I've seen and the testimony from HRD is that you can already do these things that are already delegatable.

So the challenge with the whole program is that it just delegates the process as it exists with no efficiency. So we, from my perspective, we end up doing the work, but then we still have to go back to DHRD for their final approval. So there's no efficiency gained in that.

It's just a change in who does the work. What I would like to do is in the spirit of the program. Let us do it in the way we did our pilot program that seems to be working so we actually can take on that responsibility but be allowed to have a more efficient process so it's more timely.

And then there are certain things that I think are helpful that for the temporary assignment off the list. You know, every step, every transaction, someone has to touch and it takes time. So it's work for an individual and it causes delay. When people are applying for a job, they need a job now.

So if it looks like all of our TOALs are getting approved, then is it possible we've shown in good faith we're doing it correctly? Let us send you a list for the previous month so you can check, but it won't delay the process. And if it turns out you're saying in basically retrospective review it's not working, fine, we lose the privilege. But we're just asking for some flexibility based on our record that we can try to do things differently because I believe the system itself needs to change.

Thank you very much. And I'd like to note that the bill is only for pilot program for three years it appears. 2028 until 2029.

We're just trying to experiment. And again, I respect DHRD trying to problem solve with us. They're important colleagues. We hope we can, you know, it's, I think difficult to do things statewide. So I'm hoping we can try things and see and learn from it. And frankly, I'm more afraid of not trying than failing.

Okay. So I mean, I want to do a follow up question with what Senator Moriwaki pointed out. And that is one of the reasons I have, I've scheduled this bill for hearing is because I remember at the time of your appointment, I had spoken to you and your first deputy as to what avenues you have dealt with with DHRD on recruitment. Because the vacancies with Department of Health even predated your appointment. Correct?

So have you made those? And at that time you had assured me that you are, you are trying to have these efficient recruitment processes through DHRD. Has that helped in your recruitment? Have those avenues that you have been trying to work with with DHRD, has that helped in any way reduce your long term vacancies?

So our vacancy rate in total has not decreased much. Okay, it has not decreased significantly. But we have a lot of retirees with an aging workforce. We have to work harder to keep up. So what we did find through this hire project, you know, on average, from when the recruitment closed, not to getting a list, but from the recruitment closed to making an offer, right, is now about 53 days. So that's really pretty significant for someone who's looking for a job. And for someone who's looking for a government job, we have to really remove all barriers for anyone who's willing to come work for us.

Okay. And I'd also like to point out that HGEA has put down, has submitted written testimony conditionally supportive of this pilot program. Thank you. Any other comments, questions, concerns?

Chair, one more question for DHRD Director. Hi, Director. You said you had some concerns about this bill. Is there anything glaring there that you would want to see amended so that we can try this pilot? Because I think what the Director is saying is that they have needs urgent and they want to move faster. So if this is a pilot for three years, as the Chair says, I mean, I see, you know, trying different modes of getting our vacancies filled. But if there is anything glaring that you see in this bill.

So thanks for the question. And from DHRD's perspective, we're sympathetic. I spent many years at the Department of Health. I have a soft spot for the Department of Health, and we're willing to work with them to come up with a plan that is flexible, that is timely, that does meet their needs.

And so from our perspective, I think you heard Director Fink talk about Wikiwiki, which is a tremendous workload for both sides. DHRD commits to reviewing applications for those classes that we put into Wikiwiki every two weeks. So anybody that's applied, we turn them around within two weeks, and that's our commitment.

Those applications then go directly to the managers, which I think is part of Dr. Fink's concern, trying to eliminate unnecessary steps. So the beauty of Wikiwiki is that it goes directly to the managers, and they can. And we also let the applicants know, if you're interested in this line of work, call these people and schedule the interview. We send out the notices directly to the applicant. So there's actually no need for a list, but the Department can also get a list and contact those individuals immediately. So we've given them some options.

What I have concerns about with the way that this bill is, and it does differ from what they're doing now in some very important aspects. I think right now, the concern that we have with what they're doing is that they're not giving all applicants their due process rights, which is required under our administrative rules.

So every applicant has the right to be advised whether they meet or don't meet the minimum qualification requirements. And if they're deemed to have not met, they have the ability to file an internal complaint and to pursue that through the Merit Appeals Board. And that is not happening now.

And that is a tremendous concern with what Department of Health is doing on their pilot currently. In this bill, it not only expands it, but it also delves into two other areas which I find very problematic. The first of which is that they unilaterally can change the minimum qualification requirements, which is problematic.

We have a civil service system that's rooted in our constitution. It's rooted in Chapter 76. We have classification and compensation plan which recognizes the duties and responsibilities of all civil service jobs and pays them equitably. We have equal pay for equal work statutes. And for them to unilaterally change the minimum qualification requirements.

And also in Section 4, it... Sorry, yeah, four, it allows them to make an appointment at any step on the pay scale, which violates our equal pay for equal work and our policies and procedures that we've consulted with the union on how pay is administered.

So those are two very significant changes that are not part of the delegation that they're currently operating under, which I find very problematic. Like I said, we have the Act 186, which the Legislature just passed last year, that they can avail themselves of if they want to have additional delegations.

I think there are time limits for DHRD to respond within that bill. So it's not as if we are going to hold them up. I, you know, if Dr. Fink wanted to, you know, ask us to review them within, I think the bill says maybe within five days or less, three days. If it's an urgent matter, you know, we can work on that and get a decision very quickly. The holo delegation. Actually, I think you heard him mention holo delegation. That one is they. They do the minimum qualification.

I really want to keep you guys down to one minute. And I know... Any, any other questions?

No, I just wanted to know what was problematic.

Okay, thank you. Thank you very much. Okay, moving on. SB 1043. First up, Department of Taxation providing comments. Next, Hawaii Children's Action Network Speaks providing comments on Zoom. Nicole Woo, you have one minute.

Sorry, I was just trying to get my microphone undone. Hi Chairs, Vice Chairs, Members of the Committee. I think we all agree on the tax equity that this bill intends to provide, and we support certain parts that reduce the tax burden, especially on lower income families. But the big question is who should pay for it?

The GET increase that's in this bill would make everything in the state more expensive. Every item, every service. It's a 50% increase in the GET. We know that's especially hard on low income and working class people. There are other types of revenues that hit non-residents a lot harder and target them better than the GET. So we're really happy to have more extensive talks about the best way to provide tax equity and help with the cost of living. But we don't think the GET is the way to go. Thank you.

Thank you very much. Devin Thomas, Hawaii Appleseed Center for Law and Economic Justice providing comments.

Good afternoon, Chair, Vice Chair, Members of the Committee. Thank you for the opportunity to testify today providing comments on this bill. We, again, along with Nicole from HCAN, agree with the intent of the bill to provide tax relief to low income households, especially those under the ALICE threshold. However, we think that it's hard to evaluate the net impact of this bill because we don't have fiscal notes in this state number one. And it's, with the number of measures in here it's difficult to really provide comprehensive, really reasoned analysis of this.

But we agree that the general excise tax is a regressive tax and to raise it would impose more undue burden on working class families. That's the provision that we disagree with in this bill. We urge the Committee to keep the conversation going around tax credits in general. The Earned Income Tax Credit is another great way to deliver benefits to working families that need relief right now. Thank you.

Thank you very much. Next we have Iron Workers Stabilization Fund in support.

Good afternoon, Chair, Vice Chair, Members of the Committee. My name is Cody Sula with the Iron Workers Stabilization Fund. On behalf of our Managing Director T. George Paris, we like to strongly support our SB 1043 relating to taxation. We know that this bill represents a crucial step towards the financial, towards reducing the financial burden promoting recovery, economic stability during the difficult time for Hawaii's residents. We know that a lot of residents are struggling.

We have a steady decrease in population since 2016, and with the Income Coalition's Out of Reach 2023 report says that the average worker got to work 100 hours per week to afford a one bedroom rental at fair market prices for a two bedroom residence. Got to have an hourly wage for at least $44.60.

A couple of things in our testimony we just want to highlight a few of the main points that we believe that this bill can do to alleviate the tax burden and enhance economic equity is exempting groceries and non prescription drugs from the GET. Also removing tax liability on the first $100,000 for individual incomes and also 200,000 for couples. Unemployment...

Okay, thank you very much. Next we have Tom Yamachika, Tax Foundation of Hawaii, providing comments. Tom Yamachika.

Thank you, Chair, Vice Chair, Members of the Committees. Tom Yamachika from Tax Foundation of Hawaii. We have submitted written comments. I call this bill Candy Crush because it has some sweet things in it but does have the potential to decimate the economy. We are most concerned about the bill undoing most of the Act 46 cuts from last session and raising the GET by 50%. More details are in my testimony. I'll be happy to answer any questions.

Okay, thank you very much. Next we have Michael Yadao, OPCMIA, in support.

Chair, Vice Chairs, thank you. Mike Yadao from Local 630, the Operative Plasterers' & Cement Masons' International Association. You have our written testimony. But we just wanted to highlight that we don't normally comment on matters that are not directly construction related, but we do feel that there is a construction nexus and that working families are leaving Hawaii in droves and we're facing large projected worker shortages. And so any measure that alleviates some of that suffering and some of that burden on working families, we are in full support of, and we believe this measure does.

Thank you very much. Next we have HSTA in support. Osa Tui, are you present on Zoom? IT, is Osa Tui present on Zoom?

Not present on Zoom, Chair.

Okay. Next, Grassroots Institute of Hawaii providing comments. Ana Tuiasosopo for Operating Engineers Local 3 in support. Ikaika Castillo, Hawaii Masons Union Local 1 in support. Lauren Zirbel, Hawaii Food Industry Association in support. Dwayne Bautista, Iron Worker Stabilization Fund Local 625 in support.

I'm on Zoom. Can you hear me?

Okay, why don't you wait a second, let Dwayne Bautista speak and then you can come in, Lauren.

Good morning, Chair, Vice Chair, and Committee Members. My name is Dwayne Bautista and I work for the Iron Workers Stabilization Fund under the direction of our Managing Director, T. George Paris. Summarize our my written statement with the four things that we asked to support on Senate Bill 1043.

As you know, eliminate the GET taxes, prescription drugs and over the counter, removes tax liability, increases the rent tax rent credit, and establish the Maui Fund. The reason for these things right now, the way Hawaii is going, we need some new money. What's going on right now?

Take away the Unemployment Insurance, people who's not going to be working, now they have a chance to have money in their pocket with having the uninsurance tax off. And then as for the liability, you're going to have money again inside your pocket. If not, everybody's going to start moving out. The gentleman earlier talked about his, on his part, people's moving out. That's what we want to do. Keep Hawaii home and something for us. Thank you.

Thank you very much. Okay. Lauren Zirbel, you're on Zoom. Please proceed.

Thank you so much, Chair. We submitted comments in support with amendments. We strongly support removing groceries from the GET. There are many, many studies that show that there's a strong causal relationship between grocery taxes and food insecurity.

One in three individuals in our state struggles with food insecurity and that number increase increases to 40% on Hawaii Island, which I hope we all can agree is completely unacceptable. We should do everything possible to eliminate food insecurity in our state.

In my very long testimony, I actually put together what I believe it would actually cost if you were to, you know, do it dollar for dollar, be about 256 million to remove SNAP eligible groceries. And we got there from two different angles and we got a pretty similar number. So one was using the USDA take home food budget and the other was by, you know, using the Thrifty Food Plan budget times our population and actually the numbers were very similar, which indicates that the majority of take home food is purchased...

Thank you, Lauren. Thank you very much. Okay, next we have Lynn Akatsuka providing comments. Ellen Awai in support. Mary Kawasaki in support. Kayla Marie in opposition. Don Baluran in opposition. BA McClintock in support. Lokelani Cameros in support. Nicholas Zehr in opposition. Natalie Iwasa providing comments. Mel Kahele in support. Anybody else wishing to testify on SB 1043? Come on up.

Yes. I just want to add to my testimony.

Yeah. Identify yourself.

My name is Mel Kahele. I'm with the Iron Workers. I'm going to speak on behalf of me being an affected parent, grandparent, and a taxpayer. You know, some people are good with it, some people are not too good with it, but at least we've started a conversation.

You know, I believe the Senators should look seriously at what stuff we got in this bill. And you know, I'm not going to mention all the stuff that was already mentioned by the prior testifiers, but we need to find a way to try to keep our families home. You know, we're going to be paying an additional 2% over the four years or at the fourth year of this bill, but at least we're going to be looking at saving money on the 100,000, first $100,000 that we're going to be making on income.

We get unemployment, you know, insurance, taxes that we now not going to be looking at paying. But find a way to try to keep our native Hawaiians and our, our people that lives in Hawaii here. We got more people living on a big, on, on a big, big island up in a mainland than Hawaii. So keep the conversation going. Thank you, Senators.

Thank you very much. Anybody else wishing testify? Come on up.

Aloha, everyone. My name is Scotty Reis-Moniz. I'm with Waimanalo, Friends of Waimanalo Workforce Development. We train and certify men and women in getting a better position when they're going out for getting jobs in forklift, great oil, scissors lift. And we send them all to the unions. We want to strengthen our people out here.

However, I've been working closely with one of the largest employees, Hawaiian Electric. They've been having an exodus from ages 21 to 35. My nephew is one of them, my daughter is one of them. And they don't even know the language. They don't know the culture. They lost it.

So what we're trying to say is, if we can take time to be in support of this and start working forward to bringing solutions, we feel that this actually going to bring one in the right direction to keeping our people here, keeping them here. Because a lot of the times they're only saying my money is going further everyplace else. And that's what we're trying to bring them so they can stay here in Hawaii.

Thank you very much. Okay, anybody else? Come on up.

Good afternoon, Chair San Buenaventura, Chair Aquino. Gino Soquena. I'm the Executive Director of the Hawaii... Oh, Members of the Committee. Sorry. Gino Soquena, Executive Director of the Hawaii Building Construction Trades Council, which represents 18 construction trade unions here in the State of Hawaii.

Although we normally come and testify on construction and labor issues, this issue is very important to us because it is not only affecting the residents, but also our members. And the Hawaii Building Construction Trades Council is committed to finding and working with support solutions to combat this issue. We just ask that you guys pass, pass the issue, pass the bill out to continue further discussion. Thank you.

Thank you very much. Come on up. Identify yourself.

Aloha, Chairs, Vice Chairs, Members of the Committees. Tuia'ana Scanlan, President of IATSE Local 665, IATSE International Trustee. Apologies for submitting late testimony, but we sent in our written testimony in support and urge you to continue the conversation on this bill. Thank you.

Thank you very much.

Good afternoon, Chair, Vice Chair, and Committee Members. My name is Cliff Laboy. I'm with the Iron Workers 625 Stabilization Fund under the direction of T. George Paris. I just want to share with you the number of support we have out there for this bill, which we talk to at least 1500 families. They all support, like the idea.

They want to know more about it, learn more about it. But just so that you understand what's in back of us, we have the following unions, Electrical Elevators, Plasterers and Cement Masons, insulations, bricklayers, plumbers, sheet metal, Hawaii Teamsters, IBEW, Boilermakers, ironworkers, painters, glaziers, floor layers, drywall tapers, roofers, and operating engineers.

Total, we're talking about 35,000 members, which would equate when talking, when you add in the rest of the family members and relatives, over 140,000 people that we could have had here today to testify on this bill. We couldn't all bring them all in here. You all know that.

But we have a very, very strong support out there in the communities for this bill. We urge you, if anything, to just keep this bill moving for further discussions. We know there's things that we can probably change or add, but this is something that the community, the state, the workers in the State of Hawaii needs to be done. They need help. They need help. We thank you for time to testify. Thank you very much.

Thank you very much. Anybody else wishing to testify on SB 1143? Seeing none. 1043. Seeing none. Members, any questions? Seeing none. Are we ready for this decision making or do we need to recess? Okay, recess for decision making.

Calling back the joint HHS LVT calendar for, 120 calendar for decision making. Course for FD 447. Sheriff's recommendation is to pass this as is. We note that this is a, that the primitive health has had a long term vacancy problem. We're now faced with an Avian flu. We cannot, they have been decimated after the COVID 19 pandemic.

We cannot have a more decimated departmental belt facing a potential pandemic. So any comments, questions, concerns? As is. Vice Chair for the vote.

Thank you, Chair. Voting on Senate Bill 447 recommendation of the Chair's to pass as is. [ROLL CALL] Recommendation is adopted Chair.

Thank you. For SB 104.

Sorry, Chair. For Labor and Technology, same recommendation.

Voting on Senate Bill 447, recommendation to pass unamended. [ROLL CALL] Chair, the recommendation's adopted.

Okay, thank you very much. So for SB 1043, Chair's recommendation is to pass this with substantial amendments. We're going to delete everything except for section two. We're going to put in a defective date of December 31, 2050. We would like to note that the House Bill version of this died in committee.

So the high likelihood is it's not going to pass this year. But we are heedful of the fact that the conversation needs to continue. We also would like the proponents, for anything substantial like this, we need to know the fiscal impact and there is no report as the fiscal impact to the state.

So with those amendments any comments, questions, concerns? Keeping Section 2 and defective date, deleting all else. Seeing none. Vice Chair for the vote

Voting on Senate Bill 1043. Recommendation of the Chair's to pass with amendments noting the excused absence of Senator Keohokalole. Any reservations? Any no's? Recommendation is adopted Chair.

And with that we are, oh sorry.

Labor and Technology, same recommendations. Any questions of concern? Seeing none. Vice Chair for the vote, please.

Voting on Senate Bill 1043. Recommendation to pass with amendments. Noting all committee members present. Are there any reservations or no's? Seeing none the recommendation's adopted.

Okay, we are going to adjourn the Joint Committee. But I'm going to recall the deferred, the decision making for SB 1633 for HHS only. For the decision making for SB 1633, Chair is going to follow AEN Chair's recommendation in which is to defer it again to Wednesday, February 12, 1:30pm at Room 225. Any other comments, questions, concerns? Seeing none. And with that, we are adjourned for HHS 120 and 101 calendar and 130 calendar.

Calling the single HHS calendar at 1:20pm the same colloquy said earlier is going to be summarized. Basically, in the unlikely event we have to abruptly end this hearing due to technical difficulties, committee will reconvene to discuss any outstanding business February 12th at 1pm at room 225.

For those on Zoom, audio will be muted, video disabled until shortly before it's your turn to testify. Each testify will have one minute to testify. We have a substantial calendar, so please be mindful of your time. If you've already provided written testimony, please stand on that unless you want to add to it or amend it.

First up, SB 298 relating to human services. We have Director Yamane providing comments.

Aloha Chair, and the rest of the committee. On Behalf of Director Yamane and the Department of Human Services, we stand on our written testimony, appreciating the intent. Offering comments and requesting an amendment. Thank you.

Thank you. Next up, Hawaii State Council on Developmental Disabilities in support.

Aloha Chair, we stand on our written testimony in support.

Thank you very much. Nancy Moser in support. Kate O'Connor in support. Anybody else wishing testifying on SB 298. Members, any questions? Seeing none. Moving on, SB299 relating to loan repayment for health care. First up, we have Department of Health in support. Okay, we got two Department of Health.

They really support. Will Kane, Senior Advisor, Office of the Governor in support. Jack Lewin, Hawaii State Health Planning Development Agency, in support. Thank you, Dr. Lewin. Next, Laura Reichhardt, Hawaii State Center for Nursing in support. Are you present, Laura, on Zoom?

Not present on Zoom, Chair.

Okay. Kelley Withy, University of Hawaii System, in support. Thank you very much. Jacce Mikulanec, Queen's Health Systems, in support. Jonathan Ching, Kaiser Permanente, in support. Thank you. HMSA in support. Thank you. Healthcare Association Hawaii in support. Thank you. Jeremy Creekmore, Hawaii Association of Professional Nurses, in support. Jeremy, are you present on Zoom?

Not present on Zoom, Chair.

Thank you. Erik Abe, Hawaii Primary Care Association, in support. Hawaii Medical Association in support. Alan Johnson, support. Hawaii American Nurses Association again in support. Hawaii Pacific Health in support. Hawaii Dental Association, support. Hawaii Association of Health Plans in support. Rachel Wilkinson. Thank you very much. Bronson Silva, Democratic Party of Hawaii, in support. Aloha Care in support. Mike Nguyen, are you present on Zoom?

Not present on Zoom, Chair.

Okay. Joseph Mayer in support. Joseph?

Yes. Couple comments, real quick. Given the fact that the first program increased...

You need to come up, Joseph, and identify yourself. You have 1 minute. 52 seconds. Come on up.

Given that the first year the program added 73 healthcare providers, 55 full time...

You need to identify yourself.

Joseph Mayer.

Thank you.

On a budget of 30 million, current statistics shortages, 543 full time equivalents, 10 times the first year recruiting. National physician shortage is expected to double in eight years. Nationally, as of 23, 22% of physicians are over 65 years of age. Currently, 50% of physicians over 55 are considering retirement. Given the documented need, the last year's $30 million net at 73%, 73 providers, 10% of the need. What is the rationale for cutting the appropriations in half? Thank you.

Okay, thank you very much. Next we have Germaine Kaululaau in support. Rick Ramirez in support. Lynn Murakami Akatsuka in support. Jencey Melemai-Watson in support. Avery Olson in support. Anybody else wishing to testify on SB 299? Members, any questions? Okay, seeing none. Moving on. SB 322 relating to Medicaid.

First up we have Director Yamane DHS in providing comments. Thank you very much. Next, Audrey Suga Nakagawa AARP in support. Agricenter testimony in support. Thank you. Thank you very much. Kylie in support. Are you present Kylie on zoom?

Not present.

On Zoom Chair Nancy Moser in support. Anybody else wishing testifying SB322 Members? Okay, come on up. Identify yourself.

Hi, my name is Shell and I'm a full time caregiver and I'm not used to being here so. And I actually have seven pages of testimony. But since I only have one minute I'll get to the point. Thank you. So where does the state get the money to pay for our raise?

The simplest answer to that is take it from the fund that the state saved from utilizing the foster care home industry which is not complicated at all. You just need to appropriate funds appropriately to the initiatives that saves and makes you money.

The CCFFH saves you $300 million a year and you take the $35 million that we need to fund the high option raise that will fund our livelihoods and you still get 200 plus million for yourself, for the state. And there is a difference between the state and the federal funding. And per Dr.

Yamani's testimony, the state only needs 14 million to fund the high rate option for the CCFFH. That's even a no brainer because if the CCFFH saves you 300 million a year and you pay us the high option per milliman rate, it still saves the state's 286 million. So now that we have the 14 million toys. Thank you.

Okay, I'll get to the.

Really, the big point. And yes, we already know that. That everyone is in support. I'm just letting you know. In opposition.

Okay, so now one of the solution is why don't we keep in line with the federal Medicaid policy? Not a politician, of course, and I'm not very.

I don't know a lot about this, but I do know that Hawaii's reimbursement policies disproportionately support institutional care, violating federal laws that require states to prioritize HCBS expansion and ensure patient choice. Several federal policies and guidelines. Thank you very much. Okay, sorry.

Okay. Next up, we have anybody else wishing to testify on SB 322? Seeing none. Members, any questions? Okay. SB 323, relating to mental health. First up, Behavioral Health Administration providing comments. Hawaii Department of Health. Next, we have Alan Johnson of HSAC in support. Jacce Mikulanec, Queen's Health Systems, in opposition. Randy Perreira, HGEA, in opposition. Veronica Moore in opposition.

Anybody else wishing testify in SB 323? 322. Sorry, 323. Nobody else. Okay. Members, any questions? No. SB 324 relating to pharmacists. First up, Director Yamane providing comments. Okay, thank you very much. Next, we have Insurance Division, State DCCA, providing comments. Office of the Auditor providing comments. Dawn Kurisu, HMSA, providing comments. Thank you. James Skizewski, Board of Pharmacy, in support. Thank you. Corrie Sanders, Hawaii Pharmacist Association, in support. Corrie, are you present on Zoom? You have one minute.

I'm here. We'll stand on our written testimony. I'll stand by for questions.

Thank you. Queen's Health Systems in support, Jacce. Erik Abe, Hawaii Primary Care Association, in support. Hawaii Pacific Health, Michael Robinson, support. Grassroot Institute of Hawaii in support. Tiffany Yajima, SanHi, Walgreens Company, in support. Rachel Wilkinson, Association of Health Plans. Hi, Rachel. Please proceed.

Mihoko Ito with on behalf of Walgreens. Just wanted to note that we stand on our testimony in support and request some amendments to the bill. Thank you.

Okay. You didn't register on Zoom, otherwise you would have been called. Okay. No problem. Thank you. Rachel Wilkinson. Thank you very much. Alysa Lavoie in support. Michael Sylva in support. Ronald Taniguchi, pharmacist, in support. Melissa Bumgardner in support. Melissa, are you present on Zoom?

Yes. Thank you so much. Thank you, Chair, Vice Chair, Committee, for the opportunity to speak. I just wanted to share some additional comments. I stand on my written testimony. As of 2024, there were 34 states that allowed pharmacists to be compensated for services, in addition to three other states that paid for Medicaid directly.

This year is my 30th year serving my community and pharmacy in some capacity with 25 years as a pharmacist and I've been licensed in six states, and Hawaii is the only state in which I cannot bill for the services I provide that go beyond giving medications to a patient in a bottle.

So pharmacists have made great advancements in what we do in collaborating with other providers. And our patient interactions, while they're collaborative in nature, often occur independent of the time that that the patient spends with the provider in the room.

So I'm honored and humbled to have been recognized as a provider amongst my peers and my colleagues last year by the Hawaii Primary Care Association as Healthcare Provider of the Year. And it is my great... I and my colleagues look forward to reimbursement aligning with that recognition.

Thank you. Congratulations. Okay, next up, anybody else wishing to testify on SB 324? Members, any questions? Seeing none. Moving on. SB 450 relating to autism. First up, Director of Human Services providing comments.

Appropriations. Yes, I saw. Thank you. Hawaii Disability Rights Center in support. Thank you. Ho'omau Therapy in support. Jee Eun Yasuda, are you present? Okay. Seeing none. Kristen Koba-Burdt, BAYADA, in support. Kristen, are you present on Zoom?

Thank you, Chair. We'll stand on our written testimony in support.

Thank you very much. Hawaii Association Behavior Analysts in support.

Hi, Chair. Thank you so much. Yes, I stand by our written testimony.

Okay. And your name is?

Dr. Marija Čolić.

For Hawaii Association Behavior Analysts. Thank you.

Yes, thank you.

Catherine Wilson, ABA Positive Support Services, in support. Alex Samson, Maui Behavioral Therapy, in support. Vitality ABA LLC in support. 'Imi Ola in support. Council of Autism Service Providers in support. Ho'omau Autism Services in support. Behavioral and Therapeutic Services are providing support. Golden Rule ABA in support. Hawaii Association of Behavior Analyst, support. Balanced ABA Inc. in support.

And we've got... And we've got approximately 42 other people all in support, individual support. Anybody else wishing testify SB 450? Members, any questions? Seeing none. Moving on. SB 451 relating to persons with disabilities. First up, we have Director Yamane, Department of Human Services, providing comments. Thank you very much. Hawaii State Council on Developmental Disabilities in support, Daintry. Okay.

Sorry, you stuck with me.

It's okay. Got one minute.

Aloha, Chair and Committee Members. My name is Che Silvert for the Hawaii State Council on Developmental Disabilities. I'm here for my boss, Daintry Bartoldus. She apologizes she couldn't be here today. We just are going to stand our written testimony in support. But we just wanted to highlight that we've had a few individuals with intellectual and developmental disabilities come to us who are on the cusp of basically, even with Ticket to Work programs, not being able to qualify for Medicaid.

These are individuals that are medically fragile and medical needy and they're not going to just be able to survive off of typical insurance. We've worked for the last three decades to try to encourage our IDD population to work and do things like that, and we just think this would help with that as we believe more and more people will use Ticket to Work programs and probably out qualify Medicaid. Thank you.

Thank you very much. Next we have Kirby Shaw providing late testimony of DCAB in support. Louis Erteschik, Hawaii Disability Rights Center, in support.

Thank you, Senator. Senator, I'm sure you recall a couple of years ago when we passed the Medicaid buy in day. It was a really, it was a celebratory day. I still have the picture. You, me, Che, Daintry. There was a lot of promise and hope at the time that we did that. Unfortunately, we haven't all lived happily ever after with the program.

There's been problems. So we wanted to bring it to your attention. I have Katie Meyer here who's our Staff Attorney, who's actually handled some of the clients, some of whom I think were referred by the DD Council. And so during the Q and A, if you have questions, she can probably give you more specifics. But the bottom line is that people have been getting kicked off when they shouldn't be getting kicked off. And so the program is not working.

And by the way, I think your idea of the bill of going to a full buy in program is what we always wanted to do. So I mean, certainly if the Legislature wants to do that, we're in strong support. But at the very least, I would love to see the Legislature take a look at what's going on over at DHS and try to get things together in terms of properly implementing the buy in program. So thank you. I appreciate your time.

Okay, thank you very much. Next we have Janelle Fiesta in support. Anybody else wishing to testify in SB 451? Seeing none. Members, any questions? So I do. Come on up, Judy Mohr Peterson. So I remember passing, that was back when I was a House Chair, the first buy in program. And at that time you had, you had specific amounts that you felt were needed appropriations for. And it appears that from no one is really being able... Do you have any statistics as to whether or not anybody bought in based upon the first bill?

The bill that passed that went through was not a true buy in in the sense that we chose in the implementation to not implement the buying in part, the paying of premiums part on a regular basis, because it is very administratively, there's a lot of overhead and it's administratively complex to operate a buy in program.

So how this, how we implemented the Ticket to Work was through by doing what's known as income disregards. In other words, saying, okay, we're just going to disregard your income up to a certain amount. That brings your net income down to a certain level that has you qualify for Medicaid.

We have fewer than 10 people currently who have signed up. I became aware that some individuals through administrative processes are having challenges on staying on. So that's an administrative thing to try to work through. But we also understand that for individuals who have more assets or higher incomes, they're not going to qualify.

And if you want that sort of program, then indeed we will need to, we'll do an estimate of how many additional people, what those costs would be, both to operate as well as the programmatic costs. My recollection, and this is going back decades before I was here. Because this program, people have been talking about implementing a program like this. It's in the tens of millions of dollars to provide coverage. But that being said, we're happy to bring back the numbers.

Okay. Why is it that the income disregard didn't work?

Well, I think that's a matter of opinion. Louis and I were having a conversation about this on the rail before we came in, and I was like, well, you know, it's like we can work through how to resolve the whatever administrative issues are once we are aware of them. And now that we're aware of them. I think part of it is, you know, we were in the, when we were in the pandemic, we weren't doing regular renewals for individuals.

I don't know why people are not signing up, but I think, I think we, I think there are ways that we can improve and streamline our processes that would encourage people to sign up for the current program. It's not going to address those, the situation in which people are earning more than that.

Well, it sounds like it's just an administrative. Because they are going to be buying it. They are going to be paying premiums.

If they pay premiums, then we would need to readjust the program that we have.

So they will be paying premiums. So it's just an administrative cost it sounds like.

Well, it would be administrative, but they're not paying the full cost. Yeah. So it's on a sliding scale.

I'm thinking about passing this because there's really no opposition, but I understand that you folks haven't really figured out how much it's going to cost you. So I'm thinking about delayed implementation and a defective date to give you folks time to figure out what you folks need at least to keep the conversation going. Because 10 people is not what we expected at the time when we first passed this with all that hoopla.

Yeah, I think we had estimated like maybe, maybe about 100 and so, but I think we can, we'll take a look.

Okay, thank you very much. Okay. Any other questions? Seeing none. Okay, moving on. SB 479 Hawaii able savings program. First up, we have Deputy Attorney General providing comments. Ian Robertson.

Good afternoon. Ian Robertson, Deputy Attorney General. We submitted testimony providing comments pointing out potential issues with the use of the term Hawaii public school is used in the bill and we've suggested some amendments.

Okay, thank you. We saw that. Thank you. Okay, Hawaii State Council Developmental Disabilities. Che in support.

Aloha, Chair. Che Silvert with Hawaii State Council on Developmental Disabilities. We're going to stand our written testimony in support.

We just wanted to highlight that able Accounts, a lot like the last conversation, is a really key piece to getting our population to be able to work since it allows them to be able to save additional monies and still qualify for Medicaid, Snap, HUD, SSI and things like that.

And so we, and specifically it does identify that a staff would be given to our office. And the whole point is to get people on Able Accounts. I believe there are over 200,000 people in Hawaii that would qualify. We have about 179 that currently have one.

So it all be trying to get that number up and that's only going to go higher.

Okay, thank you very much. Executive Office on Aging and Support. Caroline, are you present? I see you on Zoom. Please proceed.

Good afternoon, Chair. Thank you so much. We'll stand on our testimony in support. Thank you.

Okay, thank you very much. Next is Luis Salavera, Department of Budget and Finance in support, Hawaii Disability Rights Center in support. Okay, Kirby Shaw, DTAB in support. Kirby, are you present on zoom?

Not present on Zoom, Chair.

Kylie in support. Anybody else wishing testifying on SB 479? Seeing none. Members, any questions? SB 480. First up, Deputy AG is relaying to health, providing comments.

Good afternoon, Chair, Vice Chair, Members of the Committee. Melissa Chee with the Attorney General. We just make the recommendation that a better placement may be in HRS 481B.

Yes, I saw that. Thank you very much. Department of Health providing comments.

Chair, Vice Chair, Senator. Lorrin Kim, Department of Health. The department isn't fully on board with this yet, but we are actively working with stakeholders and like Healthcare Association of Hawaii, Hawaii Primary Care Association and the Department of the Attorney General. And we ask that this measure be moved forward to give us time to come to a compromise.

But this is a very important issue. It must be addressed and it's a matter of how. And that's what we continue to negotiate. So we ask that this bill be passed down. Keep moving. Thank you.

Thank you very much. Next up, we have Department of Health again providing comments. Melissa Lam, DCCA Office of Consumer Protection, providing comments.

Good afternoon, Chair, Vice Chair and Committee Members. My name is Melissa Enright. I'm with the DCCA Office of Consumer Protection. We just had a few comments. In addition to our written testimony, OCP is responsible for reviewing, investigating, prosecuting allegations of UDAPs, unfair deceptive acts or practices as it relates to consumer transactions.

Consumer transactions is defined in HRS 480-1 as those involving natural persons as opposed to legal persons, which could be private entities, businesses, corporations. Our concern here is that as written, this would involve OCP in business transactions between two private entities. Thank you.

Okay, thank you very much. Next we have William Goo, Pharmaceutical Research and Manufacturers of America in opposition.

Chair, Vice Chair, Committee Members. William grew up here on behalf of PhRMA, which stands in its written testimony in opposition to the bill. I'd like to have a few comments first. Foremost of which is that contrary to what the bill may imply, there is no issue regarding accessibility of 340B drugs to covered entities.

I think due to the proliferation of contract pharmacies and the lack of transparency, some of the PhRMA's members are concerned that whether or not these pharmacy patients are actually entitled to get the 340B discount on drugs, which is why they're questioning some of the contract pharmacies.

Also, there was previous testimony regarding the number of states that has taken action on this measure. And I and I think the previous testimony said over 20 states have taken some kind of action.

Just like to add that a majority of these states, measures and states have not passed and also that to our knowledge, there are eight states that have considered this issue. One state has dismissed the claim. One has. There's a stay on it because of.

Okay, we need you to wrap up. We do have your written testimony. Okay.

And the remaining six states are under litigation based on the federal preemption law. And then lastly, just wanted to add that there was some previous testimony about there being no cost to the state. There is a small cost. Thank you.

Thank you very much. Next we have JC McCullin for Queens in support. Thank you. Melissa Bumgardner in Hawaii Island Community Health Center in support. Melissa, are you present? Please, one minute.

Yes, thank you. My name is Melissa Bumgardner. I'm the Director of Pharmacy services at Hawaii Island Community Health Center. Thank you for the opportunity to testify today. I stand in my written testimony. I have only one comment to add, and that is to give a name to 340B. And I have three names for you. Amaris, Nadine, Lokelani.

There are three patients who live with type 1 diabetes who cannot access insulin at contract pharmacies because there are no manufacturers who are willing to ship it to our contract pharmacies. So they can only get it at my one little pharmacy in KL right now. This is the reason why this bill is so important.

It is for our patients to be able to get the medications they need to stay alive. That is all I have to say. Thank you so much.

Thank you very much. Next we have Ian Ross, Waianae Coast Comprehensive Health Center, in support. Ian, you present. Please proceed.

Yes, Senator. Chair, thank you very much. We stand on our written testimony for this measure. Thank you very much for this opportunity.

Okay, thank you very much. Next we have Chevelle Davis. Hawaii Children's Action Network speaks in support. Chevelle. Thank you very much. Hilton Raethel, Healthcare Association of Hawaii in support.

Chair, thank you for the opportunity to testify. We strongly support this measure. There are. This has material impacts each year for 15 hospitals in the state and FQHCs. We are currently losing. The hospitals are currently losing at least $30 million a year. We believe that we do need to keep this funding in the state.

We are working closely with DoH and the AG's office on any potential amendments. We believe we can get this resolved very soon, making progress. And we thank you for the opportunity to testify.

Okay, thank you very much. Next we have Michael Robinson, Hawaii Pacific Health and support. Then we have Aaron Ruddick, Hep Rehab Hawaii in support. William Ding, HDA providing comments. Erica Abe, Hawaii Primary Care Association, in support. Kumukahi Health and Wellness in support. Hawaii Health and Harm Reduction Center in support. Biotechnical Innovation Organization. Brian Warren in opposition.

Brian, are you present? Please proceed. That doesn't look like Brian.

No. Aloha, Madam Chair.

Excuse me. Nikos. It's Brian. It's next. Brian, please proceed.

Thank you, Madam Chair and members, good afternoon. Brian Warren with the Biotechnology Innovation Organization. The 340B program has experienced exponential growth in recent years, yet has been primarily in areas that deviate from the program's original intent. Safety net clinics such as FQHC make up only a 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 contracts, pharmacies has an increased base in access. As all this has done is allow hospitals and pharmacies gaming the system to expand more patients can get their medications at any pharmacy they want.

An analysis of 340B claims from 2022 found that as few as 1.4% of patients at contract pharmacies saw even a portion of the 340B discount. And while proponents say that 340B cost taxpayers no money, that's not true. Because Medicaid, that dispenses 340B drugs, the state does not get a Medicaid rebate. Health. Excuse me, State.

State employee health plans are paying extra money for all of this. And it's also not true that manufacturers are cutting 340B. All right, thank you, Madam Chair. We're just not cutting 340B. We have programs that are focused on hospitals. Thank you.

Nikos, your turn. Hawaii Health and Harm Reduction in support. I saw you on Zoom.

Yeah. Aloha, madam. Okay. Hello.

Yeah. And I saw. I'm sorry to bypass you, but.

No, that's fine. It's. It's a. It's a packed agenda. Niko Leverenz on behalf of Hawaii Health and Harm Reduction Center in strong support of this bill. This is really necessary for the health and well being of our clients and those that we serve in. Mahalo.

Okay, thank you very much. Let me finish this one and then we're gonna do a recess for decision making. Next we have about seven other people, all individuals, all in support. Five Minute Pharmacy in support. Veronica Sawyer, alliance for Safe Biologic Medicines providing comments. Anybody else wishing to testify on SB 480? Members? Thank you very much, Jacqueline.

Anybody else wishing testifying SB 480? Okay, at this time we're gonna recess because I'm have to be next door for waterland and we will be back. Okay, thank you. Recess.

Okay.

Recalling the 120 calendar, I went on recess too early. So next up, 120 calendar, continuing on SB 481. Okay, 480 Members. Any questions for 480? Brian, are you still present on Zoom? Brian? Okay, I apologize. I thought we had.

Not present on Zoom, Chair.

Yeah, that, that. Okay. Who else was in? William Goo. Come on up.

Yeah, the question I had was basically this is what Brian had said, but maybe you can answer them. He said the availability for medication is available at every pharmacy and certain discounts that we're talking about is available at every pharmacy. How accurate is what he had said? What he said, if you're thinking is true.

I think that as far as the availability of the drug is concerned, again, you know, there's no question about accessibility to the discounted drug at the contract of the covered entities. However, when it gets to the pharmacy, a lot of times there's no issue at that point about whether or not there's a 340B qualification of the patient.

So that's what the manufacturers are concerned. In other words, are these patients actually entitled to the 340B discount? And I think that may come up only after there's a where the drugs dispense. But then there's a question about reimbursement. So that's when the issue arises.

The only reason why I bring this up, I know particularly certain drugs that is high in demand give you three months supply, used to be $25 with the discounts, and now one month supply is $25.

So those are the things that we concern, because certain people that need the medication, like that lady said about the insulin, is the same drugs we're talking about for people that is diabetic and need these medicines for having price change from $25 for three months, now you're going from 25 dollars a month.

So those are the things that I guess is concerning and why, I guess a lot of people is supporting this bill. And that's why I do, too. I understand. Thank you, Chair.

Okay, thank you very much. Any other question on SB 480? Okay, moving on. SB 481 relating to community service licenses. First up, Board of Dentistry providing comments. Thank you. Hawaii Dental Association in opposition.

Aloha. My name is Melissa Pavlicek. I'm here today on behalf of the Hawaii Dental Association. Patient safety is our number one and we appreciate the intent of this measure. We respectfully oppose it. We've supported in the past efforts to increase the number of dentists that can serve in community service or public health settings.

But equating their service there to the equivalency of licensure bypasses some important restrictions that we have in our state for patient safety. This is why we oppose this measure in its current form.

Okay, thank you very much. Okay, next up we have Patrick Donnelly, Hawaii Oral Health Coalition, Hawaii Public Health Institute, in opposition. Patrick Donnelly, please proceed.

Thank you. Chair, Aloha Chair, Vice Chair and members of the committee. Patrick Donnelly with Hawaii Oral Health Coalition and Hawaii Public Health Institute will stand on our written testimony, again appreciating the intent, but in opposition to the specific ideas that are explained in it. Thank you for the opportunity.

Okay, thank you very much. Next we have Hawaii Provider Shortage Crisis Task Force in support. Craig Haruki, DDS, in opposition. Hawaii Children Action Network Speaks in opposition. Dent. Oh, I already said the Hawaii Dental Association in opposition. Joseph Mayer, I see you present in support. Please come on up. Identify yourself again and proceed.

Dr. Joe Mayer. This bill is more than improving access to MedQuest dental care, and it's also about the dental board's advocacy for MedQuest patients, or the lack thereof. 90% of my written testimony is the documentation of my remarks to the fact checkers on your staff.

The board appears more focused on protecting the status quo than addressing our public health crisis. The board effectively blocked Canadian candidates from obtaining community service licenses for rewording the bill 162 and 23. They initially denied a high qualified dentist from participating in the school sealant program.

They have shown no engagement with the critical public measures like water fluoridation bills or sugar flint beverages. Nine states issue an unrestricted dental license to Canadian dentists. The community service dental license is a restricted license targeted to midquest patients requiring three years of clinical experience.

I ask that this bill be amended to add the Venue Department of Corrections facilities. I have full faith and confidence in the committee, the Commerce Committee and the legislature to do the right thing. My faith in the Dental Board, based on their past actions, not so much.

Okay, thank you very much, Dr. Mayer. Okay, next we have Derek Ichimura in opposition. Robert Besa in opposition. Durazo Kim in support. Nancy Partica in support. White Dental Association again in opposition. Donald Sand in support. Mendel Sato, in opposition. Penelope Dodson in support. Eric Hasegawa in opposition. Anybody else wishing testify on SB 481? Members, any questions?

Okay, moving on. SB 482 relating to cognitive assessments. First up, we have Department of Health in support. Okay, next. Executive Office on Aging providing comments. Carolyn, please proceed. You have one minute.

Thank You, Senator Caroline Cuttyrao, Executive Office on Aging. And I just wanted to highlight. We're. We're in support of this measure, the intent, but we're offering comments. My apologies. This Bill is mandating healthcare providers to provide the cognitive assessment. And it also, the way the Bill is written will require HIPAA compliance.

So our recommendations in our testimony is to amend the Bill to ask. To offer the. To offer it instead of mandating the cognitive assessments. We also wanted to ask that we strike the age of 65 and you'll hear later, probably from DD council on that.

And we also wanted to create a pilot project to demonstrate the viability for a statewide program and ask for flexibility in the data elements. And we actually submitted with our testimony some language changes to the Bill itself for clarity. So. And I'm available for any questions. Thank you.

Thank you very much. Hawaii State Council on Developmental Disabilities and support.

Aloha. Chair Chase, the Hawaii State Council on Developmental Disabilities will stand in our written testimony and support. Also, our testimony is offering an amendment and the intent is, as Caroline had mentioned, is to just reduce the age or get rid of the age.

Thank you. Get rid of the age. Thank you very much. Jack Lewin in support for Hawaii State Health Planning and Development Agency. zero, he left. Kobe Chalk, Alzheimer's Association and support.

Hi, Chair San Ben Ventura, Members of the Committee, I'm Koby Chalk with the Alzheimer's Association. We're in support of this measure. We'd just like to highlight a few of the amendments in our testimony. We want to keep the shall administer on page six, lines four through 17.

So we want to make sure that it is a mandated cognitive assessment test.

We do defer to EOA on the data component on page 6, starting on line 18 on, to make sure we're in HIPAA compliance and can start that pilot program so that there's good continuity between what's currently happening as well as other practices that could be happening in terms of data collection and analysis and in drafting.

There was an error and we intended to include Medicare Part B as well as Part C. Medicare Part B, of course, being the public side and Medicare Part C being the private insurers. It's the same exact visit, but with Part C. That's about half of the population in Hawaii that we are missing currently in the Bill.

Okay, thank you.

So I just want to point out the written testimony we have says you are strong support of this Bill being passed without amendments. So you are changing your mind now.

Apologies. Yes, there is a change in that.

Okay. Yeah. Why Don't. And I know you were trying to submit it early on to my Committee earlier, but could you. Do you have copies of those proposed amendments? Because the one we have says strong support without. Yes, page 482. So. Okay. Provide the written testimony. Okay. We need to submit this for late testimony. Amendment of.

And I understand Waterland is ready to go in. Okay. But not until we're done. Okay. Next up we have Hilton Raithel Health Care Association of Hawaii providing comments. AARP in support. Are you present, Audrey?

Yes. Good afternoon. Audrey Suga Nakagawa from aarp. We stand in our position in support. And we defer to the Executive Office. On Aging and the Alzheimer's Association with their amendments.

Okay, thank you. Hawaii Disability Rights center and support Hawaii Primary Care Association and support PABEA and support Hawaii Public Health Association and support Alzheimer's Caregivers Caregiving and the Caregivers in support. Hawaii Pacific Health providing comments. And we have 15 other individuals all in support. Peter Black, are you present on zoom? Peter Black, please proceed.

You have one minute.

Yes, I'm here. Okay. So I'm a retired Professor and I had an early diagnosis of mild cognitive impairment. And that was a big surprise to me.

But what it did was give my wife and I some time to get our families on board to redo our ideas about the future and to make accommodations to make the development of Alzheimer's in my brain as positive as possible, which is not very positive.

So I submitted the document and I strongly encourage, if possible, this Bill becomes law. Thank you very much.

Thank you very much. Thank you very much, Mr. Black. Anybody else wishing to testify on SB 482?

Good afternoon, Chairman, Vice Chair and Members of the Committee. My name is Gino Sokwenna. Here at my role as a board. Member for the Alzheimer's Association of Hawaii in strong support with the Alzheimer's Association's Amendments. Thank you.

Thank you very much. Anybody else wishing to testify in SB 482? Members, any questions? Okay. Now, we're going to do a recession to meet with Waterland and then coming back for the 120 calendar after the Waterland Joint Committee. We are in Visa, so recalling the 120 calendar for health and Human Services.

I've been informed that we don't have enough time to finish this calendar. We are going to defer the rest of the calendar to Wednesday at 1pm 225. Right. Okay. So for those. For the rest of this, for the rest of bills, which is SB483, SB710, SB712, SB950, SB952, SB954, SB956957959 and 1609.

No further written testimony will be accepted, but we will be having the oral testimony of on Wednesday at 1pm as to those bills that we have already heard, we will be where's my decision making note? There are certain bills that we will be deferring and that would be for SB323. Sheriff's recommendation is to defer that indefinitely.

There are still problems with that Bill and we'll try it again for SB324. Chair's recommendation is to defer that also indefinitely. SB 1245, which was identical, had previously passed for SB 480. Regarding 340B.

Since the House Companion is moving, we're also going to be deferring that for SB 481, community licenses that needs work and probably a reciprocal agreement with Canada.

So we're going to defer that indefinitely and work on it in the interim with the stakeholders for SB 482 for cognitive assessments, we're also going to defer that indefinitely because the House Companion is moving. Same thing with SB483. House Companion is moving, so we're deferring that. SB712, House Companion is moving, so We're deferring that.

SB950 we're going to defer that in lieu of SB1398 and SB956 we're going to defer that because HB951 is moving. SB959 we're also going to defer that because House Companion is moving and the rest we are going to defer decision making to Wednesday at 1pm in this room. 225. Wednesday, what day is that? February 12th.

February 12th at 1pM Room 225. And with that we are adjourned for the 120 calendar.

Thank you folks for your path.