Senate Standing Committee on Health and Human Services

Calling the 1:00 pm health and human Services calendar, this meeting is being streamed live on YouTube. In the unlikely event that we have to abruptly end the hearing due to technical difficulties, the Committee will reconvene to discuss any outstanding business on Wednesday, March 12 at 1:00 pm in room 225.

For those on Zoom, your audio will be muted and video disabled until shortly before it is your turn to testify. Each testifier will have one minute to testify, and I have read all of the testimonies. Okay. But there will be time for questions, so keep it within that one minute.

If there's a technical glitch during your time to testify, we may have to move on to the 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're interested in reviewing the written testimony, please go to the Legislature's website. You'll find a link on the status page for the measure. We appreciate your understanding and remind you again that I have read and reviewed your testimony.

I encourage you to use your time because it's only one minute to either add additional comments or stand on your written testimony. So, first up, HB 72 relating to pharmacy; we have Rei Matsumoto, University of Hawaii System in support. James Skizewski, Board of Pharmacy, in support. Board of Pharmacy?

Okay, Hello Chair. I'm here on Zoom, so just want to say we're here to stand in our written testimony. Thank you.

Okay, thank you very much. Tiffany Ajima, Walgreens Company in support. Tiffany?

In support, thank you.

Thank you. Corrie Sanders, Hawaii Pharmacists Association, in support.

I stand in support.

Thank you. Okay. Forest Batts, in support. Lara Gomes in support. Ronald Taniguchi, MBA, in support. Dylan Soliday in support. Grath Hicks, in support. Anybody else wishing to testify on HB 72? Okay, seeing none.

We're going to move on and I don't have any questions. HB237 relaying to peer support programs. First up, we have Department of Health in support.

Department of Health, we stand on our testimony. In support. Thank you.

Thank you very much. Director Yamana, DHS and Support Executive Office on Early Learning providing comments. Yukio. Okay, thank you.

Sherilyn Shinoki, Family Hui Hawaii in support.

Sherilyn stand in support of her testimony. But also really want to emphasize that nobody really understands.

Thank you very much. Next. Justina Acevedo, Cross Hawaii Community foundation and support. Matthew Lauren, Matthew of Lauren Group, LLC and support. Adrian Miller in support. Jared Ellis, Commit to Keiki and support. Mike Min of Aloha Care and Support. Okay, thank you. Kevin Shinoki, Guardian Capital Management Hawaii. And support. Kiani Kawave and support.

Kiana, are you present on zoom?

Not present on Zoom. Chair.

Okay. James Lapree in support. James, you want to come up?

Good afternoon, Chair, Committee Members. I'm James Lapree. I'm standing on my written testimony and I'm going to explain a little bit about why. It's because I'm a former prostitute and I'm a grief internal facilitator.

And not very many people with disabilities or family Members know that there are people out there like us that needs peer to peer mentoring support because we may not feel comfortable on talking to our caregivers because of personal reasons.

So I highly encourage this Bill to be passed for the state to hire or find funding for people to be comfortable to talk to someone that can help individuals with peer to peer mentoring support. Thank you.

Thank you very much, James. Thank you. Next we have Leilani Novak in support. Come on.

Thank you so much.

If you're not going to stand in support, you got to speak on the mic, okay? Okay. So identify yourself.

My name is Ailani Novak speaking in strong support today. I stand with my written testimony, but also as someone who is both very excited and terrified by the prospect of starting a family.

The hope that peer to peer support programs gives me for my future and the future of my kiki is something that I really want to emphasize today and that the hope and the support that it gives families in times of isolation and strong stress. And thank you so much.

Okay, thank you very much. K. Flores in support. K, Are you present on Zoom?

Yes, I'm present on Zoom.

Please proceed.

Good morning, Chair, Vice Chair, Members of the Committee. My name is Kaylee Flores and I'm here to express my support for House Bill 237. Parenting is one of the most rewarding but challenging jobs out there. And it's only more difficult for families that have financial problems, mental illness or other obstacles.

These difficulties can isolate parents from their loved ones or other support systems. This process can create burnout for parents and in the long term have negative effects on their health and their children's health.

Without any assistance, some parents are likely to struggle offering their children the necessary care which can lead to endangering the child for possible abuse and neglect. So the need for peer to peer support is essential. These programs can provide safety to parents in the sense that they are able to identify and receive help.

These kinds of programs, parents can learn coping strategies, get empowered and obtain valuable sources of information and receive support for parents and well beings. Because of these factors, I Support House Bill 237. This Bill is an important step for families and children in the long run. Thank you.

Okay, thank you very much. Kalei, are you testifying from Hilo? Am I what? Are you testifying from Hilo? No, ma'am. I'm at, uh, in Manoa. Okay. Your background looks like a state building in Hilo. That's why. Okay, thank you very much. Next we have Adrian Miller in support. Shaleg Galiza in support. Will Tanaka in support.

Joanne Farnsworth in support. Ellen avai in support. Dr. Sharon Tisa in support. Jessica Flaherty in support. Jasmine Anderson, support. Rosalyn Maheshin in support. Lilia Galverman in support. Sade Kahue in support. Ann Davis in support. Wayna Ogata in support. Terry Barringer in support. Karen Worthington in support. And Lori Pachinki in support. Anybody else wishing to testify on HB237?

Seeing none, and I have no questions. Moving on. HB250, relaying to health, it's the prior authorization bill. First up, we have Deputy Ag providing comments.

Deputy Ag yeah, we just stand on our written testimony.

Comments. Thank you.

Thank you very much. And I see Jack Lewin for State Health Planning Developmental Agency and Support. Come on up.

Aloha Chair, Simon [unintelligible]. Jack Lewin here from Shipta.

This bill's gone through a number of changes and what we recommend, I'm recommending here, is one that is a bill that has been modified to take the best aspects of, of 250, HD1 and HD2, and bring them together with so the two elements, the reporting of prior authorization practices to Shipta so we can see transparently what's going on.

And then a working group without any binding regulatory requirements to try to come to consensus on the standards to allow us to automate prior authorization by agreeing together.

We think this version of the bill actually put a draft version of how we'd like the bill to be reworded, to include the good aspects of the other two bills, but to remove two clauses in there that are inconsistent with Shipta's statutory definitions.

And finally, just because we think those would require additional resources to, for the regulatory side of that, which we didn't request in the bill. So thank you very much. Respect your determination. Thank you very much.

Thank you very much. Next we have Derek Mizuno for eutf, providing comments. Next we have Rachel Wilkinson, Hawaii Association of Health Plans, providing comments. Rachel? Thank you very much. Tonia Neal of PCMA in opposition. Tonia, thank you. Thank you, Chair.

My name is Tanya Neal. I'm with the Pharmaceutical Care Management Association. So we've offered an amendment by our comments that would remove the pharmaceutical elements out of this. We think that it's not necessarily the intent is to include all of pharmacy. We have prior auth processes for pharmacy currently.

So this would be adding an added layer of duplication. And we also have automated services and electronic approvals for prior auth.

And so again, by requiring the state requiring a second level, that's going to actually slow down the ability for us to get those prior auths quicker to the patients when they need them, especially in the times of emergency situations.

So we would ask that the Committee amend the bill and pull out lines 15 and 16 to remove the pharmacy portion at this time and then obviously continue on with the medical side of it and then we can talk about the pharmacy side and get more information to everybody to recognize the unintended consequences that are currently in this bill.

Thank you very much. Thank you. So tonight, Neal, in opposition and we have Don Kurisu providing comments from HMSA.

Aloha Chair, Don Carriso. On behalf of HMSA, I just wanted to highlight that we have some concerns with the language on page 4, line 14, to page 7, line 2, and we request that that language be removed. But it's also consistent with the draft that Shipta has proposed to the Committee.

And so we just want to thank everybody for working really hard on this bill to make it workable and help to push prior authorization forward. So just want to request your consideration of the removal of that language. Thank you.

Okay, thank you very much. Next we have Jonathan Cheng of Kaiser Permanente providing comments. Jonathan Chang, please.

Aloha Chair. Jonathan Chang for Kaiser Permanente. We've offered comments and have suggested amendments. I will note that we understand that, you know, there's a lot of stakeholders that have interest in this bill and you know, just wholeheartedly, you know, we understand that, you know, prior authorization shouldn't inhibit the timely access to clinically appropriate care.

And that with that in mind, you know, we've offered some amendments that we believe are still consistent with the intent of this bill, but will also, I think, as other stakeholders have mentioned, really focus on ensuring that there's alignment with any of the federal developments with related to prior authorization.

Just so this it would not make any state reporting requirements and or timelines be inconsistent or duplicative of what is also required of health plans with the Federal Government. We're available for any questions and thank you for the consideration.

Chair okay, thank you very much. Next we have Kapono Chong Hansen of Ahahui Ona Kauka Association of Native Hawaiian Physicians. In support, Eric Abe, Hawaii Primary Care Association. In support, Elizabeth Ignacio of Hawaii Medical Association in support. Dr. Ignacio, are you present? Please proceed.

Aloha and good afternoon, Chair Sen Buenaventura and Committee. Dr. Elizabeth Ignacio, Hawaii Medical Association. We do stand on our written testimony with two amendments for your consideration that we had conferred and reviewed with other stakeholders.

We want to add the comment that we're deeply grateful for the engagement and aloha of the stakeholders and advocates, including in particular HMSA and Shipta. We're available for questions. Chair thank you.

Okay, thank you very much. Next we have Dr. Scott Goskritz in support. Gerald Garcia, Dr. Garcia in support for Hawaii Medical Association. Dr. Garcia, are you present on zoom? Please proceed.

Aloha. Can you guys hear me? Dr. Garcia here. I'd like to thank you, Chair Buenaventura and the honorable Committee Members. It's high time that something is done about prior auth for the sake of our patients, for the sake of the doctors taking care of these patients. This is a step in the right direction.

It's not asking for too much. We stand by our testimony. Thank you so much once again. And we're here for questions again, Dr. Jerry Garcia with Hawaii Medical Association.

Thank you very much. Next we have James Levy in support.

Good afternoon Chair, Committee Members, James LaPree. I stand in full support of HP250 because on originally on December 19th, I was supposed to have a pheno injection for my right hip due to right hip pain.

But if I did not call the Doctor to ask when to ask, how come I couldn't, I didn't get a reminder call to see how come they didn't give me priority pre procedure instructions.

They wouldn't have called me to let them let me know that they would have to cancel me because they needed to do a more invasive procedure for another patient, which I understood.

But I, I would prefer that they would actually give us a call, especially because I had to fast and that's very difficult given my condition and because I take Haleyman as well.

And I highly encourage as you pass this bill that we put in the bill for a timeline of 48 hours because right now insurance says that there's two weeks to pass all prior authorizations. But for someone like me, it's very difficult to schedule appointments.

But thank you for allowing me to take this time to test away on this bill and happy to take any questions.

Thank you very much. Thank you very much, James. Next, we have Kelly Withey in support. Kelly, are you present? I am and I stand. Moni, you stand your testimony. Thank you very much. Next we have Shayna Metsch in support of. Alan Novak in support. Colleen inouye in support. Dr. Taniguchi in support. Thomas Wiener in support.

Alistair Byros in support. Ricardo Molero. Bravo. In support. Maya Maxim in support. Anybody else wishing to testify on HB250, come on up. Mike Win.

Good afternoon, Chair. Vice Chair. Mike Nguyen, Director of Public Policy for LowCare. Apologies for the late testimony. I did submit it on the portal, but it's just not in reflected testimony. We do appreciate the concerns. We do are committed to access to care, timely access to care, and we support the intent of the measure.

But we do have concerns with the timelines proposed in Section 2 of the bill, and we're concerned that there are unintended consequences that would be resulting from such bills, such provisions, and we just ask that the timelines be removed, noting the CMS timelines to take effect in January 2026.

Okay, thank you very much. Okay, anybody else wishing to testify on HB250 Members? Any questions? So I do. Dr. Lewin, come on up. So you came up with an entire new SB, one which I did not expect specifically regarding the working group, is that any different from your bill in SB, which we passed before? Crossover in SB.

Excuse me. Yeah, the. As part of the governor's package. Is there any difference in that? In that working group?

The working group wasn't in the original governor's package. It was. It's in 1449.

1449?

Yeah, it was. We hopefully we asked it to be added.

So is the. Is the working group in Senate Bill 1449 any different from the working group you propose on your SD1?

It should be the same.

Should be the same.

Should be exactly the same.

Okay, thank you very much.

You're welcome.

Any other questions? Okay, seeing none. Moving on. HB 303, relaying to healthcare preceptors. First up, Department of Health, in support.

Yes, the Department stands on its own testimony.

Okay, thank you very much. Next is Department of Taxation providing comments.

Hello Chair, Vice Chair. We stand on our own testimonies.

Thank you very much. Kelly Whitby, University of Hawaii System in support. Kelly, are you still present on Zoom? Please proceed.

I am, and I will stand on our testimony, and I can give any numbers that you have about questions that you have regarding numbers from past years.

Okay, thank you very much. Next, we have Laura Reichardt, Hawaii State Center for nursing, in support. JC Mikulanec, Queen's Health Systems.

In support.

Paige Heckathorn Choy of Healthcare Association of Hawaii and support. Paige, are you present? Please proceed.

I am. Thank you. We'll stand on our support of this measure. Thank you, Chair.

Okay, thank you very much. Next, we have Leocadia Conlon of Hawaii Academy of PAs, in support.

Thank you, Chair. The Hawaii Academy PA stands in its testimony in support.

Thank you very much. Tom Yamachika, Tax Foundation of Hawaii, providing comments.

Not present on zoom, Chair.

Michael Robinson, Hawaii Pacific Health, in support. Jonathan Chang are you present on zoom? Kaiser Permanente, in support.

Still present, Chair: Jonathan Chang for Kaiser Permanente will stand on our written testimony supported this measure. Thank you.

Okay, thank you very much. Next, we have Eric Abe, Hawaii Primary Care Association, in support. Dr. Ignacio, Hawaii Medical Association, in support. Edward Chu, Hawaii Health Systems Corporation, in support. Linda Bechinor, Hawaii American Nurses Association, in support. Corrie Sanders, Hawaii Primary Care Hawaii Pharmacists Association, in support. Please proceed.

Good afternoon, Chair. Vice Chair. Members of the Committee, Corey Sanders, Executive Director of Hawaii Pharmacists Association. I stand in support: I just want to emphasize the comment that we provided that all other provider residency programs have their nationally accredited program outlined in the bill.

And we're asking for the same, that pharmacists have the American Society of Health System Pharmacists added to the bill.

Okay, thank you very much. Tracy Ann Lee in support. Nicholas Dela Rosa Tabilisma in support. Anybody else wishing to testify on HB 303? Mike Nguyen, please identify yourself.

Mike Nguyen, with Aloha Care. Apologies, we submitted testimony and support late as well. Thank you.

Okay, thank you very much. Okay, next we have anybody else switching testify on HB303. Members, any questions? Okay, seeing none. Moving on HB341. Yeah. Not call it then. Okay. HP341 relating to issuance of spurbs to assist Hawaii Island Community Health Association. And I see Hawaii Community Health Association wanting to testify, but let me be the witnesses.

Department of Budget and Finance, providing comments. Richard Toffee, now it's your turn. Hawaii Island Community Health center in support.

I appreciate the opportunity and I just stand in support of our.

Thank you very much. Richard. Eric Abe, Hawaii Primary Care Association and support. Mike Nguyen, Aloha Care. Thank you very much. Anybody else wishing testify on HB341? Okay, Members, any questions? Okay, next up, HB692. I see, Lieutenant Governor, but let me read my witnesses relating to preschool open doors. Hold on. Lieutenant Governor, you're up.

Thank you.

Chair and Committee Members support and will be available.

Thank you very much. Director Yamane, Department of Human Services and support Director. You present on zoom. Are you present in person? Thank you. Yuki Ar. I see you back there. Executive Office of Early Learning and Support.

Yes, we stand on our WR test.

Thank you. Elaine Yamashita, Early Learning Board in support. Elaine, please proceed.

Aloha. From Maui. The board stands on its testimony of support.

Okay, thank you very much. Next we have Hope Bennett, Honolulu County Committee on the Status of Women and support. Jen Kagiguada in support. Jordana Ferreira, City and County of Honolulu in support. Jordana, you're present. No. Arroyo for Kamehameha Schools and support. Jeffrey Masatsugo of Iupat District Council 15. Support. Jeanette Jordan Piper and support.

Deborah Bond Upson of Parents for Public Schools of Hawaii in support. Thank you very much. Jared Ellis, Early Childhood Action Strategy and support. Hawaii Children Action Network speaks. Chevelle Davis in support. Chevelle. Okay, thank you. Hawaii State Teachers Association and support. Osatui Hui for Excellence of Education and support. Thank you. Early Learning Consortium and support.

Parents and children together in support. AAUW in support. Kaohana Onapua in support. Family Hui Hawaii in support. Thank you. Kupuna Caucus of the Democratic Party of Hawaii in support. Hawaii State Coalition Against Domestic Violence in support. And then we have Joelle Edwards. Are you present on zoom? In support. Joelle.

Like to add to my testimony. My name is Joelle Edwards, a small business owner, chair of the Kauai Democratic Party, and a community advocate here in Wainiha. I strongly support HB 692. I've watched firsthand the struggles our families encounter due to lack of safe, reliable and affordable childcare.

Hawaii is a literal child care desert with less than one space for every four children. And currently we're under the threat of our only preschool in hanalei closing after 45 years. Due the land and the building being up for sale. The cost of living on Kauai exceeds the state averages.

So any help to get parents back to work through affordable, accessible child care will improve the lives of community Members, families, businesses and the economy at large. I appreciate this opportunity to have some stability for our working families and a meaningful public private partnership that shows mutual benefit.

Thank you for the opportunity to speak today and to submit testimony. Mahalo.

Thank you very much. And then we have 73 other individuals all in support. Anybody else wishing to testify on HB692 Members? Any questions? zero, I do. Lieutenant Governor, come on up. So HCAN speaks and AAUW want to increase, want to amend this Bill to add in family child care providers, I believe.

Do you have any objections to that?

You know, for now, what we're trying to do with this Bill is expand the preschool Pandora's for the current, current license facility. I think to expand it may not completely fit into what we're trying to do because this is expanding it to 2 year olds and also deal with the accreditation efforts.

And so for now, I think it should be separate.

Okay, thank you very much. Anybody else have any other questions? Okay, go ahead. Senator Hashimoto, Daeches, you're coming. Come on up. You're standing in for Director Yamade.

So thanks for being here. I just wanted to clarify. I think this Bill is very important and I think it's one step in the right direction. But what is DHS doing to help with the certification of new preschools or early childhood centers getting their certification?

Because my understanding from my conversations with providers is that it is super hard to get certification right now. So even if we expand the Bill or the use, it doesn't matter at a certain point because we just don't have enough providers who are easily getting the licensures that they need. So are you guys working on that aspect?

Because yes, we can do this Bill, but then if we're not getting to the root cause of the problem of why we're not able to enroll more people, then it's kind of mooc. Right.

Thank you for that question, Senator. Really. I do believe our licensing staff, they're working hard with their child care providers. I can take that back to our child care regulation administrator and see. But I do honestly think each of our licensing units in our counties do work with our providers.

So do we know what the expansion has been of new providers over the last couple of years?

Years of new providers. I probably have to get back to you on that one.

Okay. Because I think I, I recently talked to a provider on Maui who's just been, you know, he was telling me all the hoops that he had to jump through to open up a preschool and he's like, at a certain point, you know, it's too hard.

So people are giving up or they're just not even looking at it. Right. And then the economics of it. So I think we got to look at the whole spectrum. I think that that has continually been the conversation about all the levers that we need to pull to make the expansion relevant.

I think UEL is a part of that conversation, make sure that they're not poaching from this program either. I think I've previously made that a point to bring that up.

So hopefully you guys can get to the bottom of all that because there needs to be a more comprehensive look of understanding what everybody is doing doing for us to make this, this work.

Yes, we will work with all of our providers.

I want that information though, because that's a good question. Like what, what. How many people have been licensed? Right. Thank you, Chair.

Okay, thank you very much. So I have a follow up question, Lieutenant Governor. So I, I remember working on the whole certification requirement and I thought I was hoping it was in this Bill, but probably was in another Bill. Are you working on the problems regarding certification?

The problems with certification is a separate issue in this situation. What we're dealing with is the current DHS licensed child care facility. So certification is definitely something that you have to address because it is the whole spectrum. As Senator Hashimoto recognized under the Rent Aikiki initiative.

We just got the recent enrollment or application numbers for EOEL and the unfortunate reality it's very successful because under EOEL there is about 1700 seats. We just got the new numbers. It's about 3400 applications that came in. So in as much as we're all trying really hard to add seats seeds, there is a huge demand out there.

And the bills like this and all the efforts that people are putting together, it's raising that awareness to a parent who of a 2 year old, 3 year old, 4 year old saying there are different opportunities, but we have to do a holistic approach in increasing public seeds, supporting private seeds, ensuring that they're not cannibalizing each other, and then figuring out ways to expand on all levels.

Okay, thank you very much. Okay. Any other questions? Okay, seeing none. Moving on, HB 700 relating to cognitive assessments. First up, we have Barna Fel in support.

The Department stands on its testimony.

Thank you. Carolyn Kadirao, Executive Office on Aging, providing comments.

Good afternoon, Senator, Vice Chair and Senator Hashimoto, thank you so much for hearing this Bill. We're in strong support of the intent and we're offering some comments. I'd like to thank our partners, both Shipta and the Alzheimer's Association, for coming together and finding out a way that we could make this work as far as the data collection.

And we have some ideas. That's why we made some amendments, our recommendation, some amendments and changes so that we have flexibility to continue on the dialogue.

I also want to stress that it's important that we use a validated Tool and also strip the age of 65 and older because we know that individuals with disabilities also are at risk for Alzheimer's disease and related dementia. So we want to make sure that we can get early detection for all. And I'm available for any questions.

Thank you very much. Okay. Next we have Daintree Bartolodes of Hawaii State Council on Developmental Disabilities and Support.

Good afternoon, Chair, Vice Chair, Members of the Committee, my name is Samya Gorham and I am a intern at the Hawaii State Council on Disabilities here.

On behalf of my Boss, Daintree, we stand in support of this measure because adults with down syndrome and traumatic brain injuries, as said before, are significantly more likely to get Alzheimer's or dementia, often showing symptoms in their 40s and their 50s. For this reason, we respectfully request that the age 65 be removed. Thank you.

Okay, thank you very much. Next we have Dr. Lewins, state shifter, in support.

So come on up, Chair, Senator, Vice Chair Aquino. Members, we. We strongly support the intent of this Bill as well. And Shifter would. Would really like to work on the data reporting part of the Bill, this information reporting.

We believe that because a particular brand of electronic health record has almost captured the entire Hawaii market, it's up to. It's going to be approaching 80% use, that we could actually administer the test in that electronic health record, collate the results and report back.

That isn't something that will happen immediately, but it could certainly happen in the immediate future if we work on that together to make that reporting easier. So thank you very much.

Okay, thank you very much. Next up, Hawaii Parkinson Association and support. Paige Choi, Healthcare Association of Hawaii providing comments. Please proceed.

Good afternoon, Chair. Vice Chair, Members of the Committee, we'll stand on our comments.

I do want to emphasize in our comments that we believe having this not be mandatory, especially in terms of the reporting and maintaining it as a pilot so that we can continue to work with the stakeholders is something that our Members are very supportive of. So thank you very much for allowing us to comment.

Thank you very much. Louis Erchik, Hawaii Disability Rights center, in support. Eric Abe, Hawaii Primary Care Association, in support. Hawaii Public Health Association. Holly Kessler. In support. Hawaii Psychological Association. Alex Lichten. In support. Joanne Kealoha, Hawaii Alliance for Retired Americans. In support. Kohichok, Come on up. Alzheimer's Association and support.

Thank you, Chair Senbota Ventura, Vice Chair Aquino and Senator Hashimoto. My name is Kobichoff. With the Alzheimer's Association in strong support of this with amendments that we have provided in our written Testimony. We just want to take this opportunity to highlight our key amendment.

In the first hearing, we supported a pilot program for the data component of the Bill. However, our support for the pilot was intended solely for the data and not for the entire Bill, which is what is in this HD1.

The core and initial intent of this legislation is the requirement for a simple and brief cognitive assessment tool be used during the annual wellness visit. And a proposed amendment would codify this in statute. It's important to note that we're not expanding the scope of the annual wellness visit as it's already included.

We're just saying that it needs to be validated tool because with the new treatments available, it requires early diagnosis that we're missing so many people who could be getting better treatment and care. It's a disease that's invisible until often it's too late and progresses too far.

Respectfully ask for your support of our amendment to require the use of the validated cognitive assessment tool and statute. And we're available for any questions. Thank you for this opportunity.

Thank you very much. Next we have Kathleen Wyatt in support. Are you present? Kathleen, please, please.

Aloha and thank you for letting me testify today's Senator and and Committee. I testified in in writing as well, but I wanted to add a few comments. As a, as an adult daycare operator, I deal with the families so much and if, if they had had.

A lot of them are so frustrated because if they had had warning they could be prepared for the caregiving duties they're going to face with somebody that has dementia. If they're like the old saying is to be forewarned is forearmed.

So if they were able to get early diagnosis, I mean if they have this annual assessment, they could have earlier access to interventions, to prevention and the more they can do with their families ahead of time, be prepared for what's going to happen.

What they need to have ready when the time comes, when their folks decline is so important that they know ahead of time.

Thank you so much for letting me. Thank you. Okay, next up, we have Calvin Hara in support. Calvin, please proceed.

Aloha Vice Chair Aquino and Senator Hashimoto. My name is Calvin Hara. My background career has been in 30 years in senior care in California and Hawaii, as well as a caregiver for my mom and my uncle. I support the required use of a validated cognitive assessment tool.

As mentioned about the annual wellness visit and I'd like to highlight that the Alzheimer's Association's original draft and the current proposed language provides providers flexibility, discretion in selecting the cognitive assessment tool to briefly state the validated tests. I have two examples here, the minicog and the 88.

Both tests are short, take only a few minutes to administer, and can be conducted by various providers like doctors, APRNs, RNs, PAs, social workers, other trained professionals. The tests are free, straightforward, has instructions.

It makes it easier for the providers not using any tests right now to kind of put that into their practice with the new disease modifying treatments.

Okay, thank you very much.

Thank you.

Thank you. Next we have Ellen Awai providing comments. Chuck Taylor in support. Kristin Hartley, are you present on Zoom? In support. Kristen not present on Zoom. Kristen Hartley, are you?

I am. I'm so sorry. My camera seems to be failing. Can you hear me? Yes. Please proceed. Hi.

Good afternoon, Chair, Members of the Committee, I just wanted to say I stand on my testimony that I've submitted in writing, but just to piggyback on what Kathleen Wyatt said, that the use and requirement of a validated tool really will significantly help in both the intervention and prevention of this horrible thief of a disease.

Having watched my father go through it without the benefit of a. Of a standardized tool, knowing that he could have been a part of a larger data collection is. It's bothersome, and it feels like something we. We can do something about. Thank you for allowing me the opportunity to speak today.

Okay, thank you very much. Next we have Rick Tabor in support. Bixby Hole in support. Barbara Black in support. Barbara, you present on Zoom. Barbara? Okay, we're gonna move on to the next person. Marshall Mower in support. Joe Hittner in support. Jerry Perrone in support. Lila Mower in support. Valerie Hasegawa Takahashi in support.

Peter Western Black, are you. Peter, are you present on Zoom? Okay. Barbara, is that you?

Yes, I'm here, too.

Okay, you have one minute. Go ahead.

Thank you, Chair, Vice Chair, Members of the Committee, I'm a resident of Ninoli and a caregiver for my husband, Peter.

Please identify yourself.

Barbara Black. Sorry. Thank you, Peter. My husband had a relatively early diagnosis, which helps us plan and figure out how we would manage this disease as it progressed. And I also have done a lot of workshops and online studies about resources for caregivers, and that's been very helpful as we've moved through the progression of this disease.

Caregiving is complex and difficult, and the ability to adjust and learn as early as possible has helped me immensely. I strongly support this Bill, including the amendments proposed by the Alzheimer's Association. If more people had the benefit of an early diagnosis, it would be really, really good. And I hope money is made available to support this endeavor.

Thank you very much, Barbara. Thank you. Next person is Peter Westenblatt. Are you present? Peter ON Zoom.

He's present, Chair, but seems to be having technical difficulties.

Okay. So while we are awaiting Preston, Peter being able to turn on his monitor camera. Is anyone else wishing testify on Cognitive Assessments? HB 0700? Okay. Please proceed. Peter, you need to unmute yourself. Peter it can you unmute him?

He seems not to be connected to his microphone. Chair.

Okay, so, Barbara, since you're there, he cannot use your microphone or they have two separate computers, okay?

So, Barbara, can you turn on your monitor and your. And your microphone so that Peter can testify? Okay. Okay. Please proceed.

Peter, you can see me now?

Yes, we can hear you now. We can see you now.

So sorry about the follow up.

No problem.

I'm. I'm glad to be able to do this. I really believe in what's in. In that Bill. I am 82 years old. I'm a retired Professor. So, you know, words are my word, my world, and that's hard to cram into a minute, what I have to say.

But there's a great Bill, and my personal experience is testimony to that. I got this diagnosis 10 years ago, and now I'm able to be on Leqembi, the drug that is one of the drugs that are very recently out, that don't cure Alzheimer's, but postpone the really crappy symptoms. So here's why I support the Bill.

Getting that diagnosis was a gift, was a blessing. It was a gift that has kept on giving ever since. 10 years.

Thank you very much, Peter.

All right.

Thank you very much. And yes, you are a testament as to why we need to pass this Bill. So thank you very much for being there. Anybody else wishing to testify on HB 700 Members, any questions? Okay, moving on. HB705 relaying to Executive office on Aging. First up, we have.

First up, excuse me, Carolyn Carterao, Office of Aging and support.

Thank you, Chair and Members of the Committee, Carolyn Cartirao, Executive Office on Aging. We stand in strong support of this measure. You have our testimony. You know the three reasons how it's going to help individuals, MedQuest and also the Executive Office on Aging. The work being done right now is all being done with federal funds.

This would support us to have a generally funded position that we can also support. Getting Mac claiming, if Mac claiming is still available from the Federal Government, would help to offset some of the costs for this project. This is access.

It will help us to get access to those that don't have the normal means of applying for these subsidy, Low subsidy programs. And we will help them with the application process and wraparound services. I'm available for any questions. Thank you.

Thank you very much. Next. Daintree Bartolodes, Hawaii State Council on Developmental Disabilities and support.

Good afternoon, Chair, Vice Chair, Members of the Committee. My name is Jamil Gorham. I'm an intern on behalf of Daintree with the Hawaii State Council on Developmental Disabilities. We stand in strong support of this measure mainly because it supports individuals with disabilities under the age of 65 in our communities. So thank you.

Thank you very much. Dr. Lewin of Shipta in support.

Aloha, Senator and Members, thank you very much.

AARP Audrey Suga Nakagawa in support. Johnson Silva, Democratic Party for Biden in support. Linda Dorset in support. Barbara Service in support. Anybody else wishing to testify in HB 705 Members, any questions? Okay, moving on. HB 713 relating to rate study for home health services. First up, we have DHS providing comments. Dhs?

No. Hello, Chair Judy Moore Peterson. On behalf of Director Yamane and dhs, we stand on a written comments. Our written testimony offering comments and appreciating the intent available for any questions. Thank you.

Thank you. Next we have Paige Choi, Health Care Association of Hawaii and support. Please proceed.

Thank you, Chair. We are in very strong support of this measure. Our home health agencies provide more complex care.

So unlike personal care services, which this Committee has heard, bills to increase the funding for home health services are more geared towards helping people with therapies, pt, ot, IV drugs and then of course, wound care really helps to keep people out of higher cost settings of care such as the hospital or nursing homes.

Our home health agencies have reported that they're losing more than $1,000 per patient when they are serving Medicaid individuals. We are hoping that this rate study will help us get our reimbursements up to the cost of care and increase the proportion of Medicaid residents served by home health agencies.

We did also find that the proportion of individuals on Medicaid being treated went from 25 to 16 over the last five years, 25% to 16%. And so we think this is an important Bill to start to help address that. Thank you.

Thank you very much, Barbara. Service and support. Anybody else wishing to testify on HB713 Members, any questions? Seeing none. Moving on. Next up, we have relating to Crisis Services, HB 1462. First up, we have Dr. Lewin in support.

Chair, Vice Chair, Members. Trip stands on his testimony and strong support.

Okay, next up we have Kat Brady in support.

Please come on up. Good afternoon, Chair and Committee Members. Kat Brady in strong support, testifying for Community Alliance on Prisons. This morning I received a really disturbing phone call from someone who attended the Mental Health Commission. I don't know the exact name, but they said the February meeting was rocking.

And I think that we support behavioral health and crisis services. But we also were told that the evil ape, DHCC. There's hardly anybody there. Okay, so that's a problem.

Thank you very much. Next we have Department of Law Enforcement, Mike Lambert. Captain Lambert in support. Hawaii State Department of Health and Support. I see. Doctor. Okay. Marion Tsuji, Good afternoon.

We do support this bill. We apologize for a late submission, but we wanted to add some language that. Provided us with more flexibility for the operation. Okay, thank you very much.

Next we have Alan Johnson of HSAC and support. Cassandra Manasseh Morse in support. Cassandra, you're present on Zoom. Okay, moving on. Austin Saucedo in support. Maya Gunther in support. Veronica Moore in support. Raelyn Reynold Yeomans in opposition. Are you present on Zoom? Raelyn?

Not present on Zoom, Chair.

Ellen Oyi in support. Anybody else wishing to testify on HB 1462? Come on up. Ian Ross.

Thank you very much, Senator.

Identify yourself though.

Senator. Chair. Vice Chair. My name is Ian Ross. I'm the Public Affairs Director with the Waianae Coast Comprehensive Health Center. We submitted a written testimony and I just wanted to add a quick story to that.

On Tuesday, February 25, a team from our behavioral health Department led by Lena Kanana, our chief Community Health Services Officer, went and visited the CARE Hawaii Behavioral Crisis center in Ivola. We found that the services being offered there were very impressive to our.

Our team really helps the leeward side in a lot of ways and attempting a comprehensive care. And we think this would be a great addition.

The original draft of course called for it specifically in the zip code, but we feel that more of these types of facilities could only help with the types of operational issues we're seeing in providing the right types of services to this population. Thank you very much.

Okay, thank you very much. Next, anybody else wishing to testify on HB 1462 Members, any questions? Okay, seeing none. Moving on for HB 1477 relating to social services. First up, Department of Human Services and support, please proceed.

Good afternoon, Chair, Vice Chair and Committee, Lisa Almador from Department of Human Services on behalf of Director Yamani. The Department stands on our written testimony supporting the intent of this bill and respectfully requesting amendments to clarify the purpose. I'm available for questions.

Thank you very much. Next we have Daintree Bartolodes, Hawaii State Council on Developmental Disabilities and Support.

We are in strong support of this bill and we ask that all questions.

Thank you very much. Rachel Lewis, Easter, Sil Sabay and support. Anybody else wishing testifying HB 1477 Members, any questions saying none. Are you ready for decision making? We folks at my decision making notes. Okay, so first up for HB 72 relating to pharmacy.

Chair's recommendation is to pass this with board of Pharmacies recommended amendments and technical non Substantive amendments need for clarity, consistency and a Defective date of December 31, 2050. Any comments, questions, concern? Seeing none. Vice Chair for the vote. Chair votes Aye.

[Roll Call] Recommendation is adopted.

Chair thank you. For HB237, Chair's recommendation is to pass this just with a different Defective date of December 31, 2050. Any comments, questions, concerns? Seeing none. Vice Chair for the vote.

Okay, Members are present. Any reservations? Any noes? recommendation is adopted.

Chair so for HB250, Chair's recommendation on this is to pass this with amendments. We're going to remove the health care definition pursuant to the Department of Attorney General's concerns and we're also going to accept Kaiser's amendments which basically puts in SB 1449 in lieu of the working group.

And we're going to note that the reason we although we are super sympathetic to the positions who I'm sure are watching this YouTube, the turnaround times is super problematic because of the EUTF amendments.

And I'd like to note that we have a law that basically says that we cannot pass a bill that increases the unfunded liabilities and if you look at the EUTF testimony, the unfunded liabilities with the short time frames is going to increase it substantially.

So hopefully the working group will come up with proposed recommendations so that we can have reasonable turnaround times and but other than that, any other comments, questions or concerns? At least the physicians know why the Committee is making the proposed amendments. Okay. Any comments, questions, concerns? Basically the pass with amendments. Chair votes Aye.

Three Members are present. Any reservations? Any noes? Recommendation is adopted, Chair.

Okay, preceptors HB 303 Chair's recommendation is to pass this with technical non substantive amendments. And we're also going to add pass it with a different defective date of December 31, 2050. We we note that the effective taxable year is still December 31, 2025 pursuant to the no taxes recommendation.

Any comments, questions, Concerns? Seeing none. Vice Chair for the vote.

Okay, three Members are present. Any reservations? Any noes Recommendation is adopted.

Chair so for HB 341 SBIRB Chair's recommendation is to pass this with technical non substantive amendments. We're going to note that it's still a blank SBIRB amount, but we're gonna change it the defective date into an effective date of July 1, 2026. Any comments, questions, concerns? Seeing none. Vice Chair for the vote.

Okay three Members are present. Any reservations? Any noes? Recommendation is adopted, Chair.

Okay, for HB 692 Chair's recommendation is to pass this with only with technical non substantive amendments. Noting the Lieutenant Governor's position and we are going to pass this with an effective date of July 1, 2026. Any comments, questions, concerns? Seeing none. Vice Chair for the vote.

Three Members are present Any reservations? Any noes? Recommendation is adopted Chair.

So for HB 700 share's recommendation is to pass this where the Council of Developmental Disabilities proposed amendment which basically removes the age and puts in also individuals with propensity for Alzheimer's and also technical non substantive amendments as recommended by SMA.

I am not at this time going to accept Alzheimer's request of putting it in as part of the wellness exam because that may open us up to a requirement of a sunrise analysis. Anything we add in that is not already in as part of the requirements made may poison pill this bill.

So because we have a pilot, let's see what happens and if that says that we don't need a sunrise analysis, then we can continue on with that. Okay so basically to pass with amendments and we're also going to put an effective date of July 1, 2026. Any comments, questions, concerns? Seeing none. Vice Chair for the vote.

Okay, three Members are present. Any reservations? Any noes? Recommendation is adopted, Chair.

So for HB705 Chair's recommendation is to pass this with Office of of Aging's proposed amendments and a different effective Defective date of December 31, 2050. Any comments, questions, concerns? Seeing none. Vice Chair for the vote.

Okay, three Members are present in your reservations? Any noes? Recommendation is adopted, Chair.

So for HB 713 Sheriff's recommendation is to pass this with a different defective date of July of December 31, 2050. Any comments, questions, concerns? Seeing none. Vice Chair for the vote.

Okay, three Members are present. Any reservations? Any noes? Recommendation is adopted, Chair.

Oh I'd also like to note that it has nothing to do with the decision that the Committee report we're going to put in DHS proposed amounts of 500,000 in the Committee report with 50% of the cost to be covered by federal funds.

Okay for HB 1462 relating to crisis services, Chair's recommendation is to pass this with Department of Health's proposed amendment of adding in appropriate appropriation language so that there's a different paragraph saying basically that there shall be appropriated a blank amount to the Department of Health to implement this act and a defective date of December 312050 and technical non substantive amendments need for clarity and consistency.

Any comments, questions, concerns? Seeing none. Vice Chair for the vote.

Okay three Members are present. Any reservations? Any noes? Recommendation is adopted, Chair.

On HB 1477 Chair's recommendation is to pass this with Department of Health's proposed amendment and change the defective date into an effective date of effective immediately upon passage. Any comments, questions, concerns? Seeing none. Vice Chair for the vote.

Okay, three Members are present in your reservations. Any noes? Recommendation is adopted, Chair.

Okay. With that, we are adjourned.