Senate Standing Committee on Health and Human Services

Calling the one o' clock calendar for Health and Human Services. We are being streamed live on YouTube. In the unlikely event that for some reason we have technical issues, we will be recalling our calendar on-- Excuse me --in two days at one o' clock at this room 225.

For those on YouTube, your video will be disabled and audio will be disabled until it is your turn to testify. And I apologize for mispronouncing your names or if the transcription is not correct, but so bear with us. We are-- It's a light calendar, but I will stick to the one minute time limit for testifiers.

Present with me is Senator Keohokalole, and we are ready to proceed. So first up, SCR 10, SR 6. Urging the Director of Health to establish a working group on health insurance reform to provide recommendations for reducing the impact of prior authorization requirements on the timely delivery of health care in the state. First up, we have Department of Health providing comments. Anybody for Department of Health? No. Next we have Director Yamane providing comments. Director Yamane, DHS. Please proceed. You have one minute.

Aloha, Chair. Judy Mohr Peterson on behalf of Director Yamane and the Department of Human Services. We stand on our written testimony. We appreciate the intent of this resolution. We defer to the Department of Health, and we offer comments. Thank you so much.

Okay, thank you very much. Next we have Jonathan Ching of Kaiser Permanente providing comments. Jonathan Ching, are you present on Zoom?

Not present on Zoom, Chair.

Okay, Next we have Dr. Lewin. I see Dr. Lewin here of SHPDA, State Health Planning and Development Agency, in support. Please come on up.

Chair, San Buenaventura, Senator Keohokalole. Yes. Jack Lewin, Administrator of SHPDA. We believe this resolution, the intent, is a good one. We think we're way along the path toward developing this kind of a work group with actually more details and appointment process in House Bill 250, which would do two things.

It would, first of all, create the reporting mechanism to allow us to see what's actually going on and document more effectively to know what's going on with prior authorization and then to do something about it. We believe the work group in 250 actually provides a better solution.

But we want to make clear that House Bill 250 has been amended twice. We think some amendments are excellent, but one amendment that was added is going to be in conflict with our Attorney General in terms of SHPDA's language and definitions and the language that was inserted.

So we'd like to see section, the sections related to prior authorization... It's in the testimony, and it's very clearly stated. But we just think a few edits would make this work really well, and the 250 mechanism would be a superior one for achieving the result.

Thank you very much. Okay, next up we have Rachel Wilkinson providing comments of Health Association of Health Plans. Hawaii Association of Health Plans. Sorry.

Good afternoon, Senator San Buenaventura, Senator Keohokalole. Rachel Wilkinson on behalf of the Hawaii Association of Health Plans. We're going to largely stand on our written testimony offering comments, but I did want to highlight that we are strongly requesting that you consider adding a representative from HAHP to this working group.

Okay, thank you very much. Next we have Erik Abe, Hawaii Primary Care Association in support. Elizabeth Ignacio, Hawaiian Medical Association, in support. Elizabeth Ignacio, are you present on Zoom?

I am. Aloha, Chair San Buenaventura and HHS Committee. Dr. Elizabeth Ignacio, HMA. HMA stands on our written testimony, and we're available for questions, Chair. Thank you.

Okay, thank you very much. Next we have HMSA in support. I see HMSA. Thank you very much. Next we have Allen Novak in support. Dr. Carlisle in support. Ellen Awai in support. Anybody else wishing to testify on SCR 10, SR 9, 6. SR 6. Members, any questions? Okay. Seeing none. We're going to move on.

Next is SCR 11, SR 7 requesting Department of Human Services Medquest Division to cover behavioral health services for children in school-based settings. First up we have Director Yamane for providing comments. Judy Mohr Peterson, please proceed.

Aloha, Chair, Members of the Committee. Judy Mohr Peterson, on behalf of the Department of Human Services. We really appreciate the intent of this resolution and we do offer comments. Thank you so much. Available for any questions.

Okay, thank you very much. Next we have Erik Abe, Hawaiian Primary Care Association in support, Michael Golojuch Jr. Pride At Work Hawaii in support, Ellen Ouai in support. Holly Zimmerman, are you present? In support. Emma Hendrick in support. Emma Hendrick, are you present on Zoom?

Not present on Zoom, Chair.

Okay, Members, any questions for SR 11-- SCR 11, SR 7. Okay, seeing none. Moving on.

Next up we have SCR 13 relating to SR 9, requesting Department of Human Services and Department of Health to establish a program to incentivize community care foster family homes in the state to accept individuals who are eligible for assistance pursuant to the Hawaii State Medicaid I/DD Waiver program. First up we have Director Yamane providing comments. Judy, please proceed.

Thank you. Aloha Chair. On behalf of the Department of Human Services, we appreciate the intent of this resolution. We do offer some comments. We're happy to collaborate with the Department of Health and the Developmental Disability Division on what we believe is the intent of this resolution, to streamline access to residential settings.

However, we do see some regulatory limitations with the resolution that are preventing us from fully endorsing this resolution. We're happy to work with the stakeholders and interested parties. Thank you.

Okay, thank you very much. Next we have Hawaii State Council on Developmental Disabilities in support.

Thank you. Daintry Bartoldus, Executive Director for the Hawaii State Council. We're in strong support of this and thank you so much. And we understand DHS's concerns. We have had more individuals in the last 10 years move from the 1915(c) waiver program into the 1115. We are very strong supporters of aging in place.

And when somebody moves from the 1915, they have to move out of their homes as well. We feel that this is something definitely we could work on and look at the regulations and be able to work together and make this a very achievable goal. Thank you so much for hearing this reso.

And we look forward to the conversations coming up during the interim.

Okay, thank you very much. Next we have Louis Erteschik, Hawai'i Disability Rights Center, in support.

Thank you, Senator. Good afternoon. I'm Lou Erteschik, and yes, we are in support of the resolution. I did speak with Mary, and I've read their testimony of the departments. I understand there may be some concern that literally we're trying to put the wrong peg into the wrong hole in terms of the wording of the resolution.

I'm not sure that's true, but that might be. I think the bigger issue is how to think creatively and how to expand capacity, especially on the neighbor islands. Just to give you a quick example, after the fires, there was a DD home that closed, and we were working with a resident to try to get her placed.

There were no other adult foster homes. The regulations actually would have allowed DD to allow them to take an extra resident, and DD declined to do that.

So I think our experience has just been that on the one hand, yes, there are constraints, but that the people who are administering the program may need to think a little more creatively and a little more collaboratively. So that woman on Maui, we had her moved over here to Oahu.

So she got ripped out of her community, ripped away from her family. And so in particular, in the neighbor islands, like in your district, that's really where this is a problem. It's less of an issue on Oahu, but for the neighbor islands, it's a big issue.

Thank you very much. Okay. Hawaii Self Advocacy Advisory Council in support, Elena Wine support. Anybody else wishing testify on SCR 13, SR 9?

Yes? We don't have it. Do you have copies of it, Mary?

Okay. Why don't you come on up and tell us really fast what your testimony is because we're going to do decision-making and we don't have your written testimony.

Good afternoon, Chair, Committee. Mary Brogan for Department of Health. We're offering comments on this bill. We think that there are regulatory barriers to enacting this at both the state level and the federal level. And there haven't been that many people that as testified earlier, that have moved from the 1915(c) to the 1115 HCBS program.

There are very, very few actually making that movement.

Thank you very much. Anybody else wishing testify on SCR 13, SR 9. Members, any questions? Okay, sorry, Mary, I have questions. Come on up. And my question is why hasn't there-- what are the regulatory problems?

So the regulatory issue as we outlined in our testimony is that to be eligible for the 1915(c) waiver, you can't also be eligible for the HCBS program within the 1115. You would have-- You can't get case management from both.

So what about why can't they go into an ARCH or CCFFH?

Our folks can't go into ARCH or DDOM adult foster home in order to go to a CCFH because of the 11-800, Section 11-800 the administrative procedures for DOH to license is restricted to only a CCFH and not-- you can't get a license.

Okay, thank you. Okay, Louis Erteschik, why don't you come on up. I have a question. You've heard Mary Brogan, the regulatory problems that if you have a CCFFH license that you may not be able to accept the 1915 I/DD waivers. HCBS.

Well, I was thinking, in fact I was talking with Dr. Lewin earlier about this because he has all this national experience. I mean, some things have to be addressed at the federal level in terms of this whole two waiver rule that if you're in this waiver, you can't be. That's kind of ridiculous. But it is true.

That should be addressed at the federal level. But I think Mary is saying about if the issue is the administrative rule here in the State of Hawaii, that can be changed. Right? That's a lot easier to change.

And so quite frankly, I'm still trying to unravel what the problem is as well, because I do believe there could be some obstacles, but I'm not 100% convinced that they're insurmountable. And as I was saying earlier, I also think that what they ought to do is be more creative, even with.

I mean, I'm told that there's currently applicants for adult foster homes, people who want to be licensed or certified as a home, and there's a backlog. They just haven't gotten certified. So the state could be creating more homes.

So once you have a home, I mean, part of the other problem is, and I saw this when I used to work for the Health Department, we have this incredible maze of regulations, as I think you're aware. So if they could somehow mix them without doing anything inappropriate, there's a lot of potential capacity.

That's why I'm saying, to me, I think that's the larger issue. Senator.

Okay, thank you very much. Any other questions on SR 9, SCR 13? Okay, moving on. SCR 14... SCR 14 and SR 10. Requesting auditor to conduct a sunrise analysis of lactation consultant licensure. First up, Elizabeth Larrabee, Lokahi Lactation LLC, in support.

Elizabeth Kealoha, Mother's Milk LLC, in support. Frances Hartley in support. Sunny Chen in support. Krista Olson. Krista Olson, are you present on Zoom? Okay, not present on Zoom. Krista? Krista, could you turn on your audio and... Okay, you have one minute. Regarding lactation.

Thank you. I appreciate it. I appreciate you all taking up this measure and want to share that while we've tried alternative ways of being of assuring that we are able to bill and cover, particularly nursing parents who are on Medicaid, we haven't successfully found a way to add IBCLCs to Medicaid coverage.

And we only have one major insurer who's able to cover IBCLCs at this point. One of the things we know is that the return on investment for lactation care is significant for most families. Most families require typically two visits, often one visit, sometimes more. And the cost return for families continuing to breastfeed, the savings in healthcare costs later on can be tremendous.

And so we appreciate you taking on the issue of an audit to determine whether or not it's cost effective. We believe there are approximately 100 IBCLCs and that there is network adequacy. We've been working for the last three years to build skills among IBCLCs so they're ready and willing to credential with insurance to work closely in Medicaid billing. And we ask you to consider authorizing this audit so that we can move forward. Thank you so much.

Thank you very much. Okay, Patricia Bilyk in support. Patricia Bilyk, are you present? Okay, Members, any questions on SCR 14, SR 10? Seeing none. Are we ready for decision making? Okay, first up, SCR 10, SR 6. Chair's recommendation is to pass this with amendments.

I do note that There is the HB250 moving, but just in case it doesn't move, we are going to create this working group. What the amendments are going to going to be technical, non substantive amendments need for clarity and consistency.

We're going to remove Members 46 and 7 and replace them with Shipta's proposed 15 Members listed on the last page as 12 and 3 of their testimony.

We're also going to note that the board at any time can come I mean the working group at any time can come to a consensus of voluntary enforcement and they don't need this resolution but pass with amendments. Any comments, questions, concerns? Seeing none.

Vice Chair for the vote scr10sr6 recommendation of the chairs to pass 5th amendments. Chair and Vice Chair vote aye. Senator Hashimoto, Aye. Senator Keokolole, Aye. Senator Favela is excused. Recommendation is adopted. Sure.

So for scr11sr7 noting the written testimony that we may inadvertently cause problems with this resolution, Cherry is going to defer it. So for scr13sr9, this is work in progress. As Louis Erczyk testified, we're not quite sure what the problem is.

And so at this time, until we figure out why ccr, FHS can't accept those and whether or not administrative or federal, we are going to defer it at this time to be worked on in the interim for scr14 Sr10 we are going to pass this with amendments.

We are going to insert the number 317 for every blank Senate Bill referred to in the resolution and technical and non substantive amendments needed for clarity and consistency. Any comments, questions or concerns seeing none. Vice Chair for the vote pass with.

Amendments voting on SCR 14 Sr 10 recommendation of the chairs to pass fifth amendments noting the excused absence of center Favela. Are there any reservations, patients, any normals? Recommendation is adopted, Chair.

And with that we are adjourned. And thank you folks for coming.