House Standing Committee on Health

All right, Aloha and good morning and welcome to the Committee on Health. Today is Friday, April 11, 2025 and the time now is 10:01. Here with me, I have Member Marten and Member Amato. I am Sue Liloi, presiding officer of today's meeting. If I could find my agenda.

Alrighty, starting Members, at the top of the agenda we have 8sd1 requesting the Auditor to assess both the social and financial effects of the proposed mandated health insurance coverage for a percentage of the cost of intravenous ketamine therapy to treat depression. Looking at my list here, I don't have any testifiers listed or signed up or on zoom.

No one on Zoom. Any Members in the audience that would like to testify? Seeing none Members. Members. Any questions? Great. All right, rolling into the next one. SCR10SD2 urging the Administrator of the State.

State Health Planning and Development Agency to establish a working group on health insurance reform to provide recommendations for reducing the impacts of prior authorization requirements on the timely delivery of health care in the state. Let's see. On our testifiers list, I have State Health Planning and Development Agency, Dr. Lewin in support. Not here.

Department of Human Services in support. Hawaii Primary Care Association in support. Aloha Care on zoom. Not present. Hawaii Medical Association in support. Work Injury Association of Hawaii, Kathy Wilson in support. And one individual, Robert Carlisle in support. All right, checking in the room, any Members wanting to testify on SCR 10 SD2. Seeing none Members. Any comments, questions?

You have no one to ask. We can't. All right, Members, moving on. We're on SCR16 SD1, requesting the Department of Health to convene a task force to identify and develop minimum professional standards for community Health Workers Training program. Let's see. I have Department of Human Services in support. Department of Health in support.

Good morning. Vice Chair, the Department of Health.

Great. Thank you for being here. I have KAU Rural Health Community Association in support. A national Association of Community Health Workers on Zoom.

Aloha Chair, Vice Chair and Members of the Committee. My name is Chauncey Atiko and I'm a community health worker and the Hawaii ambassador for the National Association of Community Health Workers, also known as NASHWA.

NASHWA is a nonprofit organization whose mission is to unify CHWs across geography, sector, ethnicity and experience to support communities to achieve health equity and social justice. Community health workers are essential in connecting the most vulnerable populations to the medical and social services they need to thrive.

And I'm testifying today in strong support of SCR 16 and provide two recommended amendments to ensure a more comprehensive, inclusive and community driven approach. I respectfully recommend amending the resolution to include the Hawaii Community Health Worker Association, also known as hyeshwa, on the Task force.

As a statewide Association for community health workers incorporated in 2022, Hyeshua continues to play a vital role in advancing professional development, advocacy and peer support for CHWs across the Hawaiian Islands. Through biennial conferences, regional meetings and a leadership council representing every major island, HYWA ensures community rooted leadership and strong connections to strong frontline CHWs.

Including Hyeshua ensures CHW's voices, lived experience and insights are centered in policy decisions that directly impact their work and the communities they serve. In addition, I strongly urge an amendment to include that at least 50% of the task force Members be community health workers.

This is essential to ensure that CHWs are not only represented but but also leading the efforts to establish professional standards for their own workforce. I urge this Committee to pass SCR 16 with these proposed amendments. Mahalo for the opportunity to testify today and have an amazing day. Aloha.

Thank you so much. Have an amazing day too. I have Hawaii Public Health Institute on Zoom.

Good morning Chair and Members of the Committee. Happy Aloha Friday, Rosie Philharmony representing Hawaii Public Health Institute in support of SCR16. We stand on our written testimony and just wanted to echo what Chauncey Hatiko had mentioned that we support the resolution.

However, we just have some of those same requested recommendations to ensure that the Hawaii Community Health Worker Association is included on the task force and adding that language which ensures that at least 50% of the task force Members are community health workers themselves. All of the recommendations are outlined on our written testimony. Mahalo for your time.

Great. Thanks for being here. I have Aloha Care on Zoom. We have Kauro Health and 34 other individuals in support. Anyone else in the room wishing to testify? Members, any questions? Okay, moving on.

We're on scr69sd1 requesting the Administration of the State Health Planning and Development Agency to convene a Pharmacy Benefit Manager Working Group to determine the best policies to reform pharmacy benefit manager practices in the state to ensure transparency and fairness for consumers and in pharmaceutical sectors, lower drug costs for patient consumers and increase access to health care.

I have providing testimony Department of Health with comments State State Health Planning and Development Agency. Dr. Lewin. Thank you Dr. Lewin for being here.

Mahalo Vice Chair and Chair and Members of the Committee. You know the PBM issue is bewilderingly complex. There's a lot of crazy practices like spread pricing and you know, rebates and so forth. But it really is an issue that needs to be addressed.

SHIPD is willing to take on the responsibility of convening a work group to look at this with all the. The right parties together.

You know, it would be a monumental task and something that would be daunting except that we believe there's a kind of a simpler way to approach it, which is to look at the state legislation that's been passed and other states.

There's some great legislation out there to take the best elements of those, bring those together, achieve consensus with our group, including the AG and all the appropriate departments and constituencies within the health sector and, and then bring back to you next year something that we think works for Hawaii.

So we're happy to take it on despite the complexity of the issue. Thank you very much for the opportunity to testimony. And I must say, you really are on Zoom, because I intended to be here for SCR 10, but I missed it. But thank you. Aloha.

Thank you, Dr. Lewin. All right, I have University of Hawaii Systems in support. Walgreens on Zoom.

Aloha Chair, Vice Chair, Members of the Committee, Tiffany Ajima. On behalf of Walgreens, we stand on our testimony in support and support the comments made by SHIPD. Thank you.

Good to see you. Thanks for being here. Work Injury Medical Association of Hawaii in person. Kathy, would you mind just sharing your name?

Thank you. I'm Kathy Wilson and I'm the co-founder and board member of WIMAH, Work Injury Medical Association of Hawaii. We stand in very strong support of this measure.

Great. Thank you so much for being here. I have Tonya Neal with comments on Zoom.

Yes, Aloha, Chair and Members of the Committee. My name is Tonya Neal and I'm with the Pharmaceutical Care Management Trade Association. We are the national trade association for pharmacy benefit managers and we will stand on our testimony that we provided in written comments.

We'd also like to ask that the Committee amend this resolution to, amongst a couple things, is to include PBMs in that work group.

If you're going to be talking about the industry in a very complex industry with lots of clinical and practical parts that are moving, I think it's important that we be part of that discussion so we can represent not only the payers that are at the table, but also explain a lot of the services and how a lot of these things all intermingle together and work together.

So with that, of course, I'm available for any questions and we will look forward to working with the agency and the departments over the course of the next year. Thank you.

Thank you. And I have Alyssa Pang in support, Carrie Shibata in support 123 and 45 other individuals in support. Any other Members in the audience or on Zoom wishing to testify on SCR 69 Senate Draft 1, seeing none. Members. Any questions? Go ahead.

Thanks. I have a question for SHIPD. Dr. L. Hey, Dr. Lewin, good morning. Thanks for being here. My question is really, we've been asking you to take on a lot of really heavy and complicated health issues, prior authorizations and now PBMs.

I just wanted to get your assurances that you have the bandwidth and capacity to take on all of these things.

Thank you for your question. Representative Chun Yes, I think, yes, we do. I mean, we're convening a bunch of parties to this and we will include the PBMs as heard in the recent testimony. I basically came back at Governor Greene's request because of unfinished business in health care across the entire country.

And I've come and I really believe, having struggled to try to get things done in Washington and New York and California after my tenure as Director of Health. Well, maybe not fortunate, but I've learned a lot about what's going on in the healthcare environment and it's just unfinished business.

We are the only nation in the world that doesn't have a guaranteed access for all citizens defined and a common single regulatory system instead of 1000 regulatory models. This is just one of those areas where we need to start working on it. And it's just, you know, it's a passion for us at SHIPD.

So we are going to take on a few tough issues like prior authorization and this issue next year. But we believe we have all the expertise in Hawaii to come up with a great strategy and look forward to bringing back something to you that makes sense and works for everybody.

Thank you so much. Any other members? Questions? Okay, perfect. Moving on. Members were on SCR 70 Senate Draft 1, requesting the Director of Commerce and Consumer affairs to establish and convene a pharmacy reimbursement working group to explore and propose legislation for the 2026 legislative session. Let's see. I have Walgreens on zoom. Aloha Chair.

We stand on a written testimony and support. Thanks so much for being here. I also have Hawaii Primary Care Association in support. That's all I have in my list. Any Members in the audience or on zoom wishing to testify on SCR 70s D1. All right, seeing none members. Any questions?

Great.

Okay, next one. We have scr 86 Senate draft one requesting the Department of Health to convene an aeromedical service working group. I have Department of Health in support here in person.

Aloha, Chair, Vice Chair. The Department of Health and the EMS Injury Prevention Systems Branch stands on our written testimony and support.

Thank you for being here. I have Air Methods in support.

Morning, Chair, Vice Chair, Members of the Committee, Steve Tevis for Air Methods. We stand on our testimony and support. Thank you.

Thanks for being here. On my list I have the Sayre foundation with comments. Hawaii Medical Association in support and two individuals, Lara and Frank Sayer in support. Members in the audience or on Zoom wishing to testify. Members, any questions? Thank you. Members, moving on.

SCR118 SD1 requesting the Department of Health to convene a working group to assess the feasibility of allowing business owners in the state to utilize filtered water collection by catchment systems for business activities. Oh, did I. Members, we just finished the Aero Medical Service working group and now we're on SCR118. Okay.

I have Department of Health, Environmental Health Administration with comments. Hawaii Department of Agriculture in support.

Good morning, Chair, Vice Chair, Members of the Committee, Cedric Gates here on behalf of the Department of Agriculture. The Department stands on its written testimony in strong support of this measure. Here for any questions. Mahalo.

Great. Thanks for being here. Board of Water Supply, Ernie Lau in person.

Good morning, Chair, Vice Chair, Members of the Committee, my name is Kathy Mitchell on behalf of Border Water Supply, we strongly support this measure. Available for questions. Thank you.

Great. Thanks for being here. Department of Department of Water Supply, County County of Hawaii in support and then Chamber of Commerce of Hawaii in support. Any other Members in the audience or on zoom wishing to testify on SCR 118 SD1 seeing none. Members, any question? Thank you. Members, moving on.

We're on SCR120SD1 requesting the Auditor to assess the social and financial effects of proposed mandatory health insurance coverage for continuous glucose monitors. I have on testifiers list. I have listed. I have Hilo Benioff Medical Center Foundation, Lisa Rance in support. Hawaii Medical Association in support. That's all I have.

Any Members in the room or on zoom wishing to testify? Okay. Seeing non Members. Any comments?

Questions is do we still. Did Cedric leave already?

I think so.

Oh for Department of Department they don't have. Without funds they couldn't do it.

Tell me how to handle that. Okay. Okay. Thank you. Members, we're on scr 120 Senate draft one requesting the Auditor. We just finished that. My apologies. Looks like last one on the agenda.

SCR194 Senate Draft 1, requesting the Department of Health to encourage reductions in the use of disposable surgical equipment and the adoption of sustainable practices in the provisions of health care services. Following examples set by California and Japan, I have Department of Health with comments. Thanks for being here. And then Hawaii Reef and Ocean Coalition in support.

Any other Members in the audience or on Zoom wishing to testify? Members, any questions? Oh, okay.

Okay. Members, I have a request and I'm going to just allow it. We have a little bit of time kind of rolling along here. Back to SCR 16, Gracie Flores would like to testify. She's still on Zoom. Aloha. Please proceed.

Aloha, Chair, Vice Chair, and members of the Committee on Health. My name is Gracie Flores and I'm a strong advocate for community health workers and I've over 15 years of experience working in underserved communities on the Big Island of Hawaii. Today I submit testimony on behalf of Hawaii Community Health Worker Association where I serve as chair.

We stand at our written testimony with recommendations. The Hawaii Community Health Worker Association supports SCR 16. I request that the resolution be amended to include the Hawaii Community Health Worker Association and ensure that community health workers themselves are the center of this proposed task force.

In addition, we recommend that at least 50% of the task force task force members be community health workers leading efforts to establish minimal professional standards for their workforce.

I urge the committee to amend and pass SCR 16 so that Hawaii can be take meaningful, inclusive steps towards professionalizing the CHW workforce while honoring the lived experiences already serving our community. Mahalo for your time. Aloha.

Thanks for being here. All right.

When we make exceptions, we'll make exceptions for all. I know, Dr. Lewin, you were here for SCR 10.

Thank you, Chair, Vice Chair and members. I appreciate the opportunity to testify on this bill. As you know, prior authorization is a very difficult issue for us. It's another one of those issues that I think we can come together, convening all the respective parties and really craft some solutions.

I do think I've seen some progress in thinking among our larger health insurers that this whole process is its time for something to happen here. Ultimately, we'd all like to automate the process, eliminate the elements of it that aren't producing anything.

We see that 90% of a lot of the claims that get denied are eventually overturned and approved. What a waste of money and time for such an activity. That's expensive for the companies and for the doctors and hospitals. So, we really need to tackle this and we're going to do it.

And I thank you very much for your willingness to entertain the legislation.

Thanks, Dr. Lewin, for being here.

Dr. Lewin, if I may, before you step down, I just, I just wanted to thank you for your contributions to advancing legislation in this area as well. So, thank you.

Mahalo. Mahalo. Chair Takayama, thank you.

Sure, go ahead, Dr. Lewin. We really wanted. You go ahead. Member Amato.

Thank you, Chair. Dr. Lewin, thank you for being here. This is a very important issue to me, so I really appreciate the work and the time that you've invested in it. I'm curious, as you mentioned, a number of the denials ultimately end up overturned and approved.

Is there any evidence on how many lives could have been saved or how much, how much harm or delayed health care could be resolved by just essentially eliminating the prior health authorization system?

Thank you for that question. There really isn't great evidence. There's anecdotal evidence from all over the country, but it hasn't been put together in a great way. And the reason we don't have concise, clear information about it is the whole thing is a black box. We really don't know what's going on.

Nobody knows what the standards each company uses are that they apply for prior authorization. They each do different things. Many of them contract it out, so it's very confusing. But if we do the reporting here, we can then check back and try to understand what's happening.

And I think I told you the tragic story of my own secretary at SHPDA, who died of hypoglycemia after requesting twice to get a continuous glucose monitor and shouldn't have happened, but, and there's no one to blame, but we just - the process needs to be fixed. So, thank you for the question.

Thank you, Jack.

Thank you, Member Amato. Members, any other questions for. Okay, Seeing none. Members, I just kind of want to roll into decision making. Let me check what's up. We have enough people, right? Okay, great.

All right, at the top of the agenda; members, on SCR 8SD1 recommendation is to pass as is. Any comments, questions? Seeing none. Chair for the vote, please.

Voting on SCR 8, Chair's recommendation is to pass as is. [Roll Call]. Your recommendations adopted.

Thank you so much, members. Moving on to SCR 10 SD 2. You know, members, I know this one is really important. You know, we have a House Bill 250, you know, and listening to the testimony of Dr. Lewin, my recommendation, members, is to actually defer.

I really want to focus our energies on really passing sound legislation, on getting something done. I've heard from Dr. Lewin that, you know, he's committed, and this is a priority for the administration. So, members, that is my recommendation. Any comments, questions, concerns? Thank you, members. Chair for the vote, please. Oh, I'm - you're right. That's a great vote.

We're deferring. Okay, members, moving on to SCR16 SD1, requesting the Department of Health to convene a task force to identify develop a minimum professional standard for community health workers training program. This one, members, I'd like to pass as is. Members, any comments, questions, concerns? All right. Seeing none. Chair for the vote, please.

Voting on SCR 16, Chair's recommendation is to pass as is, noting the excused absence of Representative Garcia. [Roll Call]. Chair, your recommendations adopted.

Thank you, Chair.

Okay. Members, on to SCR 69 SD1 requesting the administration of the State Health Planning and Development Agency to convene a pharmacy benefit manager working group to determine the best policies to reform pharmacy benefits manager practices in the state and to ensure transparency and fairness for consumers and in the pharmaceutical sector, lower drug costs for patients' consumers, and increase access to health care.

This one, members, some amendments. My recommendation is that we pass with amendments taking into technical amendments needed for clarity, consistency and style. And some of the suggested amendments in the PCMA comment letter, which consists of removing some language that could inadvertently affect the study. Members, any comments, questions, concerns? Seeing none. Chair for the vote, please.

Voting on SCR 69, Chair's recommendation is to pass with amendments noting the excused absences of representatives taken and Garcia. Anyone voting with reservations, or no? Seeing none. Your recommendations adopted.

Thank you, Chair. Members, onto SCR 70 Senate Draft 1, requesting the Director of Consumer Commerce and Consumer affairs to establish and convene a pharmacy reimbursement working group to explore and propose legislation for the 2026 legislative session. Members, this one I'd like to pass as is. Any comments, questions, concerned, members? Chair for the vote, please.

Voting on SCR 70. Passing - Chair's recommendation is to pass, [Roll Call]. Recommendations adopted.

Thank you, Chair. Members, onto SCR 86 Senate Draft 1, requesting the Department of Health to convene an aeromedical working group. Members, we're going to take this one on to a House Draft 1.

There's some edits on page two, line 38, item 12 to add in at least two representatives from the independent provider operator of the state and some technical amendments just for consistency and style. I'm also going to be striking language on page three, line 26 which lists members of the Senate and House.

And this is generally unnecessary because we end up getting certified copies because we actually make the copies or make the resolution. So those are my recommendations. Members, any comments, questions, concerns? Seeing none. Chair for the vote.

Voting on SCR 86 with amendments, [Roll Call]. Your recommendations adopted.

Great. Moving on to SCR 118 Senate Draft 1, requesting the Department of Health to convene a working group to assess the feasibility of allowing business owners in the state to utilize filter water collection by water catchment systems for business activities. This one, members, I'd like to pass as is. All right. Members, any comments, questions, concerns?

I just want to share. I think this will actually go a long way for Hawaii Island who is on the largest amount of catchment systems. So, thank you for Department of Water Supply for being here. Members? Chair for the vote please.

Voting on SCR 118, passing as, [Roll Call]. Your recommendations adopted.

Thank you, Chair. Members, on SCR 120 Senate Draft 1, requesting the auditor to assess the social and financial effects of proposed mandatory health insurance coverage for continuous glucose monitors. Members, this one I'd like to pass as is. Any comments, questions? Chair for the vote please.

Voting on SCR 120 passing as is, [Roll Call]. Your recommendations adopted.

Thank you Chair. Members, last one, SCR 194 Senate draft 1, requesting the Department of Health to encourage reductions in the use of distillation, disposable surgical equipment, and adoption for sustainable practices in the provisions of health care services, following examples set by California and Japan. Members this one again I'd like to pass as is. Any comments, questions?

Chair for the vote please.

Voting on SCR 194 passing as is, [Roll Call]. Your recommendations adopted.

Thank you Chair. Members, thank you so much for being here. We are adjured.